Inspection on 31/05/05 for Amberleigh House

This inspection was carried out on 31st May 2005.

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

The inspector 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 29/11/05

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 L9 7AL Lead Inspector Jeanette Fielding Unannounced 31 May 2005 9.30 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Amberleigh House Address Longmoor Lane, Liverpool, Merseyside, L9 7AL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0151 525 8047 Community Integrated Care No registered manager currently in post Care Home with Nursing 38 Category(ies) of DE (E) Dementia - over 65 registration, with number of places Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 38 Personal Care and 19 Nursing Care within the total number of 38 To accommodate one named service user under 65 years old Date of last inspection 6.1.05 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 and furnishings are of good quality. Bedrooms are appropriately furnished and decorated and the staff strive to provide a homely environment. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Insufficient information is gathered prior to admission to the home regarding the specific needs of the individual thereby denying service users the care they require. EVIDENCE: Pre admission assessments are undertaken on all service users prior to their admission. The reports prepared by social workers are also requested, but not always provided. The assessments give full details of prospective service users physical and medical history but do not give much detail of the service users mental health. In that the home is registered to care for elderly people who have dementia, there is a lack of information on how their dementia presents itself. Little is known prior to admission to the home on issues such as wandering, aggression or past mental health conditions. A new pre admission assessment form should be prepared to ensure that all relevant information is gathered, particularly in relation to mental health. The home must ensure that all care needs are identified prior to the preparation of a plan of care. The home does not offer intermediate care services. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The lack of detailed assessments results in care plans not containing sufficient information and puts service users at risk. EVIDENCE: The care plans are completed following an assessment of need. As detailed previously, insufficient information is recorded in relation to the service users mental health condition. This has an impact on the care plans which do not give sufficient information regarding the care to be given in relation to the service user’s dementia. Qualified nurses and team leaders have been given training on care planning, but it is evident that without the necessary information being gathered during the assessment process, sufficiently detailed care plans cannot be prepared. Some risk assessments have been prepared, and generally, these are good. Additional risk assessments have been identified as necessary following recent accidents within the home. The daily reports completed by staff, and the care files, provide details of visits made to and by GP’s and other care professionals. The tissue viability nurse is contacted where necessary and the district nurse visits those service users who are accommodated for personal care as required. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 9 Medications are generally dealt with in accordance with the home’s policy and procedures. Staff are advised to provide evidence that all hand written entries on medication administration record sheets are checked and witnessed by two persons and the provision of two signatures. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Dietary needs of service users are catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: The home employs an activities co-ordinator for 35 hours each week over five days. Discussion with staff and the activities co-ordinator provided information regarding the activities provided in the home. The records regarding the activities were not in the home at the time of the inspection and so it was not possible to establish exactly what had recently taken place, which service users had participated or how much the service users had enjoyed the activities. These records should be held in the home at all times. Visitors are welcome in the home at any time and service users may meet with their visitors in the privacy of their bedroom or in one of the communal areas as they wish. Some service users are taken out by their families. 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. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 11 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 menus provide evidence that a varied and balanced diet is offered. Special diets can be provided on request or on the advice of the GP or dietician. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The home has a satisfactory complaints system with some evidence that relatives’ views are listened to and acted upon. EVIDENCE: The home has a complaints procedure that is displayed on the notice board and also detailed in the Statement of Purpose. Five complaints have been received by CSCI in the last twelve months. There is currently no manager in the home and one relative said that they were not sure who to make a complaint 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. Some of the staff have recently been given training on the Protection of Vulnerable Adults. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, 26 Recent investment has significantly improved the appearance of this home creating a comfortable environment for those living there and visiting. EVIDENCE: Considerable improvements have taken place within the home within the last twelve months to provide a more pleasant and homely environment for the service users. All service users are accommodated in single bedrooms with ensuite facilities to protect their privacy. Rooms are tastefully furnished and it is evident that staff assist service users to personalise their rooms. The home is laid out on the ground floor and is fully accessible to those service users who require the use of wheelchairs or have mobility difficulties. The home provides one large lounge dining room, one dining room and several small seating areas throughout the building. The home has a central courtyard for service users to use as they wish. One of the access points to this area is not in use as the ramp down from the building is unsafe due to deterioration and damage. The garden within the courtyard contains a lot of weeds and is in need of considerable attention. The Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 14 old wheelchairs stored in this area should be removed as they present as a risk to service users. The home is clean throughout and there were no offensive odours. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Limited progress has been made on the staffing shortage and as a result service users do not receive consistent care. EVIDENCE: The home provides a qualified nurse on duty at all times, supported by care staff. The number of accidents within the home and the complaints received by CSCI has identified a need for the staff numbers and deployment to be reviewed. 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, although a proposal has been made by the owners for the handyman to work at the home on a part time basis. The number of care staff who have achieved an NVQ qualification is extremely low, however, nine care staff are currently working towards an NVQ at level 2. There is no evidence that the staff within the home have been given training specific to the dementia needs of the service users to enable them to understand the changing needs of the service users. Two staff are currently undertaking training on care planning and the administration of medications. The home has a robust recruitment procedure. All applicants are required to complete an application form. Two references are taken and criminal record bureau and protection of vulnerable adults checks are made. The recruitment process in accordance with equal opportunities requirements. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 16 Staff are issued with workbooks to provide evidence of induction and on-going training. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 38 The quality monitoring system in place does not provide evidence that service users and relatives views are sought and acted upon. EVIDENCE: There is no registered manager in day-to-day control of the home. It is essential that a manager be recruited and an application to register the manager submitted to CSCI. 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. Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 18 The owners are appointees for some of the service users and all details are held at head office. These were not viewed at this inspection. The families or advocates deal with other service users personal allowances. 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 acting 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 F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 x x x x 3 x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 1 x 3 x x x x 3 Amberleigh House F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 20 Yes 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 3 Regulation 14 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. The Registered Person must ensure that service users care plans include information regarding mental health care. The Registered Person must ensure that sufficient staff are employed and deployed to meet the needs of the service users. The Registered Person must ensure that a suitably qualified and competent person in employed to manage the home. Timescale for action 08/7/05 2. 7 15 08/7/05 3. 27 18 08/7/05 4. 31 8 29/7/05 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 16 Good Practice Recommendations The courtyard garden should be made safe and accessible to service users. F52 F02 S25198 Amberleigh House V230828 310505 Stage 4.doc Version 1.30 Page 21 Amberleigh House Commission for Social Care Inspection Liverpool Area Office 3rd Floor 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. 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