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Inspection on 31/03/10 for Amberleigh Manor Care Home

Also see our care home review for Amberleigh Manor Care Home for more information

This is the latest available inspection report for this service, carried out on 31st March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There have been noticable improvements at the care home since the last key inspection, with efforts made to address the shortcomings in the documentation and record keeping in particular. A new management team is in place, and there has been some success in addressing issues raised previously.

What has improved since the last inspection?

At the last key inspection thirteen statutory requirements were made together with two good practice recomendations. Evidence was seen that these had been addressed. In addition a new manager has been appointed, and she has successfully been through the Commission`s registration process. The garden and patio area has been developed. Security has been improved. Fire standards have been improved, with new weekly checks implemented. Documentation has been reviewed and revised which has led to better record keeping. A new walk in shower has been created. A bathroom has been redecorated, as have many of the bedrooms and the kitchen. A new sink has been intalled in the sluice.

What the care home could do better:

Two statutory requirements relating to: Producing specific care plans for people who are taking when required (PRN) medication, and all care staff to receive training in food hygiene have been made as a result of this key inspection. Six good practice recommendations have also been made relating to: Producing the Service User Guide in alternative formats, such as with pictures or signs and symbols, Carrying out Mental Capacity Act assessments for all people where there is a question about their capacity, carrying out Deprivation of Liberties (DoLs) assessments for all people affected by restrictions on their movement through locked doors or keypads. People`s wishes at the time of their death should be recorded in all files. Consideration should be given to ways of `softening` the effect of the wrought iron gates on the entrance. Copies of Regulation 26 visits should be kept at the care home.

Key inspection report Care homes for older people Name: Address: Amberleigh Manor Care Home Primrose Hill Blackwell Alfreton Derbyshire DE55 5JF     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: Rob Cooper     Date: 3 1 0 3 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 Older People Page 2 of 26 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 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 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Amberleigh Manor Care Home Primrose Hill Blackwell Alfreton Derbyshire DE55 5JF 01773860288 F/P01773860288 sheilagh_kelly@yahoo.com mskelley@myway.com Mr Mohinder Singh Kelley Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Jane Keenan Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 40 The registered person may provide the following category of service only Care home only code PC To service users of the following gender Both Whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category code 0P Dementia code DE (Maximum number of places 20) To allow two named persons DE(E) to be accommodated in an area outside the designated area for the duration of their stay. Date of last inspection Brief description of the care home Amberleigh Manor Care home is a converted and extended country house providing personal care for up to 40 older persons, including up to twenty people with dementia Care Homes for Older People Page 4 of 26 Over 65 0 40 20 0 0 6 0 4 2 0 0 9 Brief description of the care home (all aged 65 years and over). Accommodation is provided on two floors, with mostly single bedrooms and currently 1 shared bedroom. The majority of the bedrooms do not have en-suite facilities. There is a passenger lift, handrails to corridors, grab rails provided to toilets and an emergency nurse call system throughout the home. Moving and handling equipment is provided. There is access for people to an enclosed garden and patio area. The scale of charges at this site visit are as follows: £344 - £366.40 per week Expenses such as toiletries, chiropody, and hairdressing services were additional to the weekly fee. Care Homes for Older People Page 5 of 26 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit as part of the key inspection process, so that no one at Amberleigh Manor care home knew that the inspection visit was going to take place. The visit took approximately five hours through the middle of the day, with one inspector present. In preparing for this inspection, the information that the Commission holds about this care home was reviewed, this included looking at the last inspection report, the inspection record, considering any complaints or concerns that have been made about the service, and reviewing any notifications made relating to incidents that affect the well being of people living at Amberleigh Manor. Care Homes for Older People Page 6 of 26 The methods used during this key inspection and visit were to visit the care home, where a method called case tracking was used; this involved identifying four people who live there and looking at their individual files and making a judgement about the quality of care they are receiving, and if their needs are being met. This was followed by a partial tour of the building, looking at the activities on offer, and talking to two people who live there, and three members of staff about the quality of the service, and their experiences of living and working at