Care Home: Abbotsleigh Mews Nursing Home

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What the care home does well People received written information about the service and could visit the home to view the facilities and ask questions. Staff visited people that wanted to move into the home to see what support they required and to assess if the home would be able to meet their needs. Staff developed an individual care plan for each resident. Care plans included information about the help that people required and stated if they had any preferences about the way things were done. Staff carried out assessments to identify potential risks. Strategies to minimise or eliminate risk were developed. Residents had access to community health care services. Health problems were monitored and advice was obtained from other professionals if necessary. Meals were well balanced and most residents said they enjoyed the food provided in the home.People could choose where and how they spent their time and staff encouraged people to make decisions for themselves. One resident told us that she liked to stay up to watch the news and preferred to eat in her room. The resident`s preferred routine was recorded and was followed by staff. The range and choice of activities provided in the home was excellent. Activity staff were motivated and resourceful. Family and friends could visit the home at any time. We saw staff providing emotional and practical support to relatives. Complaints were recorded in a dedicated file and were investigated promptly. Residents and relatives were familiar with the complaints procedure. Staff were aware that they must report significant issues or allegations to senior staff. Staff had access to a varied and relevant programme of training. All of the staff that we spoke to were satisfied with the training arrangements and said the training coordinator was very helpful. Good records were kept about people`s personal money and valuables. Regular checks were carried out to monitor the homes performance and residents provided feedback about the service. Regular checks and inspections were carried out to ensure that equipment was in working order and was safe for use. The manager was respected and trusted by staff. Staff told us that all of the senior staff were supportive and helpful. What has improved since the last inspection? A considerable amount of work had taken place to improve the management of medicines. We noted improvements with the records that were kept about the use of homely remedy medicines and about medicines that were omitted or not given. There was no evidence that staff were transferring medicines from one container to another and none of the medicines that we saw were marked with the residents room number. Medicines were stored at the correct temperature. The checks that were carried out when appointing new staff had improved. All of the files that we looked at included two written references and checks to confirm that nursing staff were able to practice. Footplates were fitted to wheelchairs and were used appropriately. What the care home could do better: Although significant improvements were noted with the management of medicines the balance of a small number of medicines that were supplied in packets or boxes were incorrect. Soft diets were not always presented in an appetising manner and one resident did not receive prompt assistance to eat. Condiments and sauces were not provided on the dining tables on Macmillan Unit. There was some odour in Calvin Unit and some of the equipment and surfaces on this unit were dirty. The manager and staff had worked hard to address the odour issue. The home should consider increasing the domestic hours on this unit. Although the home was well maintained some of the furniture, furnishings and paintwork looked worn in parts. A major refurbishment programme was planned. There were good systems in place to monitor staffing levels but the skill mix on Macmillan was inadequate. CARE HOMES FOR OLDER PEOPLE Abbotsleigh Mews Nursing Home Old Farm Road East Sidcup Kent DA15 8AY Lead Inspector Maria Kinson Unannounced Inspection 26th August 2008 09:35 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbotsleigh Mews Nursing Home Address Old Farm Road East Sidcup Kent DA15 8AY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8308 9590 020 8308 9540 cheesemt@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Tracey Jane Cheeseman Care Home 120 Category(ies) of Dementia (120), Old age, not falling within any registration, with number other category (120) of places Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 120 21st September 2007 Date of last inspection Brief Description of the Service: Abbotsleigh Mews is situated in a residential area of Sidcup, within walking distance of bus routes and a railway station. The home is purpose built and consists of four separate units, each of which is registered to provide care for up to 30 residents. The ground floor units are Calvin House, which provides personal care for people with dementia and Macmillan House, which provides nursing care. The first floor units are Berens House, which provides nursing care for people with dementia, and Smythe House, which provides personal care. Administration, catering and laundry facilities are centrally located within the home. All bedrooms in the home are single occupancy and have en-suite facilities. Residents have access to the homes grounds and there is a separate, secure patio/garden area for people living in Calvin House. There is a car park for staff and visitors. The fees charged by the home range from £483 - £980 per week. The fees do not include personal items such as newspapers and some toiletries and private services such as chiropody and hairdressing. This information was supplied to the commission on 26/08/08. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The last key inspection was carried out in September 2007 and a random inspection was undertaken in April 2008 to assess the management of medicines. This inspection was unannounced and was carried out over two days in August and September 2008. On 26/08/08 we visited all of the units to speak with residents, staff and visitors and examined some of the records that were kept in the home. We observed staff communicating with residents and visitors, supporting people to eat and drink and helping people to take their medicines. We viewed all of the communal areas and at least two bedrooms on each of the units. On 11th September 2008 we visited one of the units to speak with staff and spent time with the manager and some of the senior staff. Seven residents, five relatives, two health care professionals and two members of staff provided written feedback about the service. What the service does well: People received written information about the service and could visit the home to view the facilities and ask questions. Staff visited people that wanted to move into the home to see what support they required and to assess if the home would be able to meet their needs. Staff developed an individual care plan for each resident. Care plans included information about the help that people required and stated if they had any preferences about the way things were done. Staff carried out assessments to identify potential risks. Strategies to minimise or eliminate risk were developed. Residents had access to community health care services. Health problems were monitored and advice was obtained from other professionals if necessary. Meals were well balanced and most residents said they enjoyed the food provided in the home. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 6 People could choose where and how they spent their time and staff encouraged people to make decisions for themselves. One resident told us that she liked to stay up to watch the news and preferred to eat in her room. The resident’s preferred routine was recorded and was followed by staff. The range and choice of activities provided in the home was excellent. Activity staff were motivated and resourceful. Family and friends could visit the home at any time. We saw staff providing emotional and practical support to relatives. Complaints were recorded in a dedicated file and were investigated promptly. Residents and relatives were familiar with the complaints procedure. Staff were aware that they must report significant issues or allegations to senior staff. Staff had access to a varied and relevant programme of training. All of the staff that we spoke to were satisfied with the training arrangements and said the training coordinator was very helpful. Good records were kept about people’s personal money and valuables. Regular checks were carried out to monitor the homes performance and residents provided feedback about the service. Regular checks and inspections were carried out to ensure that equipment was in working order and was safe for use. The manager was respected and trusted by staff. Staff told us that all of the senior staff were supportive and helpful. What has improved since the last inspection? What they could do better: Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 7 Although significant improvements were noted with the management of medicines the balance of a small number of medicines that were supplied in packets or boxes were incorrect. Soft diets were not always presented in an appetising manner and one resident did not receive prompt assistance to eat. Condiments and sauces were not provided on the dining tables on Macmillan Unit. There was some odour in Calvin Unit and some of the equipment and surfaces on this unit were dirty. The manager and staff had worked hard to address the odour issue. The home should consider increasing the domestic hours on this unit. Although the home was well maintained some of the furniture, furnishings and paintwork looked worn in parts. A major refurbishment programme was planned. There were good systems in place to monitor staffing levels but the skill mix on Macmillan was inadequate. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff carried out a care needs assessment before confirming if the home would be able to meet people’s needs. Information about the service was made available to prospective service users and people were able to view the home and facilities before they moved in. EVIDENCE: The registration certificate and ‘Statement of Purpose’ was displayed in the reception area. The ‘Statement of Purpose’ contains information about BUPA and the facilities and services that the home can provide. A copy of the ‘Service User Guide’ was provided in each bedroom. The Statement of Purpose and Service User Guide were reviewed regularly and the commission were told about changes to Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 10 these documents. Residents were satisfied with the information that they received about the home. People that expressed an interest in the service were encouraged to visit the home to view the facilities and speak to staff. A number of people that we spoke to said they were too unwell to visit the home before they moved in but said their relatives visited the home and told them what it was like. Staff carried out a care needs assessment before people moved into the home. We looked at eight assessments. Some were for people that had recently moved into the home and some were for people that had lived in the home for several years. Staff obtained and recorded information about the person and the support they required. Information was obtained from the prospective resident and other people that were involved in their care, such as hospital staff and relatives. The assessments that we looked at provided comprehensive information about the persons physical, mental and social care needs. The home also received information about some residents from other professionals such as care managers. After the assessment staff wrote to the person to confirm if the home would be able to meet their needs. A copy of this letter was seen on resident’s files. