CQC Inspection Report 2014
What people told us and what we found
A local doctor visited the home every week to discuss any concerns staff had about people's medication. Relatives also had the opportunity to speak with the doctor. One relative we spoke with said that they used this service. The manager told us that the doctor also ensured that end of life medication and required documentation was in place.
There were effective systems in place to reduce the risk and spread of infection. We looked around most parts of the home. We found that the home was clean and tidy and no malodours were detected.
People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.
There were recruitment and selection processes in place and appropriate checks were undertaken before staff began work.
Prior to our visit we contacted the local commissioning and safeguarding teams. They confirmed with us that they were not aware of any concerns about Abbeywood at this time.
Cleanliness and infection control
We looked around most parts of the home. We found that the home was clean and tidy throughout and no malodours were detected. We saw that hand sanitizer was available in different parts of the building for people living at the home, staff and visitors to use.
Everyone living at the home had their own en suite with a toilet and hand wash basin. There were no paper towels or liquid soap dispensers in the en suites. The manager told us that a decision had been taken not to put them in the en suites. This was because it was thought that the clinical look would detract from the homeliness of people's rooms.
We saw instead staff had access to boxes containing disposable gloves and aprons, paper towels and liquid soap, which they took with them to each individual person's room when they required personal support.
We saw that in areas where there was communal use such as toilets, bathrooms, the kitchen and the laundry there was paper towels and liquid hand wash for people to use. Shower heads were cleaned every three months and water treatment checks were undertaken to help prevent and detect the presence of legionella.
We looked at the laundry room which was said to be kept locked when not in use. The manager confirmed that the home used the red bag system to transfer soiled items and that the washing machine had a sluice wash to ensure any bacteria would be killed.
We looked at the kitchen and saw different coloured clothes were being used and staff had colour coded chopping boards. Colour coded mops were also used for different areas of the home for example the same mop used in bathrooms was not used in the kitchen. The home had received a five star rating following the last inspection of the kitchen by environmental health on 6 July 2012.
We saw the home had a control of infection file. The file was held in the main office and was accessible to staff. It contained information about what action to take to help minimise the risk of the spread of infection and the telephone numbers to use to report any infection outbreaks.
A monthly hand washing audit was undertaken to ensure that staff were using the right techniques.
Staff training records showed that most staff had received training about infection control. Some new staff members had yet to receive this training. We saw a copy of the home's training needs analysis for 2014/2015, which showed that food hygiene, health and safety and infection control had been requested through the local training partnership.
Following our inspection we received information of concern about the control of infection practices during the night. We visited the home at 6am and did not substantiate the allegations made.
Management of Medicines
We saw that medication was being securely held in a treatment room. There were two medication trolleys in the room, which were chained to the wall when not in use. The room was also used to store the district nurses medication, which was held in a separate secure medication cabinet.
At the time of our visit the home was in the process of changeover to a new month's supply of medication that had been delivered from the pharmacist. Medication that had not been used had been prepared and was ready to be returned to the pharmacy.
The medication was in blister packs. We checked a random selection of medication from the packs of medication and found them to be correct.
We checked the controlled drugs cabinet and controlled drug book and found them to be properly completed and the number of the drugs recorded matched the medication held.
Medication was being stored in a lockable fridge. The temperature check of the fridge was taken daily and recorded to ensure that medication was being stored properly.
Where a person had recently died and the home had been receiving medication this was being held for seven days in line with policy and procedures.
We looked at the records for people receiving medication from staff at the home. There was a picture of the person to help staff identify the person they were to give the medication to and also the name of their doctor. Information about any allergies the person had was also available. The records we saw were properly completed and up to date.
In a small number of cases covert medication was being used. Covert means the medication was being given to the person without their knowledge. Where this was happening there was a written agreement in place, which was signed by the doctor and a relative with information about why the decision had been made.
We saw that no "as required" or PRN medication was being used to manage people's presenting behaviours. The manager said that this was because of the arrangements were in place for a local doctor to visit the home every week to discuss any concerns staff may have about people's medication. Relatives also had the opportunity to speak with the doctor. One relative we spoke with said that they used this service. The manager told us that the doctor also ensured that end of life medication and required cumentation was in place.
There was a copy of the homes medication policy and procedure held on the file. There were also sample signatures of the staff members who were authorised to give out medication as well as an instruction that only staff who had a certificate to confirm they
have received medication training could administer medication.
At the time of our visit we saw that there were only four members of staff authorised to administer medication and we asked was this enough. The manager told us that there was always one of the identified staff members on duty though there were plans in place to increase this number.
A pre-printed record book was kept that included a daily check of room and fridge temperatures and any concerns identified along with what action was required to resolve them. There was also a communication book that detailed for staff and changes that had
been made to people's medication. We were told that the pharmacist visited the home to audit medication on request.
Safety and suitability of premises
Abbeywood is a large detached property close to Tottington Village. The property has a large gate to the front that out of hours could be opened by contacting staff via an intercom system. The home had a large garden which was user friendly, attractive and well maintained.
We looked around most parts of the building. We were told that plans were in place to refurbish the dining room in the near future.
We saw that the home had recently started to refurbish people's rooms. Eight bedrooms had been completed. The refurbishment included decorating, new beds, carpets, furniture, light fittings and furnishings. All rooms had en suite facilities. We saw that some people had brought some of their own furniture with them when they moved in.
People had a 'nurse call' in their bedrooms and others had a sensor fitted that alerted staff if a person had moved. Water thermometers were found in bathrooms and a record of temperatures was maintained.
We checked the maintenance records and certificates for the fire alarm system, fire extinguishers, gas safety and passenger lift certificates and found them to be valid. The electrics certificate had recently expired and the manager told us that this would be followed up.
Requirements relating to workers
We checked the employment records of two members of staff who had recently started to work at Abbeywood.
We saw that both members of staff had submitted an application form that gave details of their previous work history, education and any relevant training they had received. The senior manager told us that when training had been completed at another service they always asked for a copy of the training certificate to evidence this. If a member of staff could not provide a certificate then training had to be completed again.
We saw that both files contained two references and these had been validated by the senior manager. Copies of documentation were taken to ensure the staff member's identity, for example a passport or driving licence. We saw that an Independent Safeguarding Authority (ISA) first response had been undertaken prior to the staff member starting work at the home and a satisfactory Disclosure and Debarring Service (DBS) certificate was received shortly afterwards. A DBS or criminal record check is undertaken to ensure that the staff member was a suitable person to work with vulnerable adults.
We looked at a third file and raised concerns about the references on the file. The provider may wish to note that where an employee has worked previously with children and vulnerable adults then they must check, as far as is reasonably practical, with this type of employer as the reason why the person left their employment.
The senior manager told us that all staff members were interviewed prior to being offered a position. We saw copies of the interview questions asked and responses from the staff member on the employment files. All staff members appointed had to complete a three month probationary period which was reviewed on a weekly basis until the period had been completed to ensure the staff member was suitable to work with people living at the home.
Induction records we saw showed that before a new staff member worked directly with people living at the home they were introduced to them. They were also made aware of policies and procedures, the homes aims and objectives, health and safety issues that included a fire drill, how the fire alarm worked and how to use the lift in an emergency.
Where a staff member held a relevant qualification, for example a National Vocational Qualification (NVQ) in health and social care they were asked questions to check their level of competence. Questions included for example their understanding of people's rights to dignity and respect, rights and choices and to maintain their independence as much as was individually possible.
Questions also included the staff member's understanding of whistleblowing, equal opportunities, cultural needs, confidentiality, disclosure of information to others, consent, person centred planning and the importance of being reliable and dependable.