Amberleigh Manor. We also sent out an Annual Quality Assurance Assessment (known as an AQAA), which allowed the care home to carry out a self-assessment; and provide a range of information relating to their service. Information provided by them helped to form the judgements in this report. We also sent out ten surveys asking for views and information to people who live at the home, and five to staff. Of these we received three surveys from people living at the home, all of which had been completed by a relative and one from a member of staff, which also helped with the judgements that we made. The registered manager Jane Keenan provided much of the information during this key inspection visit. On the day of this inspection there were fifteen people living at Amberleigh Manor care home, with a further two in for day care. People who might want to live at the care home can obtain information about it direct from them, and this would include seeing previous inspection reports prepared by the Care Quality Commission. Care Homes for Older People Page 7 of 26 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 Older People Page 8 of 26 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 9 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to detailed information about the services on offer, they have contracts or a service agreement and they receive a comprehensive assessment, which allows them to make an informed decision about whether the home can meet their needs. Evidence: Both the statement of purpose and service user guide were seen during the inspection visit. These documents contained useful information about the care home, and were available also available in a large print, although currently not in any other format, such as pictures or using signs and symbols. The information available would allow people living at the care home, and those who might wish to in the future, to make an informed choice about living at Amberleigh Manor. Both documents had been reviewed and updated in August 2009. Discussions with two people who live at the care home showed that they had been given copies of the service user guide. Care Homes for Older People Page 10 of 26 Evidence: As part of the case tracking process four people who live at the care home were identified, and their files were seen. There are a number of different funding arrangements for people living at the care home, with some people funded by the County Council, one person funded as an out of County placement, and a number of people on private contracts. Examples of each were seen and they contained either an agreement from Social Services to fund their placement, and a copy of the terms and conditions of residence, or a private contract. Each of the four files that were seen contained a formal assessment of need. The files all had an in-house assessment, which covered areas such as: the risk of falls, safe environment, communication, and likes & dislikes. The manager said that they also tried to get a formal assessment of need from Social Services, although this was not always possible. All four files had either a Derbyshire County council assessment or a FACE assessment completed by a Social Worker. The evidence showed that the information provided by these assessments had been used to draw up the care plans. In their AQAA the home said: All documentation has been reviewed, updated and implemented. Care staff have been constantly informed and encouraged to be open and transparent in all record keeping and dealings. Amberleigh Manor does not offer intermediate care, and therefore this National Minimum Standard was not assessed. Care Homes for Older People Page 11 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the care home have care plans and risk assessments in place to record crucial information, and to direct staff in best practice to keep people safe. Evidence: Each of the files that were seen contained a plan of care, which identified personal goals and identified peoples needs and how to meet them. Evidence was seen that care plans were being reviewed regularly, and there were daily entries by care staff, to record progress and any issues relating to an individuals care. A review of the care plans showed that there had been some significant improvement with regard to recording of information since the last key inspection, with no obvious gaps in the recorded information, and several different recording tools in place. One individual had information about the Mental Capacity Advisory service in their file, and identified an Independent Mental Capacity Advocate (an IMCA) who had worked with them. However there were no general Mental Capacity assessments within care files, and no information relating to the Deprivation of Liberties Standards (DoLS) which would be particularly relevent due to many areas of the home being inaccessible to people living at the home due to keypads being in place. Care Homes for Older People Page 12 of 26 Evidence: All of the files that were seen contained health related care plans. The plans included information relating to health care professionals such as visits to the doctor, or by the nurse, and any hospital visits. Two people were asked about seeing the doctor, and they both said that the staff would get them a doctor if they were unwell, and if they needed one. In their AQAA they said: Service users are able to have access to all multi-disciplinary professionals as required or as requested. These include GPs, District Nurses, Mental Health team, Chiropodist, Occupational Therapist, Hairdresser, Dentist and Optician. Boots the chemist provides Amberleigh Manor with their medication, and their last site visit to inspect the medication