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Inspection on 05/07/05 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 5th July 2005.

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

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

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

What the care home does well

The home has spacious corridors and adequate doorway access to accommodate wheelchair users. There are a variety of lounges for residents and visitors to choose from. Some lounges include themes, which are geared towards the younger adult. There is a harmony suite that has been very well appointed. The home also has a dedicated computer room, which includes equipment to facilitate usage by persons with physical disabilities. A grillroom is located on the first floor where residents may request meals at any time of the day. The room is spacious and has a small balcony leading off. Bedrooms are very personalised; residents are encouraged to bring in their own furniture. Residents are encouraged and supported in maintaining their independence both within the home and in the community.

What has improved since the last inspection?

The home has been split into three units and staff work (largely) in dedicated areas of the home to improve their expertise. The organisation has developed a management structure for the home and has partially filled those posts. Three senior sisters have been appointed.

What the care home could do better:

All of the work to be carried out is considered to require urgent attention; less important issues will be highlighted during future inspections. The home must prioritise by addressing the following: Completion of the management structure with the appointment of a deputy manager in order to provide support for the overburdened manager. All outstanding requirements from previous inspections must be addressed. Care plans have been inadequate for an extensive period of time, these must be adapted for the majority of the client group; younger adults. A programme of maintenance and re-decoration is needed to control the spiralling works required for the fabric of the building. All residents must be provided with and given choices regarding their preferred method of bathing. The home must address the long standing concerns regarding lack of formal staff supervision and provision of mandatory and appropriate training to meet the needs of residents. The organisation must in consultation with CSCI complete the outstanding audit of required staffing levels, which takes into account the ongoing and changing dependency levels of residents. All aspects of Health and Safety in respect of fire safety and maintenance of lifting aids must be fully complied with. Appropriate door opening methods such as touch pads must be installed for residents. The call system must be audible to all staff at all times.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Amberley Court Nursing Home 82-92 Edgbaston Road Edgbaston Birmingham B12 9QA Lead Inspector Kath Strong Announced 5 & 6 July 2005 th th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. 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 E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Amberley Court Nursing Home Address 82-92 Edgbaston Road, Edgbaston, Birmingham B12 9QA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 440 4450 0121 440 4670 BUPA Care Homes Ltd Karen Hook Care Home 70 Category(ies) of Physical Disability - Over 65, Old Age, Dementia registration, with number - over 65, Physical Disability - Terminally Ill of places (70)y Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. General nursing, males and females over 65 years and younger adults with physical disabilities or requiring terminal care. 2. Up to 10 persons may receive day care additional to those in residence; subject to ability to meet all needs. Date of last inspection 8th December 2004 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 youngr 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 depency care and the remainder for rehabilitation. The first floor also provides a dedicated computer room for use by residents and a grillroom where meals can be ordered throughout the day. Further rooms include a harmony suite and a lounge that has been adapted for wide screen television use and discos. The ground floor has a large dining room, which is accessible by wheelchair users, meals are served over two sittings with timings being fairly flexible. Two more lounges are available on this floor situated at each end of the home. All communal rooms, bedrooms and bathing facilities are located on the groung and first floors. All bedrooms have en-suite facilities consisting of toilet and wash hand basin. The home is surrounded by a fenced garden area, a further garden is accessible from the dining room. There is a large off road car park which accommodates many cars and larger vehicles. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the visit was to conduct an announced inspection, which was carried out by two inspectors over a period of two extended days. The outcomes were determined by various means. In depth discussions were held with the manager and briefly with the regional manager. The inspectors held independent discussions with ten residents and four relatives. Six staff members were interviewed; three trained, two carers and an activities organiser. All relevant documentation was examined including eight care plans, two of which involved case tracking in order to determine if the full needs of the respective residents were being met. The recreational programme was assessed as well as the complaints received by the home since the last inspection. The staffing levels, knowledge base and training provided for them were also reviewed. A tour of the premises was conducted and aspects of health and safety were scrutinised. Following receipt of the draft report by the home an action plan was forwarded to the Commission dated 22nd August 2005. The response included a request for five of the requirements to be removed from the report. Verbal feedback was supplied