Inspection on 18/06/09 for Amberley

This inspection was carried out on 18th June 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Amberley 01/07/08

Amberley 24/07/07

Amberley 14/08/06

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Random inspection report Care homes for older people Name: Address: Amberley 481-483 Stourbridge Rd Brierley Hill West Midlands DY5 1LB two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Edwards Date: 1 8 0 6 2 0 0 9 Information about the care home Name of care home: Address: Amberley 481-483 Stourbridge Rd Brierley Hill West Midlands DY5 1LB 01384482365 Telephone number: Fax number: Email address: Provider web address: paul.hughes@blueyonder.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Merron Care Ltd care home 25 Number of places (if applicable): Under 65 Over 65 0 25 0 dementia old age, not falling within any other category physical disability Conditions of registration: 6 0 5 The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 6, Old age, not falling within any other category (OP) 25, Physical disability (PD) 5 Date of last inspection Brief description of the care home Amberley is a purpose built private residential care home, registered to provide care for 25 older people, this may include six older people with dementia and five older people with physical disabilities. The home is situated on the main Stourbridge Road between Dudley and Brierley Hill. It is on the main bus route to local towns and there Care Homes for Older People Page 2 of 17 Brief description of the care home are many local amenities close by. There is off road car parking to the front and rear of the premises. Access to the home is through a small garden and patio area to the rear of the property. There are three storeys, with accommodation for people on all floors. A passenger lift services all floors. The accommodation comprises; communal lounge and dining rooms and 21 single and 2 double bedrooms. Toilet and bathing facilities are located on each floor and the main kitchen and laundry area are located on the ground floor. The fees are available on application to the home. Care Homes for Older People Page 3 of 17 What we found: We, the Care quality Commission (CQC) carried out this random inspection visit to monitor the safety and well being of people living at the home. This was because of considerable changes and disruption to the management of a number of the organisations homes. There had been serious concerns about the conduct of the organisation resulting in recent changes to the Responsible Individual nominated by the company and to the management of the homes. The registered manager of Amberley was recently nominated to take over the role of Responsible Individual and the current acting manager was transferred to this home from another home owned by the company. We spent a day at the home and looked at the homes medication systems, care records, the systems for dealing with complaints and safeguarding people, including staff recruitment. We also looked at how people were supported and given assistance to meet their daily needs. We looked around the premises and spoke to people living at the home, staff and visitors. We looked at a sample of the medication held at the home. We noted that staff had received medication training and were generally knowledgeable. However, some staff including the acting manager, would benefit from additional familiarisation with the medicines, as to their use, administration and potential side effects. There were some areas of good practice with medication well organised and we saw that it was administered to people in a timely manner, with records available. However there were a number of areas, which needed to be improved. We noted that the staff were not recording carried forward balances of medication stocks on the MAR sheets, which meant that the accurate auditing of medication dispensed in original containers could not be easily carried out. We undertook some random audits of medication stocks, the majority of which were not accurate. There were only four of fifteen audits of medication records and stocks, which were accurate. Examples were Lorazepam, an antipsychotic medicine where the Medication Administration Record (MAR) chart from 6/6/09 showed four doses administered, the total should have been 44 tablets remaining, and there were only 43 tablets, a discrepancy of 1 missing tablet. Another person was prescribed Rampril, a heart medication, where there should have been 15 remaining tablets but we could only find a stock balance of six tablets for this person, which meant there was a discrepancy of nine missing tablets. Another persons Adcal D3, calcium medication had a discrepancy of eight tablets in excess. This meant that there were no assurances that people were always receiving their medicines as prescribed by their doctor. There were a number of printed instructions on MAR sheets, which were as directed. These did not give sufficient guidance to staff working in the home and should be clarified with the prescriber or pharmacy provider. We also noted that handwritten entries on MAR sheets had not been signed and witnessed by two trained staff, which would demonstrate good practice and reduce the risk of errors. Care Homes for Older People Page 4 of 17 The bottles of liquid medication were sticky, as were some of the shelves in the drugs trolley. We discussed the need to maintain the drugs trolley in a clean condition to maintain good standards of hygiene and infection control. We also recommended that internal and external medicines should be stored separately to avoid contamination. We saw that two people had been prescribed a powerful antibiotic, Flucloxacillin, but the MAR charts with hand written entries did not show the quantity received and were not signed and witnessed by two trained staff. The acting manager acknowledged that there were no short term care plans in place for the people requiring this medication. Similarly there was no care plan for the person requiring oxygen for 15 