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were easy to read and provided up to date information about the support people required. Staff treated people with respect and tried to maintain peoples preferred routines. The management of medicines had improved but further work was required to ensure that the same standard was maintained on all of the units. EVIDENCE: We looked at the care records for eight residents. Some of the files that we looked at were for people that had only recently moved into the home and some were for people that had lived in the home for several years. The files included a copy of the assessment that was completed before people moved into the home. The assessment form prompts staff to look at specific areas of need such as mobility and to select a statement that most closely reflects the person’s needs. The statement selected by the staff member generates a Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 12 score. Staff were required to complete a care plan for issues that score one or above. All of the files that we looked at contained various care plans, including one person that had only been in the home for approximately 48 hours. The plans that we saw were good overall and in the main reflected peoples needs. The only exception was one care plan for a resident on Smythe that stated “Independent lady, able to maintain her own personal hygiene. The daily care notes for this resident indicated staff were supporting the person to wash and dress. Care plans about the support that residents required overnight focussed on people’s individual needs and preferences. For example some of the night plans that we saw included information about how many pillows people required, whether they wanted the light left on or off and the type of drink that they would like before they went to bed or when they woke. Care plans were reviewed regularly. Some of the plans that we saw were signed by residents or relatives and one relative told us that she had agreed a plan of care for her husband. Care plans included information about people’s health care needs and information was also recorded about the outcome of GP and other professional’s visits. Residents were able to keep their existing GP, if the GP was willing to visit the home should they become unwell. Residents were satisfied with the medical support they received in the home. Staff were trying to encourage one resident to drink more and were monitoring what they were drinking. The fluid balance chart for this resident was up to date and indicated that the resident was offered regular drinks. One of the care plans that we looked at included information about the management of leg ulcers. The plan included information about the location, size and appearance of the wounds and the type and frequency of dressing changes. Photographs and a wound evaluation record were maintained to show how the wounds were progressing. Specialist advice was obtained from a tissue viability nurse. Two health care professionals provided written feedback about the service. They told us that staff usually acted on their advice and were usually able to meet people’s health needs. Staff carried out various assessments to identify potential risks. The files that we looked at provided specific guidance for staff about how people should be moved and what equipment, if any was required. Staff also carried out assessments to see if residents were at risk of falling, developing pressure sores or might become malnourished. Strategies were put in place to address potential risks. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 13 We assessed the management of medicines on two units (Macmillan and Berens). All medicines were in stock. Good records were kept about medicines that were bought by residents into the home or were supplied by the local pharmacist. There were several gaps in respect of one medicine, on one chart but no gaps on any of the other five charts that we looked at. The concerns that we identified at the last inspection about recording room numbers on medication containers had stopped and staff were aware that this practice was unsafe. Medication was audited regularly to identify concerns and to ensure that staff were following the homes procedures. It was clear that this work had improved the records that were kept about medicines and the management of medicines in compliance devices. The amount remaining of three medicines that were supplied in boxes were incorrect. The home was advised to ensure that future audits focus on medicines that are supplied in boxes or packets. See requirement 1. Good records were kept about homely remedy medicines and the GP confirmed in writing, which medicines staff could give. The temperature in the medical room was suitable for the storage of medicines. The room was well organised and clean. Information was displayed on the staff notice board about the procedure for reporting medication errors. Communication between staff and residents was mostly good. Staff attend customer care training sessions called ‘Personal Best’. This training helps staff to identify how they can make a difference to people’s lives and experience life as resident. Staff ensured that people’s privacy was maintained and addressed people in a respectful manner. One relative told us that staff ensure that “we have privacy” during communion and family visits. Staff on Calvin and Berens were seen offering reassurance and comforting words to residents that were disorientated or anxious. Visiting health care professionals told us that staff always respected resident’s privacy and dignity. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a varied and interesting programme of activities to suit people’s needs. Residents were offered choices and were consulted about where and how they wanted to spend their time. The food provided was well balanced and people said they enjoyed their meals. One resident did not receive adequate help to eat and some of the meals on Macmillan were not presented in an appetising manner. EVIDENCE: There was a part time activity coordinator for each unit. Activity staff were responsible for developing activity plans and coordinating activities in the home and community. A ‘map of life’ was completed for each individual on admission to the home. This document provides information for activity and care staff about peoples family network, work history and interests. Staff had also developed a memory book for some of the residents on Berens with support from family members. We saw some residents painting and completing puzzles on Berens, reading newspapers and playing dominoes on Calvin and playing scrabble on Smythe. Some residents told us that they Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 15 enjoyed specific events and activities such as “growing and eating tomatoes”, visits from ‘pat the dog’, baking sessions, a local theatre trip followed by a meal in a restaurant and visits to a local day centre. The home had recently received a donation to purchase flowers for flower arranging sessions. There were photographs of parties and social events that had taken place throughout the year displayed on all of the units that we visited. One of the residents that we spoke with said he enjoyed undertaking small administrative tasks for the staff on the unit and likes to visit the local shops on his mobility scooter another resident told us that activities were “well organised”. One relative said she was concerned that residents did not have any form of exercise. We discussed this issue with one of the activity staff who told us that the company were arranging chair exercises training for staff. A number of residents on Berens had end stage dementia and were not able to take part in structured activities or attend outings. The residents on this unit would benefit from having a dedicated quiet space where they could go to relax. See recommendation 1. The home had recently recruited several volunteers from a local college. Volunteers visit the home regularly and spend time talking to residents. Activity staff had also made contact with other organisations such as the air training school that marched through the homes grounds on remembrance Sunday. Relatives said they were able to visit their family member whenever they wanted and told us “staff are welcoming and friendly”. We spoke with two visitors during the inspection and received written feedback about the home from five relatives. Most relatives were satisfied with the care that their relatives received and said they were usually kept informed about significant events such as accidents. We observed staff serving lunch on Macmillan and Calvin. There was evidence that residents were able to choose what ate from the menu and that they received the food they had requested. One resident on Macmillan had to wait for their meal. An explanation was provided and the resident was reassured that the matter was being addressed. Most of the food that we saw looked appetising, the exception being food that was pureed to a smooth consistency and placed together in a dessert/soup bowl on Macmillan. Staff provided appropriate cutlery and fitted plate guards when necessary as they handed each person their lunch. There were no condiments on the table on Macmillan. One resident asked us for some salt and one relative asked a staff member for some salt. Although the care staff on Macmillan provided assistance to eat for some people, one resident was not prompted or assisted to eat until a senior member of staff arrived in the dining room and asked staff to support the resident. On Calvin staff served all of the residents that were having meat pie Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 16 first. Some of the people that were waiting for another meal choice started to get restless and began helping themselves to other peoples meals. Most of the residents that we spoke with said they enjoyed their meal. See requirement 2. New guidance was issued to staff in January 2008 about ensuring that residents were clean and comfortable after meals. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People knew who to speak to if they were unhappy or wanted to make a complaint. The home worked in partnership with other agencies to ensure that allegations of abuse were investigated and vulnerable people were protected. EVIDENCE: The complaints procedure was displayed in the reception area and information about how to make a complaint was included in the Service User Guide. All complaints were recorded in the complaints log book and the manager completes a monthly report, which was sent to head office. The home had received eleven complaints in the past twelve months. We looked at six complaints records. The records showed that complaints were investigated and responded to promptly. In some instances the manager or deputy manager had arranged to meet the complainant to obtain more information or to explain what their investigation had revealed and what action they were planning to take to address the matter. People were advised that they could contact the manager for further information. The manager told us that she was considering including a copy of the complaints procedure with her response letter so that people would know whom to contact if they were not satisfied. