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Inspection on 10/05/06 for Amberley Court Nursing Home

Also see our care home review for Amberley Court Nursing Home for more information

This inspection was carried out on 10th May 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has spacious corridors and doorways to accommodate people who are wheelchair users. There is a good range of communal rooms for residents and visitors to frequent. These are currently under review in order to maximise their potential. There is a harmony suite that is very well appointed. The home also has a spacious computer room with specially adapted equipment for persons with physical disabilities. The usage of the grillroom situated on the first floor has been reviewed, as a result new dining tables and chairs arrived during the inspection. The room has its own kitchen, which lends itself to supervised accessed by residents. Bedrooms are very personalised and equipment installed to promote residents independence.

What has improved since the last inspection?

The management structure has been confirmed and is now completed with the recent recruitment of an experienced manager resulting in clear lines of accountability. A review of the levels of trained and care staff has been carried out and changes implemented. The recruitment drive has resulted in no agency staff usage of trained staff and a minimal amount of carers during the last two weeks. The home anticipates a total non-usage of agency staff within the next few weeks. The home has appointed a maintenance operative who demonstrated a proactive approach to ongoing remedial tasks. A replacement head housekeeper has been appointed but not yet commenced employment. The home gave an impression of being more organised and tidy, a generally lighter atmosphere and improved staff morale and team working. Although not completed the home has a programme to provide staff with mandatory training and some trained staff have had training to extend their scope of practice in order meet the specialist needs of residents. Residents and relatives are being informed and consulted about the day to day running of the home. Significant improvements have been made in respect of health and safety, many risk assessments, an audit of the premises and action plan have been developed.

What the care home could do better:

Care plans continue to be inadequate and need to be adapted for the majority of the client group; younger adults. The home needs to address the longstanding concern regarding formal staff supervisions. The commenced programme of mandatory training of all staff needs to be completed. Appropriate door opening methods such as low level touch pads need to be installed to enable residents to access all communal areas and their bedrooms. Completion of the recruitment drive to appoint an activities organiser needs to be completed as soon as practically possible. Three Immediate Requirements were left at the home regarding urgent assessment of a resident for unspecified weight loss, failure to comply with Regulation 37 by informing CSCI of incidents that affect the health and well being of residents and safe storage of a key to a COSHH cupboard.

CARE HOMES FOR OLDER PEOPLE Amberley Court Nursing Home 82-92 Edgbaston Road Edgbaston Birmingham West Midlands B12 9QA Lead Inspector Kath Strong Unannounced Inspection 10th May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 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. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Amberley Court Nursing Home Address 82-92 Edgbaston Road Edgbaston Birmingham West Midlands B12 9QA 0121 440 4450 0121 446 4670 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) BUPA Care Homes (BNH) Limited Vacant Care Home 70 Category(ies) of Dementia - over 65 years of age (70), Old age, registration, with number not falling within any other category (70), of places Physical disability (70), Physical disability over 65 years of age (70), Terminally ill (70) Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. General nursing, males and females over 65 years and younger adults with physical disabilities or requiring terminal care. Up to 10 persons may receive day care additional to those in residence; subject to ability to meet all needs. 24th November 2005 Date of last inspection Brief Description of the Service: Amberley Court is a large purpose built nursing home; it is situated within the Moseley/Edgbaston area of Birmingham. The home provides care for a diverse range of residents both in terms of age, ethnicity and care requirements. There are plans to restrict further admissions of older persons with a gradual conversion to focussing upon care for younger adults. The current occupancy of younger adults far outweighs the ratio of older persons. The premises include three stories with the top floor housing the laundry facilities, staff rooms and offices. The first floor consists of two areas, one for high dependency care and the remainder for rehabilitation. The first floor also provides a dedicated computer room for use by residents and a grillroom/dining room where meals can be ordered throughout the day. Further rooms include a harmony suite and a lounge that has been adapted for wide screen television use and discos. The ground floor has a large dining room, which is accessible by wheelchair users; meals are served over two sittings with timings being fairly flexible. Two more lounges are available on this floor situated at each end of the home. A review for the usage of communal rooms is currently in progress. All communal rooms, bedrooms and bathing facilities are located on the ground and first floors. All bedrooms have en-suite facilities consisting of toilet and wash hand basin. A fenced garden area surrounds the home and is linked to a further garden, which is also accessible from the dining room. There is a large off road car park, which accommodates many cars and larger vehicles. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the visit was to carry out an unannounced inspection, which took place over two protracted days by two inspectors. All key standards were assessed and others deemed necessary. Information was gathered from in depth discussions with the general manager, the recently appointed manager, staff, residents and relatives. Staff practices and interactions with residents were observed. Relevant documentation was examined and nine care plans reviewed, two of which were case tracked in order to determine if all identified needs were being met. Staff interviews were carried out with five members of the care team, two of these focussed upon the clinical knowledge of trained staff. The activities programme, complaints and adult protection procedures were assessed. Many aspects of health and safety were checked. Staff recruitment systems, staffing levels and training were examined. A tour of the premises was carried out. At the conclusion verbal feedback was given to the general manager, the manager and the clinical manager. Three Immediate Requirements were left with the home. What the service does well: What has improved since the last inspection? The management structure has been confirmed and is now completed with the recent recruitment of an experienced manager resulting in clear lines of accountability. A review of the levels of trained and care staff has been carried out and changes implemented. The recruitment drive has resulted in no agency staff usage of trained staff and a minimal amount of carers during the last two Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 6 weeks. The home anticipates a total non-usage of agency staff within the next few weeks. The home has appointed a maintenance operative who demonstrated a proactive approach to ongoing remedial tasks. A replacement head housekeeper has been appointed but not yet commenced employment. The home gave an impression of being more organised and tidy, a generally lighter atmosphere and improved staff morale and team working. Although not completed the home has a programme to provide staff with mandatory training and some trained staff have had training to extend their scope of practice in order meet the specialist needs of residents. Residents and relatives are being informed and consulted about the day to day running of the home. Significant improvements have been made in respect of health and safety, many risk assessments, an audit of the premises and action plan have been developed. 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. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 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 Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 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): 1, 3 The quality outcome in this area is good. Prospective residents and professionals are not supplied with adequate written information to make an informed decision about the home. The written admissions policy is out of date; the pre-admission assessment tool includes all relevant aspects to provide an indicator of the homes ability to meet the needs. EVIDENCE: The recently revised statement of purpose and service user guide were examined post inspection. Two items not included in the statement of purpose (admission criteria, care planning and reviews) were included in the service user guide. A copy is supplied to each bedroom and is also available at the reception desk. The home must ensure as indicated that a copy of the latest inspection report is available at reception. The home is strongly encouraged to change the registration category. With the current occupancy of 9.6 older persons and the planned admissions policy of younger adults only the home needs to formalise this process. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 9 The homes pre-admission assessment tool was noted to be adequate. Since the homes last inspection there have been no new admissions for inspectors to check the standard of recordings, therefore this standard has been partially assessed. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality outcome in this are is poor. Care plans do not provide a consistent system to provide staff with adequate information to deliver acceptable levels of care. The health care needs of residents are not being fully met. Staff practices to maintain the privacy and dignity of residents appeared to be satisfactory. EVIDENCE: One care plan (daily records) provides details of an incident (March 2006) action taken and the support provided; this is viewed as being good practice. Staff instructions regarding type of hoist and sling sizes have been recorded; this is viewed as an improvement. Further good practice noted was that a resident had agreed his care plan by signing each section of it. A resident said, “Everything is fine”. Care plans have not been adapted to reflect the majority occupancy, which consists of younger adults. No progress has been made since the last inspection. The following concerns were found: • Failure to carry out and record residents weights every month • The eating and drinking monthly review for a resident was last carried out 06/02/06 Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 11 • • • • • • • • • • • • • • • • • The scalp ulcer care plan did not include how the ulcer had been incurred i.e. via incorrect fitting of the head brace Daily records focus upon personal needs, these should supply more diverse information No care planning for short term complications such as chest or urinary tract infections No risk assessments in place for residents who access the community Risk assessments need to be carried out regarding those residents who require frequent checks Conflicting instructions in a file regarding the frequency of night checks, one area states half hourly and another section hourly. Another file states that a change of position should