Inspecting for better lives
Key inspection report
Care homes for older people
Name: Amesbury Abbey Nursing Home Address: Amesbury Abbey Nursing Home Amesbury Salisbury Wilts SP4 7EX
The quality rating for this care home is: zero star poor service
A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Date: Susie Stratton 2 4 0 2 2 0 0 9
This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home)
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:
This box tells you the outcomes that we will always inspect against when we do a key inspection.
This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience:
Judgement:
This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor.
Evidence:
This box describes the information we used to come to our judgement.
Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop
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
Our duty to regulate social care services is set out in the Care Standards Act 2000.
Care Homes for Older People Page 2 of 58 Reader Information
Document Purpose Inspection report Author CSCI Audience General public Further copies from 0870 240 7535 (telephone order line) Copyright Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk
Care Homes for Older People Page 3 of 58 Information about the care home
Name of care home: Amesbury Abbey Nursing Home Address: Amesbury Abbey Nursing Home Amesbury Salisbury Wilts SP4 7EX Telephone number: 01980622957 Fax number: 01980623767 Email address: [email protected] Provider web address:
Name of registered provider(s): Mrs Evelyn Mary Cornelius-Reid Type of registration: care home Number of places registered: 50
Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65
old age, not falling within any other 0 50 category physical disability 2 0 terminally ill 3 0 Additional conditions: No more than 2 physically disabled residents at any one time No more than 3 persons in receipt of terminal care at any one time No more than 50 service users over 65 years of age at any one time.
Date of last inspection Brief description of the care home Amesbury Abbey provides care with nursing for up to fifty older people. However, as a number of rooms registered as doubles are often occupied as singles, this reduces occupancy levels to a more usual figure of around forty. On the day of the first site visit, there were 30 persons living in the home and several vacant rooms. Most of the rooms are in the form of apartments with their own bedroom and sitting room as well as a bathroom. The property is a listed building, set in extensive grounds. Accommodation is provided over three floors, with passenger lifts in between. The small town of Amesbury is close by. Ample parking space is available on site and a bus Care Homes for Older People Page 4 of 58 Brief description of the care home stop is situated at the end of one of the drives. The home is close to the A303. The closest main line railway is in the city of Salisbury, about 20 minutes away. Amesbury Abbey is part of a group of four care homes. The Registered Owner is Mrs M Cornelius- Reid. The registered manager is Mrs Esther Thomas, she is supported by a deputy and a team of nursing and care staff. Mr David Cornelius-Reid, site manager, manages the maintenance, housekeeping and administrative staff of the home, as well as acting as Mrs Cornelius-Reid's deputy. Also situated within the grounds are Amesbury Abbey Mews they are not part of the registered accommodation. A deposit is required for all apartments, deposits range from 15,000 pounds to 25,000 pounds depending on the apartment. The fee range is then from 3,070pounds to 4,200pounds per callender month. The site manager reported that they are also open to negotiations on an individual basis. Items not included in the fees are hairdressing, chiropody, visitor's meals, newspapers and sundries. A copy of the service user's guide is provided in each resident's apartment and is also available in the main entrance hall.
Care Homes for Older People Page 5 of 58 Summary This is an overview of what we found during the inspection.
The quality rating for this care home is: zero star poor service
Our judgement for each outcome:
Choice of home
Health and personal care
Daily life and social activities
Complaints and protection peterchart
Environment
Staffing
Management and administration
Poor Adequate Good Excellent
How we did our inspection: As part of the inspection, 35 questionnaires were sent out and 13 were returned. Comments made by the people in the questionnaires and to us during the inspection process have been included when drawing up the report. The home's file was reviewed and information provided since the previous inspection considered. We also received an Annual Quality Assurance Assessment (AQAA) from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We looked at the AQAA, the surveys and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during visits to the home. As Amesbury Abbey is a larger registration and a range of issues of concern were Care Homes for Older People Page 6 of 58 identified in questionnaires and at the first site visit, the site visits took place over two days. The first site visit was conducted by one inspector and the second by two inspectors. These people are referred to as "we" throughout the report, as the report is made on behalf of the Commission for Social Care Inspection (CSCI). The first site visit was on Tuesday 10th February 2009, between 9:00am and 4:50pm. The second site visit was on Tuesday 24th February 2009 between 9:15am and 1:20pm. The first visit was unannounced. The site manager and deputy manager were on duty for the first day and Mrs Thomas, the registered manager was on duty for the second day as well as the site manager and deputy manager. The site manager, registered manager and deputy manager were available for the feedback at the end of the site visits. During the site visits, we met with twelve residents, one visitor and observed care for three residents for whom communication was difficult. We toured all of the home and observed care provided at different times of day. We reviewed care provision and documentation in detail for six residents and reviewed certain aspects of care and documentation for a further two residents, across all parts of the home. As well as meeting with residents, we met with two registered nurses, six carers, the training manager, the site manager, the maintenance manager, the activities coordinator, the housekeeper, a waitress and a laundress. We observed a lunchtime meal and two cleaners performing their role. We reviewed systems for storage of medicines and observed a medicines administration round. A range of records were reviewed, including staff training records, staff employment records, complaints records, maintenance records and information given to residents. What the care home does well: Amesbury Abbey provides high standards in levels of accommodation, with all rooms much exceeding our standards for sizes. Some accommodation is very large, comprising several rooms for residents to live in. The Abbey has wide, well-kept grounds, providing both pleasing views from residents' windows and areas for them to enjoy walking or sitting in. Residents are offered a range of activities by a designated member of staff. Staff are supported by a training manager, who supports them in a wide range of areas. Clear records of training are maintained. These records reflected what staff told us. Residents are supported by ancillary staff who are also trained in their roles and were aware of the importance of preserving residents' individual choices and dignity. People told us about their opinions of the services offered. One person reported,"I think the service is a good one and the service users have their needs met nearly 100% of the time", another described how the home did "provide a homely caring environment. Things to do for service users", another "I think the service runs well on the whole" and another "on the whole I've been very happy in the X years I have been at Amesbury Abbey". Some people commented on the staff. One person reported "I am entirely happy with Amesbury Abbey and its very kind and helpful staff", another that staff "all do their best", another commented about staff that "they're very good" and another "if you have a crisis, they always cope with it". What has improved since the last inspection? At the last inspection, nine requirements and eight good practice recommendations were made. Of the requirements, four had been met in full, three showed action, or had plans in place to ensure that they would be addressed. Of the good practice recommendations, three had been met in full, one was no longer relevant and two showed progress. Work has been commenced on further developing information given to residents and their supporters about the services offered by the home. Contracts for residents have been further reviewed and developed. All relevant staff have been trained in safeguarding vulnerable adults. The home has set up a detailed medicines administration policy. Additionally they have developed information packs on continence to inform staff of how to meet residents' needs in this area. Activities staff have been able to complete personal profiles for residents. Plans have been developed to address the dirt trap in the kitchen floor. Many of the corridor areas have been redecorated and many of the carpets replaced. Bathroom walls under liquid soap dispensers have been improved. A risk assessment has been devised and equipment provided for staff when pushing residents across grassed areas of the grounds. Systems have been developed so that staff can alert maintenance staff about risks to health and safety. Responsibilities for checks on bed safety rails have been clarified. What they could do better:
Care Homes for Older People Page 8 of 58 At this inspection, a range of requirements and good practice recommendations were noted. These related to all of our outcome areas. Four of the requirements and three of the recommendations had either not been addressed within their compliance dates or showed areas which still needed addressing. These had not been commented on in the home's AQAA or other correspondence with us. This is of concern Improvements need to be made in information given to prospective residents and their supporters, so that they are in a position to make an informed decision, based on all relevant information, about services provided. Pre-admission assessments would also benefit from improved clarity when describing peoples' needs. A range of improvements are needed in the provision of health and personal care. Where a resident has a need or a risk, an assessment needs to be made, so that all factors relating to the person can be identified. Such assessments need to be reviewed as residents' needs change over time. Where a need or a risk is identified, a care plan needs to be drawn up to direct staff on actions to take to meet the resident's needs and to reduce risk to the person. Parts of this matter has been identified at previous inspections. Such care plans need to be in writing and readily available to staff, so that staff can be aware of all relevant factors and provide care in a consistent manner. Where a resident is frail, full records of care provided need to be in place, so that staff at all levels can ensure that the person's individual personal and nursing care needs have been met. Records need to be clear and to accurately reflect care given. Improvements are needed in some areas of medicines' management. A full audit system relating to medicines management needs to be developed, to ensure that the home complies at all times with guidelines. This is to ensure that issues are not identified at inspection, where action should already have been taken to ensure residents' safety in medicines administration. Where residents are prescribed medicines "as required", protocols need to be drawn up, to ensure that all staff give residents such drugs as agreed and in a consistent manner. Systems need to be in place to ensure that limited life medicines are not administered after their expiry date. Developments are needed in the management of complaints. At this inspection, we were made aware of a range of areas where some people had expressed dissatisfaction with service provision, but this had not been logged and senior managers did not appear to be aware of the issues. This matter has been identified at previous inspections. The home should also consider giving residents a choice of meals at lunch- time. The home needs to make some improvements to the environment. All aids must only be used in accordance with current guidelines. Practice in the use of tablets of soap and cleanliness of electric fans needs to be improved, to prevent risk of cross infection. Other matters relating to developments in good practice relating to infection control include the management of used laundry, policies on staff changing, management of food stored in the fridge in the support kitchen and equipment for washing nurses' hands in the clinical room. Some carpets in corridors and other areas continue to need attention. The home would benefit from investing in profiling beds and further developing its bathing facilities for people with high disability needs. Systems for reporting of maintenance deficits also need to be further developed. The home
Care Homes for Older People Page 9 of 58 continues not to have full facilities to enable all staff to change or a private meeting room for the registered manager. Many improvements are needed in staffing. A wide range of people considered that there were not enough staff on duty to meet the dependency needs of residents. To ensure that residents' needs can be met, a full review of staffing needs to take place. The home needs to fully improve its system for recruitment of staff, to ensure that all necessary pre-employment checks are made so that residents are fully protected from risk in the recruitment of new staff, including during the member of staff's induction period. A requirement relating to checking prospective member of staff's employment history were identified at the previous inspection. Systems for management and administration in the home need to be improved. The home needs to develop a quality assurance assessment, to ensure that issues which may affect residents and staff are identified prior to an inspection and relevant action taken to address such issues. This should include audits on responses to call bells and staff feedback in regular staff meetings. The home needs to ensure that it complies in full with issues relating to health and safety, particularly in relation to the risks of hot surface temperatures, hot water, bed safety rails, Legoinellum infection, wheelchair safety and general risk assessments for items such as hot water bottles for residents. We are concerned that such a range of issues have been identified at this inspection, including requirements which have not been addressed. We will be taking action to ensure that residents are safeguarded within our procedures and be reporting relevant matters to other lead agencies such as the Health and Safety Executive. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from [email protected] or by telephoning our order line –0870 240 7535.
