Inspection on 22/01/10 for Amber House

This is the latest available inspection report for this service, carried out on 22nd January 2010.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Amber House 29/02/08

Amber House 07/08/06

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Amber House 25/27 Norreys Road Didcot Oxon OX11 0AT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ruth Lough     Date: 2 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Amber House 25/27 Norreys Road Didcot Oxon OX11 0AT 01235512509 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: alliedcareltd@aol.com Ashamber Homes Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Amber House comprises of two, three bedroom semi-detached properties, able to provide support to six people, which is on the outskirts of the Oxfordshire town of Didcot. Amber House provides 24-hour support to individuals who have been discharged from hospital and who require care, support and accommodation for mental health issues. Referrals to the service are received from many sources. The goal of the service is to enable individuals to regain and enhance skills to return to independent living in the community. Adjoining conservatories link the properties. Internal access can be made through the adjoining door. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 6 2 7 0 2 2 0 0 9 Brief description of the care home The current scale of fees for this service is £850 to £1700 per week. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection process generated from the adequate findings at the last key inspection process on 22nd February 2009.. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and the involvement of residents and staff on a one-day visit to the home. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The Annual Quality Assurance Assessment from this service was returned prior to the inspection process and had been completed satisfactorily. Care Homes for Adults (18-65 years) Page 6 of 28 The home currently does not have a registered manager. However, the acting manager was present when we visited the service on 22nd January 2010, between 10:50 and 17:00. During the day the records for care planning, recruitment, and administration of the service were assessed. One person who is currently using the service was involved with the inspection process. We met with 2 staff and who were present in the home. From this inspection of the service it was evident that the areas that were identified previously as to improve have been met. A small number of good practice recommendations were given at the time of this inspection as to continue developing the service and can be found in the body of this report. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Information about the care and support that an individual needs is obtained from other health and social care professionals before they are offered a place in a home. Evidence: The service is registered to accommodate 6 residents, at the time of this inspection there were 2 residents living in the home. All prospective residents are likely to be referred to the service by mental health or social care professionals. The resident who participated in the inspection process confirmed that they were involved in the decision making as to move there on a temporary basis due to personal circumstances, until a permanent place was to be found. Since moving there over 2 weeks previous to the inspection visit the staff and healthcare professionals with the individual have further reviewed and discussed the situation and are planning to further assess as to make the change permanent. Looking at the care records for this individual it was apparent that the service had used the detailed care planning records from the previous care setting, information Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: from the mental health and social care professionals and consultation with the individual themselves as to identify if the home was able to support them. There was no formal recorded assessment of need that had been carried out by the service to support bringing all this information together before the person was admitted to the home. However, since arrival a preliminary review of the persons needs has been commenced. The gaps in the quality of the documented assessment of need process carried out was discussed with the temporary manager of the home. They were advised to enhance the current practices with record keeping, ensuring that a clear picture of the decision making that the service can provide support to the person is in place. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. The people supported by the service can be confident that their needs will be identified and a programme of support arranged to assist them meet them. They can also be assured that they will be reviewed and amended to meet any changes as they occur and any risks to themselves or others will be managed safely. Throughout the support they are provided with, personal choices and wishes will be listened too and acted upon. Evidence: The resident involved in the inspection process confirmed that they thought that they were obtaining the support and encouragement that they needed to continue with developing the skills to live independently. We looked at the care planning and associated records of both residents as to assess if the deficits highlighted during the inspection in January 2009 have been rectified. The care planning record for the resident who had been living in the home for some time, showed that the information is current, had been reviewed regularly and included risk Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: assessments and monitoring to provide support to meet their needs. The service use a Care Programme Approach, which combines the input from mental health professionals providing treatment to the person concerned to ensure a consistent direction to supporting the individual. For the other newly admitted individual the staff were still working from the care planning provided from the previous service involved in their care. Through discussion with the individual and staff in the home some of detail of this is no longer relevant to the persons current needs. The acting manager was able to confirm that this was planned to be reviewed and amended as soon as possible. Throughout the care records reviewed the personal choices, wishes and participation of the person concerned had been identified and used to enable staff to support them. The daily records outlining the key events and experiences that they have had were written well by staff and provided clear evidence that a holistic approach in providing support was being given. The staff have carried out a broad range of risk assessments to support the care planning including managing behaviour at home or when out in the community, managing to care for personal hygiene, and medication compliance. During the last inspection process there were concerns with the security of the personal information held in the home as records were not kept safely. This has now been rectified with locked filing cabinets and limited access to records. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. The people who use the service are supported to pursue the education, occupation, and personal development if they wish to participate. They are also supported and encouraged to be part of the process to plan, prepare and serve the meals. Evidence: Through discussion with staff they identified that for one individual they continue to balance meeting their choices and wishes of how they wish to live with encouraging them with personal development. Support with accessing some education and occupational activities have been offered but declined. These difficulties have not arisen in regard to the other resident who has already identified personal development and educational goals they wish to achieve. These are yet to be arranged when the final decision to stay is formalised. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: One area that they need to develop further is documenting the persons chosen daily routine in greater details as to assure that all staff support them in a consistent way. Previously it could be seen that residents were not fully encouraged to participate in the running of the home. This is gradually improving with one resident keen to continue with planning and preparing their own meals and keeping parts of the home clean and tidy. Meal times are lead by personal choices or as part of their treatment and development of the persons ability to live independently as possible. Generally, mealtimes are not held as a social occasion, but this may improve as new residents come to live in the home and wish to participate. During this inspection reviewing the care records for one person, there were some concerns about their diet and eating habits. Although identified that there was a poor pattern to eating, the monitoring process to ensure their well being could be developed further to identify if they are at any significant risk from this. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are supported well to obtain their care and treatment from their mental health practitioners that they require. Evidence: The home does not provide, as routine, support for meeting personal care needs that the residents may have. However, they do as part of the approach to encourage their independence, monitor and support individuals to take care of themselves. Reviewing the care plans it was apparent that some routine health checks are undertaken to monitor individuals medical treatment but there is not an overall formal health plan to support them to obtain dental or eyesight checks. This is an area that they should develop further. What is good is the records held in the home for the consultations, assessments, and involvements with the individuals mental health practitioners. Some of the practices for the self management of medication needs were identified as being weak at the last inspection process. This was in reference to the risk assessment process in place for this. None of the current residents manage their own medication at present. However, there is a general risk assessment for medication in place for compliance to keeping to the planned treatment implemented by the persons mental Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: health practitioner. From what could be seen these have been monitored and reviewed periodically although for this one individual they did not show recent changes in the care support provided by staff for this. Likewise these changes had also not been reflected sufficiently in the overall planned care. They were advised to review their practices for this. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The people living in the home can be confident that their concerns or worries will be listened to and acted upon. The home have the necessary policy and procedures in place to protect them or others from possible harm or abuse. Evidence: The resident we spoke to was confident that any concerns or worries would be listened to by any member of staff in the home. Information given in the AQAA stated that the home had had one formal complaint made to them since the last inspection process, which was not upheld. The commission has not been in receipt of any concerns, complaints, or significant information about the service during this period, either. We looked at the mechanisms for receiving, recording and managing concerns or complaints expressed about the service. During the last inspection process a recommendation was made to improve the method that staff or residents record concerns or worries. The book used for this purpose did not provide confidentiality and residents were not given any limitations to its use. A complaints log and formal complaints records are used effectively for any concerns raised and these records are kept confidentially. Improvements to the method of recording detail in the complaints record were suggested as to assist with the overall monitoring of concerns raised. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: We looked at the processed in place for protection and safeguarding the adults and others living in the home from possible abuse or harm. From what information was available the home has policies and procedures for staff to manage any concerns as they occur and are provided with the necessary training to do so. The staff ensure that any potential risks to others in regard to the behaviour, verbal and physical aggression of residents in receipt of support is assessed regularly and actions put in place to minimise outcomes of any events occurring. These are all within the guidelines given by the mental health specialists involved with individuals treatment. The AQAA also provided information that the home had on incident of physical restraint carried out and one referral to safeguarding during the last year. No further action was required following the investigation for these. The small sample of the records in regard to the personal money that the home keep on their behalf supported that there are safe practices in place which are monitored regularly as part of the provider visits audit. Recommendations were made as to develop the recorded planned interventions and agreements in the care planning records in regard to the personal monies they hold or manage on residents behalf. Care Homes for Adults (18-65 years) Page 19 of 28 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. The environment of the home meets the needs of the people living there and can offer the facilities for residents to develop their independent living skills. Evidence: The resident involved in the inspection was complimentary about the home and was pleased with the bedroom they had had allocated to them. The home is not purpose built and has been developed from two semi detached 3 bedroom homes in a quiet residential area of Didcot. This then is able to offer residents 2 lounge, dining and kitchen areas to use and keeping the service homely. During the last inspection process it was identified that the home was not kept in the best condition with areas of refurbishment and decoration required to improve the environment for residents. There were also some concerns about the standard of cleanliness. The main areas highlighted specifically were the hallways, bathrooms and toilets. It was very evident that a programme of redecoration and some refurbishment had taken place during the last 12 months. Much of the home has been redecorated and carpets replaced. The entrance halls and lounges look clean, bright and welcoming. The lounges are kept comfortable and modern which was certainly appreciated by the Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: resident we spoke to. Reviewing the bathrooms and toilets in the home they now appear very clean, pleasant and fresh. Care Homes for Adults (18-65 years) Page 21 of 28 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. There are sufficient numbers of skilled and experienced staff employed to meet the needs of the people living in the home. Evidence: Information in the returned AQAA shows that there have been very few changes to the staff team employed in the home during the last 12 months. An acting manager has recently been transferred to the home and the 5 members of support staff have remained consistent. All five support staff have obtained an NVQ 3 in care and from information given there is a steady plan of revisiting core training for health and safety practices. Since the last inspection process there have been no new staff appointed to the home. So it was difficult to assess if the recruitment processes will be robust enough when the need arises to employ new staff. The acting manager was able to inform that a review of the records of the current staff working in the home had highlighted some deficits in key required information being found, such as appropriate references, which they were endeavouring to rectify. Listening to the resident who participated in the inspection process it was clear that the support and friendliness of staff was one of the reasons for their decision to make Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: the stay in the home permanent, if they were able to do so. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. The home is run effectively and safely and in the interests of the people who use the service. Evidence: The service has been without a registered manager for a considerable length of time with a number of interim management processes put in place to rectify this gap. The home is managed and run by an acting manager who has formally been in the post only a short while but has come from a similar post within the organisation. We were informed by this acting manager that the recruitment process to fill the permanent post was being commenced. We looked at some of the systems in place for monitoring the quality of the service and how they formally consult with the people who use or come in contact with it about their opinion of what is provided. Looking at the information in the care planning documents feedback is obtained from residents in various ways such as individual reviews of care provision and treatment with their mental health team, their Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: key worker, and through general day to day activities. Formal surveys are given periodically to residents, visiting health and social care practitioners who come in contact with the service. The provider visits, under regulation 26, also give residents and staff the opportunity to make comment about what it is like to live and work in the home. From looking at the sampled reports from the provider visits it could be seen that these are listened to acted upon as part of the development of the service. The acting manager did state that there has not been the opportunity for formal residents meetings as the number of people living in the home has impacted upon this. However, staff meetings have continued. Further information given in the AQAA states that there is a new process in place for the overall quality assurance processes which has yet to be introduced. We looked as a sample of information in the home for safe working practices and as previously stated the training records for staff training. From these it could be seen that they have the relevant processes in place, general risk assessments for the home, Control of Substances Hazardous to Health Regulations (COSHH) 1988 in place and information held about the products used in the home, and routine safety checks are carried out for fire safety. One area that they will need to review is the safety measures they have in place for some of the upstairs windows, currently none of these have restrictors in place. A risk assessment process for this should be carried out to assure whether they would be appropriate for the needs of the people living in the home. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 26 of 28 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 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 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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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