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 18 Residents and relatives were familiar with the arrangements for making a complaint. Residents said they would speak to their relatives or specific staff members if they had concerns. We saw a numerous cards and letters complimenting and thanking staff for supporting residents. Staff were aware that they must report allegations or concerns to senior staff or the manager. Training records showed that almost all of the staff had attended a protection of vulnerable adults training session and a number of staff that we spoke with said they had also covered this topic during induction training. The manager notifies us about significant events that occur in the home and seeks advice from other agencies such as social services if necessary. The manager has investigated a number of allegations some of which resulted in disciplinary action. The reports that we have seen in relation to these issues were properly investigated and well written. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was well maintained overall but some of the paintwork was chipped and some of the furnishings looked old and worn. The planned refurbishment programme should address these issues. The home was working hard to resolve an ongoing issue with odour on Calvin. Action must also be taken to improve the standard of cleanliness on this unit. EVIDENCE: We visited all of the units, and sampled at least two bedrooms on each house. Bedrooms were arranged to suit individual needs and some residents had personalised their rooms by using their own furniture and displaying personal photographs and pictures. One resident told us that staff had arranged for a shelf to put up to display their ornaments. The environment was well maintained overall but some of the paintwork and furnishings looked a little Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 20 tired in parts. One relative showed us some curtains, which they described as “tatty”. A major refurbishment programme is planned for early 2009 and some of the staff and relatives had put forward ideas and suggestions about what the programme should include. The home was mostly clean and tidy but some areas on Calvin particularly the kitchen were dirty, particularly at lower level around the base of the bin. The pressure pad in room 27 was also dirty and stained. There was some odour in the corridors near the entrance to the unit and in two of the bedrooms (27 and 39) that we visited. See requirement 3 and recommendation 2. Attempts had been made to address ongoing concerns with odour on Calvin. Laminate flooring was laid in the dining area and air purifiers were fitted prior to our random inspection in April 2008. We received a call from two relatives in July and August 2008 that suggested there were still some problems with odour. The homes manager had also identified concerns with odour and had arranged for the company’s estates officer to visit and advise staff about the management of this issue. The estates officer was in the home on the day of the inspection. The officer provided guidance for staff about cleaning carpets and agreed that new flooring should be provided in some parts of the unit prior to the refurbishment programme commencing. The flooring trim was missing in some of the toilets and some of the flooring in the toilets on Calvin and Smythe was cracked. This makes it difficult to effectively clean the surface and is likely to contribute to the odour problem on Calvin. There were a number of cigarette burns on the carpet in the quiet lounge on Calvin and the shower panel on Berens was cracked. The manager should ensure that all of these issues are addressed during the homes refurbishment programme. The shower room on Calvin was ‘out of use’ due to a leak from the bathroom above. The estates officer arranged for the necessary repairs to be undertaken. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers were satisfactory but one of the units did not have sufficient qualified nursing staff. Recruitment practices had improved. This helps to ensure that people receive safe and suitable care. Staff were supported to develop new skills and to keep up to date with current practice. EVIDENCE: The home had set minimum staffing levels for each unit and tries to exceed these levels where possible. The deputy manager was responsible for monitoring and checking staffing levels on a daily basis and working with senior staff to ensure that adequate staffing levels were maintained. Staffing levels were satisfactory in terms of numbers of staff but the skill mix on Macmillan was not ideal as there was only one nurse on duty. The nurse was responsible for overseeing the care of 29 residents, supervising care staff, administering medicines and undertaking a number of other tasks. The morning medicine round finished at 11.00am and the pm medicine round started 13.00hrs. Staff confirmed that some new staff had been recruited but said they were awaiting further checks before the staff members could commence work. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 22 Staff told us that staffing had improved and said the deputy manager visited the units regularly to check staffing levels. It was apparent that the role undertaken by the deputy manager had led to improvements with staffing but further work was required to ensure that nursing staff were adequately supported. See requirement 4. Two of the residents that we spoke with on Macmillan said that they often had to wait for the toilet, although we did not witness on the day of the inspection this has been raised in the past and should be closely monitored by senior staff. See recommendation 3. Residents told us that staff were helpful and said most of the staff were “excellent”. A new post of satellite kitchen assistant had been developed. This post enables domestic staff to continue cleaning during the lunch period. 