took place in February 2010. An inspection of the medication systems showed that medication is handled safely. Administration records were seen and found to be complete, with no obvious errors or omissions. Currently no individuals self-medicate. All aspects of the medication procedures for checking medication in and out of the building showed a clear audit trail, and indicated that people living at the care home were safe. However there were no specific care plans for people, who require as required (PRN) medication, which means that there is no clear guidance for staff when making decisions about administering this medication. Discussions with two people who live at the care home, and observation of the staff working with people generally showed that the staff treated people with respect and dignity. Both of the people spoken with said they liked the staff, and felt safe. Staff were also observed knocking on peoples doors before entering, and speaking in a respectful manner. Staff were seen offering gentle encouragement at meal times, and during an activity session organised during the morning. Personal choice was observed to be taken into consideration, and there was a relaxed and friendly atmosphere during the inspection visit. In their AQAA they said: All staff interact and communicate with all service users providing a warm, homely, and family feel to our home. Each persons file had a form to record different aspects of the individuals wishes at the end of their life. This information was in some cases missing, although the basics about burial or cremation were covered. Care Homes for Older People Page 13 of 26 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. People have a lifestyle that reflects their cultural, social and religious interests, and needs, and there is evidence that their social care needs are being met. Evidence: During the morning of the inspection visit there was an arts and crafts session organised by the staff, and there were home made cards for sale produced by the people living at the care home. There was a great deal of activity during the inspection visit, which gave the impression of the home being busy. Some people did not want to join in the organised activities, and they were mostly sitting quietly listening to music or watching the television, although staff were observed asking people if they wanted to join in. In their AQAA they said: We encourage and provide interaction, pareticipation and entertainment on a daily/ hourly basis. We believe that social activity is an ongoing minute by minute event and not just a set hour per day. Unfortunately no relatives were seen during this inspection visit, so it was not possible to gain their views directly. However comments received in two surveys from relatives included: I am very happy with the home. My husband is very happy at Amberleigh Manor, that is all that matters to me. The staff at Amberleigh Manor always show a very caring attitude and do their best to meet our mothers health and social needs, Care Homes for Older People Page 14 of 26 Evidence: despite lack of facilities and resources. The staff work extremely hard and the manager has some fantastic ideas to improve the conditions, which will enhance the lives of people living with dementia, but the funding does not seem to come from the owners of the home. Staff and relatives have to do a lot of fundraising themselves to provide equipment and social activities. Discussions with two people who live at the home about relatives, and visiting produced the following comments: My people come and see me quite often, usually on a Sunday. My family visit me here, and the staff are very nice, and kind to them. There are no obvious restrictions on visiting times, and the service user guide, and other writen material on display around the care home is quite welcoming. One member of staff did comment that a relative had said to them: The new bars outside make it look like a prison. This is in relation to new security measures taken to ensure that people have safe access to the outside areas of the home. Observations of the staff showed people who live at the home being asked about activities and supported to take part. In the kitchen, staff demonstrated how choices were offered and recorded at meal times, with people being asked on an individual basis what they would like for lunch. Discussions with two people showed that they thought there was plenty of choice in their daily lives, with comments such as: They ask us what we want for lunch. I can decide if I want to do painting. and They (the staff) ask us what we want to do. During this inspection visit there was a good choice of home cooked meal on offer, with alternatives identified on the menu, and recorded on the choices sheet. The chef was aware of important information relating to medical conditions such as diabetes, and individual likes and dislikes had also been recorded. The food was well presented, and the dining room was comfortable. Both of the people spoken with said they liked the food with comments such as: Its very nice, and we get plenty to eat. I have no complaints about the food, its very good, and theres always a choice. Comments about food received in a survey, from a relative included: Very good food, even though a fussy eater. Care Homes for Older People Page 15 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safe, as a result of the policies, procedures and systems that are in place, and people living at the care home are confident that their complaints will be taken seriously and dealt with. Evidence: Amberleigh Manor have received three complaints since the last key inspection in April 2009, these three complaints