hours each day. It was positive that there were records to show that the doctors had ratified the use of homely remedies for each person. There were also photographs with the MAR charts, which reduced the risk of medication being given to the wrong person. We also looked at the storage and administration of controlled drugs, which was satisfactory, with all records and balances of medication accurate. This meant that people requiring these powerful medicines were receiving them as prescribed by their doctor. We looked at the care records for two people and noted that there were no care plans or written protocols for the administration of when and as required (PRN) medication. We looked at the daily records for one person and noted that there was only one entry which indicated any agitated or aggressive behaviour. The lack of care plans and protocols for the use of anti-psychotic medication meant that staff did not have clear guidance and records showed that staff had administered this medication on 13 occasions in the previous 12 days without any indication of the reason for its use or any evaluation of the effectiveness. We noted that care plans were very general with replicated standard statements, and not specific to individual assessed needs or person centred. There were no care plans in place for short term conditions or for the management of dementia. We recommended the use of behaviour monitoring charts for people described as having agitated, aggressive or other challenging behaviours. The daily notes we saw were very basic, and we recommended that staff should be trained and encouraged to make them more information and meaningful about the persons life and experience at the home. There was a key worker system, which was positive and we recommended that carers as well as seniors should be involved in care planning and completing daily progress records. From our observations of people in the home, they looked well presented and dressed appropriately for weather and to maintain their dignity. A relative told us that the person they visited always had different clothes on each day and looked nice. We looked at the homes systems to deal with complaints. We saw that there was a complaints procedure displayed in the home and available in the Service Users Guide. Some of the information was out of date, it was recommended that this and other policies should be reviewed and updated. There were no other alternative formats for people who may not be able to read or understand written information. Care Homes for Older People Page 5 of 17 The acting manager told us that there had been complaints since the last inspection, in July 2008. We spoke to a relative and two people living at the home, who told us they had no complaints but could tell the staff or manager if they wanted to complain. We recommended that any minor concerns or grumbles should be recorded, with resolutions offered to demonstrate an open and proactive approach, which would encourage people to raise any concerns. The home had policies and procedures to inform staff about abuse and responsibilities for reporting suspicions or incidents. We saw that there was a programme of safeguarding training and we saw certificates for 10 staff who had recently attended training provided by Dudley Directorate of Adult, Community and Housing Services (DACHS). The acting manager told us that three additional staff had attended this training in the first two weeks in June and places for other staff had been booked. We spoke to two members of staff who told us what they would do and who they would report to. The Safeguard and Protect multi-agency procedure clearly stated that all safeguarding concerns should be reported to Dudley DACHS. The telephone number should be made available to staff, relatives and people at the home so they can directly report any suspicion or witnessed incident of abuse. We looked briefly around the premises we noted an area of serious concern. In bedroom 13 there was an area of hot water pipes next to the bed, not guarded and excessively hot to touch. This was despite written assurances of remedial action from the registered proprietor following the burns sustained from hot water pipes by the person in this bedroom on the 13 February 2009. Additionally we saw that none of the hot water pipes in any other bedroom, bathroom or toilet were guarded, posing risks of harm to people living at the home. We discussed our serious concerns with the acting manager, who acknowledged our findings. We issued an Immediate Requirement identifying the urgent actions to be undertaken. We also wrote to the company to confirm the serious concerns and the actions required to safeguard people living at the home. We were also concerned when we saw two people painting the corridors on the second floor, where they had put a protective covering placed haphazardly over two thirds of the corridor floor, presenting a tripping hazard. There were also open containers of paint on the floor and there was an open bedroom with a frail elderly person sitting in their room exposed to the paint fumes. The workmen were not supervised in this area. We asked the acting manager if there was a risk assessment in place relating to the redecorating taking place in the communal area where people at the home and staff had to be in the vicinity. She acknowledged no risk assessments had been undertaken. The acting manager did not have information about whether the painters were employed, self employed or contractors. She told us that one of the Directors had arranged for them to work at the home. When we them about their employment status. They told us that they were friends of the Director of the company and acknowledged that they did not have Public Liability Insurance or CRB clearances. We discussed this information with the acting manager who decided to request the painters to pack away their equipment and leave the home. We emphasised the need to ensure all work activities at the home were appropriately risk assessed with measures in place to safeguard