50 of care staff had attained a vocational qualification in care at level two or three. Five care staff were registered to complete this programme. We looked at the recruitment files for three staff that were appointed in the period since the last inspection. Thorough pre- employment checks were carried out for all of the staff but some references that were not company stamped or on headed paper were not verified to check that they were genuine. See recommendation 4. The training coordinator was responsible for assessing staff training needs and ensuring that staff had access to relevant training sessions. New staff attend a two-day induction-training course and complete an induction workbook that covers all of the common induction standards. Some members of staff had attended fire safety, moving and handling, food safety, health and safety, infection control, medication, bedrail, COSHH, safeguarding, dementia, customer care and mental capacity act training sessions since the last inspection. Staff were satisfied with the training arrangements and said the training coordinator was always very helpful. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed. The atmosphere in the home was open and supportive. There were systems in place to monitor and improve the quality of care provided in the home, to safeguard people’s money and to maintain safety standards. EVIDENCE: Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 24 The manager has a nursing qualification and had completed the registered managers award in the period since the last inspection. The manager was assessed to have suitable skills and experience to manage a care home for older people. Staff said the manager and deputy manager were approachable and treated staff fairly. We were told that the manager and deputy manager visit the units most days and spends time talking to staff and residents. The manager communicates effectively with the commission. We were told about significant events and allegations and about any action that was taken in respect of these issues. The home had various systems in place for monitoring the quality of care and services provided in the home and for obtaining feedback from residents and relatives. The regional manager carried out a monthly audit to check that the manager and staff were following company procedures and to identify concerns. The audit tool covers specific topics such as health and safety, management of complaints, staff recruitment and medication. In addition some other audits were carried out by staff and outside agencies. Satisfaction surveys were sent to relatives and residents once a year and staff complete a confidential survey about the manager. If concerns are identified during audits or in surveys the manager has to prepare an action plan to show what she will do to address the matter. The administrator was responsible for keeping residents personal money and valuables safe. Personal money was held in a joint account. Some people were able to look after their own money and signed to confirm that they had received money from staff. Individual records were kept about how residents used their money. Receipts were kept for items that were purchased for people or for services that were provided by other people such as the hairdresser. Money and valuables were stored securely. The home had a dedicated maintenance staff and gardening staff. Maintenance staff carried out a comprehensive programme of health and safety checks at various intervals and carried out routine repairs within the home and grounds. Health and safety records were sampled and were found to be well organised and up to date. We looked at fire safety reports. This included the fire alarm, fire extinguishers and emergency lighting service reports and internals checks such as weekly fire alarm tests, fire door tests, emergency lighting tests and fire safety training records. Health and safety issues were also well managed. Equipment such as hoists and passenger lifts were serviced regularly and competent people examined utilities such as gas and electrical appliances. Maintenance staff checked hot water temperatures regularly and made sure that bedrails were fitted properly. Footplates were fitted to wheelchairs and were used appropriately. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement Action must be taken to improve the management of medicines that are not supplied in compliance devices. Staff must ensure that residents are given prompt support to eat and that all meals are presented in an appetising manner. Action must be taken to control odour and keep all parts of the home fresh. An adequate number of trained staff must be provided on all shifts. Timescale for action 03/03/09 2. OP15 12 03/02/09 3. 4. OP26 OP27 16 18 03/02/09 03/02/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP26 OP27 Good Practice Recommendations The home should have a quiet area with soft music and sensory equipment for residents use. The domestic hours should be increased on Calvin. The manager and senior staff should obtain regular DS0000006751.V370532.R01.S.doc Version 5.2 Page 27 Abbotsleigh Mews Nursing Home 4. OP29 feedback from residents and relatives on Macmillan about staff response to call bells and requests to use the toilet. References that are not supplied on headed paper or company stamped should be verified to ensure that they are genuine. Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Abbotsleigh Mews Nursing Home DS0000006751.V370532.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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