Inspection on 08/07/08 for Amberdene Lodge

This inspection was carried out on 8th July 2008.

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

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 09/07/07

Amberdene Lodge 02/07/06

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Amberdene Lodge Amberdene Lodge 40-42 Boulevard Hull East Yorkshire HU3 2TA Lead Inspector Beverly Hill Key Unannounced Inspection 8th July 2008 09:00 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.V368084.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.V368084.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 F/P 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.V368084.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th July 2007 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 and accommodation for a maximum of 25 older people, who may have dementia. There are thirteen single bedrooms and six shared on two floors, accessed via a passenger lift or stairs. None of the bedrooms have en-suite. Communal rooms consist of two lounges, one of which people use if they wish to smoke, and a dining room. The home has three bathrooms and nine WCs. 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. According to information received from the home the weekly fees are £348.50p. Additional charges are made for hairdressing, chiropody, clothing and toiletries. Information about the home and services can be located in the statement of purpose and service user guide available in the reception. Copies of the most recent inspection reports are also on display. Amberdene Lodge DS0000000832.V368084.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 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 9th July 2007, including information gathered during a site visit to the home, which took approximately nine hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Amberdene Lodge. We also had discussions with the registered manager, three care staff members and the cook. Information was also obtained from surveys received from six people that live at the home, three relatives and seven staff members. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We checked how staff monitored the food and fluid intake of those with nutritional risks. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment, (AQAA) within the agreed timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Amberdene Lodge, the staff team and management for their hospitality during the visit and also thank the people who completed surveys. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The assessments completed by the home prior to peoples’ admission must be comprehensive enough to give staff a picture of the persons needs so they can Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 7 decide if they can meet them. The manager must also write to people following the assessment formally stating the home is able to meet their needs. Care plans must really include all assessed needs and be evaluated properly so that changes can be identified. Staff should also have time to read care plans. These points will ensure that care won’t be missed. When people are prone to having falls, poor dietary intake or have fragile skin they must have a risk assessment so that staff can plan what steps are needed to reduce the risks. The risk assessments must include monitoring and recording of their needs. Also people that need bedrails have to have a comprehensive risk assessment to check they are required and that they are the right sort for the bed and mattress. The home didn’t have full risk assessments. We issued an immediate requirement notice to the home to address this straight away and when we checked with them later this had been done. The way medication is recorded must be improved and the home should obtain the correct storage for controlled drugs. They do not have anyone using controlled drugs at the moment but any resident could be prescribed them and the home would not have a safe place to store them. The bedroom of one person with dementia was quite sparse with very few pictures and ornaments. The manager and staff could rectify this by talking to the persons’ family if possible and helping to decorate their bedroom in a way that remains safe for them but offers some stimulation. The home has routinely employed people before the return of the criminal record bureau check, although always after a check of the protection of vulnerable adults register. This system should only be used in exceptional circumstances and not routinely. Now that staff training needs have been identified the home could make sure that they are met. It is also important that staff receive training in how to safeguard vulnerable people from abuse and also conditions that affect older people. The induction new staff members receive gives them information about the home like policies and procedures but it does not cover skills for care common induction standards. The latter will enable seniors to check the competence of new staff and sign off the induction after a set period of time. It will also prepare new staff for national vocational qualification training as the next step in their development. The provider, manager and staff could check the environment more frequently to make sure it is safe for people. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 8 The way the home monitors the quality of the service it provides and its record keeping could be improved to ensure everything is up to date. 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. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 9 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.V368084.