Care Homes for Older People Page 10 of 58 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection
Care Homes for Older People Page 11 of 58 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:
People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money.
This is what people staying in this care home experience:
Judgement:
People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will not be fully or accurately informed about the services offered and so will not be in a position to make an informed judgement about admission. People will have an assessment of need prior to admission. Assessments of need would benefit from more detail in their completion.
Evidence:
Care homes are expected to draw up a statement of purpose, which describes the services they offer to people and a service users' guide which is available to residents and their supporters, to describe what life is like for someone living in the home. This must include the home's inspection report. The documents are needed so that people can be fully informed of the services provided and they need regular updating as and when service provision changes. At the last inspection, the service was required to up- date both documents, to reflect their current service provision. In their Annual Quality Assurance Assessment (AQAA), Amesbury Abbey informed us that that they provide
Care Homes for Older People Page 12 of 58 Evidence: an up-to-date statement of purpose for every client. We reviewed the statement of purpose, which is kept in the entrance hall and the deputy manager gave us a service users' guide from one of the rooms which was currently unoccupied. A review of these documents indicated that people would not be fully informed about the services offered by the home. The statement of purpose had recently been reviewed, however it did not comply with our Regulations in some areas. For example it did not include an accurate reflection of the organisational structure of the home as the site manager, who is very much involved both the day-to-day running of the home and the inspection process and to whom key people in the home are accountable, was not included in the document. It also did not include the criteria for admission in an emergency, which is indicated, as one person informed us in their questionnaire that they had been admitted to the home in an emergency when they became acutely ill and a person was to be admitted at short notice during the first site visit. The complaints procedure (which is required to be in the statement of purpose) does not have our correct address and refers to a former registration body. The statement of purpose would also benefit from expansion in some areas. For example, while it does state the age range and needs of the people the Abbey is intended to meet, the section is very brief and would give very little information, for example to a prospective purchaser, to inform them of the range of people actually cared for in the Abbey. The service users' guide was dated July 2006 and needed revision to fully inform people of what it would be like to live in the Abbey. For example it did not state that people could self-medicate if they wished and the arrangements for doing so. It did not inform people of the arrangements for choice at lunchtime when there is no actual menu choice. As at the last inspection it continues not to include a copy of the summary of our most recent inspection report. The complaints procedure also had an incorrect address for us. Discussions with managers indicated that whilst the home provided variable height beds following assessment of need, if a person was assessed as needing additional nursing equipment such as pressure relieving equipment or recliner chairs, the person or their supporter was expected to pay for such items. This information was not made available to people in contracts, the service users' guide or statement of purpose. Information provided to people needs to be accurate and fully inform them of services provided. This was required at the previous inspection, with a compliance date of 31/8/07. This is therefore an un-met requirement and the statement in the AQAA is not an accurate reflection of the current situation. We looked at contracts for people living in the home. The Abbey has a very detailed
Care Homes for Older People Page 13 of 58 Evidence: contract, which details a range of matters to inform people. For example it details fees which continue to be payable if someone is admitted to hospital or dies. All contracts seen were signed and witnessed by the residents or their advocate, as well as the provider. All people have an assessment of need prior to and at admission. Assessments are completed by a professionally qualified person. We reviewed records relating to one recently admitted person. This person had a range of assessments, including risk of pressure damage. The person had a medical condition and they had details of their self-care skills in relation to this. One part of their assessment stated that the person needed "assistance" with certain aspects of their personal care, without stating what sort of assistance was needed. For example, verbal assistance, assistance from a person and/or the number of persons or the use of aids. The person had their current medication regime documented, but there was no information on their response to medications which could affect their daily lives. All of the people who responded to the questionnaire stated that they had received a contract. One person reported that they had been admitted for respite care but had decided to remain in the home as "it seemed the easiest thing to do". Two different people commented "we're very happy here".
Care Homes for Older People Page 14 of 58 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:
People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes.
This is what people staying in this care home experience:
Judgement:
People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Abbey does not have effective systems for ensuring that assessment of need or care plans to direct staff on meeting individuals' needs are drawn up. This means that there is a risk that residents' nursing and care needs will not be met. Whilst medicines management is safe, residents could have been put at risk by a failure in ensuring that all guidelines have been complied with and the lack of directions about certain prescriptions.