the people living at the home. Furthermore there should be serious consideration of implications of any work or activity, which could compromise the homes insurance. In one bedroom we saw bedrails in place with pro pad pressure relieving mattress in use. Care Homes for Older People Page 6 of 17 The height of bedrails was less than 30mm, instead of the permitted height dimension of 200mm from uncompressed mattress to the top of the bedrails. There were also excessive gaps and no headboard on the bed, though the acting manager did not know the reason this was missing. We did not see appropriate risk assessments or regular documented checks for bedrails, which might pose significant risks of harm to people at the home. We noted that door locks on ground floor WCs were broken and there was also a toilet roll holder. We asked why these items had not been repaired or replaced. The acting manager told us that though the home had a small float of petty cash some time ago, this was not regularly replenished. We were told the home managers in the company did not have regular petty cash to deal with minor repairs or replacements. We strongly recommended that the manager has the authority and sufficient financial resources to maintain the home so that people living have their rights to privacy, dignity and independence protected. Generally the premises were not being maintained to acceptable standards. Work was needed to remedy the untidy garden areas, the flaking exterior paintwork and dirty windows. The interior of the home also needed attention in many areas. Some examples were carpets were faded, worn and stained in communal corridors, and some bedrooms, also had some unpleasant malodours. The very small laundry also needed renovation to maintain the integrity of walls and flooring for effective infection control measures, especially as there were recent infections at the home. The acting manager appointed to this home on 13 February 2009 acknowledged that she had not undertaken an audit of the premises and there was no documented repairs, replacement and maintenance programme in place. She told us that a new handyperson had been employed for all the homes but she had not met him. She informed us that the Director had recruited this person and there were no personnel records held at this home. The majority of WCs needed to be redecorated. We saw a bathroom with walk in shower, where the non slip bath mat had stains and mould on the underside and the acting manager disposed of this during the inspection visit. We saw a WC with a raised seat in need of thorough cleaning. We saw some bathing and toilet facilities, which had been painted but not finished to a good standard. For example the window frame and sill had not been painted and paint splashes had been left on the flooring. There were some improvements such as the new carpet in main lounge, and the WC and bathroom doors on ground floor had been painted red for orientation, though this had not been done throughout the first and second floors. In the kitchen there were new units, work surfaces and flooring. A replacement door to exterior had also been provided as the previous door was not closing properly. However all of the improvements to the kitchen had been required in an Environmental Health Officers report. It appeared that the work was carried out reactively as opposed to proactively. We saw that there were 21 people accommodated at the home, with a range of diverse needs. We looked at copies of staff rotas and discussed the staffing levels with the acting manager in relation to occupancy and dependency levels. We asked the acting manager to tell us about the people accommodated, to identify what were their diagnosed conditions were and the numbers of people in each registration category. She acknowledged that she was not aware of each persons primary diagnosed needs or the Care Homes for Older People Page 7 of 17 category numbers of people in each registration category. From discussions we established there were about nine people who needed two staff to assist them with personal care needs and about five people who needed feeding and others assistance to eat. People were accommodated on three floors and some people chose to stay in their rooms, which was positive that they had this choice. We saw that the staffing levels were four carers on the early shift, with a domestic and cook. The acting manager told us that her hours were usually supernumerary but on the day of this inspection she was covering the cooks duties because he was sick. It was evident that she also covered senior care shifts when the need arose. We were also told that one of the directors had recently reduced the number of carers on the late shift to three. We assessed that this was not sufficient to provide safe levels of cover at this home or to be able to meet each persons needs. We required that and that the former staffing levels must be reinstated immediately until such time a staffing proposal is submitted to the CQC. This must take account of peoples needs and the amount of time care staff spend undertaking ancillary duties such as laundry, catering and cleaning on late shifts. As already highlighted there must be sufficient resources to improve the standards of cleanliness and infection control throughout the home. There must also be allocated time for activities and socialisation for people living at the home. We looked at a sample of two personnel files of staff recently employed. The files were generally well organised with a recruitment checklist. However the recruitment process was not robust and did not provide safeguards for people living at the home. As already highlighted there were no recruitment records for the handyperson due to commence work at the home. Other examples were the application form only requested 10 years employment history, instead of a full employment history. One persons application form had an employment gap of a year, which had not been explored. The other persons application form did not give sufficient information