at the conclusion of the inspection including the rationale for the requirements. Both inspectors involved with the inspection have reviewed the evidence that generated the requirements and have concluded that the requirements are justified and will therefore remain. What the service does well: The home has spacious corridors and adequate doorway access to accommodate wheelchair users. There are a variety of lounges for residents and visitors to choose from. Some lounges include themes, which are geared towards the younger adult. There is a harmony suite that has been very well appointed. The home also has a dedicated computer room, which includes equipment to facilitate usage by persons with physical disabilities. A grillroom is located on the first floor where residents may request meals at any time of the day. The room is spacious and has a small balcony leading off. Bedrooms are very personalised; residents are encouraged to bring in their own furniture. Residents are encouraged and supported in maintaining their independence both within the home and in the community. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: All of the work to be carried out is considered to require urgent attention; less important issues will be highlighted during future inspections. The home must prioritise by addressing the following: Completion of the management structure with the appointment of a deputy manager in order to provide support for the overburdened manager. All outstanding requirements from previous inspections must be addressed. Care plans have been inadequate for an extensive period of time, these must be adapted for the majority of the client group; younger adults. A programme of maintenance and re-decoration is needed to control the spiralling works required for the fabric of the building. All residents must be provided with and given choices regarding their preferred method of bathing. The home must address the long standing concerns regarding lack of formal staff supervision and provision of mandatory and appropriate training to meet the needs of residents. The organisation must in consultation with CSCI complete the outstanding audit of required staffing levels, which takes into account the ongoing and changing dependency levels of residents. All aspects of Health and Safety in respect of fire safety and maintenance of lifting aids must be fully complied with. Appropriate door opening methods such as touch pads must be installed for residents. The call system must be audible to all staff at all times. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5 There is inadequate written information for prospective residents to make an informed decision about the home. Due to lack of comprehensive preadmission assessments the home is unable to demonstrate its ability to meet residents needs. EVIDENCE: The organisation had re-written the statement of purpose; however it was determined to be inadequate. Details in respect of registered persons were out of date and the category of registration does not correspond with the homes current registration. Some aspects of the document must to be expanded and the trend of requesting the reader to refer to the organisations policies and procedures is not acceptable. The pre-admission assessment tool was seen to be comprehensive; however recordings must be accurate in providing all relevant details in order for the Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 10 home to demonstrate its ability to meet all of the individuals needs. Staff must receive all relevant training to empower them in providing the identified care needs. Prospective residents and their relatives are encouraged to visit the home for as long as they wish and to sample the food before making a decision. The contract of terms of residency must be further developed to include the room occupied, re-issued to all residents and signatures obtained. This remains outstanding from the two previous inspections. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 There is no clear and consistent care planning system in place to provide adequate information for staff to provide acceptable levels of care. Resident’s health care needs were not being fully met or relevant risk assessments being carried out. Staff practices regarding the administration of medications were found to be unsafe. EVIDENCE: Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 12 The care plans examined included younger adults and older persons. Although some improvements have been made many gaps and inconsistencies were found. The home has introduced an interim basic assessment form that should be completed within 24 hours of admission, in some cases these were found to be only partially completed or in one case not completed at all. There were no short term care plans for occasions when residents developed complications such as chest infections. The records indicated that the monthly weight and observation charts and prescribed daily passive exercises had significant gaps. The manual handling assessment of one resident failed to include equipment used to provide means of mobilising and to carry out the prescribed daily exercises. Care planning and progress notes fail to address psychological assessments, needs and guidance on action to be taken by staff in the event of inappropriate behaviour. There was very little evidence of regular formal reviews being carried out. Another file failed to document the action to be taken regarding a resident who is allergic to wasp stings. The home fails to adequately document the length and physical symptoms during seizures of a resident who suffers from epilepsy. Few risk assessments were seen in respect of internal activities and none for occasions when residents leave the home. The use of a generic and inappropriate tool must cease immediately; risk assessments must be individual. All files must include dedicated information regarding visits made by GP’s and other professionals in chronological order to indicate trends. The recordings should include rationale, outcome and action to be taken by the home. The number of requirements made over