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Inspection on 17/10/06 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 17th October 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

There are spacious corridors and doorways to accommodate people who use a wheelchair. There is a range of communal rooms including a games room, library room, activities room, a specially adapted computer room and a separate lounge for people who smoke. This provides residents with a good choice of communal rooms where they can choose to spend time with other residents and join in activities. Bedrooms are personalised and equipment installed to promote residents independence. Resident`s relatives can visit at any time.

What has improved since the last inspection?

CARE HOMES FOR OLDER PEOPLE Amberley Court Nursing Home 82-92 Edgbaston Road Edgbaston Birmingham West Midlands B12 9QA Lead Inspector Donna Ahern Unannounced Inspection 09:30 17 & 18 October 2006 th th 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.V315803.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 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) www.bupa.com 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.V315803.R01.S.doc Version 5.2 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. 10th May 2006 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 games room and beauty salon. 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 one of the lounges is the designated smoking area. A review for the usage of communal rooms is currently in progress so that the facilities meet the needs of younger adults. 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. The level of fees range from £449-£1863. The manager said that the CSCI report is made available to residents and their relatives and the outcome of inspections is shared in residents meetings. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork visit was unannounced involved two inspectors and took place over two days lasting seventeen hours. This was the homes second key inspection for the inspection year 2006-2007. The home had an Random inspection on the 18th August 2006. The purpose of the Random inspection was to monitor progress made on requirements made following the Key inspection in May 2006. The outcome of the Random inspection was that steady progress had been made. During the fieldwork the inspectors met at least twenty residents, observed the opportunities and support provided to them, looked at the premises, and read records about care, staffing, and health and safety. Time was spent with the manager, clinical manager, heads of departments and discussions took place with three care staff and two trained staff. The home is required to report incidents, accidents and other events that occur in the home to CSCI. These are called regulation 37 notifications. All information reported via a regulation 37 notifications since the last inspection was analysed prior to the fieldwork visit. What the service does well: There are spacious corridors and doorways to accommodate people who use a wheelchair. There is a range of communal rooms including a games room, library room, activities room, a specially adapted computer room and a separate lounge for people who smoke. This provides residents with a good choice of communal rooms where they can choose to spend time with other residents and join in activities. Bedrooms are personalised and equipment installed to promote residents independence. Resident’s relatives can visit at any time. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? There was evidence of steady progress on previous requirements. A management structure is now well established. There are head of departments who meet regularly with the manager so that good communication systems are in place. Residents said, “ The home is looking really nice” “ I like the colour of the lounge it looks fresh and bright”. The head housekeeper had reviewed the cleaning systems in place so that residents benefit from a clean home. Many areas had been painted including the dining area of the terrace grill, the lounge on the first floor and some bedrooms. A Room on the first floor had been refurbished to a high standard of décor and presentation so that a salon and beauty room is available for residents use. There are plans in place to improve other areas of the home including resident’s bedrooms. Health and safety is generally well managed so that residents are protected from harm. A care plan looked at had some really good detail regarding the persons culture and spiritual needs. The care plan incorporated how the families’ cultural needs should be respected and met when visiting their relative. There are now two full time activity coordinators in post who work flexible hours to plan and organise activities. Community based activities have been organised. It was really positive to hear that some residents who had not been out of the home for several months were now getting the opportunity to go out. Residents said, “I have been out shopping to Solihull” “I have been out for lunch”. “I really enjoy the exercise to music”. Staff handover at shift change is now well established. Staff said, “handovers are thorough” “as a member of the care team I feel I get the information I need to do my job”. There was evidence that the manager had implemented disciplinary procedures for staff who have not followed the organisations procedures. This ensures residents are protected by the homes procedures and indicates a proactive management style. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 7 What they could do better: Resident individual care plans must be developed so that staff have clear information about how to support residents. The current care plan format does not flow well. It does not indicate how residents have been involved in developing their care plan. One resident said, “ I have never seen my care Plan and am not asked about what should be in my care plan”. Previous reports have raised the need for the care plan format to be developed so that it reflects the holistic needs of Younger Adults. Improvement are required to the recording, monitoring and review of residents health care so that there is evidence that peoples health is monitored and any potential complications or problems dealt with. Risk assessments must be developed so that the risk to an individual is clear and so that staff know what to do to reduce or manage any risks. Terms of condition/contacts must be available for each resident. These must specify what the fee includes and any extras that residents must pay for. These must be signed by the resident and manager and will ensure that both parties are clear about what the resident should expect from the home. Staff training on abuse and challenging behaviour is required. Staff must also have training relevant to younger adults and specialists needs so that staff have the skills and knowledge to support residents. The manager must develop and implement a quality assurance system so that residents’ views are sought about the home meeting its aims and objectives. Many of the people who live at Amberley have very complex needs. It is important that the manager keeps staffing levels under constant review so that there are adequate staff on duty at all times to meet residents needs. Please contact the provider for advice of actions taken in response to this Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents know before admission that the home can meet their care needs during their stay. The admission policy must be updated to reflect practice. Contracts signed by the residents and manager must be in place so that it is clear what the person can expect from the home. EVIDENCE: The Statement of Purpose and Service User Guide had been reviewed. The documents contained the required information so that prospective residents can make an informed choice about whether they would like to live there. A copy of the documents is supplied to each resident and available at the reception desk. The documents are not currently available in different formats. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 11 The people who live at Amberley have a range of needs and disabilities. Most residents have a physical disability and additional complex health needs. Less than 10 of the people who now live at Amberley fall into the older persons category. The majority of the people are younger adults with a Physical disability. All new admissions fall into the later category. Therefore as raised in previous reports the registration should be reviewed and an application to vary registration submitted. This will ensure that the homes registration is in line with The Homes Statement of Purpose. The manager said that this was in hand and it was pleasing to hear that the management team were actively involved in reviewing the homes registration in conjunction with senior managers. The pre admissions assessment tool was assessed for two people admitted since the previous inspection. They were comprehensive in content. This enables the manager to make an informed decision about meeting people’s needs prior to admission. The manager was in the process of ensuring suitable contracts/terms of conditions are in place for all residents. These must include rooms to be occupied, fees charged and terms and conditions of occupancy. The fee range for the home is vast £449- £1863 it must make clear what is included in the fee and what residents must pay for. These must be signed by the resident and manager and will ensure that both parties are clear about what the resident should expect from the home. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 fully met. Which potentially places residents at risk. EVIDENCE: Six peoples individual care plans were looked at. This included older and younger persons and the care plan of a person who had recently been admitted. Previous reports have raised significant concern about the shortfalls in the quality of care plans. This has the potential to put residents at risk if their care needs are not properly documented and monitored. The last two inspections have seen evidence of some improvement to care plans. The clinical manager carries out regular audits of the care plans and Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 13 identifies areas for improvement. Staff have received specific training on how to complete care plans. However, shortfalls were identified at this inspection and include the following. Short-term care plans are now well established. However some did not give details of outcomes where for examples swabs or further tests were done. This information must be documented so that health needs can be fully tracked and met. A care plan for the prevention of pressure ulcers had details of tissue viability input. There were no details of when the ulcer developed. Which again presents problem when monitoring health care needs. A resident who staff said “will refuse fluids” the fluid balance chart seen indicated that small amounts of drinks are taken. There was a very limited record of fluids taken at night. There was nothing on the persons care plan about refusing fluids. Care plans must detail specific care needs and how these are to be managed so that residents receive appropriate care. A moving and handling assessment had appropriately