Evidence:
Amesbury Abbey provides nursing and care to elderly people, some of whom may have complex conditions, including stroke, diabetes and terminal conditions. Many of the residents needed assistance with some or all activities of daily living. Some of the residents were very frail, needing supports with eating, drinking, changes of position and hygiene. Some residents had additional needs relating to dementia. Residents described the care they received. One person reported "I've been very well looked after", another "I do think they look after you well" and a relative commented "I really feel that they couldn't do more". One resident commented on the care given to a
Care Homes for Older People Page 15 of 58 Evidence: particular need, reporting that a particular nurse was "very good about my legs, she wears badges and things like that". In order to ensure that people have their needs met, their individual needs and risks need to be assessed. Assessments need to be reviewed, including when a person's condition changes. If a need or a risk is identified, a care plan needs to be put in place to direct staff on actions to take to meet peoples' individual needs. Care plans need to be evaluated monthly or when a person's condition changes, to ensure that care provided continues to meet their needs. Where people are unable to inform staff of basic needs, for example when they last had a drink, the amounts they have drunk needs to be documented. In their AQAA, the home stated that a service user plan is always drawn up after assessment. Also that care plans are continually up-dated to note any changes in condition. Of the people who responded to questionnaires, three reported they always, three usually and one sometimes received the care and support that they needed. During the inspection we met with several residents, discussed their needs with staff and reviewed records. We observed a vary varied response to assessment and care planning. Assessments and care plans are kept in folders in the manager's office. Documents are not indexed or kept in a specific order. One very frail person had a social care plan and their likes and dislikes for meals were noted. It was documented that they needed assistance to eat. The person reported to us that this was the case. This person was assessed as being at very high risk of pressure ulceration, but there was no care plan to instruct staff on how their risk was to be reduced. Their nutritional risk assessment documented that their nutritional risk had increased very recently, but their care plan had not been up-dated to show how the person's increased risk was to be reduced. Their manual handling assessment and care plan had been changed at some point, however there was no date or signature/initials by the changes to show who had made the changes and when. The person did have a care plan in relation to their mental health needs which had been regularly evaluated but actions to take to meet needs had not been documented. This observation was not an isolated occurrence. While we observed some very clear care plans for some people relating to how they have to needed their manual handling and communication needs met, other records were not so clear. Another frail person was assessed as having a high risk of pressure ulceration, risk of falls and a moderate dietary risk, but they had no care plans to direct staff on how risk was to be reduced. Another person was documented as having had three falls since December 2008, but their risk assessment and care plan in relation to falls had not been reviewed in the
Care Homes for Older People Page 16 of 58 Evidence: light of this. Another person reported to us that they had a urinary catheter in place, this was supported by records, but their records did not state why the person needed the appliance. This is indicated as the person reported to us that they did not like the catheter and as catheters present a risk to infection control for the individual, there needs to be evidence that such equipment is used only in the person's best interests. Another resident's care plan stated that they were registered blind, however they did not have any documentation in their care plan about how this affected their daily life. One person clearly had continence care needs, but an assessment of their continence had not been made and there was no documentation about the continence aids to be used for them in their records. At the last inspection, it was required that where a service user is assessed as having a risk, a written plan must always be put in place to direct staff on how their risk is to be reduced, with a compliance date of 31/5/07. This inspection shows that this requirement had not been addressed by the compliance date and the statement in the AQAA is therefore not an accurate reflection of the current situation. Some frail people had charts to document their fluid and dietary intake and that they had had their positions changed to prevent pressure ulceration. These charts were not completed in full. One person who did have a care plan for prevention of risk of pressure ulceration had a plan which stated that they needed their position changing every two hours. They had a chart which showed that this had not taken place. Another very frail person's movement chart indicated that they had remained sitting all day with no changes of position. Another person's chart did have reference to them being "repositioned" but as the record did not document which position they had been placed in, it would not be possible for the next person coming to provide care to them to know which position they had been placed in. The National Institute for Clinical Excellence guidelines, the European Pressure Ulcer Advisory Panel and local guidelines all state where a person is assessed as being at risk of pressure ulcers, that as well as providing pressure relieving aids, in order to prevent risk of pressure ulcers, people at risk also need to have their positions changed at least four hourly and for those people at higher risk, they need their positions changing two hourly. Where people had their fluid intake documented, none of the records were totalled every 24 hours. This is indicated, to assess if the person is at risk of dehydration. One person's care plan stated that they were to receive a particular dietary supplement twice a day. There was no record of this being given on their fluid charts. Before the inspection, we reviewed questionnaires where staff reported about how they found out about residents' needs. Four staff reported that they always, one usually and one sometimes were given up to date information about the needs of
Care Homes for Older People Page 17 of 58 Evidence: people they were caring for. One person reported "the report meeting in the morning and at the start of a shift tells us up to date information about the clients", however another reported "the care plans are in the office. As a carer I don't ever have much time to find and read through any care plans". Many carers reported that difficulties related to lack of staff. One person reported "to improve the quality of care that we give to the residents, we should have enough staff" (see also the section on Staffing below). During the inspection, we talked with residents and staff about how they were informed of residents' nursing and care needs. One carer was able to give us a very detailed report on how an individual resident's care needs were met. A carer informed us "we are told they are there to be read" about care plans but this person reported that they relied on report handovers, including if they had been away on holiday. One resident commented that not all staff assisted them correctly with the details of their clothing. Their care records did not document any matters relating to what the person reported they wanted. Staff were uniformly observed to knock on room doors prior to entry. All staff called residents by their preferred name, some calling them by their title and surname, others by their first or preferred name, depending on what they preferred. The laundress showed a very clear understanding of the importance of returning residents' own clothes to them promptly and in a good condition. Where a resident had a wound, there were clear and detailed records and the wound's response to treatment was regularly evaluated. A folder advising staff on the management continence needs has been drawn up to advise staff. The home has good working relationships with the local GP service, who visit the home regularly to review peoples' medical needs. Referrals are made to external healthcare professionals when needed. The home has drawn up a detailed medicines policy since the last inspection. During the inspection, we observed a medicines round. It was correctly performed, in accordance with guidelines and the homes' medicines procedure. We observed that people who had chosen to self-medicate had risk assessment relating to this and that these were regularly reviewed. Records of significant matters such as residents' allergies were made. Where a person had a potentially unstable medical condition, there was full information on the medical management of their condition, including medicines treatment. We visited Amesbury Abbey over two days. On the first day, we identified several issues relating to medicines management, which should have been appropriately dealt with before any inspection. They had been addressed by the second day of the inspection. The issues included records showing that one person had been given drugs
Care Homes for Older People Page 18 of 58 Evidence: which had not been prescribed and was reported to be on the homely medicines policy. When the homely medicines policy was reviewed, the drugs were not included and the policy itself had not been reviewed for a considerable period of time. There were stocks of Controlled Drugs in the Controlled Drugs cupboard, which had not been disposed of when the resident died. The records of the temperature of the medicines refrigerator showed high temperatures, which had not been reported to the senior registered nurse with responsibilities for medicines management. On both days of the inspection, we observed a limited life medicine in the refrigerator in the kitchenette on the second floor, which had not had the date of opening written on it. Several residents were prescribed medicines on an "as required basis". None of the residents had a care plan or protocol to specify when or how often the person was to be administered these drugs. This is indicated, so that the resident is receiving such medications in a consistent and planned manner. Most residents had a list of their medications in their care records. Many had regular prescriptions for medicines which can affect their daily lives such as aperients, mood altering drugs or painkillers. None of the residents had care plans relating to these drugs. This is advised so that the affect of such drugs on a person can be effectively assessed.
Care Homes for Older People Page 19 of 58 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:
Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes.
This is what people staying in this care home experience:
Judgement:
People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be assisted in exercising choice in their activities and daily lives. This would be further enhanced if residents could exercise choice for lunchtime meals.
Evidence:
In their AQAA, the home stated that a full programme of activities is provided and that they continue to listen to residents to improve and develop their activities programme. In questionnaires, three people reported that there were always, two usually and two sometimes, activities arranged by the home that they could take part in. One person qualified their response by reporting that they did not chose to take part and another by reporting that they felt too frail to participate. During the inspection, residents commented on activities provided. One person reported "I've a list of activities, I go to the keep fit classes, that's what I do like" and another "I used to do much more than I do now". As good practice, staff were observed engaging residents in conversation when they provided care. A resident was observed to know a domestic by their first name and to chat with her whilst the domestic was working, with the domestic chatting back. We met with the activities person who reported that they used Mondays as an
Care Homes for Older People Page 20 of 58 Evidence: organising day, setting a weekly plan, which was then distributed to all residents. There was a quiz on the back of it the plan. There was a pattern of activities through rest of the week. There was evidence of some arts/crafts activities, which related to themes, such as season. Quizzes were reported to be popular, also exercise sessions and talks. The activities person reported that they were increasing one-to-one attention and support to individual interests, for example "tactile boxes" to stimulate interest and reminiscence, reading, conversation, encouraging movement. A visiting bird of prey specialist had been able to take birds to individual rooms. Mews residents were routinely invited into activities, which encouraged social mixing and more of an "outside" perspective. Some musical events are bought in to the home and some theatre trips are organised. There are also fixed major annual events such as Christmas, the summer meal, valentine's celebrations, a barge trip. Personal profiles were completed for each resident. We reviewed four recently completed ones. The activities person takes lead on this and types them up. Profiles cover life history, interests, likes and dislikes. There was evidence of individual staff members reporting back new information to add, for example one person particularly wanted access to James Bond books. The activities person said that they were working with the training manager on a module for staff to develop involvement with activities. It was reported that activities are not a routine item on staff meeting agenda. The activities person considered that they had enough time for their role and that other staff were gradually becoming more motivated. A care assistant confirmed awareness of personal profiles and said they were very useful, especially relating to food preferences and how people liked to take their meals. They described instances of adding new information to profiles, for example someone missed having a lager to drink. In their AQAA, the home stated that visiting was unrestricted and that all clients are encouraged to be as independent as possible. Several residents reported that they went out regularly with their relatives. One reported "my family come and go when they want". One relative was visiting at the time of the inspection, they reported that residents' family all visited regularly and were free to come and go as they wished. They said "we have been made to feel so welcome, we can come any time, day or night" and "I really feel I've got to know everyone". Residents commented on choice. One resident reported on how they appreciated being able to bring their dog in with them. Another resident commented that they liked being able to come and go out of the building, reporting that they went out for walks in the grounds. Another resident reported "I have what I want" and another "I get up and go to bed when I want". In their AQAA, the home reported that all dietary requirements are fulfilled by their chefs, that an a la carte menu is provided every evening and that individual
Care Homes for Older People Page 21 of 58 Evidence: preferences are taken into account. People commented in questionnaires about the meals. One person reported that they always, three usually and three sometimes liked the meals. One person commented on the "lack of green vegetables" and that the food was "overcooked". People commented to us on the meals during the inspection. Comments varied from the "food is very, very good - excellent", and "the food's too good" pointing to their stomach, through "food does vary tremendously" and "food varies from cook to cook" to "I don"t like it every day but it's very edible" and "we do not have a choice but I eat what I'm given". The menu is written weekly, the chef said they liked to be responsive to what is available. Only one choice of meal is offered at lunch, except on days when main meal is known to be unpopular with several residents, for example liver or curry. The evening meal allowed for much more choice, there was always a hot option and several alternatives such as sandwiches or eggs. The chef said they were trying to maintain a balance of cheaper and grander meals. They reported that they worked to a policy of low fat and low carbohydrate content. There were currently no vegetarians, but some soft diets were being catered. All meals were manufactured in-house from raw ingredients. The chef reported that nursing staff notified the kitchen of changes to individual nutritional requirements, and specific requests. Sometimes family members made specific observations and requests on behalf of relatives. Information on new residents was passed to kitchen by the registered manager or her deputy. The chef said they had received few complaints and a lot of compliments, but was keen to develop consistent channels for direct feedback from residents. We observed a mealtime. Residents can eat in the dining room or their own room. The dining room was less cramped in appearance than at the last inspection. This may be because with an increasing dependency amongst residents, fewer residents go to the dining room for their lunch, as well as the number of unoccupied rooms. We discussed choice with the waitress who was serving the meals. The meal was fish, peas and potatoes. The waitress informed us that all residents liked fish. She reported that residents had a choice of meals at breakfast and supper time but there was no choice at lunch. Where residents ate in their rooms, care staff took meals to them on a tray. Most meals were observed to be hot, however for some residents on the top floor, the two carers had to stop giving out lunch, to give a resident who needed two people to assist them urgent personal care. Such actions are considered good practice, as if a resident needs such urgent care, they should not be expected to wait. However this also meant that meals were not warm for the people who had not yet been given their meal. Systems should be put in place to ensure that if a resident does need urgent care, meals can be kept warm or additional staff can quickly be summoned to assist.