a period of time for this standard illustrates the concern of CSCI and the inconsistency of the homes commitment to improvements. Some positive comments were made by residents/relatives such as “staff are very kind and very reassuring, “I help the staff with the care of my relative”. Fluid balance charts indicated that residents did not receive the prescribed amounts of water each day. Another resident who was unable to eat or drink was not receiving appropriate oral care. Another file revealed that an antibiotic had been prescribed by a GP but that it should only be administered if the resident’s condition worsened. No further recording s were found in respect of this. Of the nine comment cards completed by residents three stated that they are not always well cared for. Although the systems in place for the administration of medications were seen to be adequate the home must address the issue of individual staff practices. A MAR (medication administration record) chart indicated that a resident should receive a multifibre compound five times per day. The chart was inspected at 13.10 and it was recorded that the 15.00 dose had already been administered. Such practices are deemed to be unsafe and must cease with immediate effect. Observations revealed that residents were treated with respect by senior staff however; a group of severely physically disabled residents seated in a lounge were being supervised by a carer who made no attempt to communicate with them at all. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Internal and external activities in some instances were being restricted leading to frustrations of some residents. The systems for resident consultation were not adequate. The home provides a wholesome, appealing and balanced diet. EVIDENCE: Staff had failed to record adequate details in respect of life histories, daily routines, likes and dislikes and preferences. One file instructed staff to wake a resident at a given time each day however; the resident stated “its very hit and miss if I get the morning call, I feel at times like I don’t exist” A consequence of which is that he does not receive breakfast. The preferred recreational events recorded by trained staff did not coincide with the range of activities offered by the activities organisers. This indicates lack of communications between differing grades of staff and the residents. Resident meetings were not being held regularly. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 14 Many residents reported their satisfaction with the in-house and external activities programme however; due to the diverse needs and age groups of persons currently residing at the home there was insufficient staff and transport facilities to cater for all requests made. There was evidence that staff within the given limitations had made good efforts to provide a varied and interesting recreational programme. Staff need to be aware of and take appropriate action regarding the effects of loud music played during the monthly disco upon the older persons living at the home. The home has commenced the regular production of a newsletter, which is very informative. It would benefit from being produced in large print for those residents who have limited vision. There was evidence of attendance at day centres that provide a variety of recreational and educational skills. Comprehensive inhouse computer competency training is available; the equipment is user friendly for those persons with limited physical mobility. The staff encourage and support residents in maintaining family and personal relationships. The home has a policy of visiting at any reasonable time and residents who are able visit friends and relatives. A constant flow of visitors was observed during the inspection. Some relatives visit for protracted periods on a daily basis, some of which actively participate in the provision of personal care. The home has a four week cyclical menu that indicated residents are given choices and that the meals provided are appealing, varied and nutritious. One inspector sampled the lunch of the day, which was found to be satisfactory both in presentation and portion sizes. Cultural requirements appear to be well catered for. One resident reported that the method of cooking his meals was not to his liking, the chef had met with him in order to resolve the problem. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints procedure is readily available but lacks evidence that outcomes are being monitored. Arrangements for protecting residents are not satisfactory placing them at possible risk of harm or abuse. EVIDENCE: The home continues to receive a steady flow of complaints; the manager has investigated six since the beginning of March 2005. Some were upheld and some partially upheld. The home must develop a system of monitoring the outcomes to ensure that action taken remains constant. Following the inspection carried out December 2004 CSCI has received two complaints, which were investigated, and the following elements were upheld: • Visitor sat in a badly soiled armchair • A residents room was being used as a storage room for her equipment • The care plan failed to record the daily nutritional prescription for the resident • The fluid balance chart indicated that the prescribed amount of water was not being administered • A resident was not being transferred to his wheelchair and taken out of his room • The footplates for the wheel chair were missing • Lack of appropriate and amount of recreational stimulus. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 16 The home was required to address these issues. Some residents and relatives raised specific practice issues, these were brought to the attention of the manager and further discussions concerned identification of a means of addressing the issues. The written policy regarding adult protection, missing persons and physical intervention were examined, no progress has been made; all were found to be in need of amendment and further development. The training matrix indicated very little progress in respect of provision of appropriate training for all staff. Lack of compliance with this standard has been raised on numerous occasions; the home has provided little evidence of its intention to address this issue. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22, 24, 25 and 26 Limited improvements to the décor have been made. The outstanding matters do not provide people living at the home with, safe, accessible and comfortable surroundings. EVIDENCE: As with previous inspections the home continues to give a general appearance of tiredness with many areas being in need of re-decoration. This has been exacerbated by the departure of the maintenance operative. The diverse and complex needs of residents have not been specifically provided for. There is a good selection of lounges for residents to choose from, meals are taken by two sittings in the dining room or the grillroom and residents may eat in their own rooms. Access to the garden leading from the dining room Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 18 continues to be limited to non wheelchair users due to lack of action to address the gradient. All bedrooms have en-suite facilities consisting of toilet and wash hand basin. There has been no progress in respect of adaptation of communal bathing facilities in respect of the plans, which were discussed at the last announced inspection. Bathrooms are a good size and in the main provided ease of access. The specialist bathing equipment failed to be sufficient to give all residents choice in respect of bath or shower and one resident is unable to access any bathing facilities whatsoever. The manager advised that a specialist shower chair has been ordered. The home must provide documentary evidence that showering is the residents preferred choice. An armchair in a bedroom was found to be badly ripped. An assessment of the premises has been carried out; both inspectors reviewed the report and found that it failed to cover all aspects of the home: • No reference that some residents are unable to open their bedroom and communal doors • Staff inability to hear the call system when attending to residents in their bedrooms • Non access of wheelchair users to the garden from the dining room • Lack of individual risk assessments for communal areas maintained within the individuals care plan Bedrooms continue to be very personalised; residents bring personal possessions and items of furniture into the home. All rooms have a lockable bedside cupboard, telephone socket, television with remote control, suited door locks and a nurse call system. Temporary extra sockets have been provided for those residents who have a large number of electrical devises. The home needs to carry out risk assessments until sufficient permanent electrical sockets are provided. The heating, lighting and ventilation were determined to be satisfactory; lighting was domestic in design. The hygiene levels within the kitchen were satisfactory, food was stored appropriately, a cleaning schedule was in place and cooked food was temperature probed. Carpets in general were noted to be stained; the carpet in one room was heavily soiled and sticky. The bed frame and side table in a room were found to be very dirty. A programme of deep cleaning should be devised and implemented. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The allocated staffing structure fails to provide evidence that there are sufficient staff numbers to meet resident’s needs. Recruitment practices fail to ensure the safety of vulnerable persons. Staff do not possess the skills and knowledge to provide satisfactory standards of care. EVIDENCE: Although the staffing rota indicated that the organisations staffing target was being met there was no evidence to support that the allocated levels were adequate. The ratio of younger adults to older persons has increased resulting in higher specialist and complex needs. The home was required to carry out an audit of staffing levels at the announced inception of July 2004 but has failed to action this. Throughout the inspection process differing persons raised many concerns. Nine relatives had completed comment cards four of which stated that staffing levels are poor and three out of nine residents reported that they are not always well cared for. The organisation had received an anonymous complaint from a member of staff regarding staff shortages. People spoken to during the inspection expressed their concerns Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 20 about poor staffing levels, these included two residents, three relatives and three members of staff. One comment received was, “too much is expected of us”. An audit of the required staffing levels must be carried out in consultation with CSCI. A maintenance operative has been appointed and was due to commence within two to three weeks. The grillroom was not fully functional due to the temporary lack of a member of staff from the kitchen. The home did not have the required amount of care staff that had completed NVQ level 2 training or above but a large number of staff is currently undergoing training. Historically the home had recruited staff without possession of appropriate work permits, references or CRB checks. The current manager had been working towards correcting the anomalies. Examination of staff files indicated that recent recruits are commencing employment with the receipt of only one satisfactory written reference. Newly recruited staff is required to undergo an acceptable induction programme. Previous inspection s have highlighted the need for all staff to receive all mandatory, refresher and training to meet the needs of the current client group, yet again this remains outstanding. There has been little progress since the last inspection; this issue must be addressed as a matter of urgency. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37 and 38 The manager has a clear development plan and vision for the home but does not have the supporting structure in place to achieve the goals. Staff management and formal supervision is inadequate resulting in poor communications and standards of care. The home has not fully complied with health and safety thus putting residents and staff at risk. EVIDENCE: The manager possesses the clinical skills, knowledge and experience to manage the home and is further developing her management skills. Throughout this inspection as well as previous inspections it was evident that Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 22 the level of responsibilities placed upon the manager in such a large and complex home appeared to be impossible to be achieved. During a meeting with the area manager advice was given that a temporary deputy manager would be found until the home recruited to the vacant position. The further development of a management structure with the recruitment of three senior sisters has been achieved. A proportional on call system should be devised and implemented. The inspectors observed an open and positive approach of the manager towards residents and staff. She must ensure that strategies are in place for enabling staff and residents to affect the way in which the service is delivered. A regime of regular staff meetings must be introduced. Two relatives regarding the attitudes and expectations of staff in respect of their involvement with the delivery of care raised concerns. The incomplete documentation and direct observations of an inspector indicated that there is insufficient shift-by shift direct staff supervision. A resident was unable to access the call system; following the input of carers the situation was repeated. A comment received from an external professional indicated that there were poor communications with her. Regular formal staff supervisory meetings were not being carried out. The manager advised that senor staff have recently received training and that allocations of care staff were imminent. Many policies and procedures were in need of review. The home has successfully undergone the Bettal quality assurance programme. The manager advised that the residents and relatives complete satisfaction questionnaires but the results of these are maintained by head office. In view of the negative comments received via comment cards and face-to-face discussions during the inspection there is evident need for the home to devise and carry out a regular quality assurance audit with copies of such exercises being forwarded to CSCI. Concerns were raised by the homes failure to fully address health and safety issues. Risk assessments in respect of the premises, fie safety, staff, infection control, and food were in need of review. The weekly testing of the fire alarm system and monthly testing of the emergency lighting had not been carried out since the departure of the maintenance operative. Although portable electrical equipment had been tested there was no certificate to verify this. The certificate regarding testing of water for Leigonella was found to be out of date. The lifting aids had been serviced May 2005 and the majority were determined to be in poor condition with no action having been taken to carry out the required repairs. The manager commenced action to address this issue during the inspection. The recommendations made from a recent inspection of the hydraulic lift were being actioned by the home. As discussed previously the nurse call system is in need of urgent attention. Three trained staff were interviewed in order to elicit their knowledge in respect of their responsibilities under Regulation 37. One displayed no knowledge. CSCI must be informed within 24 hours of any adverse incidents. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 23 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 1 2 2 3 2 4 1 5 3 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 x 1 2 x 2 3 2 Score Standard No 7 8 9 10 11 Score 1 1 1 2 x Standard No 27 28 29 30 2 2 1 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 2 x 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 2 33 2 34 x 35 x 36 1 37 3 38 1 Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)c Schedule 1 Requirement The satement of purpose requires numerous amendments and additions as outlined in the body of the report. A review of the registration of the home must be carried out and the statement of purpose amended to reflect this. The service user guide requires significant development to include those items listed under Standard 1.2. N.B. Not assessed but carried forward. The home must amend the contract of terms and conditions to include the room ocupied and re-issue to all residents. The homes written admission policy must include a three month trial periosd followed by review. The pre-admission assesments carried out must be comprehensive and include mental health state and cognition. The registered manager must undertake an urgent review of all care plans and ensure that the Timescale for action 10th October 2005 2. OP1 5(1)a-f 31st October 2005 3. OP2 5(1)b 30th September 2005 30th September 2005 15th August 2005 4. OP3 12(2)(3) 5. OP3 12(2)(3) 6. OP7 15((1)(2) bc Schedule 31st October 2005 Page 25 Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 3 7. OP7 13(4)abc 8. OP8 12(1)ab 9. OP9 13(2) 10. OP10 12(4)a 11. OP12 16(2)mn 12. OP13 16(2) 13. OP14 12(4)a files provide comprehensive documentation in respect of redients long and short term needs and include regular and formal reviews. Gp visits must be clearly documeneted. All relevant risk assessments for residents activities both internally and externally must be carried out and regularly reviewed. The registered person must ensure that proper provision of the health care needs are fully met. The adminstration of prescibed amounts of water, oral hygiene and passive exercises must be carried out. Monthly observations and weightd must be monitored. Observations of abnormal physical episodes must be accurately monitored and recorded. The registered person must ensure safe staff practices in respect of administration of medications at all times. The registered manager must ensure that all residents and relatives are treated with dignity and respect and any requests actioned. The home must adopt a comprehensive and cohesive approach to the provision of inhouse and external activities that takes into account residents preferences. The organisation must ensure that there is adequate resources providie to fulfill the recreational expectations of all residents. The home must provide documentary evidence that residents are consulted and that regular meetings are held with minutes produced and circulated 31st October 2005 30th August 2005 7th July 2005 30th August 2005 31st October 2005 31st Octiober 2005 31 August 2005 Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 26 accordingly. 