Inspection on 26/09/07 for Amberley Court Nursing Home

This inspection was carried out on 26th September 2007.

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

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

Other inspections for this house

Amberley Court Nursing Home 29/04/09

Amberley Court Nursing Home 06/05/08

Amberley Court Nursing Home 17/10/06

Amberley Court Nursing Home 10/05/06

Amberley Court Nursing Home 24/11/05

Amberley Court Nursing Home 05/07/05

Amberley Court Nursing Home 08/12/04

Amberley Court Nursing Home 30/06/04

Amberley Court Nursing Home 23/02/04

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Amberley Court Nursing Home 82-92 Edgbaston Road Edgbaston Birmingham West Midlands B12 9QA Lead Inspector Kath Strong Key Unannounced Inspection 26th September 2007 09:15 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.V345975.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.V345975.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) Ltd vacant post Care Home 62 Category(ies) of Dementia - over 65 years of age (62), Old age, registration, with number not falling within any other category (62), of places Physical disability (62), Physical disability over 65 years of age (62) Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care with nursing and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: - Old age not falling in any other category (OP62) - Dementia over 65 years of age (DE(E)62) - Physical Disability (PD62) - Physical disability over 65 years of age (PD(E)) The maximum number of service users to be accommodated is 62. 2. Date of last inspection 17th October 2006 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. The home is actively restricting 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 when staffed, meals can be ordered throughout the day. A beauty room has recently been established on the first floor and is furnished to a very high standard. A television room is also being developed; the room includes a large screen television to enhance people’s enjoyment. The ground floor has a large attractively presented 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. Communal rooms are gradually being refurbished in styles and themes that suit younger people. 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.V345975.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home did not know that the fieldwork visit would be carried out. This is to enable the inspectors to obtain a true picture of the standards of the services provided. On the day of the visit, the home had 55 people living at the home. Assistance was provided by the recently appointed manager. At the conclusion feedback was given to the manager. No Immediate Requirements were made. Information was gathered from speaking with people who reside at the home, relatives and staff. Care, health and safety and the arrangements for medications were inspected. Staff personnel files were checked and staff were observed whilst performing their duties. A partial tour of the premises was carried out. Six care plans were reviewed and case tracked. This involves obtaining information about individuals’ experiences of living at the home. This is done by meeting with or observing people, discussing their care needs with staff, looking at care plans and focussing on outcomes. Tracking peoples care needs and how the care is delivered helps us to understand the experiences of those people. Each of the two inspectors spent time in separate communal areas carrying out an assessment about how staff and other people spend time with people who live in the home. It included how staff and others communicate with them, what they did and how it affects the daily lives of people. This is referred to in the body of the report as SOFI (short observational framework for inspection) in the section concerning daily life and social activities. Prior to the fieldwork visit the home had completed the annual quality assurance assessment and sent it to us. The information within the document advises of what the home does well, improvements made during the last 12 months and what the home would like to further improve. This provided details that contribute to the inspection process and highlights areas that may be explored during the fieldwork visit. A number of people who live at the home were requested by the inspector to complete a questionnaire. These give personal opinions about the services provided and the results are included in this report. The focus of inspections undertaken by us is based upon the outcomes for people who live in the home and their views about the services provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and aspects of service provision that need further development. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The corridors have been redecorated and they look fresh and attractive for the benefit of the people living in the home. Lounges were being re-developed to give individuality and themes that suits younger people. This work is being carried out following requests received from people living in the home to provide a home that has a younger and appealing outlook. Records found indicated that some bedrooms, an office, three bathrooms, the grillroom and a lounge had recently been redecorated. This ensures that fresh and pleasing accommodation is provided. A snooker room and bar has been developed and the snooker table has been adapted to enable wheelchair users to make use of it. The external grounds have been improved and a safe pathway around the circumference of the premises has been developed and seating areas incorporated. As a result of peoples requests to include a paved area outside of the dining room a contractor has been allocated the work, which will improve access for wheelchair users. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 7 The inspectors noted an improved atmosphere between staff, they appeared to be working well both independently and as a team. This was confirmed during staff interviews. A request had been made for menus to be presented in large print. During the first day of the fieldwork visit inspectors evidenced the menus on display on each floor in large print. However during the second day the menus had not been replaced with the menu of the day. A new tool has been implemented for conducting pre-admission assessments and is added to on admission and on an ongoing basis. This provides an overall picture of peoples needs from pre-admission and throughout their residency. All newly admitted people are supplied with comprehensive written information about the home and services it provides. They are also given a contract of the terms of residency, which supplies people with information about the services they can expect and their rights. Although some further work needs to be carried out a significant improvement has been achieved in the care planning. More staff guidance has been incorporated and good information about people’s personal preferences. Staff have received training in the care of specialist tubes that people may have. This ensures that staff are competent to care for people with complex needs. The manager has recruited a number of bank staff who may provide cover during absences of permanent staff. This reduces the usage of agency staff and promotes continuity of care for the people who live in the home. A good number of the requirements made at the last inspection have been addressed. This indicates that the home views inspections as a positive procedure and that it is continually striving to make improvements. What they could do better: Further work needs to be carried out in the care plans to ensure that assessments are individualised. This work is required to promote a safe environment and provide staff with clear guidelines. Risk assessments need to be personalised and provide clear instructions for minimising identified risks. Cramming of written recordings is not good practice, staff should be encouraged to use a second page. One file included differing sling sizes and the bedroom contained a sling that did not reflect either of the sling sizes mentioned in the file. Inconsistencies are not acceptable practice and may result in the wrong size of sling being used. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 8 On some occasions only one trained nurse is on duty on the ground floor during morning shifts. Staff indicated that this situation imposes too much pressure on them. Although agency staff may supply limited support staff spoken with reported that agency staff are useful for carrying out a number of tasks. The quality assurance programme needs to be fully implemented for the home to demonstrate that continuous improvements are being made for the benefit of the people who live there. A review of the damage caused to lower walls and skirting boards needs to be carried out and systems put in place to redress these. People living on the first floor of the home need to be provided with the same number of meal courses as those people who reside on the ground floor. The home must evidence equality in all aspects of the services supplied. Despite numerous requests made by inspectors the home remains registered for older persons. There are very few older persons living in the home. When the current 5 of older persons reaches 0 the home may be in breach of its registration. 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. The summary of this inspection report can be made available in other formats on request. Amberley Court Nursing Home DS0000024817.V345975.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.V345975.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 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have written details they need to enable them to make an informed decision about living at the home. Pre-admission assessments need to be such that the home can demonstrate that it is able to meet all of the individuals needs. EVIDENCE: The statement of purpose and service user guide were reviewed and both documents appeared to contain adequate information to assist people in making decisions about the home. Copies of these are available in every bedroom. Consideration should be given to producing them in audiocassette and other languages to ensure that they are fully understandable by the diverse and cultural people who live at the home. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 11 The certificate of registration was clearly on display in the reception area. Some changes are required to the certificate so that it reflects the current younger age group as being the primary services supplied. Everyone who is admitted to the home receives a contract of terms and conditions of residency. The document includes all of the relevant information that people require to be advised of their rights whilst residing in the home. The home has introduced a new pre-admission tool, which can be added to throughout a persons stay. The pre-admission assessment of the latest admission was seen to include all relevant information needed for the home to make a decision as to whether it was able to meet all of the persons needs. For another person who was admitted as an emergency the home had relied on the written information supplied by the NHS but there was no written details that the home had checked that this was sufficient to determine if the home was able to meet all of the persons needs at the point of admission. Documentary evidence needs to be in place that confirms that the home has carried out sufficient explorations before accepting a new admission. Amberley Court Nursing Home DS0000024817.V345975.