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some gaps in the assessment process could mean that the home does not have sufficient information about the prospective resident to enable a decision to be made about meeting their needs. EVIDENCE: We examined three care files during the visit, one of which belonged to a person recently admitted to the home, to check the assessment process. All three contained assessments of need, and two contained care plans, produced by the local authority for people funded by them. The management team had also completed the homes own assessment to check there had been no change in need. The homes own assessments Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 11 contained basic information and needs to cover all aspects of health, social, emotional and psychological needs to enable them to make a decision about whether they could meet needs. Those admitted privately would need a more in depth assessment than the ones examined. One of the previous assessments examined was not dated or signed so it was difficult to audit when they had been completed. The manager did not formally write to people stating that, having regard to the assessment, the home was able to meet the identified needs. She confirmed this was done verbally. In the file of the person recently admitted, which was four and a half months ago, the personal profile had not been completed. This section of the assessment gave additional information for staff to use in the care planning stage and should be completed as soon after admission as possible as it would identify diverse needs, routines and preferences. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were provided with support in ways that promoted their privacy, dignity and independence. However some gaps in care planning, risk assessing and recording means that staff may not have full information about specific tasks and care could be missed. The recording of medication was not sufficiently robust to evidence good management and ensuring all people received the medication as prescribed for them by their physician. EVIDENCE: There were care plan issues that required attention. There appears to have been slippage since the last site visit, as on that occasion this standard was met. Temporary management cover had been in place since last November and the registered manager had only recently returned to work part-time and was due to return full time later this month. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 13 We examined three care files during the visit. To make the care files easy to read they could be divided into sections. Not all needs identified at the assessment stage had been transferred to the care plan, they were basic in content and did not contain clear tasks for staff, and they did not reflect what the person could do for themselves, thereby helping to promote independence. Each of the care plans followed the same format and had brief details in each section of need but the details were more like a follow on of assessment information rather than a plan of how the needs were to be met by staff. They would not give clear instructions to staff in how to carry out tasks. For example a care plan for a person with dementia, who had sustained three falls in one month between May and June 2008 stated, ‘mobility good, mainly independent, does tend to rush’. This plan gave no guidance to staff to how to manage her mobility. Staff had completed a moving and handling risk assessment but this just stated the person could be unsteady and rushes. There was no risk assessment for falls and daily notes stated the person walked with a frame. The same person had a care plan for nutrition that just stated, ‘good diet, prefers/loves sweets’. They had not had a nutritional risk assessment completed and daily notes made by staff indicated her diet was poor on some days and she had food supplements. There was no food/fluid monitoring charts in place. There was no care plan to manage her dementia care needs yet daily notes clearly recorded her confusion and disorientation. A review in May 2008 makes reference to the need for pressure relief, elevation of her legs due to fluid retention and the application of cream to her legs but none of these points have been referred back to the care plan. The other two care plans examined had similar issues of not being sufficiently thorough or fully individualised to meet needs. It was also noted during the visit that one person often declined personal care tasks and had behaviours that could be challenging for staff to manage. A clear behaviour management plan needs to be formulated that guided staff on the best way to support the person. Care plans were not being evaluated thoroughly taking into account information documented in other parts of the file such as daily notes, risk assessments, accident reports and reviews, therefore they were not being updated when needs changed. Two of the files examined had evidence of a care plan review but review documentation was not in the file for the person recently admitted. It would be expected that the person had a review after the first few weeks to decide if the admission was to be permanent. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 14 There was evidence of some risk assessments being completed, for example for general moving and handling needs, and individual risks such as one person spilling hot drinks and smoking. However risk assessments were not in place for other important areas such as nutritional needs, falls, the need for bed rails and pressure relief. There was evidence of referral to health professionals for advice and treatment and recorded visits from district nurses, doctors, emergency care practitioners, opticians and chiropodists. Peoples weight was monitored and the manager advised how they had called a GP to request referral to a dietician for one person but it was decided this was not required at the moment. The manager had also tried to refer a person to the local falls prevention team but had been advised staffing issues were concentrating their input to people in the community and not in residential care homes. Daily recording did not give a full picture of the care provided during the day or night and there were times when issues were referred to but not followed through to the next shift. It is important that daily recording improves to evidence that full care is being provided to people. In discussion some staff told us they did not always read the care plans and did not always have full information about people. They said that seniors were responsible for writing the daily notes and they informed them if there were any issues with the people they had supported that day. For example, they said they checked peoples’ skin daily for reddened areas and would report this straight away. It was important that all staff read and understood care plans to ensure they knew how to care for people. People spoken with described care provided to them that respected their privacy and dignity, ‘the staff are very good’, ‘oh yes (very emphatic) the staff are very nice – I get on with them all’ and ‘the staff are lovely and kind’. In discussions staff were clear about how to maintain privacy and dignity. Surveys from people and their relatives were also complimentary about the care they received. People wrote, ‘its very good care’, ‘excellent staff’, ‘all staff are always polite and welcoming’, ‘they make the residents feel needed’, ‘mam is always dressed nice and clean’. Five people wrote that they received the care and support they needed, ‘always’ and one person stated this was, ‘usually’. Two of the three relative that returned surveys stated that the home gave support as expected /agreed, ‘always’ whilst the third stated this was, ‘sometimes’. There were some areas in the management of medication that required attention. • Medication was not consistently signed as received into the home. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 15 • One persons’ medication had been changed by their GP in mid cycle and staff had handwritten the changes to the dose on the medication administration record but had omitted to sign the record. • Generally medication was signed when administered but there were some missed signatures with no coded reason as to why it was omitted. • The home currently does not have any storage facility for controlled drugs. At present there are no people prescribed controlled drugs but this could change at any time and the home would need to address storage at short notice. • One person self medicates a part of their medication. Whilst this is good practice in supporting the person to be independent a thorough risk assessment needs to be in place and information included in the care plan as to how this is to be overseen by staff. • Some records were missing photographs of people, which aid in the safe administration of medication. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had flexible routines and promoted choice and individual decisionmaking. The home provided meals that met peoples’ nutritional needs. EVIDENCE: The home provided a range of in-house activities such as bingo, quizzes, hand and nail care, dominoes, music and dance sessions, birthday and other seasonal parties, watching films together and craftwork. Outings were organised to places of interest such as local shops on Hessle Road, Darleys (public house), theatre trips on special occasions and one person had recently visited an art gallery. Clergy visit monthly for church services and one person makes trips to the local library. One person likes to crochet samples and another likes to spend time colouring. The home had access to a minibus as often as possible obtained from a local scout troop. The staff advised that community wardens pop into the home to Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 17 chat to people and, as a lot of the residents are locals from the Hessle Road area they feel at home and part of the community. The manager and staff had recently discussed activities with residents and drawn up a list of requests. The manager is looking into the suggestion of more physical exercise. In surveys people stated they had enough activities, ‘always or usually’, whilst one person stated this was, ‘sometimes’. Some people joined in more than others and there was evidence that choice was respected. The home did not employ an activity coordinator so care staff fulfilled this role. This could be difficult at times, as they could be called away to assist people in the middle of an activity. People spoken with stated their visitors could come at anytime and could be seen in private. This was confirmed in discussions with staff, and surveys received from people. We observed visitors coming and going freely. Relatives commented in surveys that staff kept them informed and the atmosphere was good, ‘ carers let me know, they are very good’, ‘you are made to feel welcome’ and ‘always rings me about falls or not feeling well’. People were able to make choices about aspects of their lives. Some people chose to continue smoking and facilities were arranged for this, some people managed their own personal allowance and one person managed part of their medication. People had the choice of where to sit and have their meals, the times of rising and retiring and whether they preferred to stay in their bedrooms. People spoken with