Care Home: Adlington Manor

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What the care home does well What has improved since the last inspection? Care plans are more individual so that the needs of people who live at the home are met. The majority of care staff working at the home have achieved NVQ level two in care. What the care home could do better: Handwritten entries of medications should be signed by two nurses to ensure accuracy, and the quantity should be recorded so that the audit process can verify whether the correct number are left. Instances where a resident was prescribed a drug that they were not receiving should be clearly recorded on the medicine administration record sheet. Two written references should be obtained before staff commence working at the home so that only people who are suitable to work with vulnerable people are employed. CARE HOMES FOR OLDER PEOPLE Adlington Manor Street Lane Adlington Cheshire SK10 4NT Lead Inspector Joan Adam Unannounced Inspection 10:00 23 January 2008 rd 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 Adlington Manor DS0000069250.V352057.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. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adlington Manor Address Street Lane Adlington Cheshire SK10 4NT 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) 01625 856710 01625 871630 adlington@barchester.com Barchester Healthcare Homes Ltd Helen Lewis Care Home 88 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (56) of places Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a total number of 88 service users to include: * Up to 56 service users in the category of OP (Old age not falling within any other category) * Up to 32 service users in the category of DE(E) (Dementia, aged 65 years and over) Date of last inspection Brief Description of the Service: Adlington Manor is a two-storey building set in 10 acres of grounds. The home is divided into two units. Cedar Unit provide accommodation and nursing care for up to 56 elderly frail people, and Rowan Unit, (Memory Lane Unit) accommodation and nursing care for 32 older people suffering from dementia. Each unit has sitting rooms and dining facilities, two sensory garden areas, and all bedroom and communal areas have an alarm call system fitted. The home is staffed with trained nurses at all times. Care staff, domestic, laundry, catering, maintenance, and administrative staff are also employed at the home. The current charge for the home is from £721.40p to 936.38p. This information was provided by the manager. Adlington Manor DS0000069250.V352057.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. This visit, part of the key unannounced inspection of the home, took place over 7 hours. Two inspectors visited the home on 23rd January 2008. The findings of the inspection were given to the manager on the same day. Before the visit the manager was asked to provide information as part of the inspection. The views of residents and relatives about the home were also sought; their comments are incorporated into this report. During the visit the inspector spoke to the manager, training officer, residents, relatives and some staff members. Four residents’ records were looked at to check the care they receive. Policies and procedures and records of medication, care plans, staffing rotas and training records were also examined. What the service does well: The home has a warm, friendly and homely atmosphere so the people who live there feel comfortable. It was cleaned to a high standard on the day of the visit. People living in the home and their families were very complimentary about the staff and the care provided. The following comments were made on questionnaires given to residents and relatives during the inspection visit: • • • • • ‘My relative is happy and well cared for. The staff look after families as well. ‘Everything is done to a high standard’. ‘All the family feel that we have found our relative a lovely place to stay in’. ‘The staff are all very caring and very helpful at all times’. “It feels like home” Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 6 The needs of people who live in the home are assessed so that they can decide if it is the right place for them to live and if the home can meets their needs. A further assessment is carried out when a person enters the home and a plan of care developed to make sure that staff at the home are aware of the needs of that individual. Care plans at the home are of a high standard and paint a picture of the person and their needs so that staff can care for them and know when any changes to their care has been made. The activity programme is excellent and all staff are involved in the social and psychological well being of the people who live there. Food is varied and of a high standard with small snacks between meals so that the people living there are always sure of a balanced wholesome diet. Advice from healthcare professionals such as doctors, specialist nurses, opticians, dieticians and chiropodists is sought when needed and acted on by staff to make sure that people’s healthcare needs are met. The people who live in the home said that staff keep them up to date of changes and are supported in maintaining their independence as much as possible. The staff who work in the home are highly motivated and offered regular training and are supervised regularly to check they can carry out their duties so people living in the home know that their needs will be met. The majority of the care team have obtained NVQ level two in care so that people who live there can be sure the staff are trained in the care of elderly people. The people living in the home and relatives spoken with said that the manager and the staff are approachable and felt that they would be able to discuss any concerns they had. What has improved since the last inspection? Care plans are more individual so that the needs of people who live at the home are met. The majority of care staff working at the home have achieved NVQ level two in care. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Adlington Manor DS0000069250.V352057.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 Adlington Manor DS0000069250.V352057.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): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A robust admissions procedure ensures that all prospective residents have their needs assessed, and are assured that the home has the capacity to meet their needs, prior to admission. EVIDENCE: The pre admission information for two newly admitted residents on the Rowan Unit were looked at. An assessment of the residents’ physical, social and mental needs had been assessed by a senior staff member before they were admitted so that staff at the home were aware that their needs could be met. This had helped to build a clear picture of the person’s needs and had enabled staff members at the home to develop plans of care for daily living. A DVD has been produced to give prospective residents and their families an introduction to Rowan.(Memory Lane Suite). Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 10 The home provides a family support worker on Rowan who works with new residents and their families and provides on-going support. The home does not provide intermediate care so this standard was not assessed. Adlington Manor DS0000069250.V352057.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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans of care ensure that residents’ health and personal care needs are met. The recording of medications at the home needs to improve to ensure that residents receive the correct prescribed medication at the right time. EVIDENCE: All the people who live at the home had care plans in place. The care plans for four residents living at the home were looked at. These were detailed and concise and all areas of needs were addressed such as hygiene, moving and handling, nutrition, tissue viability and mental health. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 12 The plans provided all staff members with sufficient information about each person to enable them to care for residents and painted a picture of each resident with comments such as “ he is a quiet man and responds well to a smile and a calm voice “ The importance of family involvement was also recorded such as “ It is important that staff are aware of giving private time during visits from his wife and daughter and nursing intervention should be limited at this time.” Changes that had taken place with the care had been recorded so that staff were aware of these. For residents that required intervention of other health care professionals such as tissue viability nurse, dietitian GP, or chiropodist this was documented. Staff interactions on both units were very positive and each staff member was seen to take time to talk to the residents and a touch of the hand and laughter was important to them. Staff constantly referred to “ our community” and talked of residents as “ part of our family”. One relative spoken to said that “ all the staff are caring and supportive, from the laundry and cleaning staff to the nurses, carers and manager. It was important to us as a family that staff referred to the unit as a memory loss unit not dementia care unit. We feel we have been supported as much as our parent has” Another said “ the attitude of all the staff is marvellous, it feels like home” (Nov 07) Comment from the family of a person who lived at the home for six years: we particularly observed the respect and dignity offered to all the residents and how they were all treated as individuals (Sept 07) Comment from husband: I would like you to know that the care she received was exemplary … she was nursed with great tenderness … her life was made as comfortable and happy as is probably humanly possible There is appropriate storage for medicines in both parts of the home and medicines are handled only by registered nurses. Records were very good in Cedar unit. In Rowan unit it was found that handwritten medicine administration record sheets were not signed or dated by the nurse who had written them, and the quantity of medicines received was not recorded. Handwritten entries should be signed by two nurses to ensure accuracy, and the quantity should be recorded so that the audit process can verify whether the correct number are left. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 13 There were two instances where a resident was prescribed a drug that they were not receiving. There was no explanation on the medicine administration record to show why these weren’t being given. The unit manager and the second nurse on duty were both aware of the reason for this, but it needs to be clearly recorded on the medicine administration record sheet. Adlington Manor DS0000069250.V352057.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): 12,13,14,15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The routines of daily living and activities available are flexible and varied so they suit the expectations, preferences and capacities of the people who live at the home. EVIDENCE: An activities co-ordinator is employed at Adlington Manor and has responsibility for organising activities, however all staff see the social side of care as part of their day to day care for each resident. A varied programme of activities was on offer and “themed weeks” take place and staff dress up in the varied clothing of the time. For instance a 1930’s theme was arranged and even a 1930’s car was hired for the day. Other weeks have been India, the seaside, France and China. Picture books and DVD’s are made so that discussions are stimulated and relatives that were unable to attend can see how the day went. Monthly music therapy takes place and the home has two sensory gardens for all to enjoy and the pet dog, Darcy, is well loved by all. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 15 Staff on the Rowans Unit (Memory Lane Unit) had received training in the importance of short social contact with the residents at all times of the day. (Butterfly training) as part of a year long study to improve the care of people with dementia. Objects were brought in by staff for residents to hold and touch and these items were chatted about to promote response from people with profound memory loss. There is lots of stimulation in the environment on walls and tables including beads, scarves, mirrors, textiles, objects that people can pick up and handle. Children from a local high school visit the home and join in with social activities. One relative was seen taking her husband to visit a local place of interest. She said she often takes him out and that staff are “very good”. The atmosphere throughout the home was warm and welcoming and it was observed that staff acknowledge residents instead of walking past them and refer to residents as ‘ladies and gentlemen’ The dining rooms were bright and calm and residents can sit down and eat wherever they choose to. Three main meals are served and finger foods are available at 11am and 3pm. The home employs kitchen waitresses to serve meals which gives the care staff more time to spend with the more frail people who are assisted individually with their meals. People who live at the home were spoken with and there was high praise for the choice and standard of food provided. “the food is second to none” “always lovely and plenty of it” Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are acted on to show they are taken seriously and the staff have received guidance to make sure they are able to protect the people who live at the home from possible abuse. EVIDENCE: The manager keeps a record of any complaints that are received. Three complaints had been recorded during 2007. The records showed that these were dealt with appropriately using the company complaints procedure. The home has a policy and procedure on adult protection. The manager and training co-ordinator confirmed that all staff have attended training on adult protection within the last year and more updated training was scheduled for the near future. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 17 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and well-maintained environment, which is equipped to meet their needs. EVIDENCE: The bedrooms looked at during the visit were nicely decorated and adequately carpeted and furnished and were well personalised. Rowans (memory lane unit) was completely decorated during the last twelve months and the standard of fittings is good. The lounge area is large but divided into different areas by furniture which makes it look more homely. There is lots of stimulation in the environment on walls and tables including beads, scarves, mirrors, textiles, objects that people can pick up and handle. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 18 There is a quiet lounge and small kitchen on the first floor. Cedar unit is the older part of the home and is to be completely rebuilt commencing in March 2008. The rooms are personalised and have been redecorated and recarpeted as needed. Some of the bedrooms are not in use at present. The home was cleaned to a high standard and there are six domestic staff on duty each day. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 19 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): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good recruitment process in place to ensure that staff are suitable to work in the home and staffing levels were excellent to ensure the needs of people living at the home are always met. There is a training programme in place to provide a skilled workforce that protects residents’ welfare. EVIDENCE: Rotas showed that a very good level of staffing on both Rowan and Cedar is maintained over 24 hours. The nurses employed on Rowan are all specialist mental health nurses. The home has a training co-ordinator who is employed for 30hours per week and a training plan is in place to provide all staff with up-to-date training. There are two in-house NVQ assessors but the manager said that they have ‘run out of candidates’. Only four of the care staff employed at the home have not achieved NVQ level 2 in care. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 20 The domestic staff have achieved NVQ level 1 and the housekeeper has achieved NVQ level 2 in leadership. There are two administrators at the home and both have achieved NVQ level 3. One is at present undertaking a Barchester Healthcare leadership award and NVQ level 4 in financial business advise and the other administrator is on a foundation degree course in business studies. The home also has its own in house moving and handling trainer. All staff working at the home have received training regarding safeguarding adults and this is also part of the induction training. Training is provided in all aspects of care such as health and safety, infection control, moving and handling, adult protection, fire prevention and food hygiene. Staff on Rowan (Memory Lane unit) have received “butterfly training” which is the importance of short social contact with the residents at all times of the day. This is part of a year long study at the home to improve the care of people with dementia and profound memory loss. The training has been given by a training consultant from the National Alzheimer’s Society and Manchester University. This training is to be extended to all staff who work at the home. Staff files were looked at for four people who started working at the home during 2007. For three of these people all recruitment checks had been completed to a satisfactory standard. The fourth was still awaiting return of a CRB disclosure but had a POVA first check. Also, no written references had been received by the home for this person. The manager said that she had spoken to his last employer and had received a very good verbal reference, but there was no record of this. The staff member had brought some references with them on interview. It is advisable to extend the probationary period until the CRB and written references are received. (This member of staff is not providing direct care to residents.) Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 21 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well managed service providing them with safe financial procedures and equipment to meet their needs. Quality assurance systems are in place to ensure the views of residents, relatives and staff are sought and acted upon. EVIDENCE: The home manager is a qualified nurse with experience of management and managing care homes. Monthly monitoring visits are undertaken to Adlington Manor to monitor the practice and conduct within the home, to provide guidance to management and staff during the visits and to obtain the views of people cared for. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 22 There were monthly audits completed by the manager that covered care plans, accidents, pressure ulcers and treatments, medication, the building including; kitchen, laundry and standard of cleanliness, and notifiable incidents. Formal relatives meetings and staff meetings take place and minutes are available. All spoken with said that the manager and senior of the home are approachable and that they felt supported. The home does not have any responsibility for residents’ finances. The accident records were checked and accidents were thoroughly recorded. The fire policies and procedures manual was checked and provided evidence of satisfactory fire safety checks and staff training. Information provided by the acting manager prior to the inspection (Annual Quality Assurance assessment) stated that all the required maintenance and health and safety checks of the building and equipment had been completed. The home has two administrators. One deals mainly with matters relating to staff and the other with residents. The home does not handle any residents’ money. Barchester has a system of quality auditing that includes all aspects of the service. This is completed each month focussing on one area such as activities, care plans, medicines, nutrition. It is externally verified by the clinical development nurse. In 2007 the home scored well in all areas. There is also a monthly return to head office which identifies any residents with special needs. There are two full-time employees who maintain the house and the grounds. Daily, weekly and monthly checks of installations and equipment are carried out and are recorded in a maintenance file. These include a weekly test of the fire alarm system and a monthly test of emergency lighting. Thermostatic valves are fitted to all hot water outlets except for three that are accessible for staff only. Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 23 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 24 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 Timescale for action Ensure that when printed 17/03/08 instructions are not provided with medicines that staff handwrite all the details from the medicine label onto the record sheet, these should be checked by a second person and both sign the record. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Adlington Manor DS0000069250.V352057.R01.S.doc Version 5.2 Page 26 - 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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