Inspection on 19/07/05 for Amber Lodge

This inspection was carried out on 19th July 2005.

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

Other inspections for this house

Amber Lodge 15/04/08

Amber Lodge 19/04/07

Amber Lodge 07/06/06

Amber Lodge 08/11/05

Amber Lodge 22/10/04

Amber Lodge 12/05/04

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Abbey The

Snydale Care Home

Whiteley House

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Amber Lodge 21 Thornhill Road Armley Leeds LS12 4LL Lead Inspector Carol Haj-Najafi Unannounced 19th July 2005 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 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 J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Amber Lodge Address 21 Thornhill Road Armley Leeds LS12 4LL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0113 2633231 0113 2038556 Meridian Healthcare Ltd Mrs Lynne Dawson Care Home Only 40 Category(ies) of Old Age (40) Dementia over 65 (10) Mental registration, with number Disorder Over 65 (10) of places Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The 10 places for MD(E) or DE(E) are specifically for the service users named in the variation dated 24th February 2004 Date of last inspection 22nd October 2004 Brief Description of the Service: Amber Lodge is a two-storey purpose built home situated in Wortley, near Armley. It has a large private garden to the rear of the building. A large car parking area is located at the front of the building. Local shops and bus routes are within easy access.The home is registered to provide personal care for up to 40 older people. Accommodation is provided on two floors. There are 38 single bedrooms and one double bedroom. All bedrooms have en-suite facilities. Lounge and dining areas are located on both floors. There are three bathrooms, two of which have hoisting facilities, and two shower rooms. All laundering is undertaken on the premises. The gardens are enclosed; a large lawn and patio area is at the rear of the building. Service users can access the garden from the dining room. Service users and staff prefer the term residents, therefore this term has been used throughout this report. . Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection between 9.30am and 5.45pm. The purpose of the inspection was to ensure the home was operating and being managed to a satisfactory standard. The inspector looked around the home, and spoke to residents, visitors, staff and the registered manager. Records were inspected including pre-admission assessments, service user plans, risk assessments, daily records, financial records and staff training and recruitment records. What the service does well: What has improved since the last inspection? What they could do better: The home is registered to provide care to people with a mental disorder or a dementia; staff have not done enough training to understand how to meet these people’s needs. The home must improve the service user plans and assessments to make sure resident’s needs are properly met and they are not exposed to unnecessary risk. Some records are not accurate and do not reflect fairly on residents. Very few individual or daily activities are provided in the home, and residents said there is ‘often very little to do’. Staff recruitment is very bad, and this inspection is the fourth time that it has been pointed out to the manager and the registered providers. The home looks after money for several residents. The financial records are not properly maintained and the manager could not confirm how much money was in the home’s amenity fund. Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 6 Requirements and recommendations identified at this inspection can be found at the end of this report. 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 J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 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 standard(s) 3, 4, & 5 The admission’s process is good, and residents receive relevant information and support. The home does not have the specialism to provide care for people with a mental disorder, and staff must receive appropriate training to ensure they have the knowledge and skills to meet the needs of people with a dementia. EVIDENCE: Three residents who recently moved into the home have pre-admission assessments. The manager confirmed that pre admission assessments are always completed before a resident moves into the home. One resident discussed her experience of the admission’s process, and although she did not have an opportunity to visit the home, a relative had visited on her behalf. She confirmed that the manager had visited her at the hospital and staff had talked to her about different arrangements at the home. She attended a review after six weeks to confirm the placement was suitable. Two visitors also discussed the admission arrangements, and said they had looked around the home and received a brochure. The home is registered to provide care for up to ten people with a dementia and up to ten people with a mental disorder. At the last inspection and this inspection the manager confirmed that the home is not equipped to provide Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 9 specialist care for people with a mental disorder. Staff spoken to the inspection said they had not received any training relating to mental health and acknowledged their knowledge in relation to dementia and mental health was very limited. Although they had knowledge of individual residents, they were unable to confirm which residents had a dementia or a mental health need. Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7 & 8 The care planning system continues to gradually improve although further improvements are still needed to provide consistency. The home has failed to properly assess some risks and update some care plans which puts residents at unnecessary risk and does not provide current guidance on how a resident’s needs should be met. Resident’s health care needs are met. EVIDENCE: Care records for three residents were looked at. Each resident had a care plan and risk assessments but these did not cover all their needs. Some elements of care plans gave good information about needs but others were general and applied to general care, for example ‘ensure teeth are in good state of repair, ensure lamps are in good working order, all trained staff to medicate’. It is not necessary to record this information in care plans and this practice should be automatically applied throughout the home. Specific care needs and risks were seen in the daily notes and other records but were not recorded in the care plan or risk assessments. A pre admission assessment identified that a resident was at risk of falls. There was no information in the care plan and a risk assessment had not been completed; the service user had sustained two falls, one which had resulted in a broken bone. One care plan stated a service user likes to sit in her room, and she tried to access her room when the inspector was looking around. However, the service user has been stopped Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 11 from using her room during the day. Nothing was written in the care plan to state why or when the bedroom is locked. Staff described some major changes in one resident’s needs but the care plan had not been updated to reflect these changes. The manager has very recently allocated a senior carer to take responsibility for monitoring care plans, which it is hoped will address the shortfalls in the care planning process. The last inspection identified that care plans needed to include more information. There have been some improvements but more information is still required. ‘Medical intervention records’ are written up every time any health appointment takes place. These are generally well recorded and follow up action is acted upon. A chiropodist visits the home on a regular basis. Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13 & 14 Residents enjoy the group activities. The range and frequency of daily and individual activities should be improved to ensure residents are stimulated and motivated. Resident’s likes and dislikes should be established to generate ideas for activities. One resident would benefit from the involvement of an advocate to explore ways of increasing choice and control. EVIDENCE: Staff members spoke of some group activities, which included clothes parties, group outings, arts and crafts and motivation sessions, they did not give many examples of daily or individual activities. Residents said they had recently spent a lot of time sitting outside enjoying the good weather but often there is very little to do. They did say they enjoyed clothes parties and the art and craft session which is held every two weeks. The manager said the home could improve daily activities. Resident’s likes and dislikes have been left blank on some care records. Visitors said that they can visit at any reasonable time and they are made welcome and informed about any issues or concerns. Family members support the majority of residents with their finances although the home is corporate appointee for several residents. It was agreed that one resident who felt they had lost control over their life would benefit from the involvement of an independent advocate. Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 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 standard(s) These standards were not assessed at this inspection. EVIDENCE: Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24 & 25. Amber Lodge is a ‘hotel-style’ home with a very pleasant and clean environment. The manager has taken appropriate steps to address problems that have been raised about the standard of the laundry service. EVIDENCE: The home has recently been redecorated, and new carpeting, furniture, and furnishings have been purchased. Pictures and mirrors were displayed in communal areas and bedrooms. All bedrooms have been painted, and have new curtains, bedding and light fittings. Two bathrooms have been converted to shower rooms, which now gives residents a choice of a bath or a shower. The home was clean, tidy and free from odours. The manager said there are no outstanding requirements or recommendations from the last environmental health or fire officer’s visits. Recently residents and relatives had raised concerns with the manager about the efficiency of the laundry service; apparently clothing often got mixed up. Visitors and residents made comments about this problem at the inspection. The manager has introduced a new Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 15 system to address this issue, which had been agreed at a staff meeting; all staff were made aware of the problems. Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 The recent allocation of specific duties should help address some shortfalls within the home. The manager must closely monitor staffing levels to ensure residents’ needs are met. The home’s recruitment process is very poor, which could result in unsuitable persons working at the home. The staff team have worked hard to achieve their NVQ awards. EVIDENCE: Staff had a good understanding of their roles and responsibilities. A meeting had been held to clarify staff roles; specific responsibilities were allocated to senior carers. Four staff meetings have been held in the last twelve months; issues that have caused concern have been raised and action plans agreed. All meetings are recorded. The staff rota was examined. Tippex was used when changes had been made. Staff said that sometimes the home can get busy at certain periods, which includes evenings and mealtimes; this had been discussed at a recent staff meeting and changes to mealtime routines were introduced. The manager said she is monitoring this. Major shortfalls with the recruitment process have been highlighted at three previous inspections. Recruitment records for the most recent recruit were looked at. An application form had been completed but there were gaps in the employment history. A Criminal records check was not available. No references were available; one referee had written confirming their policy was not to Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 17 provide references but no follow up reference had been applied for. The staff member has started work as a care assistant. Staff have attended a range of mandatory training courses, which includes fire training, moving and handling, health and safety, and first aid. All staff are starting a distance learning infection control course. Ten staff members have nearly finished their NVQ level 2 award and one staff have already completed the award. Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36 & 37 The financial system is poor and residents’ monies are not safe guarded. Staff have not received regular formal supervision, which looks at personal development and provides opportunities to discuss specific issues. EVIDENCE: The home is responsible for several residents’ finances. Their pensions are paid directly into the home’s bank account. An individual record of personal allowances is maintained but there is no individual record of fees paid. Cash that is withdrawn from the account has not been recorded. Although the manager was able to explain the type of expenditure, cash withdrawals could be accounted for. Resident’s finances and the home’s amenity fund are held in the same account. The manager was unable to confirm how much money was in the resident’s amenity fund. No records were available. Regular entries are made to resident’s records, which enable health and welfare to be monitored. Wording in some records was misleading, and the Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 19 manager said they did not accurately describe events. For example the term ‘aggressive’ was used regularly but the manager said the residents involved would not be aggressive. Staff have received some formal supervision for the manager and deputy but this has not been six times per year. The manager has recently allocated supervision responsibility to the deputy manager, and is hoping staff will receive more regular supervision. Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x 1 2 2 x Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? 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. 2. Standard OP4 OP4 Regulation 12 18 Requirement The registered provider must confirm in writing the proposals for categories of registration. The registered provider must ensure that staff have the skills and experience to meet the needs of residents. The registered manager must ensure care plans identify how individual and specific needs should be met. The registered manager must ensure risk assessments are completed in key areas. The registered manager must make arrangements to enable residents to engage in a programme of regular activities. The registered provider must ensure a thorough recruitment process is operated at the home.(timescale of 22nd October 2004 not met) The registered manager must ensure a written record of all financial transactions is maintained. Timescale for action 30th September 2005 30th September 2005 30th September 2005 31st August 2005 30th September 2005 With immediate effect 31st August 2005 3. OP7 15 4. 5. OP7 OP12 13 16 6. OP29 19 7. OP35 9 Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 22 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. 2. 3. 4. Refer to Standard OP14 OP27 OP36 OP37 Good Practice Recommendations The registered manager should make a referral to advocacy services on behalf of one resident. The registered manager should not use tippex on staffing rotas. The registered manager should ensure that staff members receive formal supervision at least six times a year. The registered manager should ensure records are accurate. Amber Lodge J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 J52 J03 S1412 Amber Lodge V230110 010605 Stage 4.doc Version 1.30 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. 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