documented a resident’s refusal to be weighed. Staff were aware of other techniques that could be used to monitor the persons weight including measurement of the persons upper arm. This has been discussed in handover sessions and requested by the manager but had not been followed through in practice. Another residents care plan stated that weekly weight checks should take place. The person was being weighed more than monthly but not as stated in the care plan. Waterlow assessments assess the risk of residents developing pressure ulcers. The waterlow assessment for a resident had not been reviewed when they began to lose weight. These must be kept under review so that the risk of developing pressure ulcers is appropriately managed. A referral to Speech and Language Therapy should be made for one person who has difficulty swallowing, so that their eating and drinking needs are fully assessed and staff are clear about how to manage their needs safely. Residents have access to a range of health care provision including General Practitioner (G.P) dieticians and physiotherapist. The recordings of the outcome of advice and treatment were really difficult to follow. Entries were made on different pages and dates had become muddled. Recordings must be recorded in a way that resident’s health care needs can be followed through and met consistently. One care plan looked at had some really good detail regarding the person’s cultural and spiritual needs. There was very specific information about how the persons personal hygiene should be managed which respected the person’s wishes and cultural needs. The care plan also incorporated how the family, who Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 14 visit daily, culture needs, should be respected and met within the home environment. A care plan had identified a risk of inhalation of fluids but no risk assessment had been implemented to detail how the risk was to be managed and minimized, which has the potential to put the resident at risk. A number of risk assessments were on peoples care plans. Some of these are specific to the individual such as risk assessments for the use of wheelchairs and lap belts. Many of the people have extremely complex needs and require intensive input from staff to meet their assessed needs. Many of the risk assessments are generic in format such as for bathing and the use of bedsides. They do not detail the specific risk to the individual. Risk assessments must be developed so that they are specific to the individual so that resident’s safety is well managed. One resident said, “ I have never seen my care Plan and am not asked about what should be in my care plan”. Previous reports have raised the need for the care plan format to be developed so that it reflects the holistic needs of Younger Adults. Information in the care plan should flow. It should incorporate needs, aspiration and goals and develop as the residents life and needs change. Where possible residents should be fully involved in the drawing up of their care plan so that they are at the centre of service delivery. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In-house and external activities have been improved and offer a stimulating lifestyle that reflects the age gender and culture of residents. Residents are encouraged to maintain contain with their relatives. The meals served offer residents a choice and variety of food. EVIDENCE: Residents said, “I have been out shopping to Solihull” “I have been out for lunch”. “I really enjoy the exercise to music”. Since the last inspection another activity coordinator and an escort have been recruited. There are now two full time people in post who work flexible hours to plan and organise activities. Community based activities have been organised. A mini bus is available three times a week and activities are planned in advance. Recent trips out have included Botanical Gardens, Touchwood Solihull, Cinema, Moseley village and Merryhill. It was really positive to hear that some residents who had not been out of the home for several months were now getting the opportunity to go out. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 16 There was evidence of improvement to in-house opportunities and activities. The activity coordinators have been seeking out suitable activities for residents cared for in bed reading, hand massage, jewellery making and musical activities have been introduced so far. There are also concerts, music to exercise, sing- a-long and themed entertainment night, which all residents are invited to join in and staff across all roles in the home help to organise and support. The activity coordinators keep their own records of what activities have been provided, who participated and how the activity went. It was really positive that symbols had been used to help with the recording. A record sheet had been developed and was waiting approval from the manager. This sheet will then be added to the individuals care plan so that there is a record of what the person has done and whether the activity was successful to assist with future planning. One resident said “I enjoy going to quizzes in the local pubs and will arrange a taxi when I want to go out”. Some resident attend day centres in the community run by Birmingham City Council. There are opportunities for residents to practice their chosen religions. Some residents attend places of worship in the local community. One resident was supported to return home for the day to join relatives in a religious festival of celebration. Residents said that their relatives and friends are made welcome at the home. The visitor’s policy states that visitors are welcome at any time. Many