generally enjoyed the meals provided by the home. Out of six surveys received five people stated they liked the meals, ‘always’ or ‘usually’, one person stated this was ‘sometimes’. Comments were, ‘its good food’, ‘I’m quite happy thank you’ and ‘the meals are very good – very nice’. The manager stated a recent audit had indicated the menus were a little repetitive so they were being updated to reflect more choices. In a survey one staff member stated that a way to improve the service would be with a better choice of menu. Special diets were catered for and food supplements obtained via residents own GP’s. The cook advised that they visited each person daily to check what they wanted from the menu and two choices were offered at each meal. They stated the home had four weekly rotating menus but Monday was always, ‘meat pie day’ and there was always a roast dinner on Sundays. Staff members were observed supporting people to eat their meals in a patient and sensitive way. The home had gained a ‘B’ in Hull City Council’s ‘scores on the doors’ assessment system of food management. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home continues to provide an environment where people and their relatives feel able to complain. Not all staff members have received training in how to protect vulnerable people from abuse, which may mean they lack skills in how to recognise abuse and what to do if they suspect it has occurred. EVIDENCE: The homes complaints policy was on display and via surveys staff indicated they were aware of how to record and action complaints. A complaint form was available that had space to detail the complaint, how it was investigated, whether any meetings took place, what the outcome was, what, if any, action was taken and whether a review was required. To improve the form could detail whether the complainant was satisfied with the outcome and have space for a signature of the person completing the form. The home had only received one complaint since the last visit and this had been dealt with in a low key way. The Commission had not received any complaints. People spoken with stated they were aware of how to complain Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 19 and who to speak with if they had any concerns, ‘I would tell Elaine (manager)’ and ‘oh yes I would definitely complain, I would go to whoever was in charge’. In surveys most people wrote that they knew how to complain. Staff members in discussion stated they had not had any training in how to safeguard adults from abuse and were unsure about the different types of abuse. They did however state they would report any concerns immediately to the person in charge of the shift or the manager and one person knew the local authority, as the lead agency for safeguarding adults, would investigate any allegations. It is important that all staff receive up to date training in how to safeguard vulnerable adults from abuse. The registered manager had completed safeguarding training with the local authority and was very aware of the multi-agency policies and procedures regarding alerting, referral and investigation of allegations of abuse. The home had referred an allegation of abuse perpetrated by a staff member, to the local authority as soon as they were made aware of it. This was investigated and the staff member dismissed. Their name was referred to the protection of vulnerable adults register for inclusion but the registered manager is unaware of the outcome yet. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some areas of the environment required attention to ensure it was a safe place for people to live in and to enhance their wellbeing. EVIDENCE: Communal rooms consisted of two lounges, one of which people use if they wished to smoke, and a dining room. The rooms were decorated in a homely way and were clean and tidy. The dining room had four separate tables and chairs to seat six people at each. This would enable all residents to use the dining room at any one sitting. The manager advised that some people chose to have their meals in their bedroom or in the lounge. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 21 The home has three bathrooms and sufficient toilets throughout. However during the visit it was noted that only one of the bathrooms, which had recently been refurbished, was available for use. The other two were used as storerooms, one temporarily to house items from the hallway during its redecoration, but the other was obviously a more permanent storage area. It was clear that people had still been using the toilets, which could place them at risk of tripping over the stored items. 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. The home had thirteen single bedrooms and six shared rooms over two floors, accessed via a passenger lift or stairs. None of the bedrooms had en-suite facilities. Shared bedrooms had privacy screens and all rooms had a privacy lock for the door. Some of the bedrooms had a lockable facility to store personal items. The bedrooms seen were personalised to varying degrees and people spoken with confirmed they were able to bring in small items of furniture, ornaments and possessions to make the bedrooms more homely. It was noted that one person with dementia had a bedroom that was quite sparse with very few possessions or pictures to offer stimulation. Some environmental issues that needed attention included: • The window in one of the bedrooms had a large crack that compromised the double-glazing. • The carpet in one bedroom was worn and had ridges near the bed, which could be a trip hazard. • Several of the toilets and two of the bathrooms had no soap and paper towels, and two toilet doors did not