Inspection on 01/08/06 for Amber Lodge

This inspection was carried out on 1st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Amber Lodge 10/07/07

Amber Lodge 06/04/06

Amber Lodge 25/04/05

Amber Lodge 11/08/04

Amber Lodge 19/04/04

Similar services:

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Byars Care Home

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

CARE HOMES FOR OLDER PEOPLE Amber Lodge 686 Osmaston Road Derby DE248GT Lead Inspector Janet Morrow Key Unannounced Inspection 1st August 2006 10:40 X10015.doc Version 1.40 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 Lodge DS0000002156.V306520.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 Older People. 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 Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amber Lodge Address 686 Osmaston Road Derby DE248GT 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) 01332 740740 01332 740923 None Diginew Limited Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (6) of places Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 places for OP 6 places for PD aged 50 years and over included in the total above Date of last inspection 8th June 2006 Brief Description of the Service: Amber Lodge is a forty bedded care home with nursing for older people. Six of these beds are available for younger people with physical disabilities. The home is situated in the Allenton area of Derby and was purpose built. Resident’s bedrooms are located on both the ground and first floor and are accessed by a passenger shaft lift or stairs. Bedrooms are attractively decorated and personalised. Communal areas are bright. There is a garden area with some outdoor seating. Support services are in place with a choice of GP, optician and dentist. Community psychiatric nurses, occupational therapists, physiotherapists and dietician are accessed as required. Staff training takes place to inform and enable staff to care for residents appropriately. Some entertainment and outings are arranged and residents are assisted to go out if they wish. The scale of fees for 2006 is £425 - £525 per week. Additional top ups may be payable according to assessed needs. Details of previous inspection reports can be found on the Commission for Social Care Inspection’s website: www.csci.org.uk Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place for a total of 6.5 hours. The acting manager was not on duty at the time of the inspection. Care records and staff records were examined. Nine of forty residents, two members of staff, one visiting professional and two visitors were spoken with. One relative and two visiting professionals were contacted by telephone following the inspection visit. One additional unannounced visit has been made since the previous inspection on 6th April 2006 to monitor progress on a Statutory Requirement Notice issued after that inspection. Additional requirements and recommendations were issued on this visit. What the service does well: What has improved since the last inspection? Efforts were continuing to be made by the owner and acting manager to improve communication between staff by holding more regular meetings and encouraging closer working relationships between different staff groups. Staff training had improved and included new induction material for care staff and more thorough health and safety training. The acting manager and owner had familiarised themselves with adult protection procedures and received training in this area. Adult protection training for staff was planned for September 2006. The written information on care records had improved and moving and handling assessments were available on the files examined. There was also more consistency in addressing care needs where risks were identified. Medication procedures had improved and medication administration record (MAR) charts were completed accurately, which helped minimise the risk of errors. Staff recruitment procedures had improved and the home had developed a better recruitment system, which meant that all relevant information, such as Criminal Record Bureau checks, was being obtained. The home had made a start on monitoring quality assurance by the owner conducting monthly audits in the home. Complaints were being investigated properly and the outcomes were recorded. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There was sufficient admission information available to establish that the home could meet residents’ needs but terms and conditions of residence did not meet legal requirements and compromised residents’ understanding of fee agreements. Standard 6 is not applicable, as the home does not provide intermediate care. EVIDENCE: Four residents’ care files were examined. There was assessment information available on each file, including information received from the assessment and care management process and the home’s own admission document. Risk assessments were available on all four files for nutrition, pressure sores, moving and handling and falls. Copies of terms and conditions were available in the four files examined. However, they did not specify the breakdown of costs into accommodation, personal care and nursing care as required by the Care Homes Regulations 2001. This has been raised as an issue at inspections since December 2004. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care arrangements and medication procedures had improved, which ensured that risks to residents were minimised but lack of consistency in addressing specific risks has the potential for health needs to be missed. Privacy and dignity was not consistently upheld, which meant respect was not guaranteed. EVIDENCE: Four residents’ care records were examined. Care plans were in place on all of the files examined and the resident or their representative had signed them or an explanation was given as to why a signature could not be obtained. Two files that had a nutritional risk identified did not have a care plan on how to address the risk. Care plans were in place on all files where risk of falls was identified and there were details available on the treatment of pressure sores where these existed. However, there were no care plans on how to prevent pressure sores where a risk was identified. There was a lack of clarity on one care plan as the index and individual care needs did not correspond. This was Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 10 raised as an issue at the additional visit in June 2006 and it has the potential to cause confusion. Residents spoken with stated that the staff were ‘marvellous’ and that their care needs were met. One resident who identified problems at the last key inspection in April 2006 now stated that these were resolved and they received the help they needed. Twenty of forty medication administration record (MAR) charts were examined to check for accuracy in signing for medication administered. There was only one gap seen on the twenty records. The MAR charts for four residents were examined in more detail. These were completed accurately with details on the charts and dispensing system corresponding, with the exception of one pain killing medicine for one resident. All handwritten charts, except one, had been checked and signed by two people. The controlled drug record and storage was examined and the record corresponded accurately with the stocks held. The refrigerator temperatures were recorded and were within safe limits and drug stocks were within expiry dates. Privacy and dignity was generally respected but a recent incident involving a public argument by staff members in the home was observed by outside entertainers and indicated that staff conduct was unprofessional and had the potential to compromise the respect of residents and was not welcoming to visitors. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Contacts with relatives and the local community, well managed meals and an improved range of activities enhanced residents’ daily lives. EVIDENCE: Daily routines were varied and residents had the choice of staying in their rooms or being in the lounge. Evidence of individual interests were seen in residents’ own rooms such as books, magazines and music. A wider range of activities and games was taking place following the appointment of a specified member of staff to co-ordinate this. Outings had been organised and monthly entertainers were arranged. However, four residents commented that more entertainment was needed. Relatives spoken with confirmed that visitors were able to visit at any time and that they were made to feel welcome. Visiting professionals also confirmed this. The previous inspection in April 2006 noted that the acting manager knew how to contact advocacy services if required. Access to personal information on care files was in place. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 12 The majority of residents spoken with during lunchtime stated that they enjoyed the food. Staff spoken with had knowledge of particular diets and provided alternatives to the menu if required. A visiting professional also felt staff were knowledgeable about nutrition and commented that menus were ‘diverse’. Staff spoken with felt that additional training in nutrition and health would be useful and a visiting professional also recommended this. The kitchen was clean and tidy and food stocks were good. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Complaints were handled objectively and adult protection procedures ensured residents were safeguarded from abuse. EVIDENCE: The complaints procedure was on display and was clear. It had the correct contact details for the Commission for Social Care Inspection. The complaints record was examined and showed that recent complaints had been dealt with properly and outcomes were recorded. The Derby and Derbyshire Local Authority Social Services adult protection procedures had been obtained. These procedures had been utilised for a recent allegation. This showed a significant improvement in the response to potential allegations since the last inspection in April 2006. The owner and manager had undertaken training in May 2006 to fully familiarise themselves with the action needed in response to allegations of abuse. The administrator stated that adult protection training for staff was arranged for September 2006. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home was well maintained, which ensured residents’ comfort and safety. EVIDENCE: The home was clean, tidy and reasonably well maintained. There was no odour detected during the inspection visit. Two bedrooms were seen and both were personalised and comfortable. Staff were aware of infection control procedures and confirmed that they had received training in this area. A two-pot sterilizer had been purchased and was waiting commissioning by the supplier before it could be utilised. Some minor repairs that need attention were scratches on bedroom doors and the main lounge carpet needed replacing. This was recommended at the previous inspection in April 2006. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There were sufficient qualified staff to meet residents’ needs. Recruitment procedures had improved, which helped to safeguard residents’. EVIDENCE: There were sufficient staff on duty to meet residents’ needs at the time of the inspection. Written records supplied by the home confirmed that National Vocational Qualification (NVQ) training was undertaken and showed that out of thirty care staff, thirteen had achieved an NVQ Level 2 or above. This meant that the home was striving to achieve the target of 50 of staff having an NVQ2. Staff training in health and safety had been improved and included a distancelearning course as well as input from external trainers. Qualified staff were undertaking specialist training in palliative care. Other in-house training had included information on Parkinson’s disease, dysphagia and continence. However, training recommended at the last inspection in April 2006 such as dementia care, disability and communication awareness had not yet occurred. Four staff files were examined and showed improvements in the recruitment process. All four files had a Criminal Record Bureau check in place or an application had been made and a POVA First check was obtained whilst waiting for a full disclosure; three had two written references; all had a completed application form that accounted for gaps in employment and qualified staff had had their PIN number checked with the appropriate registering body. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 16 The home had also taken appropriate action where there had been a significant delay in obtaining a full disclosure from the Criminal Record Bureau. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Quality assurance systems had improved but were not yet robust enough to ensure the home was run in residents’ best interests. Health and safety needs were addressed. EVIDENCE: The acting manager had not yet applied to be registered with the Commission for Social Care Inspection. The owner had begun monthly quality audits and was forwarding reports to the Commission. However, there had been no views obtained from residents, relatives or visiting professionals. Four residents’ financial records were examined and found to be in order with the written record corresponding with the cash held. Monies were stored securely and there were receipts available for individual purchases. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 18 Health and safety issues were generally addressed and staff interviewed confirmed that training was undertaken in key areas, such as moving and handling, fire safety and infection control. Training certificates also confirmed that fire training had occurred in February 2006, moving and handling in May 2006 and infection control in April 2006. Maintenance records were seen that showed water safety was tested twice monthly and fire alarms were tested weekly. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 2 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 3 3 Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 20 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 OP26 Regulation 23(2k) Requirement The home must provide a sluicing disinfector. Previous timescales of 1st December 2003, 1st September 2005 and 1st August not met. Improvements made. Timescale extended. Timescale for action 01/10/06 2. OP2 5(2a) 01/10/06 Terms and conditions (contract) must state which room a service user is to occupy, additional charges, nursing and personal care charges and accommodation charges. Previous timescale of 1st December 2004 and 01/08/06 not met. Timescale extended to 01/10/06. A written plan must be prepared as to how residents’ care needs are to be met. Unnecessary risks to the health of residents must be identified and as far as possible eliminated. There must be a plan for reviewing the quality of care at DS0000002156.V306520.R01.S.doc 3. 4. OP7 15 (1) 13 (4) (c) 01/09/06 01/09/06 OP8 5. OP33 24 (1) 01/12/06 Amber Lodge Version 5.2 Page 21 the home. 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 OP30 Good Practice Recommendations Staff should undertake training in areas relevant to the service user group catered for, such as communication skills, disability awareness, and dementia. This is a previous recommendation and has not yet been addressed. Care staff should receive advice and clarification on how to contribute to care plans. This is a previous recommendation and was not assessed on this occasion. The views of residents, relatives and visiting professionals should be sought and acted on to improve the quality of care in the home. This is a previous recommendation and has not yet been addressed. Residents should receive a bath at times of their choosing and in line with their care plan. This is a previous recommendation and was not assessed on this occasion. Scratches on bedroom doors should be repaired and the marks on the lounge carpet should be removed. This is a previous recommendation and has not yet been addressed. The care plan index and the care plan should correspond. This is a previous recommendation and has not yet been addressed. All identified individual needs should have a care plan. Care records should have details of how the risk of pressure sores and nutritional risks are to be minimised. Staff behaviour should comply with the General Social DS0000002156.V306520.R01.S.doc Version 5.2 Page 22 2. OP7 3. OP33 4. OP8 5. OP19 6. 7. 8. 9. OP7 OP7 OP8 OP10 Amber Lodge 11. 12. OP28 OP30 Care Council code of conduct. 50 of care staff should have a NVQ at Level 2. Catering staff should receive training in nutrition. Amber Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 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 Lodge DS0000002156.V306520.R01.S.doc Version 5.2 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!