of the relatives are actively involved in their relatives care. There is a good use of communal areas for residents use including a library room, games room and smoking room. A Salon and treatment room has just been opened on the first floor providing a well-appointed room for hair and beauty treatments. The manager said that the use of communal rooms continue to be under development so that residents have a range of in house facilities to use that is really geared towards younger adults. Because of the level of support many residents require there is a degree of routine in the home. This is so that residents get the right support to meet their personal hygiene needs. Some residents said they prefer to spend time in their own room and they said staff respect this. Some residents said they have to wait a little while when they ring the nurse call because staff are busy supporting someone else. The layout and structure of the home provides limited opportunity for residents to develop independence or maintain their living skills. This was discussed with the manager who said she was keen to explore possibilities. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 17 Meals are provided in the main dining room on the ground floor. “The Terrace” snack bar is located on the first floor and was being refurbished. When it reopens the end of October residents will be provided with a greater choice of meals and flexibility in meal times. Some people have continued to have their meals sent up from the main kitchen to the dining area within the terrace snack bar providing residents with a choice of eating areas. Some residents choose to have their meals in their own room. A four-week menu is in place, a choice is offered. The head chef explained the organisations nutritional tool that is in place to ensure that menus are well planned and nutritionally balanced. Alternative diets are provided for people with dietary requirements due to health reasons or religious /cultural beliefs. The chef was in the process of asking residents for their ideas on menus. The minutes of residents meetings indicated that food and menus are discussed directly with the chef. Residents said, “ I enjoy the food” “I can eat my breakfast later if I want”. There were some discrepancies with the dietary requirements of a recently admitted resident that required addressing so that their dietary requirements are met. Some residents have complex eating and drinking needs and have peg feeds. Dietician advice and support is provided. Some matters in relation to peoples eating and drinking needs are raised under the previous section of this report. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements must be made to the recording and logging of complaints so that concerns raised by residents or relatives are acted upon. EVIDENCE: A copy of the complaints procedure was on display in the reception area. It is wall mounted and presented in large print. There were complaints leaflets in reception, which had details of the organisations senior manager and CSCI in London. The local CSCI contact details should be added so that people know how to contact their local office if they need to. Four complaints had been received since the last Key inspection. Two were partly upheld and the concerns were regarding care practice. One complaint was outstanding from February 2006. There was a lack of information about what action had been taken about the complaint and the information had not been put on the log of complaints for February. One complaint was appropriately dealt with through the homes personnel procedures. A complaint was received by CSCI in August 2006 and was passed back to the provider to investigate. There were four parts to the complaint. Three parts Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 19 were not upheld and one part was dealt with through the organisations personnel procedures. There is a need to record each part of the complaint and the outcome. All letters sent to do with the complaints must be kept in the file. Improvements in the recording and logging of complaints will ensure that information can be tracked and demonstrate that concerns raised by residents or relatives are taken seriously and acted upon. A suggestion box is available in the reception area welcoming comments from residents or any relatives. The missing persons procedure, physical restraint and adult protection procedure have not been reviewed. These remain outstanding from previous inspection reports. It is essential that these be reviewed so that the policy and procedures incorporate current policy and practice and reflective of the needs of younger adults. Staff training on abuse and challenging behaviour is required so that staff have the skills and knowledge to protect resident and to appropriately raise matters of concern. The manager had appropriately made a referral to Social Care and Health regarding an incident that happened in the home. The investigation was ongoing. Two care staff spoken with were clear about their responsibility to inform their manager of matters of concern. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):19, and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is ongoing work to improve the environment so that it is comfortable and homely for residents. EVIDENCE: Amberley court is a large purpose built home over two floors with a laundry and staff facilities on the third floor. A partial tour of the premises was completed. There was further evidence of improvements in the organisation of rooms, storage of equipment and hygiene levels. The head housekeeper had reviewed the cleaning systems in place so that residents benefit from a clean home. When rooms are vacant they are now deep cleaned. Curtains throughout the home had been cleaned. There are Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 21 good systems established for the handling and washing of resident’s laundry so that their clothes are cleaned properly and returned to the resident. Residents said, “ The home is looking really nice” “ I like the colour of the lounge it looks fresh and bright”. Many areas had been painted including the dining area of the terrace grill, the lounge on the first floor and some bedrooms. A room on the first floor had been refurbished to a high standard of décor and presentation so that a salon and beauty room is available for residents use. There was some leak damage to the corridor on the first floor and redecoration of the wall was in hand. There are plans in place for further painting and decorating work including resident’s bedrooms. The bedrooms of the people whose care plans were examined were checked. They were found to be comfortable, hygienic and personalised. Care plans seen stated that residents should be able to have familiar objects, ornaments and belongings in their room that reflect the individuals culture and individual tastes this was seen to be the case. Many of the bathrooms had been decorated and pictures, mirrors and curtains had been added so that the rooms were more welcoming and comfortable for residents. Some refurbishment work was still under way in some bathrooms so that the facilities are improved to meet residents assessed needs. Another mobile hoist was on order so that there is adequate lifting equipment available to meet residents moving and handling needs. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were adequate and currently meet the needs of residents. Staff must receive the required training so that they perform within their job role and have the skills and knowledge to meet resident’s needs. EVIDENCE: Many of the people who live at Amberley court have complex health and medical needs. Many residents require two staff to use the hoist to move them from bed to their wheelchair or to the bathroom. Some residents require three staff. Ensuring that there is adequate staff on duty at all times is a real challenge when considering the complexity of need. Two trained staff are on duty every morning and afternoon and one on each floor at night. The numbers of care staff currently on duty was adequate. The manger must keep staffing levels under review so that sufficient staff are on duty to meet residents needs at all times. Staff spoken to said although staffing levels seem adequate because of the complex needs of residents they can still feel really pushed on some occasions. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 23 Staff handover at shift change is now well established. Staff said, “handovers are thorough” “as a member of the care team I feel I get the information I need to do my job” Six staff files were examined. The POVA check for a staff member who commenced employment in March 2006 was on file but the CRB check was still outstanding and required follow up by the manager. This will ensure that the correct procedures to protect residents have been followed. There was evidence that the manager had implemented disciplinary procedures for failure to follow the organisations procedures and performance related matters, which ensures residents are protected by the homes procedures and indicates a proactive management style. Staff follow an induction package that incorporates the “Skills for Care” induction standards and were waiting for a delivery of the new foundation standards. This should ensure that staff have the skills and knowledge to work in a competent manner. 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. The training plan received by CSCI indicated that Fire safety and Manual handling training had been received by almost 100 of the staff team. However in all other areas such as Adult Protection, Health and Safety and Care planning there is significant gaps with many areas showing less than 25 of the staff team completing required training. There was no evidence that staff have been provided with training in respect of younger adults and their specialist needs. All outstanding training and training specific to residents needs must be addressed so that residents benefit from staff who are suitably trained. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):31, 32 33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management team promote good standards so that the home is run in the best interest of residents. Some minor health and safety matter must be addressed so that residents and staff are safe. The quality assurance system must be fully established so that the Home can continue to develop. EVIDENCE: Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 25 The manager was appointed in April 2006. She is a registered nurse and 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. The manager said she would be making an application to CSCI for registration. The clinical manager, housekeeper, catering manager and maintenance team, supports the manager in her role of overseeing the management of Amberley Court. The clinical manager does monthly audits of residents care plans and carries out regular medication audits. The manager said she intends to develop and implement a quality assurance system so that residents’ views are sought about the home meeting its aims and objectives. The arrangements for the safe storage and financial transactions of personal monies held on behalf of residents were found to be satisfactory. All incoming and outgoing transactions are witnessed and