Care Homes for Older People Page 22 of 58 Evidence: Where residents needed assistance to eat their meals, care staff sat with them, supporting the person. We observed one carer feeding a resident in a kindly manner and assisting the resident at a pace that the resident needed. They were engaging the resident in conversation whilst they were assisting them.
Care Homes for Older People Page 23 of 58 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:
If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections.
This is what people staying in this care home experience:
Judgement:
People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be safeguarded from abuse, however there is evidence that concerns and complaints are not bought forward, are not always documented and that actions are not taken to address issues.
Evidence:
At the last inspection, it was required that the home must ensure that clear records of all complaints, including verbal complaints are made, together with investigations into the matter, outcomes and actions taken. The requirement had been identified at the previous inspection, with a compliance date of 16/7/06. At the last inspection, it had been addressed in part and a new compliance date of 31/5/07 was set. In their AQAA, the home reported that all residents and staff have access to the home's complaints procedure and that management are always available to listen to complaints. They reported that they had received two complaints in the last twelve months. No complaints have been made about the home to us since the last inspection. In questionnaires, all people who responded reported that they knew how to make a complaint, however people responded differently when they were asked who they would speak to if they were not happy. Here three people reported that they always, three usually and one sometimes knew who to talk to if they were not happy. Several people responded that they knew how to raise issues but did not feel that action was taken. One person reported "does not mean any action is taken", another "we get very
Care Homes for Older People Page 24 of 58 Evidence: frustrated, if we have any concerns, we may have to pass the information on numerous times and usually nothing gets done", another "when we have concerns/problems that we inform to the manager, we find it frustrating that nothing has been done very often". One resident reported in their questionnaire that they had reported clothes going missing during the last year. Several residents commented on concerns relating to shortage of staff (see Staffing below). We spoke to residents during the inspection. One person reported "I'm not backward in coming forward, so I would complain", another "I talk to Matron, oh yes she would do her best" and another "there have been one or two occasions when I've complained". The site manager was able to describe a complaint in relation to staffing that he had recently investigated. He reported that records relating to this complaint were on his own computer file, not on the complaints log. We spoke to staff who reported that, due to the increasing dependency of residents, they felt that they did not have enough staff to meet resident need (see Staffing below). We were also informed by a person that a relative had raised issues about staffing and its impact on care between the two days of the inspection. The manager of the home does maintain a complaints log, but as at the previous inspection, it appears that not all complaints are documented in this log. The log did not record the complaint investigated by the site manager, there were no references in it to loss of clothes, as reported by the person in the questionnaire, concerns about lack of staffing were not documented and there was no note of the issue raised by the person in between the two days of inspection. The complaints register did show investigation of matters brought up and actions taken to address them. It appears from the findings of this inspection that the home continues not to take full actions to receive and act upon complaints made to them. Comments made in questionnaires and to us during the inspection indicate that more than two people feel that they have made a complaint, as was documented in the AQAA. This may relate to not all issues of concern being reported, that one single person does not have responsibility for receiving and documenting complaints and complaints not being seen as an area which is important in monitoring quality control in the home. In their AQAA, it was reported that the home has an excellent training programme in relation to safeguarding adults. No safeguarding referrals have been made about the home since the last inspection. The home employs a training manager who maintains clear records of training attended by staff. These records clearly show that all staff, at all levels in the organisation, have been regularly up-dated in safeguarding adults. We discussed training materials with the training manger and she was able to provide evidence that training takes place and that passive materials such as DVDs are not used or only used at end of sessions to consolidate learning. A training session on
Care Homes for Older People Page 25 of 58 Evidence: safeguarding was taking place during the second site visit. All staff spoken with showed an understanding of their role in ensuring that vulnerable people were safeguarded.
Care Homes for Older People Page 26 of 58 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:
People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it.
This is what people staying in this care home experience:
Judgement:
People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be cared for in pleasing surroundings, which are generally clean and well maintained. However some facilities would benefit from modernisation and attention needs to be paid to some areas of infection control to reduce risk to people.
Evidence:
In their AQAA, the home states that they have a well adapted environment, with rooms which exceed minimum standards, that all the accommodation is well equipped, including a Parker bathroom and two shower rooms for special needs. They commented on the excellent infection control. They reported that the environment is constantly monitored to ensure that it meets standards and that they employ a team of maintenance staff. They report that since the last inspection, areas of the home have been redecorated and re-carpeted and that the plumbing of the home has been up-graded. In questionnaires, five people reported that the home was always, one usually and one sometimes fresh and clean. One person commented "my nice room is well cared for too", however another commented on small areas of maintenance, which needed attending to. Residents commented on the environment to us during the inspection. One reported that the home was "very comfortable". We observed that the main entrance areas and general corridors had all been redecorated and re-carpeted in a
Care Homes for Older People Page 27 of 58 Evidence: light colour, which enhanced the size and cleanliness of the areas. However the back corridors and the lifts still needed attention, with staining evidence in carpets and dirt traps visible in the placements for the lift doors. Residents who live in Amesbury Abbey all have large rooms, which much exceed minimum standards. Much of the accommodation is in the form of apartments, with the person having a sitting room, as well as a bedroom. Nearly all the rooms are en- suite. It was reported by staff that only four residents were able to use their own en- suites and the rest use the communal bath or shower rooms. All of the communal bath and shower rooms need the individual to be able to bend at the waist or be able to stand and the home should consider developing bathing facilities for more disabled persons, so that they can have a bath if they wish, rather than having to have a bed bath or strip wash to ensure their personal cleanliness. The home are advised that there are a wide range of such facilities available and that these are provided in most other care homes with nursing. Amesbury Abbey has a dining room and drawing room for residents and, as noted above, some of the apartments also include a sitting room. Some residents also chose to sit in the main entrance area, which has seating available, and chat to staff and people coming in and out of the home. One resident said that they liked the main corridors, reporting "I walk round the corridors a couple of times a day". Some residents commented on the communal areas. One resident said to us "I don't go to the sitting room - too posh, I'd like somewhere to go & plump down with someone" and another "I would like a cosy room where we can sit and chat at any time of the day". During the inspection, we reviewed systems for maintenance. As we toured the building, we observed three minor areas needing maintenance, including a dripping tap, holes in the wall of a bathroom and a window which would not shut. We met with the maintenance manager, who reported that staff report defects in a register and that he reviews the register every day. He had not been informed about the three minor deficits we observed and reported that he and his team would not have a difficulty in addressing them, if they had known. The site manager and maintenance manager reported that they have developed a system with the domestic staff, so that they report deficiencies in the environment in a record, which includes an assessment of risk to health and safety. They reported that this is a new system which has only recently been developed. It was discussed that all staff should be made aware of their individual responsibilities for reporting maintenance matters and to not assume that a matter was already known about. We reviewed support facilities. The hairdressing room was bright and warm,
Care Homes for Older People Page 28 of 58 Evidence: presenting a clean pleasing environment. At the last inspection, we recommended that the manager be provided with a private room where she could meet with people when needed, including interviewing, counselling and supporting relatives and staff. The manager's office is an alcove in a corridor, with no door. Staff will need access to it at all times, as it includes residents' records. She could also use the drawing room, but this is a communal area and it would be inappropriate for it to be taken out of use if residents wish to be in there. The site manager has an office by the front door but it is shared with the finance officer and its shape would make a meeting with more than one person difficult. There is also an office upstairs but this is the training managers and catering manager's office. At the time of the inspection, as there were so many empty rooms, such an empty room could be used, but when the home is at capacity, this is needed, to ensure privacy and confidentiality is maintained, as is observed in other care homes with nursing. At the last inspection, we recommended a larger staff changing area be provided, including a shower. This has not been addressed, and the staff changing room continues to be a small area, which is poorly maintained, including wall-paper coming off the walls. Such a facility is not likely to support staff morale. As the home employs both male and female staff, we asked how they ensured that both sexes could change in privacy. Managers did not appear to have considered this matter and were of the opinion that most staff came on duty and went off duty wearing their uniform. We advised that this is not regarded as good practice in ensuring that the principals of infection control are up-held. Staff should be encouraged to wear their own clothes and change in the home before coming on duty and to change before they leave the home, particularly in relation to footwear, to ensure that micro-organisms are not transported out of the home into the community and into the home from the community. The home provides equipment to meet residents' needs, including hoists and slings to aid manual handling. Residents who need nursing care are cared for in variable height beds. The beds seen were of the metal framed type and was discussed that the home should provide more profiling beds which go down to the floor, as other care homes with nursing do, so that the use of bed rails can be reduced and because they give a more homely, less clinical appearance. Residents who were at risk of pressure ulceration were provided with air mattresses and pressure relieving cushions. For one person, we observed that a Kylie sheet was tucked in over an air mattress. The need for this continence aid was not documented in the residents' notes. The home are also advised that the senior tissue viability nurse for the Wiltshire Primary Care Trust states that: "Kylies are absolutely not recommended, on any patient who is at high risk of developing pressure ulcers, on any surface".
