Inspection on 02/07/06 for Amberdene Lodge

This inspection was carried out on 2nd July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Amberdene Lodge 08/07/08

Amberdene Lodge 09/07/07

Amberdene Lodge 20/10/05

Amberdene Lodge 21/06/05

Amberdene Lodge 11/11/04

Amberdene Lodge 20/07/04

Amberdene Lodge 09/02/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Amberdene Lodge Amberdene Lodge 40 - 42 Boulevard Hull East Yorkshire HU3 2TA Lead Inspector George Skinn Key Unannounced Inspection 20th July 2006 09:30 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 Amberdene Lodge DS0000000832.V304871.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. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amberdene Lodge Address Amberdene Lodge 40 - 42 Boulevard Hull East Yorkshire HU3 2TA 01482 587774 01482 587774 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) Mr Graham Abel Elaine Kathryn Grant Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2005 Brief Description of the Service: Amberdene is a large care home comprising of two Victorian houses on The Boulevard, off Anlaby Road in the west of Kingston-upon-Hull. Local services on Anlaby Road include a chemist, a GP surgery, taxi office, pubs and the Hull Royal Infirmary. Bus services to the city centre and out of the city are a short walk away. The home provides care for a maximum of 25 older people, who may have dementia. There are thirteen single rooms and six doubles on two floors, accessed via a passenger lift. None of the bedrooms have en-suite. There are three bathrooms and nine WCs. The home has two lounges and a dining room. There is a garden to the rear of the house, which is accessible via a concrete ramp. There is parking for two cars at the front of the building. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit and took 9 hours to complete. The inspection included talking to service users, staff and the manager of the home. Prior to the site visit satisfaction surveys were sent to service user staff and relatives. Their comments helped to make a judgement about the quality of the care provided at the home. The building was looked at as were some of the records. What the service does well: What has improved since the last inspection? What they could do better: The staff need to have more one to one supervision to make sure they feel supported to help them care for the service users. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 6 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. Amberdene Lodge DS0000000832.V304871.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 Amberdene Lodge DS0000000832.V304871.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): 3 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service user needs are assessed prior to moving into the home. Contracts/terms and condition are agreed with service users or their representatives. EVIDENCE: Service users sign their plan of care, which are in large print making them easier to read. The majority of those interviewed knew that the home kept records and information about them. The Manager completes an enquiry form following any contact with care coordinators or placement officers from social services departments. She then completes a new client assessment detail form once it has been decided the prospective service user will be spending a trial stay in the home. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 9 The Manager consults the service users and their relatives or representatives during the stay to make a complete assessment of the service users needs. The Manager uses all of this information, along with risk assessments and staff observations to compile a service user plan of care. Service users do have contracts and these were on the confidential files kept in a locked filing cabinet in the office. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users have care plans which instruct the staff on how to meet their needs Service users can make decision about their lives with assistance when needed. Service users are protected by the home medication procedures. Service users feel they are treated with respect and their right to privacy is upheld. EVIDENCE: A plan of care is compiled using information gathered and observations undertaken before and during the trial stay. Relatives and service users are involved with this process., Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 11 The care plan contains documents such as risk assessments and action plans. The plan is available in large print for service users to make reading easier and there is a space where service users can sign to say they agree to the plan; those files seen were signed. Reviews of the care plan are held monthly and six-monthly in a more formal setting. Due to the dependency levels of the service users only one was aware that the home kept any information. Following a complaint that was received expressing concerns about the home medication administration procedure the home were required to take action in some area. These requirements were complied with within agreed time scales, and procedure put in place to ensure the service users welfare. The home has a good medication trail for handling medicines. The medication is receipted, correctly stored and appropriately administered and disposed of. The staff follow a medication policy for administering medicines and there is a self-medication policy for service users who self-medicate. Staff receive training from a Pharmacist on medication administration. The Manger and Deputy Manager have completed a Boots Advanced Care in Administering Medicines course. Only the management team or senior carers administer medication. The Venalink Monitored Dosage System is in use, and medication administration record sheets are used and accurately maintained. Storage arrangements are good and each service user has their own lockable cabinet in their room should they wish to self-medicate. Staff respect the service users’ right to privacy and dignity, and any personal care is given in private. Telephone calls can be made by the service users in the privacy of the office if they have no line of their own, and mail is received unopened. Screening is provided in double rooms. Family and friends can be seen in service users own rooms if they wish, but the tendency is to visit in the lounge and talk to several people. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users life styles matches their expectations Service users maintain contact with relatives and friends. Service users can exercise choice in their daily lives. Service users receive a well-balanced and varied menu. EVIDENCE: Flexibility is fundamental to the running of the home and the service users commented on being able to exercise freedom of choice in all daily activities regarding such as going to bed, rising, etc. Service users are encouraged to make choices on a daily basis regarding the care they need and some were observed instructing staff in care tasks, to ensure their comfort and wishes. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 13 There are some service users who are unable to make fully informed choices, but staff are sensitive to their needs and try to meet them respectfully. Service users wishes in relation to contact with family and friends are recorded in their plans of care. There are no restrictions on visiting unless imposed by the service users themselves. Bedrooms are used for receiving visitors or if preferred the lounges and dining room are available. Visiting relatives commented on being welcomed to the home and had good relationships with the staff Some comment cards indicated that the home provided plenty of opportunities for the service user to access local amenities and have frequent day trips but there was a lack of in house activities. Evidence gathered during the site visit indicated that the service users do have a choice of activities and these are available on a daily basis. These activities range from bingo to pass the parcel. Service users commented on being able to undertake personal interests with support of the staff. There are no service users who make regular requests to view their records or files, but one was aware of the review process and that documents are kept and can be viewed if wished. Staff offer information as necessary to service users and relatives/representatives. Some of the comment cards indicated that the home do not provide a choice for diabetics. Evidence gathered on the site visit indicated that there is a good choice for all the service users and any individual specialist medical diets are catered for. The care staff do work closely with dieticians and District Nurses concerning individual diets. Service users spoken with were satisfied with the meals provided comments included: “The food is just like home cooking nothing fancy which suits me”. At least three full meals a day are offered, one is always a hot cooked meal, and snacks are also available. Any religious or cultural diets would be and are catered for. Menus are produced after consultation with service users and take into consideration their likes and dislikes; menus are displayed, or explained to service users these are changed according to requests or the seasons. Mealtimes are set, but in reality become flexible to accommodate service users individual needs. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 14 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 & 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users know who to complain to and are confident that complaints will be taken seriously. Service users are protected from abuse. EVIDENCE: The home’s statement of purpose and service use guide contains details for making a complaint, and a complaint procedure, which is also posted around the home. Service users spoken with said they would talk to the manager if they had a concern. There is also an information pack in place in the lounges, informing service users of the way in which to make a complaint. A complaint record is maintained and staff are instructed on how to receive complaints during their induction. Those service users spoken with knew who to complain to and were confident that complaints are taken seriously. The home has the Hull and East Riding Vulnerable Adults Procedure and procedures in place, which includes a whistle blowing policy. The manager and Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 15 the deputy manager have completed POVA training, which accompanies the Hull and East Riding procedure, and have cascaded this information to the rest of the staff. Staff sign to acknowledge their understanding of the procedure. Records would be maintained of any allegations made by service users or other stakeholders. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 16 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 & 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service user live in a safe well maintained environment. Service users have the specialist equipment they require to maximise their independence. The home is clean, pleasant and hygienic. EVIDENCE: The home is situated in a residential area along The Boulevard in Hull and is well maintained within a programme of routine maintenance. There is a rear garden for use by service users and this is accessed via a ramp; the building complies with the requirements of the local fire service and environmental health department. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 17 Service users commented on the cleanliness of the home and how the rooms are kept clean and tidy. The home is clean and tidy all areas both communal and private are well maintained and welcoming. There is an infection control policy in place to protect the service users from the risk of cross infection. Staff were seen to be using protective clothing again to eliminate the risk of cross infection for the service users. Some staff did comment on a lack of equipment. Evidence gathered during the site visit indicated that the service users are provided with the appropriate equipment and there is equipment for staff to use to meet the needs of the service users. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 18 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 & 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users needs are met by the number and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the homes recruitment policy and practice. EVIDENCE: The Commission for Social Care Inspection (CSCI) have been advised that recommended Department of Health guidance should only be applied to new registrations. For homes registered prior to April 1st 2002 staffing levels must at least meet the minimum requirements of the previous regulatory authority. This the home achieves. No new members of staff start working at the home until a satisfactory Criminal Records Bureau (CRB) check has been received. The home provides staff with at least three paid days training per year, in line with the identified training and development needs of the staff as individuals Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 19 and as a group. Training and development programmes are written in staff files and records of training are maintained. There is a recruitment and selection policy in place and a procedure in operation, which includes the taking of two written references and a CRB check. Staff are given contracts of employment and statements of terms and conditions. Equal opportunities are followed. Staff work in line with codes of conduct adapted from the codes of conduct and practice published by the General Social Care Council. Those files inspected indicated that all the relevant checks had been made prior to the employment of staff. Staff files inspected indicated that one to one supervision had not been carried out on a regular basis. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 20 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 & 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a home which is well managed. The home is run in the best interests of the service users Service users financial interests are safeguarded. Service users health welfare and safety is promoted and protected. EVIDENCE: There is a quality assurance system in place. The system involves an annual development plan, staff training plan, audit checklists on the premises, the Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 21 service of care, food provision, administration etc., with staff, service users and relatives questionnaires being used for the gathering of this information. The home produces an annual report of the quality assurance system and this is available for perusal by all interested parties including the CSCI. There is a policy on handling service users’ finances. All transactions entered in to on behalf of service users are recorded individually and money held for them in safekeeping is kept in individual containers. Storage of money is safe and secure. Where possible service users are encouraged to handle their own finances or the responsibility is passed to a family member. Staff are trained in moving and handling, fire safety, first aid, food-hygiene and medication administration if appropriate. There are policies, procedures and safety notices in place, covering all areas of safety within the home and these are followed. There is a general Health & Safety policy statement. There is safe storage and disposal of hazardous substances. Boilers and electrical equipment are adequately serviced, hot water outlets are fitted with thermostatic control valves, which are tested and results recorded, and there are restrictors on upper level windows to prevent them opening beyond a safe width. The home’s kitchen equipment and the fabric of the building are adequately maintained. Risk assessments are completed for the property; the care practices are safe and based on the combination of risk assessments and clear policies and procedures. Records are maintained of accidents and incidents relating to health and safety issues. Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 22 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 3 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 23 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 Standard OP36 Regulation 10, 18, 19, 24 & 26 Requirement The registered person must ensure that the staff receive the appropriate supervision at the required intervals Timescale for action 30/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Amberdene Lodge DS0000000832.V304871.R01.S.doc Version 5.2 Page 25 - 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. 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