about employment dates and gave no employment history since 2001, which had not been explored. Both staff files only contained one satisfactory written reference and one persons reference form had been returned with the comment, no record of this person. The acting manager acknowledged that there was no evidence that this had been explored or that another reference had been obtained. She told us the recruitment had been undertaken by the previous Responsible Individual, Jenny Green. There were no job descriptions, or copies of interview questions and answers on personnel files, which would demonstrate good practice and there were and no copies of evidence of identification on one persons file. On a positive note there was evidence of an in house induction on the staff files and evidence of the Skills for Care Common Induction Standards being completed. We discussed the management arrangements for Amberley Care Home with the acting manager, Tracey Williams, and the acting Responsible Individual, Yvonne Hughes. We clarified information contained in a letter sent to the CQC, which stated that Tracey Williams would be the acting manager at The Mount Care Home. We were told that a decision had been made that Tracey Williams would move from The Mount to take up a post as manager at Amberley and a newly employed acting manager would be the manager at The Mount Care Home. We were told that Tracey Williams had previously worked at Amberley for seven years as a night care assistant, promoted to senior carer and then promoted to deputy manager. She had been requested to go to The Mount Care Home and she then returned to Care Homes for Older People Page 8 of 17 Amberley as interim acting manager in February 2009. We were told she had an NVQ 3 qualification and had recently enrolled on the Leadership and Management for Care Services Award, with training provider GB Training. She also had an NVQ level 2 Team Leading award and up to date mandatory training. The acting manager told us she was aware of the voluntary agreement with the CQC that there should be no further admissions to the home until there was satisfactory evidence that the management arrangements are stabilised and there could be assurances for the safety and well being of the people living in the homes owned by the company. There were some rudimentary quality assurance checks but as already identified there was insufficient evidence of rigorous audits, with remedial actions for improvements. Examples were the concerns about the management and administration of medication, the standards of the premises, the lack of rigorous recruitment and lack of risk assessments to safeguard people at the home. We were told the company director and previous Responsible Individual had not provided supervision sessions for the manager. The acting manager and the new acting Responsible Individual (RI) acknowledged there were no recorded Regulation 26 visits and reports. We were told that the acting (RI) frequently visited the home and was planning to introduce unannounced Regulation 26 visits and Reports in the near future. We looked at the fire safety records, which appeared satisfactory and noted that there were regular fire drills, which had included night staff and new staff. We also looked at accident records and Regulation 37 notifications. However the acting manager acknowledged there was no accident analysis and evaluation, which would be good practice to identify trends and identify risks, which could be controlled or minimised. It was positive that risk assessments for bed rails completed during the inspection visit. What the care home does well: What they could do better: There must be robust management arrangements are in place at all times and any changes must be notified to the CQC without delay. This is to give assurances that all persons living at the home are safe from all risks of harm. We were concerned that some of the medication practices observed were potentially Care Homes for Older People Page 9 of 17 unsafe. The organisation must make sure that all staff who are involved in the administration of peoples medication are trained and competent, and that everyone living at the home receives their medication as prescribed by their doctor, with safeguards in place to maintain their health and well being. Plans must be put in place to meet the needs of people with complex needs such as dementia. The premises was not being maintained to acceptable standards, it was shabby, dirty and had unpleasant malodours in places. There must be a properly planned maintenance programme with arrangements to keep all areas of the home clean and fresh at all times to create a pleasant place for people living there. There must be adequately numbers of trained, experienced and competent staff with robust and thorough employment checks in place at all times to make sure the people living at the home are safe and cared for appropriately. There must be improved quality assurance audits of all areas of the service, including medication, the premises and risks of accidents to people living at the home. There were other significant areas of health and safety at the home, which required prompt attention and improvement, such as the use of bedrails. We were also seriously concerned to see that hot water pipes, which had previously caused an injury to someone living at the home, were left unguarded, despite written assurances this work had been carried out. We issued immediate requirements for those areas, which required the most urgent action. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 10 of 17 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 11 of 17 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 38 13 Action must be taken to 06/07/2009 devise and implement documented risk assessments for all unguarded hot water pipes in the home, identifying control measures with immediate effect. Action must be taken to arrange for all hot water pipes accessible to people living at the home, to be appropriately guarded in a timescale to be identified to the Care quality Commission. Action must be taken to notify the appropriate Health and Safety Agency of the accident, without further delay. This is to safeguard people living at the home from risks of harm. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The registered persons must 20/07/2009 ensure there are care plans in place for the administration of when and as needed medication and staff act appropriately to Page 12 of 17 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action monitor and inform the relevant healthcare professionals as needed. This is to safeguard the health and well being of people living at the home. 2 9 13 To ensure that all persons 20/07/2009 living at the home receive their medication as prescribed by their doctor, with medication receipted into the home and Medication Administration Records must be accurately completed to demonstrate either medication has administered or an appropriate code entered to record the reason for non administration. This is to maintain the health and well being of people living at the home. To ensure that there are 01/08/2009 systems in place for cleaning all areas of the home, with sufficient numbers of ancillary staff, to diligently maintain effective standards of cleanliness and infection control. This is to safeguard people living in the home from risks of infection and provide them with a clean and pleasant living environment. 4 27 12 To review the occupancy and 01/08/2009 dependency levels of people Page 13 of 17 3 26 12 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action accommodated at the home and clarify the diagnosis and numbers of people in each registration category and submit staffing proposal to the CQC demonstrating that the needs of each person are understood and can be met at the home. This must include information about ancillary duties undertaken by care staff, which may negatively impact on availability to meet each persons needs. This is to ensure that the health, well being and safety of people living at the home can be assured at all times. 5 29 19 The registered persons must 20/07/2009 ensure that all staff employed at the home are recruited following robust recruitment procedures, with documentary evidence to demonstrate diligent compliance with The Care Homes Regs 2001, Reg 19(1). This is to safeguard people living at the home from risks of harm. 6 33 26 The Registered Provider or a 31/07/2009 nominated person must consistently undertake monthly unannounced quality monitoring visits as to the conduct of the home with reports available to the home and CSCI in Page 14 of 17 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action compliance with Regulation 26 of the Care Home Regulations 2001. This is to ensure that the health, well being and safety of people living at the home can be assured at all times. 7 38 13 To ensure that the risk 10/07/2009 assessments for bed rails are expanded to incorporate all areas of risk to the person, including risks of entrapment and incompatibility with the bed and or mattress. This is to safeguard people living at the home from risks of harm. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is recommended that carers as well as seniors should be involved in care planning and completing daily progress records to make them more meaningful. That the all health care risk assessments and care plans include all of each persons assessed needs, and accurately reflect all changes to health and needs, and be referred for professional advice where necessary. It is recommended that serious consideration should be given to use of Antecedent, Behaviour, Consequence (ABC) records to evaluate the effectiveness of strategies and use of PRN medication for residents with challenging or distressed behaviours. That internal and external medication should be stored separately and the drugs trolley and containers should be Page 15 of 17 2 7 3 8 4 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations maintained in a clean condition. 5 9 It was recommendation that Patient Information Leaflets should be obtained from the pharmacist for medication dispensed in blister packs, so that staff have written guidance as to how medication should be administered, what it is used for and to be aware of possible side effects. That all handwritten entries on MAR sheets are dated signed and witnessed by staff who are trained and competent. That carried forward stocks of medication are recorded on each persons MAR sheet and random audits of medication stocks should be carried out, with recorded remedial action for any discrepancies. It is strongly recommended strongly recommended that there should be allocated time for activities for a minimum of 15 hours per week, with staff training to ensure appropriate social stimulation was offered to everyone and especially to people with dementia and sensory disabilities. The telephone numbers of social service departments who support the people living at the home should be available to staff, relatives and each person so that they can report any suspected or witnessed abuse directly if needed. It was recommended that all staff should be given time to read and familiarise themselves with the homes safeguarding procedures and the Safeguard and Protect procedure for vulnerable adults with signatures and dates to evidence their awareness. We strongly recommended that the manager has the authority and financial resources to maintain the home so that people living have their rights to privacy, dignity and independence protected. It is strongly recommended that a copy of the DoH guidance Essential Steps should be used to audit and improve infection control measures at the home. It is strongly recommend that a competent person should undertake a visual check of bedrails in the home on a daily basis to ensure that they are safe. A record must be made of these checks. 6 9 7 9 8 12 9 18 10 18 11 19 12 38 13 38 Care Homes for Older People Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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