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. People’s health and personal care is generally well met but in some instances care plans fail to include personalised risk assessments or appropriate and consistent staff guidance. The arrangements for medications need to be more robust to ensure that a safe process is in place for people to receive their medications as prescribed. EVIDENCE: Each person has a written care plan. This is an individualised plan about what the person is able to do independently and includes what assistance is required from staff in order to maintain their health and well being. The document should include details of all assessments carried out, staff guidance on how to meet a persons needs and the tools to monitor that that the information is still relevant. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 13 Six people were case tracked, two of which were looked at in detail. Since the last inspection there had been obvious improvements found in the way in which the files are presented and significant improvements were noted in respect of staff guidance and incorporation of people’s personal preferences. The home should be commended for some of the excellent recordings made regarding peoples life history/background, how care should be delivered and discussions held with relatives. This information provides staff with clear descriptions and guidance to enable them to carry out their roles effectively in providing care that is tailored to the person’s needs and personal preferences. There was also some good information recorded about people’s psychological status such as when a person becomes excitable. Short-term care plans were in place in some instances when people had illnesses such as chest or urinary tract infections. Staff need to ensure that they are developed for all shortterm illnesses. This enables staff to monitor progress during a person’s illness. Recordings made in respect of specialist equipment and nutrition have also improved in providing staff with comprehensive guidance. A risk assessment was noted for a person who is at risk of choking, this is viewed as being good practice. Shortfalls and inconsistencies were found regarding personal risk assessments that need attention. The home uses pre-typed forms for the majority of them and these are not individualised and therefore unacceptable. Staff need to add further information that is specific to the person for the home to evidence that the risk assessments are comprehensive. One risk assessment seen included a total of nine hazards, which were not clearly defined and details pertinent to a section had been entered in another. Another risk assessment contained numerous hazards and due to cramming of information it was not possible to read the document. Bathing risk assessments seen all contained the same pre-typed information and had not been added to. There was no indication that forms had not been checked for their appropriateness for the individual. Generic pre-typed forms had also been used for falls risk assessments, these are based on ticks and are not personalised. Again the generic profiling bed risk assessment includes ‘long hair’ but the occupant has short hair. Some mobility charts were good and supplied information about the type and size of equipment required, other were found to be in need of further development. One fails to include uncontrolled involuntary movements. Signed permission for the use of bedrails need to be re-visited regularly to determine that they are still relevant and permission valid. Another for permission had not been dated or signed. Risk assessments for use of bed rails were pre-typed and failed to include specific information such as protection of tubing or spontaneous limb movements. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 14 Moving and handling assessments carried out need to include all aspects for consideration such as the presence of pressure ulcers. Another form states that a medium sling should be used but the care plan states a small sling is required. However, the bedroom contained a large sling. A continence assessment carried out had not been dated or signed, this does not enable staff to monitor effectively. Daily recordings about one individual stated ‘physical aggression but no risk assessment or behavioural plan had been developed. The same file failed to include staff guidance regarding bathing and safety measures to protect the person’s head. There was good evidence that external healthcare professionals see people who live in the home. The range of external specialists who have input were noted to be high, this promotes peoples health and well-being. People appeared to be well kempt and were dressed appropriately for their age and to suit their personal preferences. This was evidence whilst speaking with people who confirmed that they were wearing clothing that they had chosen. Comments received included: “Its OK living here” “I go to a day centre three times a week, they come and pick me up” “Staff deliver my post to me, it is not opened” “It is always good to know that the staff care about me” “Staff are good, they work hard” “I feel safe here”. The management of medications were reviewed on the ground and first floors. Copies of prescriptions are kept so that staff can check that they have received the correct drugs into the home. Most medications