have locks. • The bulbs in some of the lamps need replacing. • Some of the commodes were old and rusty and in need of replacing. • There was an unpleasant odour in one of the bedrooms that needed investigating and eliminating. • Three people had bed rails that were not suitable. This is discussed in the management section of the report. • Some wardrobes examined could be tidier and it was noted not all the clothes were hung up on hangers. People spoken with during the day were generally happy with their home and confirmed they had keys to their bedroom doors and were able to lock them Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 22 when they wanted to. One person told us they didn’t like to share their bedroom with people that sometimes came in for short stays. The manager needs to check this out with people who share and should people no longer wish to share steps should be taken to offer them single room accommodation when it becomes available. In surveys all six from people that lived in the home, stated the home was clean and fresh either, ‘always’ or ‘usually’. The home had sufficient laundry and cleaning equipment. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Gaps in mandatory and service specific training mean that staff members may not have the required skills to meet peoples’ diverse needs. The homes recruitment processes were not sufficiently robust to safeguard vulnerable people. EVIDENCE: Discussions with care staff members indicated that there were three care staff members, and the registered manager on duty during the day, and two care staff at night. The manager calculated the home provided 434 care hours a week. Based on the dependency levels of the twenty-one people that currently live in the home, there should be 417.49 hours a week so the home is meeting this standard. However the home has two vacancies at present and should these be filled with people that have medium dependency levels, the home would need to provide 456.44 care hours. The registered manager will need to look at how dependency levels are calculated so that care hours can be adjusted accordingly. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 24 People spoken with were complimentary about the care they received from staff, ‘they are marvellous and kind’, and surveys received from people had positive comments, ‘they are always on the ball’, ‘they make the residents feel needed’, ‘it’s a really good service from what I have seen’, ‘I think they all do a good job’ and ‘excellent staff’. Staff members spoken with stated they had a nice team to work with and they commented that ‘the residents are loved’. There was a good skill mix of staff, however there were three staff on long term sick and one part-time carer had recently left. The manager was in the process of completing a recruitment drive for two permanent part-time carers, one permanent bank carer and cook and one temporary night carer. Permanent staff had been filling in the gaps but the new staff should address any shortfalls. The induction for new staff covered an orientation to the home and shadowing more experienced carers. The induction process needs to ensure staff work through common induction standard booklets that enable managers to assess competence and sign this off on completion. Information was provided to the manager regarding skills for care induction. The registered manager had just completed an audit of training and there was evidence of gaps in mandatory training. Each staff member needs to have an individual training and development record, which is kept up to date. The registered manager forwarded a training plan to us and there was evidence she had several courses booked throughout the next few months, which should address the shortfalls. Service specific training covered items such as, diabetes awareness, the Mental Capacity Act, continence care and care of the dying. The home also needs to look at training staff in conditions affecting older people such as, strokes, Parkinson’s’ disease, arthritis and dementia. Those staff administering medication should complete an accredited medication course and all staff should complete training in how to safeguard vulnerable adults from abuse. According to information received from the manager the home had 37 of care staff trained to national vocational qualification (NVQ) level 2 and 3. A further three staff members were progressing through the course and two were waiting to start. This is good progress and the home should aim for 50 of care staff trained to this level. It is acknowledged that recent staff changes had affected figures. Generally the home made sure that people had checks prior to starting work. References and criminal record bureau checks were obtained and checks made against the protection of vulnerable adults register. Care staff members were selected via an interview process. All three new staff files examined evidenced that they had started shifts after the povafirst check but prior to the return of the criminal record bureau check. This must only occur in exceptional circumstances and should not be routine practice. Staff did confirm that they Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 25 shadowed other more experienced staff for a few shifts. However one of the files was for a night care worker and it was not possible to have stringent supervision in place, as there were only two night carers per shift and staff may have to work alone with people. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, and 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The interim management arrangements put in place during the registered managers absence had not been wholly successful and some management systems such as staff supervision and quality monitoring had slipped. These will be addressed now the registered manager has returned to work. The provision of inappropriate bed rails and a lack of risk assessment in this area place people at risk of injury. EVIDENCE: The registered manager had only recently returned part-time to her post after an absence of ten months. She is due to return full-time next week. In her Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 27 absence interim management arrangements were put in place but these had not been wholly successful, as there has been some slippage in management systems. The registered manager has worked in care for seventeen years and has a wealth of experience. She has management qualifications and has completed the Registered Managers Award. She is very enthusiastic about her role and knows the people that live at the home very well. The registered manager stated the proprietors were very ‘hands on’ and visited the home most mornings to complete maintenance tasks, decoration, support the staff team, chat to residents and even to assist with outings. The staff described the manager as, ‘very approachable’ and ‘understanding’ and they stated they could go to her with problems. They described morale as good and that they were generally kept informed and up to date about things. One person in a survey did state that shift handovers could be improved to ensure that important information is not left out. People that lived in the home knew the managers’ name, which told us she made her presence felt about the home. It appeared from discussions and documentation that the registered manager was quickly grasping what needed to be improved and had started implementing this. The home had a quality assurance plan that consisted of audits each month and surveys to people to obtain their views on the services provided. There was no evidence that quality monitoring had been completed in the registered managers absence. The last survey carried out was in June 2007 and covered a range of topics such as, complaints, staff attitude, menu’s, activities, cleanliness and how to improve. Those seen had positive comments about the home. There were some suggestions about improvements but no evidence that an action plan had been produced to address them. There was no evidence of surveys to other people visiting the home such as care management, district nurses and other health professionals and GP’s. The annual quality assurance assessment (AQAA) requested by the Commission was provided within the timescale and the home had gained both parts of the local authority quality development scheme. Residents’ finances were not inspected during this visit but the registered manager described the process they used to safeguard monies entrusted to them. People had individual record sheets and monies deposited were receipted. All monies out were signed for and if staff purchased items on residents’ behalf they had to obtain a receipt. Monies were securely maintained in the safe with limited access, however residents and their relatives had access to finance records for checking. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 28 Staff supervision records were examined as part of the visit. It was clear that staff had been observed in their role during the registered managers absence but formal documented supervision had not been completed. Staff described a system whereby they were observed completing particular care tasks such as bathing, and assisting people to eat and drink to ensure this is done in a sensitive and correct way. This is good practice but needs to be complimentary to one to one discussions with staff that covers the philosophy of care in the home, training needs and all aspects of practice. There was evidence that not all the documentation required for the running of the home was in place and up to date. Shortfalls in documentation covered, care plans, risk assessments, a behaviour management plan for one person, photographs of residents and staff, and notifications of incidents affecting residents welfare were not always forwarded to the Commission. Generally the home was a safe place for people to live in and staff to work in. Some health and safety issues were noted such as, steradent tablets left out, a lack of hand washing items in some toilets and bathrooms, two bathrooms cluttered with stored items, a worn carpet in one bedroom causing a trip hazard and inappropriate bed rails. Three residents had the bed rails in place but when examined all three had issues that required immediate attention. There appeared to be a mismatch between the bed, mattress and bed rail. There were no correct bed rail risk assessments in place that covered the need for the bed rail and whether the ones used were suitable for the person and the bed. An immediate requirement notice was issued and when followed up the home had completed full risk assessments in line with health and safety guidance and determined they were not required as they would be more of a risk to people. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 29 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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 1 Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14 Requirement The registered provider must ensure the homes own assessments of peoples’ needs covers all aspects of health, social, emotional and psychological needs to enable them to make a decision about whether they could meet needs. The registered provider must ensure the home formally writes to prospective residents following the assessment stating its capacity to meet their needs. The registered provider must ensure that all assessed needs are included in the plans of care and there are clear tasks for staff in how they are to support people. Care plans must be individualised and evaluated thoroughly taking into account information in other parts of the care file and changes in need that are identified must be planned for. This will enable staff to have up to date information and guidance Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 31 Timescale for action 31/10/08 2 OP3 14(1)(d) 31/10/08 3 OP7 15 31/10/08 4 OP7 15 5 OP8 13(4) 6 OP9 13(2) 7 OP18 13(6) 8 OP19 23 9 OP26 16(2)(j) & (k) about how they are to support people. The registered provider must ensure that a specific resident has a management plan that will give guidance to staff on how to manage aspects of their behaviour that could be challenging and could compromise their hygiene. The registered provider must ensure that risk assessments are completed with measures in place to reduce risks for people who experience falls, nutritional deficits and fragile skin, and for those who wish to self medicate. The registered provider must ensure that the following medication shortfalls are addressed: • All medication admitted to the home is signed in. • Two signatures are required when staff hand write instructions on medication administration records. The registered provider must ensure that all staff receive training in how to safeguard vulnerable adults from abuse. The registered provider must ensure that environmental issues identified in the text of the report are addressed: • Bathrooms removed of clutter. • Double glazed window in one bedroom that is compromised. • The carpet in one bedroom that has developed a ridge and is a trip hazard. • Untidy wardrobes and some bulbs not working in lamps. The registered provider must ensure that hand-washing equipment is available in bathrooms and toilets to prevent infection and the unpleasant DS0000000832.V368084.R01.S.doc 31/08/08 31/08/08 31/08/08 31/10/08 30/09/08 31/08/08 Amberdene Lodge Version 5.2 Page 32 10 OP29 19 11 OP30 18 12 OP33 24 13 OP37 17 and 37 14 OP38 13(4) odour in one of the bathrooms is investigated and eliminated. The registered provider must ensure that staff are routinely employed only after a satisfactory criminal record bureau check and not as a matter of course after a povafirst check and prior to the return of the CRB. This will assist in the safeguarding of vulnerable adults that live in the home. The registered provider must ensure that all staff members complete mandatory training in line with the homes training plan and investigate training courses in conditions that affect older people such as dementia, strokes, Parkinson’s disease etc. This will ensure staff members are skilled and competent for their roles. The registered provider must ensure the system of monitoring the quality of services provided is re-started to allow for people to be consulted and improvements to be made. The registered provider must ensure that all records required for the safe running of the home are in place and up to date and notifications of incidents affecting the wellbeing of people living in the home are consistently sent to the Commission. The registered provider must ensure that the three people with inappropriate bed rails are risk assessed in line with health and safety guidelines and measures taken to minimise the risks associated with a mismatch of equipment. Regular maintenance checks must be in place for any bed rail that DS0000000832.V368084.R01.S.doc 31/08/08 31/12/08 31/12/08 31/10/08 10/07/08 Amberdene Lodge Version 5.2 Page 33 remains in place. Immediate Requirement notice issued. 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 OP7 OP7 OP7 OP8 Good Practice Recommendations To make the care files easy to read they could be divided into sections. The registered manager should make sure that all staff read care plans to ensure they are equipped with the information they need to support people. The registered manager should ensure that daily recording consistently covers the care provided to people. The registered manager should ensure that people with a poor diet have their daily food and fluid intake monitored so staff can see at a glance whether to refer for professional advice. The registered provider should consider the installation of a controlled drugs cabinet and book in preparation for any person admitted with controlled drugs or prescribed them by their GP. The registered provider should consider the employment of an activities coordinator. The registered manager should ensure one of the bedrooms is more personalised to provide stimulation for the person with dementia care needs. The registered provider should audit the commodes used in the home and replace any found to be unsuitable. The home should continue to work towards 50 of care staff trained to NVQ Levels 2 and 3. The manager should obtain information regarding skills for care common induction standards for use when inducting new care staff members. The registered provider should consider broadening the consultation process for quality assurance to gain views from other stakeholders such as care management, health professionals and other visitors. The registered manager should ensure that care staff members receive up to six, formal, one to one supervision DS0000000832.V368084.R01.S.doc Version 5.2 Page 34 5 OP9 6 7 8 9 10 11 OP12 OP24 OP19 OP28 OP30 OP33 12 OP36 Amberdene Lodge sessions per year that covers the philosophy of the home. All aspects of practice and, training and development needs. Amberdene Lodge DS0000000832.V368084.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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