Care Homes for Older People Page 29 of 58 Evidence: We observed a domestic performing her role, she worked carefully in a methodical manner, cleaning under items such as toilet rails as well as on top. She was wearing protective clothing, which she correctly disposed of when she had finished the area she was cleaning. The site manager reported that the home had recently invested in a new carpet shampooer, which was much lighter and easier to handle. All waste, including clinical waste, was correctly disposed of. We observed in the second floor bathroom and the ground floor bathroom that tablets of soap had been left in the soap holder. Communal use of tablets of soap has been identified as a risk to cross infection. Tablets of soap must be returned to the resident, or of the resident cannot be identified, promptly disposed of. To prevent risks, single use soap should only be used in communal bathrooms. On one corridor there was a large standard electric fan. The grill of the fan was very dusty. Such items need regular cleaning as dust in care homes with nursing have the potential to harbour micro-organisms, which can then be spread in the air, when the fan is operated. We visited the laundry and met with the laundress. The laundry was clean throughout, including the areas behind the washing machines and dryers. The laundress showed an up-to-date knowledge of the principals of infection control. She reported that staff always placed infected and potentially infected items separately in the correct bags. She reported that the washing machines were regularly serviced. Discussions indicated that the laundress re-sorts laundry in the laundry room. As good practice, the home should invest in laundry bag systems where laundry such as bed linen, towels, residents' personal clothing and the like can be separated at source, to reduce the risks presented to infection control by re-sorting in the laundry. The home has one sluice room. It was clean and well organised. We observed that some of the commode inserts were beginning to show signs of staining with age and they should be replaced before they deteriorate further. The home has a clinical room for storing drugs and clinical dressings. We observed that the only hand wash basin had ordinary taps. As good practice, mixer taps should be provided at this basin to ensure that registered nurses can perform safe practice in hand washing, when preparing to perform clinical procedures. The main kitchen was being inspected by the environmental health officer on the second day of the inspection. The site manager was able to advise us on works improve the kitchen flooring to remove the potential dirt trap and when this would be taking place. The home also has a small kitchenette on the second floor where breakfast and snacks can be prepared by staff. On the first day of the inspection, there were several items of food in the fridge, for example sandwiches. These were covered but did not have a date on them. This is indicated, to ensure that all items given to
Care Homes for Older People Page 30 of 58 Evidence: people are fresh. By the second day of the inspection, all such items had been removed.
Care Homes for Older People Page 31 of 58 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:
People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes.
This is what people staying in this care home experience:
Judgement:
People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents could be put at risk as there are not always enough staff on duty, there are staff who have not been safely recruited and fully supervised when they commence their role. Residents will be supported by staff who have received a formal induction programme and are given a range of training opportunities.
Evidence:
In their AQAA, the home states that every endeavour is made to always provide adequate staff, with the correct skill mix. They did report that they needed more bank staff. The information provided indicated that there had been some staff turnover during the past year. The manager reported that as the home is in Amesbury, much of this related to staff who were married to members of the armed forces being affected by troop movements. Many people commented about what they considered to be inadequate staffing levels in questionnaires. One person reported "The NH is understaffed" and "S.R.N.s are short. Particularly at night", another "in the last few months there has been a shortage of staff - and one feels that they are always rushed", another "I feel the nursing home does not have enough carers, they are all rushed off their feet" and another "the matron should find enough staff". This was echoed by in comments made by staff. One person reported that the home should "provide more staff, that would then provide us
Care Homes for Older People Page 32 of 58 Evidence: all with more time to be with the service users more", another "the service would improve on a whole, if we had more staff" and another "to improve the quality of care that we give to the residents, we should have enough staff". People also commented on the length of time it took for nurses to attend to them when they needed assistance. One person reported "not infrequently, there is a distressing wait of over 20 minutes before my buzzer is answered". As we had had so many comments about staffing levels in questionnaires, we particularly considered this area when we did the inspection, talking to residents and staff and reviewing records. Whilst records indicated that the home had a high number of vacant beds, the AQAA and discussions with staff indicated that those residents who were in the home, particularly those who had lived in their home for many years, had increased dependency, with nearly all residents needing assistance with some activities of daily living and a proportion needing assistance from two people at all times. The home provides accommodation over three separate floors. A review of information showed that people with high nursing and care needs were cared for across the three floors of the building. Comments made to us by people about staffing during the inspection included "I'm certain they are short of staff", "they're tottering along as they can" and one person commenting on the lack of staff availability saying "I know, it's like this all the time". We did not receive any comments from people who considered that the home was well staffed. We received similar commented from staff. One person reported "very busy here, some days fine others less so", another "very, very short of staff because dependency gone up, having to rush people to get them up" and one member of staff reported that they were worried about they did not have enough time to spend with someone who was dying and that this was "wrong". One member of staff reported that they found evening shifts busier than mornings because of the pressure on time created by serving suppers, then straight into bed routines. Residents commented on time taken when they used their call bell. One person reported "I have to ring my bell very little but if I do they do come" and another "very fast response to my bell". However this was not echoed by other residents. One person reported "sometimes reasonably quick, sometimes a bit held up", another "if I ring my bell sometimes yes, sometimes no, depends on what they're doing" and another "they used to come very, very swiftly but not now they always come but when they actually come varies, they never neglect you, they really do come in the end". During the inspection, as noted in Daily Life and Activities above, there were not enough staff on the second floor to both give out meals and provide urgent care to a person at lunchtime. Additionally, as noted in Health and Personal care above,
Care Homes for Older People Page 33 of 58 Evidence: assessments, care plans and monitoring records are not up to date and on some occasions care to very frail people had not been provided in accordance with care plans or accepted guidelines. This inspection indicates that staff may not be completing required documentation or performing necessary care because they do not have time to do so. In order to ensure that residents are cared for effectively, the home needs to perform a full review of staffing, including factors such as residents' dependency and layout of the building and submit it to us, together with an action plan to detail how the situation will be improved. In their AQAA, the home reported that they had an excellent recruitment procedure and that they had fully re-vamped their documentation and policy and procedure. Five of the six staff who completed the questionnaire reported that the home had carried out full recruitment checks prior to their employment. However one person commented "I was already working in care where I had a clear CRB so I was pleased to be able to start a.s.a.p.", which suggested that the home had not carried out their own Criminal Records Bureau (CRB) check. We looked at the files of four recently employed staff, including one registered nurse. All four of them had already started working at the Abbey. The files were not indexed and records were not kept in a specific order, which made audit complex. All of the files included proof of identity, however some of the photographs were photocopies of passports and the quality of at least one of the photographs was not sufficient to provide a proof of identity. One person's passport stated that they had limited leave to remain in this country, dated eight months previously, there was no evidence that the situation had been verified further, to ensure that the person was able to work. One of the four files had no record that a check had been made with the protection of vulnerable adults (pova) list before they started working in the home. This is required to ensure that the person is suitable to work with potentially vulnerable people. Three of the files evidenced that a CRB check had taken place, but one did not. One person had a CRB certificate from their previous employer. Due to the risks of working with vulnerable people, all care providers must obtain new CRB certificate when someone commences in their employment. The home did not have systems in place, as advised, to safely dispose of CRB records within advised timescales and did not have an ongoing documentary system for providing evidence to us that they had received CRB clearance for individual people once CRB records had been disposed of. Discussions with managers indicated that they would not be aware of correct procedures, including risk assessments under equal opportunities to take if a prospective member of staff had issues raised by their CRB certificate.