are delivered in blister packs others are in boxes or liquid format. On the whole the arrangements were satisfactory but some areas that require attention were found. Weekly audits are being carried out by senior trained nurses to audit that staff practices are appropriate. Hand written instruction on MAR (medication administration record) charts had not been signed by a second nurse to confirm that the details were correct. A liquid drug was noted to be of insufficient quantity to last for the 28 day period that it was prescribed for. This needed to be addressed to prevent lack of drugs for the weekend period. A prescribed cream found in an en-suite bathroom should be stored in a locked cupboard. One drug was impossible to audit because staff had failed to record the carried forward balance. The home must demonstrate a safe mechanism is in place to ensure that people receive their medications as prescribed. Amberley Court Nursing Home DS0000024817.V345975.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 adequate. This judgement has been made using available evidence including a visit to this service. Activities provided meet the needs and expectations of the majority of people and they can choose their activities, this promotes independence and individuality. The meals offered are varied, nutritious and culturally appropriate but the full menu needs to be provided to all people who live in the home. EVIDENCE: An inspector held a discussion with the activities organiser who is a qualified art teacher. She advised that she makes time to talk with all people who live in the home and their relatives. She works full time and another person has recently been recruited for two days per week to assist in providing recreations that suit people preferences. The organisation has a rota system for transport, which is available for use every five weeks. Information was given by a person who lives at the home that he goes to shopping centres. The individual recordings in the care plans suggest that people go on various outings such as bowling, holidays and some stay with relatives. A number of people go to day centres and various clubs. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 16 One person who lives in the home makes attractive greeting cards and people can buy them. There was evidence of internal activities offered to people as well as one to one sessions with people who remain in their bedroom. An older person is supported in doing her knitting. Other activities are geared towards younger people. The computer room was noted to be well occupied by a number of people. The equipment has been adapted to enable people with physical disabilities to use it. A joint Halloween party was being arranged for people living in the home and staff. A person who had been admitted three months previously had not been assessed regarding his recreational abilities or his preferences. The activities organiser confirmed this. There was no documentary evidence that he had been asked to participate with activities. The activities programme on display in reception was noted to be out of date. The outcomes of the SOFI (short observational framework for inspection) exercise were mainly positive but there were some negatives that the home needs to take into consideration. On the whole when staff interacted with people they spoke appropriately and where possible tried to stimulate people. Shortfalls included occasions when staff entered a room to carry out a routine task but although they had opportunity to talk with people whilst carrying on the task they failed to do so. When people were transferred from the grillroom to the television room 10 minutes lapsed before a carer thought to negotiate with people about which channel they would prefer to watch. When a person declined the offer of transferring to the television room the carer said, “You will be bored”. Regular residents and relatives meetings are held, the minutes of the last meeting were not available but minutes of previous meetings were seen. An inspector observed lunch being served during day one of the fieldwork visit. Meals are served in the main dining room situated on the ground floor and people can also be served their meals in the grillroom on the first floor. Staff were noted taking trays to peoples own bedrooms, plate covers were used to keep the food at an acceptable temperature. Staff assisted people with the meal in a respectful manner. A person living in the home confirmed that he is asked the previous day what he would like to eat the following day, he also advised of his satisfaction with the meals provided. The home operates a summer and winter menu and there are ample alternatives offered to suit every ones tastes. There was also evidence of other meals being prepared for people of ethnic minorities including Halal meat products to comply with religious beliefs. Examples of the menus are accessible in the reception area, these reflect that peoples cultural needs can be met. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 17 It also includes a variety of snacks that can be ordered from supper time until breakfast. This was supported in a care plan that provides staff guidance regarding a persons food needs when he retires. In response to peoples requests the menus are presented in large print and the meals of the day are displayed on both floors. However, the menu had not been replaced for the second day of the fieldwork visit, this requires attention. It was noted that the lunchtime menu consists of three courses but only two were noted to be served on the first floor. The kitchen assistant who was serving lunch in the grillroom confirmed that only two courses are routinely served on the first floor. This was brought to the manager’s attention as there was a failure to apply equal opportunities for people. Lunch was being served on the second day of the fieldwork visit and the meals were very nicely presented and appetising. The manager advised that the chef visits every person in the home to discuss their preferences. Comments received included: “I will eat English or Indian food as long as it is well cooked, but these days it isn’t” “There’s plenty of it and its well cooked” “They ask us the day before” A hot and cold water dispenser is located in the corridor of the ground floor where anyone including visitors can help themselves to refreshments. The home has carried out a risk assessment to minimise the risks of scalds to people who use the dispenser. Amberley Court Nursing Home DS0000024817.V345975.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. People’s opinions are listened to but only recently received complaints have been dealt with effectively. The arrangements regarding adult protection appear to be sufficient to protect people from risks of abuse. EVIDENCE: There is a comprehensive complaints procedure, which is on display in large print in the reception area for ease of access. Consideration should be given to producing it in audiocassette and other languages to enable people of all disabilities and backgrounds to fully understand it. The complaints folder was reviewed and it was noted that four complaints had been received by the home since the last inspection. In some instances documentation regarding the investigations and outcomes were not present. Therefore it was not possible to determine if they had been dealt with appropriately. Two complaints were received by us, the newly appointed manager carried out the investigations. The outcomes found were that some shortfalls were identified such as communications between nurses and the chef. The responses sent to the complainants were honest and included actions that will be taken to rectify areas of concern. This indicates that the new manager deals with complaints effectively. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 19 The home has a written missing person procedure and uses Birmingham and Solihull’s multi-agency guidelines regarding adult protection. Since the last inspection two allegations have been made but investigations revealed that they were unfounded. The home has evidenced that correct procedures are followed out when abuse is suspected. The majority of staff have received training in adult protection and some have had training in dealing with challenging behaviour. During discussions with staff they demonstrated that they would respond appropriately if abuse was suspected. Amberley Court Nursing Home DS0000024817.V345975.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, 20, 21, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A homely, age appropriate and comfortable environment is provided for people to live in where they appear to be safe and secure. EVIDENCE: Amberley Court is a purpose built nursing home that is being gradually being upgraded in respect of décor and leisure facilities for younger adults. Doorway access in the corridors are via low level touch pads. Much work has already been completed; there is evidence that requests made by people living there are being actioned. More work to be carried out includes installation of patio doors and paved area to the garden off the main dining room. Communal areas were visited and bedrooms of the people whose care plans were seen. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 21 There are ample communal rooms for people to choose from and each one is themed such as large screen television room, snooker room, computer room as well as others. People can have their meals in the main dining room that operates flexible meal times, the grillroom on the first floor or their own bedroom. There are numerous quiet areas where people can have confidential discussions including seated areas throughout the garden that circumvents the premises. Access to the front door is via a ramped area form the car park. Assisted bathroom and shower rooms are located on each floor and separate toilets are strategically located throughout the home. One bathroom seen required ceiling repairs and redecoration. An inspector advised that the work had been identified and would be carried out shortly. All bedrooms are of ensuite status consisting of toilet and wash hand basin. The call system extends to all bedrooms and communal rooms, people who are unable to access the call system receive half hourly checks by staff. The home had a comprehensive assessment carried out last year by an external agency about the amount and type of moving and handling equipment to ensure that there was sufficient to meet every ones needs. However, staff said that there are not enough hoists available to provide a timely service to people. This was confirmed during a complaints investigation whereby a person had to wait a long time for a hoist to become available. It would be advisable for the home to carry out a further review that takes into account the numbers, needs and dependency levels of the current client group. Safe transfers need to be completed within an acceptable timescale. Bedrooms are located on both the ground and first floors. They were found to be comfortable, hygienic and very personalised. They contained many familiar objects, ornaments and belongings to reflect the person’s tastes, individuality and culture. Bedroom doors are fitted with suited locks to enable people to hold their own room key and promote their privacy. Many communal areas and bedrooms have been redecorated to provide fresh and appealing accommodation. Due to the large amount of equipment within the home there were many scuffs to lower walls and skirting boards, which detract from the appearance of the home. During the first day of the visit an officer of the Health and Safety Executive also checked the premises. Some areas requiring attention were brought to the attention of the manager. A sluice room contained a clinical waste bin that needed to be fixed to the wall. A member of the laundry room personnel advised that soiled linen was being soaked although the home had a supply of red (alginate) bags, which negates the needs for soaking and prevents infection. Some COSHH products were left unattended in the laundry room. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 22 The maintenance file suggested that plenty of remedial work was being carried out. The hot water outlets that people who live in the home have access to were being regularly tested and the outcomes recorded to ensure that people are protected from the risks scalds. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 23 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. There are not sufficient trained staff allocated to meet peoples needs. Recruitment practices are robust; this protects people from risks of abuse. Staff undertake some training to supply them with the knowledge and skills to carry out their roles effectively. EVIDENCE: The majority of people who live in the home have complex health and medical needs. Many of them require full assistance of two staff in transferring and some require three. Review of four recent weeks of staffing rota indicated that on some occasions only one trained nurse is on duty for the morning shift on the ground floor. Discussions held with staff indicated that two staff are needed even though the assistance of some agency staff is limited it was felt that their help is valued for some tasks. A recent complaint alleged that medications had not been received at the required time. The MAR (medication administration record) charts are pre-printed and the actual time of administrations are not recorded. The home needs to demonstrate that there are sufficient staff on duty to provide appropriate standards of care with an acceptable timescale. The remainder of shifts appeared to be adequately covered to meet people’s needs. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 24 Trained and care staff are supported by a full ancillary team to permit them to carry out their designated roles. Ancillary staff work seven days per week. Some “I get “Staff “Staff comments were received about staff: on well with the staff here” take their time to speak to people who cant talk for themselves” are good, they work hard”. A number of staff personnel files were reviewed including the latest recruit. The files indicated that all relevant checks are carried out and employment gaps explored before a position is confirmed. Two written satisfactory references are obtained. This indicates that procedures are in place to protect people living in the home from risks of abuse. Newly appointed care staff are required to complete a comprehensive induction programme to equip them with the basic skills for working within the care sector. Less that 50 have successfully completed NVQ level2 training but more are currently undertaking the course. The training matrix supplied suggests that all staff have received training in Fire Safety, Moving and Handling and Health and Safety. However the matrix only covers the period from April 2007 and it is therefore impossible to obtain accurate information about other courses that staff have completed to provide them with the knowledge and skills to meet people’s needs. The matrix also fails to include any specialist courses that staff have received as described in the AQAA (Annual Quality Assurance Assessment) recently supplied to us. The matrix suggests that other training includes COSHH, Infection Control and Food Hygiene. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 25 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 manager is striving to improve the services and has a vision for further development of the services for the benefit of the people who live there. The quality assurance programme needs to be fully implemented to ensure consistency to improving standards. The majority of the arrangements for health and safety are good and protect people from risks of injuries. EVIDENCE: The recently appointed manager was previously the clinical manager and therefore has good knowledge of people’s needs and an insight into the dayto-day management of the home. She advised that she was being well supported by senior staff. Someone who lives at the home said, “We can speak to the manager in private if we like”. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 26 Staff interviewed reported that the manager is approachable and that the home is continuing to improve. Staff also said the atmosphere was positive this indicates a well motivated workforce is in place. The regional manager advised that recruitment to the clinical managers post was in progress. An audit of peoples opinions about the services provided was carried out December 2006 and the results were mostly positive. This is viewed as being good practice and needs to be incorporated into the quality assurance programme when it is fully implemented. At the conclusion a report will need to written that outlines the positives and shortfalls and how and when they will be addressed. Regular unannounced Regulation 26 visits were being carried out and a report given to the manager. There is a good system in place for the safekeeping and transactions of people’s personal monies that are held on their behalf. This ensures that risks of financial abuse are limited as far as practically possible. Accidents were being well recorded and action taken where necessary. Some of these were being reported to us if it was determined that the health or well being of a person was being compromised. Servicing and checks of equipment were being carried out to ensure that they were fit for purpose. The fire alarms were being test weekly and emergency lighting monthly and the results recorded. There was evidence of action being taken to rectify any mal functions found. Fire drills were being carried out and the names of staff who have attended were being recorded. On the whole the arrangements in respect of health and safety appear to protect people who live in the home and others from risks of injuries. Some shortfalls were identified regarding laundry staff practices and safe disposal of clinical waste. Amberley Court Nursing Home DS0000024817.V345975.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 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 N/A 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 2 2 X 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X X 2 Amberley Court Nursing Home DS0000024817.V345975.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 pre-admission procedure must ensure that the home is able to demonstrate that it is able to meet the person’s needs at the point of admission. This is to ensure that people’s needs are fully met at all times. 2. OP7 15(1)(2) (abcd) Care plans require further development. Risk assessments need to be personalised, presented in a readable format and include all aspects to be taken into. Short-term care plans need to be developed and all recordings must be dated and signed. This is required to provide staff with clear an individualised guidance on how care needs to be delivered. To promote peoples personal health. Timescales of 31/07/06 and 31/12/06 have not been met therefore this required urgent attention. Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 29 Timescale for action 10/11/07 15/12/07 3. OP9 13(2) Staff must ensure that there are sufficient prescribed medications available to cover ‘out of hours’ periods. A carry forward system must be in place and prescribed creams must be stored in a locked cupboard. This is needed to ensure that people receive their prescribed medications in a safe and effective way. 31/10/07 4. OP12 16(2)(m) New admissions must be assessed regarding their abilities and aspirations and appropriate activities provided. The displayed activities programme must be current. This is needed to ensure that people receive physical and mental stimulation to improve the quality of their lifestyles. 10/11/07 5. OP15 16(2)(i) All people must be offered the same number of courses regardless of which floor they choose to eat their meals on. This is needed to promote peoples right to equality and nutrition. 10/11/07 6. OP16 22(1)(2) The system of recording complaints must be expanded to include full details of the complaint, investigation, action taken and monitoring process. Timescale of 30/11/06 has not been met. 30/11/07 7. OP21 23(2)(b) The proposed work to repair the ceiling of a bathroom and redecorate needs to be completed. 30/11/07 Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 Page 30 This is needed to provide people with facilities of good integrity and of a pleasure appearance. 8. OP26 13(3) & 13(4)(b) Staff practices within the laundry room must be appropriate and safe. This is needed to prevent cross infections from occurring and prevent accidental ingestion of toxic products. 9. OP27 18(1)(a) Sufficient trained staff must be allocated to morning shifts on the ground floor. This is needed to ensure that all of peoples needs may be fully met within an acceptable timescale. Timescale of 31/12/06 has not been met therefore this requires urgent attention. 10. OP33 24(1)(2) (3) Implementation of a quality assurance system that takes into account the opinions of residents, relatives and external professionals must be completed. Timescale of 30/12/06 has not been met. 15/01/08 15/11/07 10/11/07 Amberley Court Nursing Home DS0000024817.V345975.R01.S.doc Version 5.2 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. Refer to Standard OP1 Good Practice Recommendations The home is advised to produce the statement of purpose and service user guide in audiocassette and other languages to enable physically disabled and people of differing ethnic groups to understand the contents of the documents. 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. The home is advised to produce the complaints procedure in audiocassette and other languages to enable physically disabled and people of differing ethnic groups to understand the contents of the documents. The home is advised to carry out a review of the numbers of people and their needs in respect of hoisting equipment and if a shortfall is evidenced then appropriate action should be taken. The home is advised to carry out a review of the scuff marks on the lower walls and skirting boards and a plan produced to deal with them. At least 50 of the care staff should have successfully completed training in NVQ level 2 or equivalent. The home is strongly urged to apply to us for change of Registration category. 2. OP14 2. OP16 3. OP21 4. OP20 5. 6. OP30 OP31 Amberley Court Nursing Home DS0000024817.V345975.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.V345975.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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