were identified in the homes AQAA. A review of the complaints showed that they had been dealt with in line with the homes complaints procedure, which is on display in the foyer, and also forms part of the service user guide, and the complaints were well documented. Discussions with two people who live at the home indicated that they knew who to complain to, one indicating the staff, and the other the manager. In their AQAA they said: All complaints are addressed immediately, taking priority in order to bring them to a timely conclussion. A review of the staff training records in relation to safeguarding adults, showed that all of the thirteen care staff at the home had undertaken this training in the last twelve months. This training is aimed at staff, to offer people greater protection against abusive practice, and to ensure staff understand the correct policy and procedure to follow. Three members of staff were asked about safeguarding adults training and they said they were aware of the issues, and had undertaken this training. Amberleigh Manor have not had made any safeguarding adults referrals since the last key inspection. Care Homes for Older People Page 16 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, clean, well maintained and comfortable home, with their personal possessions around them, in surroundings that meet their needs. Evidence: A partial tour of the care home showed that it was comfortable and well maintained, with good quality fixtures and fittings, including a talking lift, which announces the floor, and warns to Mind the doors please.. Some areas have been refurbished since the last key inspection, and this has included a spacious walk in shower room. To improve the security and safety of people living at the home, wrought iron gates and fencing has been installed to the front of the property, and while this works from a practical point of view, it has left the entrance looking intimidating. Discussions with two people who live at the care home showed that they thought the home was clean, comfortable and meets their needs. Several bedrooms were seen, and these were well personalised, and homely, and all of the people who were spoken with during the inspection visit said that they felt they had everything they needed, and that they thought their bedrooms were comfortable and the home was well equipped. Comments receivede from a relative in a survey included: More toilets are needed in the communal living area. There are only two tables that are accessible to all on the ground floor, and the bedrooms do not have en-suite, which seems totally inadequate to meet the needs of this type of client group. TV points and more plug sockets are required in bedrooms. Care Homes for Older People Page 17 of 26 Evidence: Staff were seen cleaning in different parts of the building during this inspection visit, and discussions with staff showed that there were systems in place for cleaning, and that the care home had a good supply of cleaning materials. The building was found to be clean, and smelt fresh. In relation to cleaning they said in their AQAA: The home is maintained to a high standard of cleanliness and decor. We ensure regular environment checks and maintainence programme. Care Homes for Older People Page 18 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have been recruited professionally, and are receiving training to do their jobs, which means that the people who live at the care home are safe, and have staff who are able to meet their needs. Evidence: The staffing rota was reviewed and this showed that there were enough staff currently employed to meet peoples needs at the care home. Two people living at the home were asked about staffing levels, and they said that they thought there were enough staff. During the course of the inspection visit there seemed to be enough staff working to meet peoples needs, and in their AQAA the home said: We have better retention of staff (low staff turn over) resulting in better stability for the service users and the home. With a robust recruitment process to ensure safety of service users. The care industry considers National Vocational Qualifications (NVQ) to level II in care to be the basic qualification for staff working in residential care. A review of the staff training records showed that currently there are thirteen care staff at Amberleigh Manor (identified in the AQAA), of whom there are ten staff with NVQ level II qualifications (also identified in the AQAA), and three working towards getting their NVQ level II. Certificates were seen in staff files to evidence NVQ training, and two members of staff were spoken with who said they had completed their NVQ level II training. Care Homes for Older People Page 19 of 26 Evidence: The files of six members of staff were seen, to check that they contained all of the information that would show that staff at Amberleigh Manor had been recruited in a safe manner, namely that applicants had filled out an application form, provided two written references and had had a Criminal Records Bureau check. The documentation showed that the homes recruitment policy and procedure had worked to protect the people living there. Discussions with three members of staff about their recruitment showed that they had gone through all of the pre-employment checks, and had not started working until those checks had been completed. The staff training records showed that staff were receiving the training to help them to do their jobs, and this includes the mandatory training in areas such as moving & handling, fire safety and health & safety. However the training matrix identified a gap with regard to food hygiene training, which the manager