14. OP16 22(1)(2) The system of recording complaints must be expanded to include monitoring and susequent reviews. The homes written adult protection, missing persons and physical restraint policies and procedures must be further developed and amended. All staff must receive training in these aspects of care. A programme of maintenance and re-decoration of the fabric of the home must be compiled and a copy forwarded to CSCI. The home must demonstrate and make provision for residents to make choises regarding their preferred method of bathing. The resident who is unable to access any bathing facilities must be provided with acceptable facilities. Some bathrooms require refurbishment and re-decoration. A schedule was requested by CSCI at the last inspection. iThe registerd person must address the gaps identified by the inspectors following an assessment of the premises by an occupational therapist. Specific areas that require attention are the lack of wheelchair access to the garden from the dining room, lack of an audible nurse call system and residents inability to open their bedroom and communal doors. Immediate interim action is required to resolve the failure of residents to summo assistance at all times. The registered manager must advise CSCI of the replacemnet of the ripped armchair in a 31st August 2005 31st October 2005 15. OP18 13(6) 16. OP19 23(2)b 30th September 2005 30th September 2005 17. OP21 23(2)j 18. OP22 23(1)a 31st October 2005 19. OP22 23(1)a 9th July 2005 8th July 2005 Page 27 20. OP24 16(2)c Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 residents bedroom. 21. OP26 16(2)k Attention to the hygiene levels and odour control of the home is required. A schedule of deep cleaning must be produced and implementted. Staffing levels must be appropriate in numbers taking into account changes in the client group and dependency needs. The organisation must carry out a review of the staffing levels out in consultation with CSCI, which takes into account the changing needs and dependency levels of residents. N.B. This has been outstanding from the two previous inspctions. The home must ensure that 50 of the carers possess training certificates in NVQ level 2 or equivalent. The registered person must ensure that robust recruitments practices are adhered to at all times. The registered person must ensure that all mandatory, refresher and other training to meet the needs of the current client group is provided for all staff. NB. This remains outstanding from the two previous inspections. The organisation must complete the process of recruitment of a deputy manager to ensure the manager is given adequate support to carry out her role. The registered manager must reestablish the programme of regular staff meetings. The registered person must produce and implement a quality assurance system that takes into 31st August 2005 22. OP27 18(1)a 14th July 2005 23. OP27 18(1)a 15th September 2005 24. OP28 18(1)a 15th December 2005 9th July 2005 30th November 2005 25. OP29 19(1) Schedule 2 18(1)c 26. OP30 27. OP31 18(1)a 31st October 2005 30th August 2005 30th November 2005 Page 28 28. 29. OP32 OP33 18(1)c 24(1)(2)( 3) Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 30. OP36 18(2) 31. OP36 17(1) 32. OP38 13 (4)abc 33. OP38 13(4)abc 34. OP38 13(4)abc 35. OP38 13(4)abc 36. OP38 13(4)abc 37. OP38 13(4)abc 38. OP38 13(4)abc account the opinions of residents, relatives and external professionals. Staff must receive supervision when on duty as well as formal supervision at least six times per year with a record os such maintained. Staff must have annual appraisals. The registered person must develop and amend all written policies and procedures regarding all practices including specialised procedures the home provides. Evidence must be produced of regular reviews being carried out. The registered manager must supply CSCI with eveidence that Leigonella testing has been carried out. The risk asessments in respect of environment must be reviewed at least annually or when circumstances change. The registered person must provide certified evidence of the portable appliance testing carried out May 2005. The temporary electrical sockets supplied to residents rooms must be risk assessed in order to ensure there is no risk of overload. The weekly testing of the fire alarm and monthly testing of the emergency lighting must be resumed. The registered manager must supply CSCI with evidence that the fire fighting equipment has been serviced. The home must provive documentary evidence the the required repairs have been carried out to a bath hoist that was determined to be in poor 30th September 2005 30th November 2005 134th July 2005 30th September 2005 21st July 2005 21st July 2005 9th July 2005 21st July 2005 21st July 2005 Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 29 condition. 39. OP38 37(1)a-g All care staff employed at the home must have knowledge of and comply with their responsibilities within this Reglation. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP31 OP13 OP22 Good Practice Recommendations The registered person should develop and implement a formal and proportional on call system. The home should develop a running log of the Regulation 37 reports forwarded to CSCI. The home should make an inventory of the specialist equipment which would provide a tool for cross referencing purposes such as servicing dates. Amberley Court Nursing Home E54_S24817_AmberleyCourt_V228251_050705_ Stage 4.doc Version 1.30 Page 30 Commission for Social Care Inspection Birmingahm & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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