Inspection on 29/02/08 for Amber House

This inspection was carried out on 29th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Amber House 17/05/07

Amber House 09/06/06

Amber House 06/12/05

Amber House 19/07/05

Amber House 07/12/04

Amber House 22/07/04

Amber House 18/01/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Amber House 68-70 Avondale Road Gorleston Great Yarmouth Norfolk NR31 6DJ Lead Inspector Mrs Judith Last Unannounced Inspection 29th February 2008 01:30 Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amber House Address 68-70 Avondale Road Gorleston Great Yarmouth Norfolk NR31 6DJ 01493 603513 01493 656702 amberhouse2@ntlworld.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Pauline White Ms Paula D Algar Care Home 22 Category(ies) of Learning disability (22) registration, with number of places Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2007 Brief Description of the Service: Amber House is a residential care home that provides accommodation and care for up to ten residents with a learning disability, some of whom may be over the age of sixty-five. The home is comprised of three adjacent houses that have been linked by recent building work. A range of communal areas is provided. There are several shared rooms. Work is continuing to create two new ground floor bedrooms for people who find stairs difficult to manage. There is a small well-kept garden via the rear of the next-door property owned by the proprietor and there is roadside parking to the front of the property. The home is situated in the town of Gorleston, close to the sea front and within easy walking distance of the shops and other facilities. There is a 24 hr bus service that links Gorleston to nearby Great Yarmouth and Lowestoft, each with many amenities and places of interest. There is easy access to the local doctors, dentists, opticians and other health care professionals. The proprietor has owned Amber House for a period of 40 years and some of the residents have been living there since the service opened. The fees range from £337 to £356 per week according to information available for prospective service users. Copies of CSCI’s inspection reports are made available to the residents and their relatives upon request from the home’s office. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This is an improvement over the last inspection and means that the manager and staff are working hard to continue improving things. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. We have rules that tell us how to do this and we think some of these groups are more important than others because of the way they affect people’s safety. We visited the home unannounced and spent about four hours there. We spoke to four of the people living there, the manager and one of the staff on duty. We got other information from the Annual Quality Assurance Assessment (AQAA) the manager filled in before we went and from the records we looked at in the home. We also had written comments from 14 people living at the home, 3 staff, 1 relative and 2 visiting professionals. What the service does well: The staff work hard to meet people’s needs as they change with increasing age. They also try hard to create a homely and family atmosphere for people living at the home. People told us that they like living there. There are good links with other professionals who can help people to stay well or manage difficult conditions. These professionals told us that they are satisfied with the way that the staff work to support people, and how willing they are to take part in training that will help them to do this better. The home does well in supporting people to meet their health care needs, including appointments with the doctor or dentist. Staff will help with this and explain what is going on. People living at the home say they feel safe there and that they know who to talk to if they have any concerns about their care. They named people on the staff team they could talk to, including the manager. This shows us that people are not wary of approaching people if there is anything they want sorted out. Staff showed us in their comment cards and in discussion that they are enthusiastic and committed to their work. More than half of them have the qualifications they need to support them in their work with people living at the home. When different things arise the manager tries to organise training and so helps staff keep up to date and understand people’s needs. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are four things that need to happen by law. The building works have continued and will provide extra bedrooms on the ground floor. However, this has meant the bathrooms and toilets that are badly in need of refurbishment and redecoration have not yet been done. We have been concerned about this for five inspections in total and four timescales for completion of the work have not been met. This means that people already living at the home do not have access to homely and pleasantly decorated bathrooms and toilets. We saw that one of the toilets does not have a suitable lock or bolt. This is needed to help protect people’s dignity. The manager has not completed the full range of checks that the law now says she must have in place, before someone starts work. This means that she cannot show the way that all staff are recruited wholly protects people living at the home. Although the manager meets regularly with her staff team, the records of these meetings do not show that the supervision she offers meets the standards. They do not show she has discussed the things the standards say she should, each time they meet. She needs to be doing this so that she can show how issues are addressed and that she is effectively checking that staff understand their roles and they way she expects them to work. There are some other things the manager should think about doing that would make things even better and the manager can tell you about these. