Inspection on 29/11/05 for Amberleigh House

This inspection was carried out on 29th November 2005.

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

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

Other inspections for this house

Amberleigh House 17/04/07

Amberleigh House 06/06/06

Amberleigh House 31/05/05

Amberleigh House 06/01/05

Amberleigh House 05/07/04

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

CARE HOMES FOR OLDER PEOPLE Amberleigh House Longmoor Lane Liverpool Merseyside L9 7AL Lead Inspector Jeanette Fielding Unannounced Inspection 29th November 2005 10:50 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 Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 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. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Amberleigh House Address Longmoor Lane Liverpool Merseyside L9 7AL 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) 0151 525 8047 Community Integrated Care Limited Care Home 38 Category(ies) of Dementia - over 65 years of age (38) registration, with number of places Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 38 Personal Care and 19 Nursing Care within the total number of 38. To accommodate one named service user under 65 years old ate of last inspection 31st May 2005 Brief Description of the Service: Amberleigh House is registered to provide nursing and personal care for up to thirty-eight elderly persons who have dementia. The home was formerly called Longmoor Lodge. It is located within the grounds of Fazakerly Hospital, on the corner of Longmoor Lane and Lower Lane. All service users are provided with a single bedroom with en-suite facilities. Recent work has been undertaken within the home to provide full access to all areas, redecoration and refurbishment. A number of communal areas are provided to enable service users to choose which area they spend their day. Service users are free to use their bedroom or any of the communal areas as they wish. All décor is good. Bedrooms are appropriately furnished and decorated and the staff strive to provide a homely environment. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over two days. The manager was not on duty on the first day and so a further visit was made to meet with the manager and access confidential information. A new manager has recently been appointed to the home and was able to provide evidence of a review of the service together with identified changes in the service provision. The records within the home in relation to the assessment and care plans of service users were poor. Requirements have been made for these to be addressed within a short timescale. Staff records were found to be in order with all checks made prior to their appointment. Staff training needs have been identified by the manager and training courses have been planned. Additional training in relation to mental health care is required by some of the qualified nurses. Full induction training is given to all new staff. Some of the furnishings provided in the home are in a poor condition. This has been raised to the owners of the home in separate communications but no action has yet been taken. The records relating to controlled medications were found to be inaccurate and the manager was undertaking an investigation into this. What the service does well: What has improved since the last inspection? What they could do better: The documentation within the home requires considerable input to provide staff with sufficient information to meet the service users individual care needs. Training in relation to mental health, specifically dementia care, is Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 6 necessary for some of the staff. The record keeping in relation to the controlled medications must be reviewed and accurate records maintained. 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. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 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 Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 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 The pre-admission assessments on prospective service are poor resulting in inadequate care planning and a potential for service users to not receive the appropriate level of care. EVIDENCE: A new manager has recently been appointed to the home. The Statement of Purpose has been changed to reflect the changes in management of the home. A copy of the statement of purpose is on display in the entrance area of the home and fully accessible to all visitors to the home. The pre-admission assessments undertaken on service users do not give sufficient information for an effective plan of care to be prepared. The plan of care for one service user who had been admitted three weeks prior to the inspection was particularly poor. No plan of care had been prepared and no risk assessments undertaken. No mental health assessment had been made and so it was not possible to ascertain the service users mental, physical, health or social care needs to be provided. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 The care planning system within the home is inadequate and does not provide staff with the essential information to provide an appropriate level of care to the service users. The systems for handling and recording controlled medication are poor and potentially places service users at risk. EVIDENCE: Care plans were found to be generally poor and do not contain the necessary information to enable the care staff to provide the level of care required by the service users. The dietary needs of the service user were not recorded which could result in a deterioration of the service users health condition. One service users file gives details of a low salt diet being required but does not record the fact that the service user is a diabetic and receives a diabetic suitable diet. Failure to record this essential information in a plan of care has the potential for an incorrect diet to be served which may result in a deterioration of the service users condition. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 10 One care plan inspected had not been reviewed since March 2005 and there was no record of changes to the service users needs since that time. No information is recorded of the types of aggression displayed by some service users, the triggers which cause the aggression or of the action to be taken by staff to aid and assist the service user during this time. The risks to the service user, other service users and staff are not recorded to enable the appropriate level of care to be given. Mental health assessments require to be undertaken on all service users to identify how their dementia is displayed and a plan of care prepared to enable their mental health problems to be addressed. The daily reports completed by the staff do not give sufficient information regarding the nursing care afforded to service users by the qualified nurses. The record should give details of the service users condition and any treatment or intervention. It is essential that service users care needs are reassessed and comprehensive care plans prepared. All nursing and care staff should be given the opportunity to read the new plans when they have been prepared to ensure that they are made fully aware of the care needs and intervention required by all service users. Issues relating to the lack of documentation held in the home, relating to assessments and care plans, have been raised on previous inspections but have not been fully addressed. Consideration should be given to changing the documentation currently in use to a more service specific format for assessments and care planning. The recording of controlled medication gave serious cause for concern. Some entries in the Controlled Medication Record book were inaccurate and had been amended by a member of staff. The amendments were also found to be incorrect. It was evident from the CMR book that qualified nurses had failed to accurately record the amounts of medication held in the home and to record new medication entering the home. Nursing staff have a responsibility to ensure that accurate records are maintained at all times and a full investigation into this matter should be conducted. All nurses are required to handle medications in accordance with the Nursing and Midwifery Council guidelines. Failure to follow these guidelines may result in nurses being reported to the Nursing and Midwifery Council. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Dietary needs of service users are well catered for with a balanced and varied selection of food available. EVIDENCE: The records held in the home do not provide any evidence that service users cultural, social or religious interests or needs. No record is held of religious services held in the home or of service users individual participation in events taking place in the local area. Families and friends are encouraged to visit the home and to spend time with the service users. Service users may meet with their visitors in one of the lounges or in the privacy of their own bedroom. Relatives meetings are held bi-monthly to give information about the home and the high number of changes that have been made over the last twelve months, and to give them the opportunity to speak with the management team. Meals are served in the two dining rooms or in service users own bedroom as they wish. Service users are encouraged to take their meals in the dining room to promote social interaction. A choice is offered at all meals and the Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 12 menus provide evidence that a varied and balanced diet is offered. Special diets are available on request or on the advice of the GP or dietician. A review of special diets, particularly in relation to the soft diets should be undertaken. The soft diet on the day of the inspection was found to be liquidised curry which was served with rice. Whilst this may be appropriate for some service users who require a soft diet, it is not suited to others. Desserts were seen on a trolley being transported along a corridor. None of these desserts were covered to protect them from contamination. All meals being transported must be covered. Some service users choose to take their meals at the over bed table in their bedroom. Staff should ensure that these tables are cleared of other items prior to serving food and every effort made to present meals attractively with all necessary cutlery and condiments. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home has a detailed complaints policy and procedure and this is readily available to ensure that service users are protected. EVIDENCE: The home has a complaints procedure that is displayed on the notice board and also detailed in the Statement of Purpose, which is readily available in the foyer. A new manager has recently been appointed to the home who says that she has made herself known to relatives and service users to ensure that they know who to refer concerns or complaints to. Training is given to staff on the various types of abuse and the action to be taken in the event of it being suspected. Information is held in the home on the action to be taken in accordance with Liverpool City Council Adult Protection Unit. The new manager will ensure that all staff who have not undertaken training on the various types of abuse, and the action to be followed, will be given the opportunity to this. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The décor within the home is generally good, however, the poor quality of some of the armchairs detracts from the homely environment. EVIDENCE: The décor within the home is generally good with only little damage to paintwork in corridors. Some of the specialist furniture within the home is in a very poor condition. The home uses Kirton chairs for those service users who are at risk and it is these chairs which require urgent attention. Some of these chairs are damaged, being held together with tape and exposing the infill in parts. This has been highlighted as requiring attention at the previous inspections and must be addressed as a matter of priority. One chair is split along the seam between the side and the seat, denying the service user suitable support. A number of toiletries were seen to be stored in bathrooms. It is imperative that these are removed and stored safely as many of the service users do not have the capacity to understand the risks involved if these substances were to Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 15 be ingested. One bathroom used for the storage of two hoists and a wheelchair, denying access to the toilet. This bathroom has a Parker bath which is used on a regular basis and it is not appropriate for this room to be used for storage. Toilet roll holders are to be provided where they are currently missing to avoid service users having to reach to the floor or the back of the toilet to access toilet rolls. Bedrooms are decorated to a good standard and are furnished appropriately. It is evident that staff and relatives have strived to provide a homely environment for the majority of service users. Some rooms were particularly stark, with no pictures or items of memorabilia. Relatives should be encouraged to assist with the personalising of bedrooms. The smoking lounge was particularly cluttered on the first day of the inspection. The room contained three wheelchairs which were awaiting repair, two damaged Kirton chairs, together with the furniture allocated to the room. The public telephone and the television were not accessible to service users who wished to use the room. A plastic liner was seen to be in the bin. Metal bins and ashtrays should be used to prevent the risk of fire from the disposal of lit cigarettes. The home is clean throughout and there were no offensive odours. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 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 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 All staff are recruited in accordance with the set procedure and checks are made on all staff to ensure the service users protection. EVIDENCE: The home provides a qualified nurse on duty at all times, supported by care staff. Agency staff are employed to cover vacant posts, annual leave and sickness. The number of agency staff used has increased since the last inspection. In addition to the nursing and care staff, the home employs a chef and catering staff, housekeeper and domestic staff, an administrator and a handyman. The home provides qualified nurses, most of whom are Registered General Nurses. The home provides care for elderly service users who have Mental Health problems, specifically dementia, and so every effort should be made to employ Registered Mental Nurses or provide appropriate post qualification training to General Nurses. All prospective staff are recruited under the CIC recruitment procedure. This involves the completion of an application form prior to being selected for interview. Two references are taken together with checks on the Criminal Record Bureau and Protection of Vulnerable Adults registers. A five-day induction training programme is followed by all new staff. One of the days is spent in the home and four days undertaking training in health and safety, moving and handling, basic food hygiene and first aid. An employee handbook Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 17 is issued which clearly lists all the training topics and these must be signed to indicate that they have been completed during the following few months. The new manager has identified a number of training courses which she feels that staff require to undertake or refresher courses. These include first aid, nutrition, tissue viability, diabetes and continence. The manager is currently undertaking appraisals on all staff to establish where training is required. NVQ training continues to be encouraged amongst the care staff to ensure that the home meets the required 50 trained staff. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 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 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, 38 The recent change in management of the home now provides staff with leadership to further ensure the protection of service users. EVIDENCE: A new manager has recently been appointed to the home. She is a qualified nurse who has considerable experience in management. An application to register the manager requires to be submitted to CSCI. The manager had only been at the home for a few weeks at the time of the inspection. It was evident that she has identified a number of changes that are necessary to provide the service users with a quality lifestyle. New systems and methods of working have been identified and these will be implemented during the next few months. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 19 The owners of the home, CIC, undertake a quality monitoring system through the use of questionnaires. The findings are published and are available from the foyer of the home. The quality monitoring system is corporate and is not specific to the home. The views of service users, relatives and staff at the home are sought, however, it is not possible to evaluate whether the views are positive or that suggestions are acted upon. The owners produce a quarterly magazine to inform service users, staff and other interested parties about changes within the organisation and in individual homes. Records required for the protection of service users, including safety certificates, are held in the home and were found to be up to date. Copies of reports prepared following the monthly visit by the representative of the owner are held in the home. Health and safety issues are addressed by the manager and the handyman. All staff are responsible for identifying risks to health and safety and for reporting breaches. Risk assessments have been prepared for the building and the equipment provided. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 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 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 3 Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement The Registered Person must ensure that full assessments are undertaken on service users, particularly in relation to mental health, prior to admission to the home. This remains outstanding from the inspection of 31/5/05. The Registered Person must ensure that service users care plans include full information regarding the care needs, including mental health care. This remains outstanding from the inspection of 31/5/05. The Registered Person must ensure that a record of nursing intervention is detailed in the daily reports. The Registered Person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines. The Registered Person must ensure that service users DS0000025198.V270337.R01.S.doc Timescale for action 27/01/06 2. OP7 15 27/01/06 3. OP8 17(1)(a) Schedule 3(3)(k) 31/12/05 4. OP9 13(2) 29/11/05 5. OP12 12(4)(b) 29/11/05 Amberleigh House Version 5.0 Page 22 6. OP15 14(1)(a) 7. 8. 9. 10. 11. OP15 OP19 OP19 OP19 OP19 16(2)(j) 23(2)(c) 13(4)(a)& (c) 13(4)(c) 13(4)(a) 12. OP30 18(3)(a) 13. 14. OP31 OP33 8 24 religious and cultural needs are met. The Registered Person must ensure that the advice of the dietician is sought regarding special diets. The Registered Person must ensure that all food is transported hygienically. The Registered Person must ensure that all damaged furniture is replaced. The Registered Person must ensure that toiletries stored in bathrooms are removed. The Registered Person must ensure that toilet roll holders are provided. The Registered Person must ensure that the smoking lounge is cleared of stored items and made accessible to service users. The Registered Person must ensure that Qualified Nurses hold the appropriate qualifications to provide mental health care. The Registered Person must submit an application to register the manager of the home. The Registered Person must ensure that effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place. 13/01/06 29/11/05 27/01/06 29/11/05 31/12/05 31/12/05 30/06/06 13/01/06 27/01/06 Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Consideration should be given to reviewing the format of the documentation in relation to assessment and care plans. Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Amberleigh House DS0000025198.V270337.R01.S.doc Version 5.0 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. 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