Care Homes for Older People Page 34 of 58 Evidence: One person had no references on file. Another person had only one reference on file. A different person two references on file but one of them was so brief as to not be able for a future employer to have an opinion as to the person's suitability for the role, but a third suitable former employer, who was listed on their application form, had not been approached. One person's reference did not clarify what position the person had been known in, so it was not possible to assess why this person was providing a reference. There was no documentary evidence that these matters had been probed. At the previous inspection, it was required that full details of a person's employment record or gaps in employment be recorded by 31/5/07. This inspection shows that this requirement had not been addressed. One person had a significant gap in their employment record and there was no evidence that this had been probed at interview. Another person's file only listed employment for the past two years, although the Abbey's application form requires employment for the past ten years be listed. One person had no dates for previous employment on file. There was no documentary evidence that these matters had been probed at interview. Staff commented on induction in questionnaires. Two reported that the induction very well and four mostly covered everything they needed to know about their job when they started. One person commented "we have training sessions", another "When I started, X years ago, it did, however we are finding lately, due to lack of staff, it isn't. The new members of staff are being thrown in at the deep end", another about the induction "but I find it not happening due to lack of staff" and another "if it's new staff, new to the job they don't have the knowledge or experience to know". Amesbury Abbey employs a designated training manager. She has the responsibility of inducting new staff at all levels into their role. She reported that the manager lets her know that she is interviewing a new member of staff and of progress after that. She then prepares induction for the member of staff. The training manager reported that four care assistants had started working at the Abbey since the beginning of 2009, three had not worked as a care assistant previously. The training manager also performs inductions for ancillary and registered nursing staff. Separate induction packs, are provided for such staff, which are specific to the roles they are to perform. The training manager reported that she has recently up-dated the induction. All new members of staff are given an induction pack, this includes a range of material, including information on the local safeguarding procedure and General Social Care Council code of practice. She reported that all new members of staff undertake Health and Safety training on their first day of employment and safeguarding of vulnerable adults on the second day. The pack includes lots of questions and answers and complies in full with guidelines. She reported that she uses a lot of role play, questions
Care Homes for Older People Page 35 of 58 Evidence: and answers and scenarios from staffs' past and present experience. All new members of staff are allocated to a mentor who writes reports on the person's progress. The training manager works with each new employee two days a month. The induction takes three months. During induction, each member of staff fills out a personal development plan. At the end of induction all staff have an appraisal with manager. The records we saw were clear and fully reflected what the training manager reported. During the inspection, we discussed induction with staff. One person reported that the training was "fine" from the training manager and that staff were allocated to a mentor, however that in practice, new members of staff were not always put to work with their mentor and occasionally new carers worked on their own. We were given an example of a recent weekend where two new carers were not supernumerary and not working with their mentors. We were given an example of a weekend where only two established staff were on duty and the rest were new carers. We looked at the off duty and this provided evidence to support such reports. Our Regulations state that once pova clearance has been obtained that a person may start working but that they must always work fully supervised until they have received CRB clearance. There did not appear to be systems for ensuring that this was taking place and clear records of supervision during this period was not evidenced. In their AQAA, the home stated at over 50% of care staff were trained to National Vocational Qualifications (NVQ) level II. The training manager reported that the provider encourages staff in undertaking NVQ and knows how to support staff in seeking funding for this. If staff wish, they are supported in undertaking NVQ III and staff can also do an NVQ III in communication. The training manager is an NVQ assessor, so all training can be performed in-house. The training manager also provides or facilitates other training for staff. She reported that staff are always sent staff on the local Palliative Care course. If the home are admitting new resident with different condition, she will facilitate training. For example the home recently admitted new resident with Parkinsons disease and arranged an up- date for all relevant staff. They also have people in to talk, for example the speech and language therapist came in to train staff in nutrition and assistance with eating. Staff are supported in dementia care training and they have an in-house dementia care booklet. Registered nurses are able to undertake specific training, for example wound care and management of syringe drivers. Staff commented in questionnaires about the training provided and all people felt that up-to-date training was provided by the home, which was suitable for their role. One person reported "training is always up to date" and another "they always give us up- to-date trainings to my job". All staff have individual training records, which provides
Care Homes for Older People Page 36 of 58 Evidence: evidence of the support given in training by the home. A matrix is also maintained so that the training manager can see at a glance who had undertaken what training and who is due for up-dates in mandatory areas.
Care Homes for Older People Page 37 of 58 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:
People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers.
This is what people staying in this care home experience:
Judgement:
People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems at Amesbury Abbey are not in place to ensure that residents' health, safety and welfare are up-held. Whilst there are systems for review of quality of care, these are not centred on receiving comments from people and matters which are in the public domain have not been addressed in a timely manner to ensure quality of service provision.
Evidence:
The current registered manager has been in post for many years. She is supported by the representative of the owner, who acts as site manager and is based on site, although he is also involved in management activities at the provider's other homes in Hampshire. The manager is supported by a deputy manager, who had also been in post for a period of time. Additionally, there is a housekeeper who manages catering, domestic and laundry staff. The manager has completed the registered managers award and the site manager has an NVQ 4 in management.
Care Homes for Older People Page 38 of 58 Evidence: Several people commented on management in questionnaires. One resident described the manager as "good at heart". One member of staff commented that the home needed "regular staff meetings which would help to iron out problems the staff have and different issues within the home", another "there should be a regular staff meeting where we can air our grievances and problems, In the X years I have been here we have only had 1 meeting" and another "I wish that there will be a set regular meeting among the staffs and the manager". There was a notice on an office door showing a staff meeting was to be held 28/02/09. A care assistant said "we used to have staff meetings, then they stopped, now they are starting again". The person hoped they would be sustained, as they saw staff meetings as important. Several staff reported concerns about management of current working practices. One person reported "we seem to have a high turnover rate of staff, that do not get replaced very quickly. We tend to feel guilty about phoning in sick as we know the home will be short staffed", another that management needed "not to rely on the staff they already have to cover shifts when they are short, when the staff need to do things in their time off and need a break" and another "we feel so guilty when we are asked to come to work when we can't. I felt really bad when I can't give the level of care that residents deserve to have due to lack of staff". There do not appear to be systems for monitoring of quality of service provision and feedback from residents and staff. The home does perform regular audits on clinical areas, such as infection control, incidence of pressure ulceration, manual handling, continence and accidents. The home used to have a system for reviewing response times to the nurse call bell system but the equipment is reported to be broken. Spot checks can still be made, however there is no routine system for assessing response times to call bells. There do not seem to be effective audits on management of medicines or records keeping. Additionally the home does not appear to use any systems to identify residents, relatives and staff opinion of service provision. Information from questionnaires and discussions during this inspection show a wide range of dissatisfaction amongst residents and staff in a range of areas, particularly relating to staffing levels, response times to call bells and staff feeling pressurised to support the home when a member of staff is off sick. If the home had a quality audit system, they would have been aware of such factors and taken action to address these issues before being identified at an inspection. The home needs to develop its own quality audit system so as to clearly identify its strengths and weaknesses and enable it to take action to address deficits. The home does have systems for staff supervision. The registered manager supervises the registered nurses and the training manager supervises the care assistants. The training manager has a matrix for supervision, so that she can ensure it is taking place
Care Homes for Older People Page 39 of 58 Evidence: on a regular basis. We saw that this matrix was fully completed. The home has a supervision policy and all staff sign a supervision contract. Staff receive a supervision at end of induction, when they come back to work after a period of sick leave or maternity leave, after they have completed NVQ and also if people feels that someone needs additional supervision. Supervisions seen were individual in tone and any training needs were clearly identified. All records were signed by the supervisor and supervisee. All staff have an annual appraisal performed by the registered manager. She reported that she finds appraisal meetings helpful in identifying what staff consider needs to be done to improve the service. She might find that identifying general trends following appraisals could be used to inform quality audits in the home. One person looks after residents' finances. The home only looks after one individual's personal moneys. There was a clear documentary system in relation to this, with full records and two people signing all records. All other additional services are dealt with by invoice. We looked at the system for hairdressing. There were clear records, which were easy to audit, so that it could be identified when an individual had had their hair done and the cost. This was then debited from their individual account and added to their invoice. Similar systems were in place for chiropody and sundries, most of which were from the home's shop. The training manager is a qualified manual handling trainer. She keeps a clear matrix of health and safety training, this shows how often all members of staff have been up- dated and when next training is needed. The home maintains records of regular servicing of equipment and services such as the lifts and boilers. The fire log book was fully up-to-date. During our tour of the building, we observed a number of issues relating to ensuring the health and safety of residents. These matters have been in the public domain for an extended period of time and should have been addressed by management a period ago and not identified during an inspection. We observed hot radiators, both in corridor areas and residents' rooms. These were not protected or low surface temperature. A review of accident records showed that many of the residents had a history of falling. One resident who we visited in their room had a wall heater which was very hot to touch, this was not protected in any way. The resident had a history of falling, but risk to them from contact with hot surfaces had not been identified in their care plan. If a frail resident falls against a hot surface and cannot move, there is a significant risk of burning injury to them. The home needs to take action to ensure the safety of residents. This is a matter which will be reported to the Health and Safety Executive, as they are the lead agency in this area.