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 7 We think that she would find it helpful, when she is thinking about these, to use the computer. If she did that she would be able to look at our website and get up to date information about any changes to the law as well as guidance and advice. This might have helped her avoid mistakes when she recruited staff. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use the 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 who may use the service and their representatives have the information needed to choose a home. The assessment process means that the service could be sure it would be able to meet their needs EVIDENCE: The service users guide and statement of purpose reflect the changes that have been made to the premises and also include the charges. However, as the Commission’s local office is closing and moving to Cambridge, the details of how to contact us now need to be updated. We have made a recommendation about this. There are forms for assessing people’s needs that show a full range of information is gathered about people’s needs. Those for people already living in the home had been fully completed and where needs had changed there were additional entries. One person’s needs have changed significantly since admission, having developed dementia. Although there is some annotation to the initial assessment the change is significant and warrants revisiting the whole assessment form in the interests of making the information clear. We have made a recommendation about this. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 People who use the 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 satisfied with the support they receive and their individual plans set out clearly the support required and risks involved. However, despite the increasing age of the resident group, there is room to improve how people are encouraged to participate in the running of the home and decision-making, to help increase their autonomy and independence. EVIDENCE: We looked at the care plans for three people. Comments about assessments are included under the previous section. Care plans were generally reviewed and set out clearly the interventions staff needed to make to support people properly. Guidance was clear and had been reviewed within the last six months. Visiting professionals commented specifically about care plans: “Staff have always accurately completed any charts etc to provide additional information to aid diagnosis and accurate and relevant care plans.” Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 11 “My client has an individual package of care tailored to meet his needs” “I have never had any problems with care plans not being followed or receiving inaccurate information.” There could be additional efforts to make sure that the information is more accessible to people living at the home as this is currently only presented in written form. We have made a recommendation about this. There are variable responses from service users about their participation in decision-making. Just over half responding (8) feel they are always involved. Two feel they are not and four feel they are “sometimes”. We asked about simple decisions, like planning what to eat and two people told us that the “staff do it”. We asked the manager and people living at the home about the things they do in it on a day-to-day basis. People told us that they did some things like helping to set tables. The manager told us that one person regularly does their own tidying of their rooms and we saw one person engaged in sorting out their belongings with staff support. Other people told us that staff did things. One person told us that they did help with preparing vegetables for the meal but also commented that they were “spoiled rotten” as staff did a lot of things for them. There are risk assessments for the activities that people take part in and the manager says in the AQAA that they try not to limit people’s choices of preferred activity, subject to risk assessment. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social, educational, cultural and recreational activities meet individual’s expectations. There is some room for showing how people are supported to develop their life skills although we acknowledge that for the older people living at the home this will be more difficult. EVIDENCE: Eleven out of 14 people (almost 76 ) completing comment cards say they always have good activities. One says not and two say sometimes. People told us what they did, including traditional day service placements, shopping trips, going to the pub, clubs, playing pool and cookery classes. Two people told us about their holidays. A staff member we spoke to confirmed the range of activities people told us about and what the manager had told us. We were also told that some people who were becoming more elderly, liked to spend quite a bit of their time watching television. One person we spoke to was doing this in their room, others were in one of the sitting rooms. We were Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 13 told that people do not have to join in if they don’t want to. We concluded from people we spoke to that they would sometimes be difficult to motivate as they consider it is the job of staff to keep things tidy, cook and clean. Daily records show that people are able to keep in contact with family members, with assistance from staff if this is needed. This includes one person requesting to see their brother and staff arranging this. People we spoke to told us that they were able to see their families. There are shared rooms. However, people who do share say that they get on well with the person they share with. One person told us they like to be on their own in their own room for peace and quiet. All 14 people completing comment cards say that their privacy is