be carried out every three hours but every four to five hours in another section of the file Failure to update nutritional assessments every month Documentation regarding difficult to manage behaviour for some residents needs to be more specific to in clued likely triggers and behavioural pattern or how staff should deal with such incidences Accidents and incidents found documented in the accident book have not been taken into account when care planning or carrying out reviews Lack of care planning regarding self-harm Initial care plan stated that physiotherapy was being supplied every two weeks but reviews had not taken into account that the frequency of the visiting physiotherapist had decreased Another care plan informed that a PEG feed had been discontinued but did not indicate the date A fluid balance chart had not been completed since 04/05/06 A continence assessment had not been signed or dated Recordings made in incorrect section of care plans i.e. entitled ‘Epilepsy’ also states that staff should contact the GP if the resident refuses to eat, the infection of a head wound had been included in the section entitled ‘Care of Gastrostomy Feeding Tube’. A care plan regarding personal hygiene indicates that the resident should be showered three times per week, which has later been crossed out and changed to twice, this has not been dated or the rationale included A wound ulcer chart does not reflect the improvement from grade four to possibly grade two. Concerns regarding the health care of a resident and the knowledge of a trained member of staff were identified: • Resident MC’s unexplained weight loss in excess of 10 over the last six months. Further loss of 8.8Kg during the previous month was identified and not acted on. The charts in respect of types and amounts of food and fluids taken indicated poor food and fluid intake. An Immediate Requirement was left at the home for urgent assessment to be carried out by a GP or Dietician Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 12 • • • • • The care plan of a resident states that she should be re-positioned every three hours however, the charts indicated that this was being carried out three or four times a day A trained member of staff failed to demonstrate acceptable knowledge regarding the communication ability of a resident and the involvement of external professionals. This was compounded by her lack of knowledge of how to assess a pressure ulcer A member of staff said that there was a need to increase the mobile hoists by one in order to prevent residents experiencing excessive delays in being transferred A trained member of staff raised concerns regarding the lack of intensive physiotherapy for those residents who show potential to improve The needs and lack of action regarding a resident’s temporary placement were discussed and recommendations made. PHARMACIST REPORT Name and address of Home Amberley Court, Oakfield Road, Edgbaston Date of inspection 22/05/06 Time 10.10 Date of report 22/05/06 Inspecting Pharmacist Debby Railton Other inspectors present Supplying pharmacist Parade Pharmacy PCT SB PCT practitioner General What the service does well: What has improved since the last inspection? The medicine management has improved to a safe level. Staff have worked hard to ensure that all the medicines are administered as prescribed and records support this. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 13 What they could do better: JUDGEMENT: The systems for medicine management have improved since the last inspection. Clear comprehensive arrangements had been installed to ensure service users medication needs are met. EVIDENCE: All the nursing and managerial staff have worked hard to improve and maintain the level of medicine management seen in the home. Audits undertaken to demonstrate that the medicines are administered as the doctor intended and records supporting the transactions were accurate. Staff refer to the Medicine Administration Record (MAR) chart, offer and administer the medicines and accurately record the transaction. Staff support residents who wish to self-administer their own medicines. Compliance checks are undertaken but staff to not react to information gathered from the compliance checks. This was discussed at the inspection and was to be implemented. The nursing staff have a good relationship with the doctor and also the supplying pharmacist. One resident interviewed during the inspection was pleased with the level of care she received and also the practice surrounding the administration of her medicines. Managers regularly audit the staff to ensure that they administer the medicines as prescribed and accurately record the transactions. In house training sessions have been attended by the nursing staff to maintain and improve practice. All the Controlled Drugs audited where accurate and the supplying pharmacist witnessed the destruction of any surplus, which was commended. All the medication rooms have had an air conditioning system installed. All the medication was stored in the correct environment to maintain their stability. Nursing staff assess all new residents medication before they come into the home, including those receiving respite care. Information gathered was not checked with the prescribing doctor before administration but the MAR charts were well written recording all the required information for other nursing staff to follow to accurately administer medicines. Observations revealed no concerns regarding the maintenance of privacy and dignity of residents. Staff were noted to use the preferred term of address and personal care was delivered in the privacy of a bathroom or the residents own room. One carer displayed excellent skills in her ability to communicate with a resident and another her knowledge of resident’s likes/dislikes and preferred portion sizes during the serving of a meal. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 14 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 The quality outcome in this area is adequate. The in-house and external activities programme fails to reflect the needs and aspirations of residents. Residents are encouraged to exercise control about their lives and the day to day running of the home. The meals are good offering both variety and choice and catering for special diets. EVIDENCE: The weekly activities programme for the week commencing 1st May provided options for each morning and afternoon covering seven days. The programme appeared to age appropriate for older persons but rather limited in scope for younger adults. The home no longer has an activities organiser; as a consequence no further programmes have been collated. Advice was given that the home is actively recruiting to this post. Files include the life history, background, likes and dislikes and residents preferences. Some care staff were noted to be instigating and participating in activities where possible. Residents were seen accessing the computer room, which provides recreational activities as well as training. Future programmes need to include the preferences of both types of clientele whilst ensuring that the various staff disciplines communicate with each other, there are sufficient resources available to meet the programme and documentary evidence of those residents who have participated. The home does not have its own transport. On the first day of the inspection due to clement weather the monthly disco was being Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 15 held in the garden. The event included a buffet, soft and alcoholic drinks. Good interactions were noted between staff and residents and a relative was in attendance. One resident said, “It makes you feel better”. He also reported that the lack of activities organiser had impacted a little by restricting resident’s ability to be accompanied to go out shopping. The home has themed events such as a 1950’s night and St Patrick’s Day celebrations and is currently planning a beach party. Residents spoken with provided positive feedback about the themed events and parties. A resident goes to a community centre regularly and another was enjoying various external events involving periods a way for the home. Monthly residents and relatives meetings have recently been established, from which minutes are collated and distributed accordingly. The home has residents with a large range of cultural and spiritual needs. Documentary evidence needs to be in place regarding how these will be met. The atmosphere in the home was relaxed, sociable and conducive. The home has a four week rolling menu that provides a good range of choices resulting in a balanced and nutritious diet for residents. The menu provides flexibility in respect of when the main meal of the day can be taken with both lunch and the early evening meal offering hot and cold meals and a number of desserts. Supper is provided each day offering salads, snacks and fresh fruit however, this meal is not included on the menu. Meals are well presented and staff were observed offering constructive assistance as required. Residents are able to take meals in the main dining room, the grillroom or in their own rooms. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 16 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 quality outcome for this area is adequate. Action taken in response to residents and relatives comments and concerns are not comprehensive. The arrangements for adult protection are not robust enough to ensure that residents are protected from harm or abuse. EVIDENCE: A copy of the written complaints procedure supplied to an inspector was dated March 2003 and did not include a timescale for resolution. However two copies of a complaints procedure found in the reception area were noted to be satisfactory. The home is advised to operate from one uniform procedure. One formal complaint has been received by the home since the last inspection of November 2005. The process of logging did not include all aspects of the complaint, there were no details regarding the type of investigation carried out and the response letter sent to the complainant did not cover all of the issues raised in the complaint letter. The home is currently using Birmingham City Councils written guidance on adult abuse and management’s responses in respect of recent events in this aspect have been appropriate. The programme of staff training in protection of vulnerable adults needs to be completed for all staff. The written policies regarding physical restraint and missing persons need to be updated. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 17 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, 20, 21, 22, 24, 25, 26 The quality outcome in this area is adequate. Accommodation provided to residents is warm, comfortable and homely. Work needs to be carried out to enable ease of access to all communal rooms and respective bedrooms. EVIDENCE: The recently appointed maintenance operative escorted an inspector during her tour of the premises. He was noted to adopt a proactive approach to recording of repair works that were found during the tour; this is viewed as being good practice. The home has continued to generally improve since the last inspection and two subsequent monitoring visits. Communal rooms, corridors and bathrooms have been redecorated resulting in a cleaner and fresher appearance and some furniture has been replaced. The usage of the communal rooms is currently being reviewed to maximise their potential. The smoke room situated on the ground floor is to be converted to a general lounge with doors off leading to the enclosed garden that surrounds the building. The doorway from this room will need to have a ramp installed for ease of access by wheelchair users. This garden area provides much potential Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 18 but needs to be tidied and cleared of weeds. The