Care Homes for Older People Page 40 of 58 Evidence: The home has a Parker bathroom on the ground floor. When we visited the bathroom on the first day, we observed that the last record of temperature documented in the temperature recording book was on 31/1/08 and before that it was 1/6/07. We tested the temperature of the bath water, it was 48C. Staff confirmed that the bath is regularly used by residents. Bathwater temperatures need to be at or below 43C, to prevent residents being at risk of scalds. On the second day of the inspection, there had been two records put in the temperature book, one for 15/2/09 of 38C and one for 19/2/09 of 60C. When we checked the water, the temperature was 47C. We also inspected a bathroom used by a resident. It had a temperature book which had not been completed. There was no thermometer in the room for us to check the water. Frail elderly people are at high risk of scalds from hot water, therefore there need to be safe systems to ensure that they are not put at risk. This is a matter which will also be reported to the Health and Safety Executive. During the inspection, we met with one resident who had safety rails on their bed. Safety rails can present a major risk to an individual and must only be used after full assessment, to ensure that they are in the best interests of the person. The assessment used by the home does not conform to Health and Safety Executive guidelines and was not reviewed regularly. When we visited the person, there was a gap between the head end of the rails and the bed head, which could have presented risk to the resident. One of the rails was very loose in its fixings. When we returned later in the afternoon, one of the rails had not been put back in place correctly. The resident also had an air mattress on their bed but no assessment had been made to ensure that the height of this mattress did put the person at risk. We discussed this with the maintenance manager, who reported that he performs regular checks on bed rails but that staff would at times adjust them in between checks which could render them unsafe. This is a matter which will be reported to the Health and Safety Executive. The home has two disabled showers and some residents have shower facilities in their en-suites. There was no evidence that shower heads are regularly checked for lime- scale. This is indicated as presence of high levels of lime-scale is associated with Legionellum, which can be a risk in facilities such as nursing homes. The maintenance manager reported that they regularly check wheelchairs in the home, however he does not maintain a record of checks and actions taken to ensure resident safety when using wheelchairs. Such a record is needed to show when a wheelchair was last serviced and actions taken to ensure safety. The home has developed some risk assessments, for example a risk assessment on
Care Homes for Older People Page 41 of 58 Evidence: pushing wheelchairs across grass. As a result they have purchased more suitable wheelchairs for residents and staff to use. During the inspection we observed items in resident's rooms which could potentially put residents at risk such as a kettle, a hot water bottle and a simple bolt on the outside of a resident's bathroom. We looked at the assessments for the person who had a hot water bottle in their room. They did not have a risk assessment or directions to staff as to how they could continue to use a hot water bottle in a safe manner.
Care Homes for Older People Page 42 of 58 Are there any outstanding requirements from the last inspection? Yes R No £
Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 29 19(4,b,i), Full details of a person's 31/05/2007 S(2,6) employment record or gaps in employment must always be recorded. This requirement was identified at the previous inspection, with a compliance date of 31/5/07. An employer needs to know a prospective member of staff's employment history, to assess their suitability for their role. Gaps in employment need to be probed so that the prospective employer can verify what the person was doing and when, in their employment history. Until a prospective employee's employment is known, the future employer will not be in a position to assess the prospective member of staff's suitability for their role.
Care Homes for Older People Page 43 of 58 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action
Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 1 5 The home's statement of 30/06/2009 purpose and service users guide must be up-dated and revised to reflect current service provision and regulations. Both documents must agree in relevant areas. The service users' guide must include a copy of the summary of the inspection report. Parts of this requirement were identified in the inspection of 13/4/07, with a compliance date of 31/8/07. People need full information about services provided so that they can make an informed decision about whether the home can meet their individual needs. 2 7 12 Where a person is assessed 08/05/2009 as having a need or a risk, a full individualised care plan must be put in place, to direct staff on how the need
Care Homes for Older People Page 44 of 58 is to be met or risk reduced. Care plans must be readily available to staff. Parts of this requirement relating to care plans to reduce risk were identified at the previous inspection, with a compliance date of 31/5/07. It has not been addressed. Care plans are needed to advise staff on actions to take to meet need or to reduce risk, this will ensure consistency in approach by all staff. As care is provided over a 24 hour period, all care plans need to be in writing to advise all staff. Care plans need to be readily available for all staff, so they know actions to take to meet individuals' needs. 3 7 12 There must be written 08/05/2009 evidence that all residents have a full assessment of their nursing and care needs, including risk assessments. Assessments must be regularly reviewed and, when needed. All changes must be signed and documented. Where residents have nursing or care needs, an assessment is needed, so that the type and extent of need can be established. Elderly and frail peoples' conditions can change,
Care Homes for Older People Page 45 of 58 sometimes this happens quickly and sometimes over time. Assessments need to be reviewed to establish the degree of change. Changes need to be signed, so that the person who made the re-assessment can be identified. Changes need to be dated, so that information is available on when the changes were made. This will then feedback into further evaluations. 4 8 12 All people who need 08/05/2009 assistance with basic activities of living such as food and/or fluid intake and changes of position must have a monitoring chart. Monitoring charts must accurately reflect care provided, conform to care plans and be completed contemporaneously. Where people are very frail and unable to perform basic activities of living, monitoring charts are needed so that staff know what care has been provided and when. If monitoring charts are not accurate or completed contemporaneously, managers will not be in a position to assess if a person has received the care that they need. Care plans direct staff on actions to perform to meet needs, if care charts
Care Homes for Older People Page 46 of 58 indicate that a person is not receiving the care they need, the resident could be at risk of not having their basic nursing and care needs met. 5 9 13 All limited life medicines 08/05/2009 must always have the date opened noted on the medicine container. Medicines must not be used after their expiry date, as this could put the resident at risk. The container needs to be dated, so that there is a record of when the container was opened. 6 9 13 The home must set up a full 30/05/2009 written audit system to ensure that all systems in relation to administration, storage and documentation of medicines always comply with Nursing and Midwifery Council guidelines, our guidelines and their own policies and procedures. Audits must take place regularly and clearly document actions taken to ensure safe practice. Administration, storage and documentation of medicines is a key area in ensuring that residents' needs are met and medicines control is managed in an effective manner. Audits are needed between inspections to ensure that all systems are
Care Homes for Older People Page 47 of 58 safe and conform to accepted guidelines. 7 9 13 Where a resident is 08/05/2009 prescribed a drug on an "as required" basis, there needs to be a care plan or protocol to direct staff on actions to take when administering the drug. If a doctor prescribes a drug on an "as required" basis, registered nurses need to know the indicators for the administering of such drugs and how often they may be given. This is to ensure consistency in approach to such drugs and to ensure that peoples' needs are met. Evaluations of such documents will also assist in assessing the effectiveness of the medicine for the individual resident. 8 16 22 The home must ensure that 29/05/2009 a record of all complaints, including verbal complaints are made, together with investigation into the matter, outcomes, actions taken and follow up. Parts of this requirement have been identified for the past two inspections. People who have concerns or complaints need to know that their concerns have been listened to and investigated. People need to know what action will be
Care Homes for Older People Page 48 of 58 taken to ensure that their concerns are addressed. 9 22 13 All aids, including continence 08/05/2009 aids and air mattresses must be used only in accordance with research based guidelines. If equipment is not used correctly in accordance with accepted guidelines, people could be placed at risk. 10 26 13 Where electric fans are 08/05/2009 used, the grill must always be clean and dust-free. Micro-organisms can live in dust. If an electric fan is turned on where there are significant deposits of dust on the grill, there is a risk that such organisms will be spread across the home, providing a risk to cross infection. 11 26 13 Tablets of soap must never 08/05/2009 be left in communal bathing facilities. If soap is left it must either be returned to the resident or disposed of. Tablets of soap provide a medium where micro- organisms can grow and develop. Residents will be placed as risk of cross infection if such soap is used communally. 12 27 18 A full review of staffing 05/06/2009 levels must be undertaken and submitted to us to ensure that the home can evidence that residents'
Care Homes for Older People Page 49 of 58 nursing and care needs can be met. The review must include among other areas, consideration of resident dependency needs and the layout of the building. This must be submitted to us. If there are not enough staff on duty to meet residents' nursing and care needs, they will be placed at risk. We need reassurance that the home are taking appropriate action. 13 29 19 There must be clear 29/05/2009 evidence that staff who have commenced employment after their pova clearance has been returned but before their CRB clearance had been obtained, always work supervised. Whilst a prospective member of staff may not have been referred to the pova register, they may have been referred to the CRB and therefore could present a risk to residents. So new members of staff must not work unsupervised with residents until the home are assured that they do not have a criminal record which may affect people in the home. 14 29 19 All people must have two 08/05/2009 satisfactory references obtained before they commence employment.