respected. We heard that staff interacting with the people who live at the home. Although not “measurable” we formed the view from what we saw and heard that people were relaxed in the home and in the company of staff. However, we did hear staff praising people for their efforts or cooperation using phrases such as “good girl” and “good boy”. Discussion with the manager and observation of interactions shows that this is habit rather than any intentional disrespect, but it is not age appropriate. We have made a recommendation about this. We have commented elsewhere about people’s perceptions of who chooses the food. However, people told us that the food was good and everyone who completed a comment card said that they liked it. A staff member and the manager told us that the deputy would generally consult with people about what they would like to eat and plan menus accordingly. People were having tea reasonably early because some of them needed to go to club during the evening. One person told us that they sometimes helped with meal preparation. Another told us that they were not allowed in the kitchen to make drinks. One person we saw was assisted to both eat and drink and was given thickened drinks for this purpose. A staff member assisted them discreetly in the kitchen. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the 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 health and personal care that people receive is based on their individual needs and involves consultation with other professionals where this is needed. The systems for managing medication help to protect people from errors. EVIDENCE: Support plans set out the kind of assistance or supervision that staff are expected to offer to help people maintain their personal care and hygiene. This is based on the assessments we saw which record people’s “self help” skills. Everyone who completed a comment card said that they felt well treated by staff. Thirteen out of fourteen “always” feel well cared for and one does “sometimes”. People’s individual plans set out their health care needs including where there is need for specific monitoring. This includes monitoring behaviour, weight and positioning for someone vulnerable to pressure sores. We saw separate records showing that staff carried out the monitoring and recording that was needed and as directed in care plans. One person is being supported and encouraged with each day that they have given up smoking. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 15 Other health professionals such as behavioural specialists require some monitoring and we saw from correspondence and daily notes that they were involved. Two such people wrote to us in comment cards that: “Any concerns or issues are always acted on promptly” “Staff at Amber House are extremely vigilant and proactive in monitoring the health of the individuals living there.” “I work closely with the staff and primary care services, when appropriate, to ensure all aspects of individuals health and well-being is maintained.” “Although the manager and staff do not especially enjoy caring for people with dementia, especially late stage dementia they are very experienced and adept at this type of care, and provide a high quality service with the individuals needs and maintenance of their identity being of paramount importance.” The manager says that only trained staff administer medication. These are the team leaders and she says there is one of these on each shift. The team leader on duty showed us what they would do and explained the process. They also gave an appropriate account of what they would do in case of an error. There is a monitored dosage system in use. Medication that is not in blisters in prompted by both Medication Administration Record (MAR) charts and another entry in the daily diary as a reminder for staff. The account of the checking process was acceptable and involved cross checking MAR sheets with blister packs. The staff member said the MAR chart would be signed after she had seen someone take the medicine. There is no controlled medication in use, based on observation and the AQAA. When teatime medications were administered, the medication was taken on the blister folder, into the kitchen and administered from there. This was left unattended by the person concerned while she administered medication to people. However, it was under the supervision of another member of staff who was present so that people living at the home would not interfere with it and be at risk. We have made a recommendation about this. Training records confirm that team leaders have had training by pharmacy staff. A staff member said that they observed practice and were then observed themselves to make sure that they were competent and confident to administer. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the 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 who use the service (or their representatives) are able to express their concerns and can be confident these would be taken seriously. Staff are trained to help protect people from harm or abuse and to report concerns. However, measures to safeguard people are compromised but are dealt with under the staffing section. EVIDENCE: Everyone we spoke to and who completed comment cards, says they know who to speak to if they have any concerns or complaints and named either the manager or their keyworkers. People who live at the home have meetings with their keyworkers regularly to talk about their care and whether they have any concerns. They told us that they were very happy with the home and did not have any complaints or concerns about things. Three staff sent us comment cards and said that they knew what to do if a resident or their representative raised concerns about the service. One visiting professional says: “Any issues raised have been dealt with effectively and swiftly” The manager refers in her self-assessment to the procedures that Norfolk has in place for care homes to raise concerns about safeguarding people and how these should be dealt with. She also says that staff have training in safeguarding vulnerable adults and we saw evidence of this in staff training files. A care plan we saw set out where someone might harm themselves as a Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 17 result of behaviour that may challenge and the strategies staff need to use to reduce this risk. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been significant investment in the home to improve the environment for people living there. However, the creation of additional facilities for prospective residents has taken precedence over some long outstanding refurbishment needed to WC’s and bathrooms, which would benefit people already living at the home. EVIDENCE: Extensive building work continues at the home. The manager was unable to tell us when these were likely to be complete as it was outside her control and dependent on the builders. She indicated the redecoration or refurbishment of toilets and bathrooms would be carried out afterwards. In most cases these facilities have flooring and tiles that are damaged and paintwork in poor condition. One WC has no suitable privacy bolt. The redecoration and refurbishment of bathrooms has been required at the last four inspections and needs repeating for the fifth time. These now need to be prioritised in the interests of existing residents. See requirement outstanding for five inspections. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 19 We have not repeated requirement about replacing carpets. This is because some work has been done where new areas have been created and some is in progress. We will want to see that items are in good condition when the work is finally complete. We did not see immediate concerns for health and safety associated with carpets. The building works that are complete have created a light and airy reception area, additional communal spaces and a large and very well equipped kitchen. One relatively new sitting room on the first floor had a games table in one corner without its legs fitted, laying on the floor, and a lack of other homely domestic furniture to add to the seating and create a more homely atmosphere. The manager says in the AQAA that staff have had training in infection control and we saw evidence of this on some staff records. The laundry has been refurbished and we were informed that one of the two new machines we saw has a sluice cycle for soiled linen should this be needed. The home has been given five stars out of a possible five for food hygiene by the district council environmental health department. This is commended. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use the 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 are supported by staff who have a good understanding of their roles and who are generally well-trained and competent to meet people’s needs. Improvements are needed to show that supervision meets minimum standards. The outcome would have been good had checks before recruitment shown these properly contributed to protecting people living at the home. EVIDENCE: There are 14 permanent care staff and one relief staff member. The manager says nine of these people including the relief worker, have National Vocational Qualifications (NVQs). This means that over half of the staff have the required qualification to help them support people competently and effectively. We sampled staff files and saw some certificates for people the manager named. We checked recruitment files for two people recently taken on as permanent members of the care staff team. The file for one we checked did not contain evidence that the required enhanced Criminal Records Bureau check (CRB) had been applied for before the person started work. The manager said that the Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 21 application had been made two days after the person started work. She told us in the AQAA that staff were always checked before they started work. There was no evidence of initial checks against the register for the protection of vulnerable adults (PoVA First) before the person started work. The manager says that the person never works without supervision and this is the case for all new staff pending receipt of the CRB. We have made a requirement about this. The requirement made at the last inspection, for staff to have training in food hygiene has been met and the home has been awarded 5 stars for food safety. This shows that staff are more aware of the issue and have the underpinning knowledge to support good practice. We identified from two of the files we saw that some people have epilepsy but that this is generally well controlled. This meant that the staff we spoke to had some difficulty saying for certain how many people living at the home were epileptic. They did not have any relevant training and we did not see this listed in the AQAA or on training files. This may mean that if needs change, staff will not be properly equipped to recognise and respond to what is happening. We have made a recommendation about this. Staff confirm that they have induction and comment cards show us that all three completing these felt that their induction covered what they needed to know very well. They also felt that they were given training that is relevant and keeps them up to date with new ways of working. This has included training in dementia. A health professional commented in writing to us that: “If an individual has a specific problem the staff have not encountered before, the manager will request training and information to ensure the individual receive the best possible care.” “The manager and staff are always keen to extend their knowledge and experience.” Although the schedule we saw shows the manager meets regularly with staff, the individual records do not record each individual date or show discussions cover the agenda set out in minimum standards. We have made a requirement about this. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the 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 manager is competent and capable of running the service in a way that generally promotes the health and welfare of people living in it, taking into account their views. Ms Algar now needs to ensure that the service is carried out in a way that complies with regulations other than Care Homes Regulations (specifically in relation to smoking in the workplace), as action by other enforcing authorities could affect the service. EVIDENCE: The manager is qualified and has considerable experience of working at this home. We saw that both people living at the home and the staff related to her well. We checked maintenance and fire records to see whether people’s safety was properly promoted. These show that the requirement made at the last Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 23 inspection, about testing of fire equipment has been met. Electrical appliances are tested appropriately. Testing to the wiring system was last carried out in March 2003 and is due imminently. The fire officer is satisfied with arrangements having visited in accordance with the building works that have taken place. The manager says in the AQAA that all staff have had in house training in infection control and a sample of training records confirm that staff have training in first aid and food hygiene. The manager has provided a smoking room for people living at the home that complies with regulations. However, workplace safety as set out in recent legislation regarding smoking is compromised. From discussion and observation there are clearly occasions when staff smoke inside the workplace. The manager is reminded that two offences are created by the legislation – that of smoking in the workplace, and that of the employer in failing to prevent it. There is a system in place for looking at the quality of the service. The manager says that this involves surveys of family members, people living at the home, and “outside agencies/professionals” who are connected with the service. The manager attaches timescales to any improvements that are considered necessary. The annual quality assurance assessment that the manager completed for us gave us plenty of information about the service. She says that policies and procedures are reviewed annually and information we saw showed that this was last done in September 2007. This shows us that she makes efforts to monitor the quality of the service and to take into account and respond to the views of other interested parties. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 2 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23(2)(b) Requirement Outstanding requirement Toilets and bathrooms must be given priority for refurbishment and redecoration, so that they meet the needs of people already in residence in a homely and comfortable manner. (Previous timescales of 31st March 2006, 30th June 2006, d 31st December 2007 and 31/07/07 have not be met) Timescale for action 30/09/08 2. YA24 12(4)(a) A suitable privacy bolt that can 30/04/08 be opened from outside in an emergency, must be fitted where such is missing. This is so the privacy of more able people who would wish to lock the door, is respected. No staff must start work without the records and checks the revised regulations say the manager needs to get. If she does not obtain this in full detail she cannot show that she is acting to properly safeguard people in her care. The manager must show her DS0000027371.V360506.R01.S.doc 3. YA34 19 & Sch 2 30/04/08 4. YA36 18(2) 31/05/08 Version 5.2 Page 26 Amber House supervision of staff is “appropriate”. The National Minimum Standard sets out what is considered appropriate in terms of the agenda to be covered. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations Information for people using (or thinking about using) the service should be updated so that is shows the new contact details for the Commission. This is so people know how to contact us if they need to get information or raise issues about the home. Where people’s needs have changed significantly since their admission, the full assessment should be revisited from scratch. This is so information about people’s current needs is more clearly presented - so that staff are more aware of the support they need to offer to meet them. Individual support plans should show how they have been communicated to people who may not be able to understand the written word, and efforts to make the information accessible in other formats. This is so the home can show improved evidence that they have tried to involve each person in planning their care. Staff should avoid using terms that are not appropriate to people’s age (and could be perceived as belittling or patronising). Specifically these terms would be “good boy” and “good girl”. This action is needed to show that they are treating people with dignity and respect. Medication should be taken directly from the blister packs in the cupboard and locked up between times, unless there is a formal means of supervision of the packs when they are unattended by the person responsible. This is to avoid potential risk to people living at the home and retain clear lines of accountability. Training in understanding and dealing with epilepsy should be offered. This is because, although it is well controlled for existing residents, this might not always be the case. Staff need to understand the needs of people in their care DS0000027371.V360506.R01.S.doc Version 5.2 Page 27 2. YA2 3. YA7 4. YA16 5. YA20 6. YA35 Amber House with the condition. Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Amber House DS0000027371.V360506.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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