said was being addressed, and training booked, although no dates have been set yet. Discussions with two staff members provided evidence of the training courses staff had attended, together with certificates seen in staff files, together with the staff training matrix. In their AQAA they said: Ongoing training programme for all staff in order to provide improved services. Care Homes for Older People Page 20 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This care home has good management systems in place, and there is a system for monitoring the quality and improvement of the service. Evidence: Jane Keenan was appointed as the home manager in June 2009, and successfully completed the Commissions fit persons interview process in January 2010, when she was appointed as the Registered Manager. Amberleigh Manors quality assurance system is in the process of being updated. There are monthly management meetings between the providers and the manager, and minutes of these meetings were seen. These monthly meetings will also be the corner stone of any improvement strategy, and the manager said that for example this inspection report will be an agenda item for discussion and any necessary action. In addition Regulation 26 visits (these are monthly audits by a representative of the owners management team) are taking place, however copies of reports are not stored at the home, and therefore were not seen; these also form part of the homes quality Care Homes for Older People Page 21 of 26 Evidence: assurance system. Monthly meetings for people who live at the home were started in February, and copies of minutes were also seen. In the past the home has used questionnaires being filled in by people who live at the home, relatives and visitors as a measure of the quality. However there was a low return rate, and the manager is looking to reintroduce these, and to look at ways of improving the number of questionnaires that are returned. Amberleigh Manor has a system for peoples small cash needs. This is operated on behalf of some by the staff (dependent on individual choice and their ability to manage the money, or relatives involvement). Four peoples finances were checked at random. All of the cash tallied with the records, and receipts were seen, which enabled a clear audit trail of the individuals financial expenditure to be followed. In addition the manager carries out a three monthly audit of the system. The care home has a formal staff supervision system in place, in which staff receive supervision, either with the manager or with one of the other senior members of staff. This is usually in a one to one meeting. Formal supervision offers staff support and guidance in carrying out their work, and is seen as an essential management tool in residential care. The records showed that the National Minimum Standard of six formal supervisions sessions for every member of staff during a year is being achieved. Staff supervision records were seen to evidence this. In addition two members of staff were asked about formal supervision, and they said they felt well supported, and were receiving regular supervision. A range of different health & safety records were seen, including the fire safety records, water temperature checks and the Control of Substances Hazardous to Health (COSHH) records, all were found to be correct and up-to-date. Evidence was seen that routine health & safety checks are being carried out, and the staff training records showed that staff were receiving relevant training in health & safety related issues. in addition information provided in the AQAA showed that electrical systems, and gas appliances had been serviced and checked within the past twelve months. Care Homes for Older People Page 22 of 26 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 Older People Page 23 of 26 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 9 13 Any person receiving as require (PRN) medication must have a care plan detailing the reasons for the administration, and giving staff clear guidance on all aspects of the decision making process. This will ensure that people are safe, and there is a consistent and reasoned approach from the staff. 30/06/2010 2 30 18 All staff with any 31/10/2010 involvement in food preparation, delivery or assistance to people living in the home must undertake food hygiene training, with an annual update and refresher. Food hygiene training for all staff will ensure that people are safe and the risk of food related illnesses is reduced. Care Homes for Older People Page 24 of 26 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 Consideration should be given to producing key information in the Service User Guide and Statement of purpose in alternative formats such as using photographs or signs and symbols to help those people who have difficulty with written English. Assessments relating to the Deprivation of Liberties should be carried out for all people whos free movement in and around the care home is restricted. People who live at the care home should have Mental Capacity Assessments carried out and recorded within their care files. Full details of peoples wishes at the time of their death should be recorded and held on file. Consideration should be given to ways of softening the appearance of the wraught iron gate and fence at the entrance. Possibly by the use of plants to minimise the effect, while maintaining security and peoples safety. Copies of completed Regulation 26 visits should be available at the home, ready for inspection. 2 7 3 7 4 5 11 19 6 33 Care Homes for Older People Page 25 of 26 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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