well appointed harmony room is available at all times for residents to frequent. The infrequently used lounge adjacent to HDU on the first floor has been converted to an activities room. The grillroom will be supplied with dining tables and chairs; these had been delivered to the home during the inspection. The kitchenette off provides potential for residents to access to develop their skills in food preparation. Advice was given that only two residents smoke, the smoking room has been re-located. Inspectors noted that some aspects, which have not been taken into account during the previous assessment of the premises, remain outstanding: • Due to physical disabilities some residents are unable to access their bedrooms • The lack of ramp from the garden to the dining room, difficulties in access were observed during the disco evening • Difficulties encountered by some residents to open the corridor and communal room doors, this is especially evident for the residents who have an extended wheelchair. Bathing rooms were found to be improved regarding decoration and facilities. Some concerns were noted: • An assisted bathing facility required attention. The manager had reported this to the supplying company November 2005 who acknowledged their slow response to the problem • A trolley located in a bathroom contained inappropriate items • A wheelchair and walking frame were found stored in a room • A wheelchair in a room was being used for the storage of pads • The light fitting in bathroom was not working • A shower room needed a number of tiles replacing, advice was given that this work has been scheduled to be carried out • The light pull cords were found to be very dirty and in need of replacing • Discussions with staff revealed that they check the temperature of bath water before immersing the resident however; there was no system in place to make the respective recordings. A sample of resident’s bedrooms were visited by both inspectors and found to be generally tidy and no longer being used as storage areas for equipment. Rooms are very personalised and residents may bring in their own furniture. All rooms have a lockable facility, telephone socket, television with remote control, suited door locks and a nurse call system. Where temporary sockets are in use these have been risk assessed. An inspector noted a bedroom carpet that had a mal odour; the manager reported that the carpet is to be replaced with appropriate waterproof floor covering. Regular checks of the hot water outlets and recording of findings are being carried out. With the exception of one bathroom the lighting was found to be acceptable and domestic in design. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 19 The home was noted to be generally clean with a cleaning schedule in place and adhered to in the kitchen. Food storage was appropriate. The laundry room door is kept locked. The key to the COSHH cupboard in the area was not stored in safe place; an Immediate Requirement was left at the home. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 20 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 The quality outcome in this are is adequate. Staffing levels were appropriate for the current client group. The arrangements for the recruitment of staff are satisfactory in ensuring the protection of residents from harm. The programme of staff training is incomplete therefore staff did not possess the full knowledge and skills to carry out their roles. EVIDENCE: Senior management had recently carried out a review of required staffing levels for those employees who provide personal and nursing care and implemented the new system. The home is aiming to provide two trained staff on the ground floor each morning and has partially achieved this except for three days a week where gaps persist. This initiative is in response to concerns raised previously by staff and the inspectors. The home needs to ensure that two trained staff are on duty every morning. When accomplished the home will have two trained staff on each floor every morning and some afternoons and one on each floor at night. The numbers of care staff currently rostered was found to be sufficient. Some staff commented that there is insufficient staff on duty at times. The manager assured the inspectors that care staff numbers would be monitored and increased when the occupancy levels rise. The home has separate ancillary staff for housekeeping, laundry, and the kitchen that provide cover seven days per week as well as a full time maintenance operative. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 21 Five staff files were examined, it was determined that the previous poor practices of staff recruitment has ceased. Staff do not commence employment until all checks and two written satisfactory written references have been obtained. The induction programme supplied to care staff was determined to be satisfactory. It is recommended that the manager obtain a copy of the new Skills for Care induction programme. The staff training file indicates that 17 of staff have achieved NVQ level 2 training and 10 have level 3, a further 7 staff are currently undergoing training in level 2 in care. Some trained and care staff have not received training in basic Food Hygiene, Moving and Handling, Fire Safety, Health and Safety and Prevention of Cross Infection. The home has a programme of further training organised for those staff where gaps have been identified. There was no evidence that staff have been provided with training in respect of younger adults and their specialist needs. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 22 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, 32, 33, 35, 36, 37, 38 The quality outcome in this area is poor. The management structure is such to provide leadership throughout clarity of staff roles. The quality assurance system is not fully established. CSCI are not being notified of accidents and incidents affecting the health well being of residents. EVIDENCE: The confirmed management structure has been well received by staff that are now in need of consolidation of practices and culture of the home. The home has recently recruited a manger who is a registered nurse and she has a wealth of experience within the care sector. She has obtained the City and Guilds Advanced Management in Care certificate and advised that she is currently pursuing enrolment for the Registered Managers Award. Advice was given that the manager will apply to CSCI for registration. She provided good examples of how to educate staff and improve their motivation. The clinical manager supports the manager. Further support and advice is available form Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 23 the general manager and operations manager. Discussions with staff revealed that the manager is readily available and makes her presence in the home known to all by frequent tours. All care staff are allocated responsibility for a number of residents at the commencement of each shift, this is viewed as good practice. Concerns raised previously regarding the lack of allocated times for handovers at each shift or sharing of the contents of care plans with care staff have not been addressed. A formal management on call system was evidenced. A quality audit of the home has been carried out by Birmingham City Council and was readily available to all staff. Examination of the document revealed that the outcome was generally positive but there are some areas requiring attention. The home has introduced a system of monthly audits of 25 of residents and reviews of care plans. The clinical manager carries out regular medication audits. The manager informed an inspector that she intends to develop and implement a quality assurance system. The arrangements for the safe storage and financial transactions of personal monies held on behalf of residents were found to be satisfactory with the exception of one element. All incoming and outgoing transactions must be witnessed and confirmed by the signature of the resident, relative or a member of staff. Although the written policies and procedures had been reviewed June 2005 no changes to the documents were found. As with previous inspections some documents were in need of further development. Most trained staff had had a formal supervisory meeting but these had not been maintained and most care staff have not had a meeting for an extensive period of time. The documentation in respect of the content of the meetings held were found to be grossly inadequate. The process in place for the safe storage of resident’s files whilst permitting staff access at all times was noted to be satisfactory. Significant improvements were found regarding health and safety practices. All relevant checks and servicing of equipment had been carried out and recorded. Weekly fire alarm and monthly emergency lighting checks were being carried out and documented. Regular fire drills were evidenced. A full audit if the premises has been undertaken and an action plan compiled. The premises and fire system have been risk assessed. Some concerns were raised: • The accident book revealed details of many accidents that should have been forwarded to CSCI and incorporated into care plans and reviewing process. An Immediate Requirement was left at the home. • An incident reported concerned a scold resulting in an alleged blister but no follow up action had been taken Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 24 • The information supplied previously within this report regarding some staff that have not yet received training in Health and Safety, Moving and Handling and Fire Safety. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 25 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 2 2 X 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 2 1 3 1 Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 26 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 OP1 Regulation 4(1)(c) 1 Requirement The statement of purpose requires further amendments as outlined in the body of the report. A review of the registration of the home must be carried out and the statement of purpose amended to reflect this. The service user guide requires further development to include those items listed under Standard 1.2. The homes written admission policy must be reviewed and include details of a three-month trial period followed by a review. The pre-admission assessments carried out must be comprehensive and include mental health state and cognition. N.B. Not assessed on this occasion, carried forward. The manager must undertake an urgent review of all care plans and ensure that the files provide comprehensive documentation in DS0000024817.V290457.R01.S.doc Timescale for action 31/07/06 2. OP1 5(1)(a-f) 31/07/06 3. OP3 12(2)(3) 14 12(2)(3) 14(1)(2) 31/07/06 4. OP3 30/06/06 5. OP7 15(1)(2) (b,c)(3) 31/07/06 Amberley Court Nursing Home Version 5.1 Page 27 6. OP7 7. OP8 respect of residents long and short term needs and include regular reviews. GP visits must be clearly documented. Monthly reviews must be carried out for all care plans and include cross-referencing of accidents/incidents. A system of formal reviews must be implemented. Documentation pertaining to difficult to manage behaviour must be comprehensive. A care planning process appropriate to younger adults must be developed and introduced. 13(4)(a,b All relevant risk assessments for c) resident’s external activities must be carried out and regularly reviewed. 12(1)(a,b) The registered person must ensure that proper provisions of the health care needs are fully met. Monthly observations and weight must be monitored and recorded. Care plan instructions regarding the frequency re-positioning must be adhered to. 31/07/06 31/05/06 8. OP12 16(2)(m, n) An urgent review of the resident who has lost a significant amount of weight must be actioned. Timescale: 12/05/06 The home must adopt a 31/07/06 comprehensive and cohesive approach to the provision of inhouse and external activities that takes into account residents’ preferences. The homes already commenced drive to employ an activity organiser must be completed. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 28 9. OP13 16(2) 10. OP16 22(1)(2) 11. OP18 13(6) The organisation must ensure that there are adequate resources provided to fulfil the recreational expectations of all residents. The system of recording complaints must be expanded to include full details of the complaint, investigation, action taken and monitoring process. The homes written missing persons and physical restraint policies and procedures must be further developed and amended. All staff must receive training in these aspects of care. Timescale: 15/08/06. 31/07/06 31/05/06 30/06/06 12. 13. OP19 OP21 23(2)(o) 23(2)j The garden must be appropriately maintained. Inappropriate items must not be stored in communal bathrooms. The home must complete the already identified need to replace a number of shower room tiles. Timescale: 15/07/06 The pull cords for lighting in communal bathroom must be replaced. Timescale: 31/07/06 The registered person must address the gaps identified by the inspectors following an assessment of the premises by an occupational therapist. Specific areas that require attention are the lack of wheelchair access to the garden from the dining room and resident’s inability to open their bedroom and communal doors. N.B. This remains outstanding from two previous inspections. 30/06/06 31/05/06 14. OP22 23(1)(a) 31/08/06 Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 29 15. OP38OP25 13(6) The non-functioning bathroom light must be repaired. Care staff must record in the books provided the water temperature check carried out in communal bathrooms. The organisation must regularly review staffing levels taking into account numbers and dependency levels of residents. The home must complete the recently implemented new staffing structure by ensuring that two trained nurses are allocated to the ground floor every morning. The home must ensure that 50 of the carers possess training certificates in NVQ level 2 or equivalent. N.B. Remains outstanding from the last three inspections however, the home is working towards it. The registered person must ensure that all mandatory, refresher and other training to meet the needs of the current client group are provided for all staff. NB. This remains outstanding from the two previous inspections but mandatory training has been partially completed. The home must have an acceptable means of providing staff handovers at the commencement of each shift. N.B. Remains outstanding from the last inspection. The registered person must produce and implement a quality assurance system that takes into DS0000024817.V290457.R01.S.doc 31/05/06 16. OP27 18(1)(a) 30/06/06 17. OP28 18(1)(a) 31/08/06 18. OP30 18(1)(c) 31/08/06 19. OP31 18(1)(a) 30/06/06 20. OP33 24(1)(2) (3) 30/09/06 Amberley Court Nursing Home Version 5.1 Page 30 21. OP35 13(6) 22. OP36 18(2) 23. OP36 17(1) account the opinions of residents, relatives and external professionals. N.B. Remains outstanding from the last two inspections. All financial transactions carried out on behalf of residents personal monies must be witnessed and two signatures recorded. Staff must receive supervision when on duty as well as formal supervision at least six times per year with detailed records of the topics discussed. Staff must have annual appraisals. The registered person must develop and amend all written policies and procedures regarding all practices including specialised procedures the home provides. Evidence must be produced of regular reviews being carried out. 07/06/06 31/07/06 30/09/06 24. 25. OP38 OP38 13(4)(a,b, c) 37(1)(ag) 26. OP38 13(4) N.B. This remains outstanding from previous inspections. The home must maintain records 30/06/06 of the regular inspections of the mobile and static hoists. The provider must ensure that 12/05/06 any incidents or accidents that occur in the home are reported as required and that staff in the home are fully aware of their responsibilities to record and report such incidents. All care staff employed at the home must have knowledge of and comply with their responsibilities within this Regulation. The key for the COSHH cupboard 13/05/06 located within the laundry room must be stored securely. Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 31 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. Refer to Standard OP1 OP13 OP22 Good Practice Recommendations The home is strongly urged to apply to CSCI for change of Registration category. The home should develop a running log of the Regulation 37 reports forwarded to CSCI. The home should make an inventory of the specialist equipment, which would provide a tool for crossreferencing purposes such as servicing dates. It is recommended that the manager obtain a copy of the Skills for Care induction programme. The manager is requested to consider residents being permitted to have supervised access to the grillroom kitchen in order to increase their independent living skills. It is recommended that all nursing staff confirm with the prescribing doctor, all new residents medication following assessment to confirm the current drug regime is available for administration. It is advised that compliance aids are obtained to support those residents wishing to self administer their own medication where risk assessments identify that they do not take their medicines as the doctor intended. Nursing staff should also prompt any administration and a decision whether to allow residents to self-administer their medicines. 4. 5. OP36 OP14 6. OP9 7. OP9 Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Amberley Court Nursing Home DS0000024817.V290457.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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