Care Homes for Older People Page 50 of 58 In order for a home to ensure the suitability of a person for their role, they need to obtain at least two verifications from people who are able to comment on the person's suitability. 15 29 19 The home must seek its own 08/05/2009 CRB clearance for all new staff. A CRB clearance from a previous employer must not be used. The home needs to be aware if a prospective new member of staff is suitable to work in the home. As prospective members of staff may be referred to the CRB whilst they are working with a previous employer, the home needs to ensure that they have checked with the CRB prior to confirming a person in post and not use an older certificate. 16 29 19 People must not commence 08/05/2009 employment until they have clearance from the pova register. The pova register has been set up to ensure that vulnerable people are safeguarded. People who are unsuitable to work with vulnerable people are put on this register. Therefore staff must not commence working in the home until they have confirmation that the person
Care Homes for Older People Page 51 of 58 has not been placed on the register. 17 29 19 Where a person has limited 29/05/2009 leave to remain on their passport, the home must be able to evidence that they are able to employ the person on their file. So as to comply with employment legislation, the home needs to be able to provide evidence that an employed member of staff is legally able to work in the home. 18 29 19 The home must ensure that 08/05/2009 staff photographs are clear enough to provide proof of identity. Photographic proof of identity is needed. If photographs are not clear, they cannot provide proof of identity. 19 33 24 A system for regular reviews 30/06/2009 of feedback on quality of care must be put in place. This must be based on seeking the views of residents and their advocates. Following analysis of views received, a development plan must be drawn up and submitted to us. Ensuring that a home meets the needs and expectation of residents and their advocates is a key area in quality assurance. This
Care Homes for Older People Page 52 of 58 inspection identifies a range of areas which management should have appraised themselves of and taken action to address, before the inspection. We need to be reassured that the home are taking appropriate action. 20 38 13 Where a resident chooses to 08/05/2009 use an item of equipment which could present a risk. An assessment of that risk must always be drawn up and a care plan to direct staff on how the risk to the person is to be reduced. Resident choice must be up- held, however where an item could present a risk to them, the extent of the risk must be assessed. If a risk is identified, a care plan must be agreed with the resident, so that risk can be reduced. 21 38 13 Records must be maintained 29/05/2009 of checks on the safety of wheelchairs. If wheelchairs are not regularly checked, they can present a risk to the person who uses them. Written records are needed, so that persons can know when they are next due to be checked and of actions taken to address any deficits.
Care Homes for Older People Page 53 of 58 22 38 13 Shower heads must be 08/05/2009 regularly reviewed for presence of Lime-scale and record of checks and actions maintained. In order to reduce risk of infection from Legionellum to people, shower heads need to be regularly checked for lime-scale and any lime- scale promptly removed. 23 38 13 Where a resident is assessed 08/05/2009 as needing bed safety rails, a full assessment of risk for the use of such rails must be in place. Assessments must be regularly reviewed. Bed safety rails must be safe and positioned in accordance with guidelines. Bed rails can present a significant risk to residents, therefore they must only be used if they are assessed as being the only way to meet a person's needs. Assessments must be regularly reviewed. There is a large body of evidence to show that residents have been put at risk by the inappropriate use of bed rails, therefore they must only be used in accordance with guidelines from the Health and Safety Executive. 24 38 13 There must be documentary 08/05/2009 systems in place to ensure that residents are not put at risk of scalding from hot water.
Care Homes for Older People Page 54 of 58 Older frail people are susceptible to scalds from immersion in hot water. On two occasions, bathwater temperatures were documented as being over safe temperature levels. The home does not have documentary systems in place to ensure that this risk is reduced. 25 38 13 All hot surfaces must with 31/07/2009 be guarded or low surface temperature. Older frail people are very susceptible to burns if they are in contact with hot surfaces for any period of time. A review of accident records showed, as would be anticipated in a care home with nursing for older people, that many residents experienced falls and were unable to assist themselves to get up. If a person fell against a hot surface, they would be at risk from burns from the hot radiators in the home.
Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 1 Responsibilities for providing nursing equipment such as air mattresses should be clarified in information given to residents prior to admission. 2 3 Pre-admission assessments should include clear
Care Homes for Older People Page 55 of 58 information on all of the person's nursing and care needs.
3 7 The clinical indicator for urinary catheters should always be documented. 4 7 Assessment and care folders should include an index and all documents be maintained in the same order, to assist in ease of access. 5 7 Fluid balance charts should be totalled every 24 hours 6 7 All care records should include measurable language and the use of imprecise terminology such as "repositioned" should be avoided. 7 9 Where residents are regularly prescribed drugs which can affect their daily lives such as painkillers, aperients or mood altering drugs, a care plan should be drawn up to assist in the evaluation of the effectiveness of such medicines treatment. 8 15 Residents should be offered a choice of meals at lunchtime on the menu. 9 16 One central complaints register should be maintained. 10 16 One manager in the home be designated with the responsibility of reviewing all complaints and ensuring that actions have been taken. 11 16 All staff be trained in their responsibilities for documenting complaints. 12 19 A larger staff changing area should be provided, including showering facilities. A similar recommendation was identified at the previous inspection. 13 19 The back corridors and lifts should be re-carpeted and attention paid to the cleaning of areas which present a dirt trap. 14 19 The manager should be provided with a private office where she can hold meetings of a confidential nature. A similar recommendation was identified at the previous inspection. 15 19 All staff should be advised of their responsibility for documenting maintenance deficits. 16 21 Bathing facilities should be reviewed and consideration be given to providing bathing facilities for people with complex disability needs. 17 22 The home should provide profiling beds which go down to
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18 25 Equipment should be provided so that laundry can be separated at source and not re-sorted in the laundry room 19 26 Mixer taps should being provided at the wash hand basin in the clinical room. 20 26 A person should be designated the task of regularly checking the fridge of the second floor kitchen and ensuring that all items are safely stored and disposed of when relevant. 21 26 Commode inserts should be reviewed and replaced before they deteriorate further. 22 26 Staff should be encouraged not to come to work or to go off duty wearing their uniform. 23 29 To comply with the principals of equal opportunities, senior managers should make themselves aware of appropriate actions to take, including risk assessment in the event of a criminal record showing issues which need to be considered. 24 29 Referees should be asked to state the capacity they have known the prospective employee in, so that their relevance as a referee can be assessed. 25 29 A system for indexing staff files should be set up and all documents kept in an orderly manner. 26 29 The home should develop a system for ensuring that all CRB certificates are securely disposed of within guidelines and set up a system to evidence that CRB clearance was obtained for members of staff and when. 27 30 The home should ensure that it complies in full with its mentoring system for newly employed staff. 28 33 Management should include regular audits of response times to call bells as part of their audits of quality of care. 29 33 Regular staff meetings should take place and comments from staff, for example covering from other members of staff, should be taken on board when developing management policy. 30 38 Nursing and care staff should be trained in the safe use of bed rails.
Care Homes for Older People Page 57 of 58 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: [email protected] Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website.
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