confirmed by the signature of the resident, relative or a member of staff. Receipts are maintained where possible and the administrator audits the money daily. The established systems safeguards residents. The manager said that the reviewing of required policies and procedures are underway. These will need to be thoroughly reviewed in light of the homes move towards providing a service to younger adults so that they include relevant legislation and provide staff with appropriate guidance. Extensive health and safety checks of equipment are in place so that both residents and staff safety is promoted and protected. Fire safety check had been completed. The fire risk assessment was reviewed in January 2006. This document must be kept under review and reflect any changes to fire safety arrangements as required by the Fire regulations. The checklist on bedrails sides must be completed in full so that staff know how to use them safely for individual residents. The safety checks of equipment was completed monthly and signed off. These must have the actual date of the test and not just the month so that accurate monitoring systems are in place to ensure residents safety. The policy on “The safe use of wheelchairs” policy must be dated so that it is clear when it was put into practice and can be kept under review. The hoist and specialist bathing equipment had been in-house inspected and serviced by the manufacture so that equipment is safe for residents use. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 26 Hot and cold water checks are in place so that residents are protected from the risk of scalding. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 27 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 2 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X 2 Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 12(2)(3) 14 Requirement The homes written admission policy must be reviewed and include details of a three-month trial period followed by a review. N.B. Timescale of 31/07/06 has not been met. Timescale for action 31/12/06 2 OP2 5 (c) 3. OP7 15(1)(2)( back)(3) Contracts/terms of conditions 31/12/06 must be in place for all residents. These must include rooms to be occupied, fees charged what the fees include and terms and conditions of occupancy. The resident and manager must sign these. Care plans require further 31/12/06 development as outlined in the body of the report. A care planning process appropriate to younger adults must be developed and introduced. N.B. Timescale of 31/07/06 has not been met although improvements have been made. Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 29 4 5 6 7 8 9 10 11 12 13 OP7 OP7 OP8 OP8 OP8 OP8 OP8 OP8 OP12 OP16 13 (4) 13(4) 12 (1) a, b 12 (1) a, b 12 (1) a, b 12 b 12 b 12 b 15 (1) a, (1) a, (1) a, (b) 22(1)(2) A risk assessment for aspiration is required. Risk assessments must be developed so that the risk to the individual is clear. Short-term care plans must detail outcomes of tests. Care plans for pressure ulcers must detail when the ulcer developed. Weight monitoring must be followed through as stated in the persons care plan. Waterlow assessments must be kept under review. A speech and language referral is required for one resident. Health care recording and monitoring must be improved. Activities and their outcomes must be recorded on care plans. 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. N.B. Timescale of 30/06/06 has not been met. The bedrooms and ensuites require refurbishment. Work was in progress The home must carry out refurbishment works to the communal bathrooms, which meet the needs of the client group. Considerable progress made work ongoing. 16/11/06 16/11/06 16/11/06 16/11/06 16/11/06 16/11/06 16/11/06 16/11/06 30/11/06 30/11/06 14 OP18 13(6) 31/12/06 15 OP19 23 (2) b 28/02/07 16. OP21 23(2) j 31/12/06 Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 30 17. OP27 18(1)(a) The organisation must regularly review staffing levels taking into account numbers and dependency levels of residents. N.B. Ongoing process during the phase of increasing the numbers of residents. 31/12/06 18. OP30 18(1)(c) 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. The home is making progress towards meeting this requirement. 30/11/06 19 20. OP29 OP33 Schedule 2 7, 9, 19 24(1)(2) (3) CRB check for one person was required and required follow up to why it remained outstanding The registered person must produce and implement a quality assurance system that takes into account the opinions of residents, relatives and external professionals. N.B. Work has commenced in implementation of a system. 30/11/06 30/11/06 21. OP36 18(2) 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 maintained. Staff must have annual appraisals. Not assessed at this inspection. Requirement carried over. 30/11/06 Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 31 22. OP36 17(1) 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. N.B. Although work has commenced this remains outstanding from previous inspections. 31/12/06 23 24 OP38 OP38 23 (b) (c) 13 (4) Monthly safety checks must have 30/11/06 a specific date and not just a month. Safety check list for bedrails 30/11/06 must be completed in full 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 OP31 Good Practice Recommendations The home is strongly urged to apply to CSCI for change of Registration category. 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. 2. OP14 Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Amberley Court Nursing Home DS0000024817.V315803.R01.S.doc Version 5.2 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. 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