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Inspection on 06/05/08 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 6th May 2008.

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 a friendly, welcoming atmosphere. Staff interact very well with the people living in the home demonstrating a good understanding of their needs and how to communicate effectively with them. There is a robust recruitment procedure in place that helps to safeguard the people living in the home. Care practice observed was of a good standard and reflected the care documented in the individuals care plans showing that the individual`s specific needs were being met. People living in the home had a range of comments to make during the inspection including: "I`ve been here for 8 years. I go to the day centre 3 days a week, and I take a packed lunch made by the chef. We are well taken care of." "Its pretty good here, getting better all the time. It`s like family here." "We are well looked after, the staff are lovely"

What has improved since the last inspection?

Since the Relief Home Manager and Deputy have been at the home there have been a number of improvements to the service, in particular the documentation relating to the people who live in the home. Care plans are detailed and provide clear guidelines to enable the staff to meet the specific needs of the individual person. Risk assessments are now in place for bedrails and bumpers listing the potential hazards and the control measures needed to reduce those hazards, ensuring those people using them in the home are safe. The nursing staff make sure the care that people receive is meeting their specific needs by reviewing the care plans and risk assessments monthly. Short-term care plans for temporary problems such as chest or urinary infections have been introduced and give clear instructions to staff as to how to manage these short-term issues for the benefit of the individuals.

What the care home could do better:

Where individuals are unable to use the call bell or verbalise for help a system needs to be introduced to ensure their safety is maintained. Staff are to have training in fire safety procedures and individual fire evacuation techniques for each person living in the home, so that in the event of a fire evacuation, procedures are carried out safely and competently. A programme of staff training and supervision must be implemented to ensure staff have the skills and competencies needed to meet the needs of the individuals living in the home.

CARE HOMES FOR OLDER PEOPLE Amberley Court Nursing Home 82-92 Edgbaston Road Edgbaston Birmingham West Midlands B12 9QA Lead Inspector Sara Gibson Key Unannounced Inspection 09:30 6th & 8th May 2008 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.V364271.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.V364271.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 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.V364271.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 8th April 2008 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 needs of the younger adults range from acquired brain injury to cerebral palsy. 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 home has a number of aids and adaptations to assist those living there, such as hoists for lifting and transferring, a passenger lift to the upper floors and automatic opening doors in the home to allow easy passage for wheelchairs. 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. Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 5 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.V364271.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate outcomes. The focus of our inspection is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Following the last key inspection of the home in September 2007, a random inspection with regard to ongoing concerns about the homes failure to provide satisfactory care to people in respect of medication management took place in April 2008. As a result of this both Birmingham City Council and Solihull Metropolitan Borough Council suspended their contracts with Amberley Court. This means that no social services admissions are being made to the home at present. Two inspectors undertook this key fieldwork visit to the home over 14 hours, and the Acting Manager assisted us throughout. The home did not know we were visiting on that day. There were fifty-two people living at the home on the day of the visit. Information was gathered from speaking to and observing people who lived at the home, four people were “case tracked”, and this involved discovering their experiences of living at the home by meeting and observing them, looking at medication and care files, and reviewing areas of the home relevant to these people, in order to focus on outcomes. A further two care files were partly reviewed. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Random questionnaires were sent out to staff and people who live at the home in order to gain their views about the service, however none had been returned at the time of writing this report. During our visit we spoke to eight people who live at the home, ten staff members and two relatives. Comments received were generally positive, although some negative comments were received about the home. These will be included throughout the report. Prior to the inspection the manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements made, and plans for further improvements, which was taken into Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 7 consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. No immediate requirements were made on the day of our visit. What the service does well: What has improved since the last inspection? What they could do better: Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 8 Where individuals are unable to use the call bell or verbalise for help a system needs to be introduced to ensure their safety is maintained. Staff are to have training in fire safety procedures and individual fire evacuation techniques for each person living in the home, so that in the event of a fire evacuation, procedures are carried out safely and competently. A programme of staff training and supervision must be implemented to ensure staff have the skills and competencies needed to meet the needs of the individuals living in the home. 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.V364271.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.V364271.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, 3, and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who may wish to use the service have detailed information about the home to enable them to make an informed decision as to whether the home can meet their needs. EVIDENCE: The home has just reviewed the information that is available to prospective users of the service. The information includes a statement of purpose that is specific to the home and the resident group they care for. It sets out the objectives and philosophy of the service supported by a service user’s guide. The service user guide that we saw details what the prospective residents can expect and gives an account of the services provided, the quality of the accommodation, the qualifications and experience of the staff team, how to make a complaint and recent CSCI findings. We saw that all the people living in the home had a copy of the guide in their bedrooms to refer to if needed. Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 11 The manager said that when requested the service can provide a copy of the statement of purpose and service user guide in a format which will meet the capacity of the resident, such as large print, other languages or Braille. Admissions are not made to the home until a pre-admission assessment has been undertaken. For people who are self-funding and without a care management assessment, a senior member of staff undertakes an assessment. The assessment involves the individual and their family or representative, and other professionals where appropriate. Six completed assessments were looked at during the inspection. All the assessments were very detailed and thorough, and covered area’s such as Communication, Lifestyle, Maintaining a Safe Environment, Mobility, Mental State, Memory, Cognition, Eating & Drinking, Elimination, Personal Cleansing, Sleeping, Medication, End of Life arrangements and Relatives expectations. In one assessment for example, under mobility it states: “Requires assistance of one person. Uses manual wheelchair, propels independently. Transfers using the handrail and wheelchair with one person”. We spoke to the person who was referred to in this assessment and she confirmed that before she came to live at the home, a member of the homes staff who carried out a full assessment visited her, and asked a lot of detailed questions about her specific needs. She said that the care she receives is good; it meets her needs but allows her to keep her independence. The assessment also states the persons reason for admission to the home, and their past medical history, their preferred name, date of birth, GP and next of kin. All the assessments seen were signed and dated, and had been reviewed in the last 6 months. From case tracking four of the people living at the home, we were able to see that the pre-admission assessments had been completed in detail, were specific to the individual and allowed a detailed care plan to be developed to meet their individual needs. Amberley Court Nursing Home DS0000024817.V364271.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 good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs and promotes their well-being. EVIDENCE: People living in the home receive personal and healthcare support using an individual approach. Personal healthcare needs including specialist health, nursing and dietary requirements are recorded in each persons plan. They give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Six care plans were examined during the inspection, and were all found to be comprehensive, detailed and contained clear guidelines for staff to follow to meet the individual needs of the person. The plans identify the assessed need, the aim of the intervention, and the support plan that is reviewed monthly, or as needs dictate. Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 13 For example, in one of the plans the assessed need was: “A’s lifestyle has changed and she has to adapt to living in a care home”. The aim of the intervention is: “ To enable A to maintain the lifestyle of her choice. To allow A as much choice and independence as possible”. The support plan is detailed and gives guidance to staff to allow A’s needs to be met in a way that she prefers. A told us that the staff are very good, and she is able to tell them what she wants and how she wants things done. A number of people living in the home have problems with eating and swallowing so have been assessed as needing help with feeding via a PEG feed. The care plans seen were comprehensive and included a detailed feeding regime, a documented 24-hour fluid chart, monthly assessments of the PEG site and monthly weights to ensure individual’s weights are maintained. Oral care for these individuals is important so an oral care plan is in place with an assessment chart, with particular emphasis on hydration. Personal support is responsive to the varied and individual needs and preferences. The delivery of personal care is individual, and is flexible, consistent and reliable. Staff respect privacy and dignity and are sensitive to changing needs. For example, where a person has continence issues, and has a urinary catheter, there is detailed information about the catheter and catheter care. Regular tests are carried out to make sure there is no infection. The home listens and responds to individual’s choices and decisions about who delivers their personal care. It is recorded in the individuals care plan as to whether they prefer male or female care staff. We saw that was taking place when people were receiving personal care. People are supported and helped to be independent and can take responsibility for their personal care needs. One concern that was identified during the inspection was that staff carry out ½ hourly visual checks on people who are unable to use the nurse call bell or verbalise for help. The risk assessment states that these checks should be documented, timed and signed by staff. A number of these records were seen and there were gaps where checks had not been carried out, particularly between 6am – 8am, and 8pm – 9pm. It is vital that this issue is given attention to ensure people are safeguarded. The manager said that during these times staff are busy and it is also handover time, but she stated that they would introduce a system to rectify the problem. Residents have access to healthcare services. Staff make sure that those who are able, are encouraged to be independent and visit local healthcare services. The health care needs of people unable to leave the home are managed by visits from health care services. The people living in the home have the aids and equipment they need, and these are well maintained to support them and the staff in daily living. Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 14 Staff work to clear guidelines when caring for individuals who have degenerative conditions. Care plans contain information about the individual’s wishes, choices and decisions as their health deteriorates. Staff monitor pain, distress and other symptoms to ensure individuals receive the care they need. End of life arrangements are noted and staff respect the individual’s final wishes. The pharmacist inspector visited the home on the 8th May 2008 as part of the key inspection to assess what progress had been made in meeting the immediate requirements made at the last visit on the 8th April 2008. Following the last inspection the organisation has taken action to improve the medication administration, recording and storage. These actions include: -Improving the induction process for new nurses -New nurses undergo two supervised drug rounds prior to commencing lone drug rounds. -Regular competency assessments for all nurses. -Daily medication audits. -Medication rounds where the nurses are protected from interruptions. -Medication now stored safely in secure cabinets. We found that the recording of the receipt and administration of medicines had significantly improved compared to the last inspection. We found that the home was recording the maximum and minimum temperatures of the fridges on a daily basis and were ensuring that the medication requiring cold storage conditions was being stored within the correct temperature range. During the visit the following areas of medication practice were identified as needing improvement to ensure people receive their medication as prescribed: -One bank nurse was observed giving medication unsafely. Further training and supervision is required for this nurse. -The home had failed to improve the recording of the refusal and disposal of medication, and as a consequence a significant amount of medication could not be accounted for. Amberley Court Nursing Home DS0000024817.V364271.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. People who live in the home are able to make choices about their life style, and are supported to take part in social and recreational activities to allow them to maintain an active lifestyle. EVIDENCE: People using the service take part in activities within the home and in the community. The home has a part-time activities co-ordinator at present, and they are recruiting to fill the position full time. The co-ordinator has to rely on the good will of the staff to help provide activities for the people living in the home. Activities range from reading to theme nights and discos. People living in the home decide what activities they want to do with staff. A number of the staff give up their free time to help with activities in the absence of a full time activity co-ordinator. The home has a fully equipped Internet café, and one of the care assistants comes in one afternoon a week to deliver I.T skills. Other staff members come in on their days off to take people out shopping or to accompany them on outings. The male staff run a Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 16 “Gentleman’s Poker Night” fortnightly, which is well attended, and the ladies have pamper sessions in the beauty room. Once a month the care staff organise a theme night, where the evening is dedicated to a certain theme, including room decoration, costumes, food, drink and music. On the day of inspection an Indian theme night had been planned for the people living in the home, the chef produced an Indian menu, and the staff were decorating the dining room to add to the theme. The theme nights are extremely popular. For those people being nursed in bed, favourite books or newspapers are read to them, music tapes are played and on theme nights the bedrooms are decorated and where possible they partake of the theme menu. The food in the home is of satisfactory quality, well presented and meets the dietary and cultural needs of people who live in the home. Each floor has a drinks and snack menu available between meals. Dietary requirements such as pureed, peg feed, diabetic, soft, supplements or preferences such as no rice are listed on the daily choice menu by each name. People have a choice of menu for lunch and dinner. There are two hot choices or sandwiches plus a grill menu for burgers, sausages, jacket potatoes, toasted sandwiches, mixed grill, or omelettes. Breakfast choice is cereals, toast, fruit, yogurt, or a full English breakfast. People living in the home are happy with the choices available. One person said, “The chef knows I don’t like foreign food so will cook me what I like” Staff were observed giving out drinks and snacks, one person asked for a banana and another yogurt. Staff offered biscuits to one person stating: “We’ve got the ones you like, the chocolate ones”. Staff were seen feeding a person, sitting with him and interacting well. There was good interaction observed between staff and people living in the home, and a good atmosphere in the dining room during the meal. Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 17 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 who live in the home are able to express their concerns, and have access to a complaints procedure and are confident that their concerns will be listened to and acted upon. Staff require further training to ensure people living in the home are protected from harm in the event of an allegation of abuse. EVIDENCE: People living in the home are able to express their views and concerns. We saw that there was good interaction between the staff and the people living in the home. Four of the people we spoke to confirmed that if they had any concerns they would speak to a member of staff or the manager. A number of the people living in the home rely on their relatives to express any concerns they may have. They are happy with the service provided and feel safe and supported by the staff team. The home has a complaints procedure on display and it is available to anyone involved with the service. It is available on request in different formats such as other languages or Braille to allow people to complain or make suggestions for improvement. Since the last inspection recording of complaints has improved. There is now a record of complaints including details of the investigation and any actions Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 18 taken. There have been 4 complaints made since January 2008, three of which have been resolved satisfactorily; the fourth is still under investigation as it concerns an adult protection issue. Policies and procedures are in place that refers to safeguarding, but on talking with staff they had not read the policy or were not aware of its existence. There have been previous concerns over the lack of understanding of safeguarding procedures, and learning from issues and outcomes of safeguarding referrals, but the current management team are working to improve staff understanding and knowledge. The six staff spoken with had an understanding of what to do should they have any concerns about adult protection but were not aware of the homes policy. It is recommended that staff refresh their knowledge of the homes policy regarding adult protection to ensure people living at the home are safe. Equipment that is used to keep people safe, for example bed rails and wheelchair belts that restricts a persons movement, is individually assessed and people are involved in the decision making process. One person has decided against using a lap strap when in her wheelchair, the assessment shows that the risks have been explained to her and she has signed a disclaimer form to that effect. Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 19 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, 23, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The layout of the home enables people who use the service to live in a safe and comfortable environment that meets their needs. EVIDENCE: The living environment is appropriate for the individual requirements of the people living there; it is homely, clean, safe and comfortable. People can personalise their bedrooms to reflect their personal taste, gender and interest and there has been consultation with the people living in the home about the décor. There are various communal areas both inside and outside the home, this means that people living there have a choice of place to sit quietly, meet with family or friends, or be actively engaged with other people who live in the home. Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 20 There is a rolling programme of maintenance, and all equipment is regularly serviced and repaired. It was noted that some of the walls in the bedrooms have scuffmarks and dents from the wheelchairs, and carpets in two of the bedrooms were worn and need replacing. The maintenance man is aware of these issues and requests for new carpets have been made. The home is well lit, clean and tidy, and smells fresh. Infection control procedures have improved and staff are aware of the policies and procedures. The laundry and kitchen were seen to be clean and tidy, with cleaning products stored appropriately. Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 21 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 poor. This judgement has been made using available evidence including a visit to this service. There is insufficient staffing in the home to support the people living there, which could potentially place people at risk. Training and supervision for staff requires further input to ensure the specific individual needs of people using the service are met. EVIDENCE: People living in the home are generally satisfied with the care they receive to meet their needs, but there are times when they have to wait for staff support and attention. There are three staff vacancies at present, plus the full time activity co-ordinators post. People living in the home report that staff working with them know what they are meant to do, and that they meet their individual needs in a satisfactory way. The staff employed are competent and experienced, and are clear regarding their role and what is expected of them. The home has a recruitment procedure that meets statutory requirements, and ensures that only staff who are suitable to work with vulnerable adults are employed by the home. Six staff files were looked at, and the evidence shows there is accurate recording at all stages of the process. There is occasional use Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 22 of agency staff but it doesn’t adversely affect the quality of the individual care and support people receive. Staff comments included: “I’ve been here nearly 8 years, and am starting nurse training in September. I like it here.” “I do like this home and enjoy my job. It’s the only home I keep coming back to. There’s a good atmosphere.” “ I’ve worked here for 8 years. I look up people’s condition on Internet no training on epilepsy or strokes” “ No recent training on epilepsy.” Staff training and staff supervision in the home is limited. There is no comprehensive training plan and much of the training is out of date. There were no reliable records of staff training undertaken, although the homes Regional Manager had carried out an audit of staff training the month before. It showed over half the staff needed refresher training in: Infection Control, Protection Of Vulnerable Adults, Challenging Behaviour, Manual Handling, Fire Training, Fire Evacuation, COSHH (Care of Substances Hazardous to Health), Health & Safety, Food Hygiene, and an overview of the Mental Capacity Act. The Manager is at present in the process of developing a training plan for all the staff. Staff spoken with said: “We do have training” “We watch the training videos”. When asked if they had had specific training to enable them to meet the specific needs of people living in the home, such as care of a person with epilepsy or care of a person following a stroke, they said no. This is of particular concern as a number of the people living in the home have these conditions and have specific care needs. There is the potential for these care needs not to be met due to a lack of staff training. There is inconsistent, inadequate supervision of staff with infrequent individual sessions and few staff meetings. Records of supervision show that staff have received one group supervision session since January 2008. The supervision records seen were poorly documented, for example, some of the forms just had comments such as: “seemed aware” “very quiet” and “wasn’t interested” written on them. People living in the home would benefit from the introduction of a planned programme of supervisions for all staff, to ensure standards of care practice are maintained. Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 23 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, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Changes to the management arrangements have meant that the views of people using the service are responded to. EVIDENCE: At the time of inspection a Relief Home Manager was temporarily managing the home. A permanent Manager has been recruited and is due to start shortly. The relief management team in the home are very experienced and have made a number of improvements to the service. Staffing levels had increased and all care documentation has been reviewed and is now updated on a monthly basis. Staff feel supported by the current management team but are concerned about another change of Manager. The Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 24 Relief Manager will work alongside the new Manager, and ensure that a comprehensive handover is given. Staff comments included: “Been here 12 years, there’s variety, I like it, there’s always something going on. The Manager is very good. You get used to a manager then another one comes in, it can be very hard. Lots of upheaval.” “Worked here quite a few years on and off. There are lots of changes of manager. I do feel supported by the managers”. “I feel supported by the current manager”. “Everywhere has its ups and downs but there is a good staff team”. The staff assist people living in the home who are unable to manage their own finances. A small amount of money is kept in the homes safe for immediate access, the rest is banked. Accurate records are kept and are available for the individual to see at ay time. We saw two individuals access their money before going out to the shops, and a third asked for a statement of their account to be printed off. Of the four people being case tracked during this inspection we saw their account statements that showed small amounts of money was taken out to buy toiletries or to pay for the chiropodist or hairdresser, receipts were present in the file. Health and safety practices such as 1st aid, fire safety, manual handling, food hygiene and general health & safety are inadequate due to a lack of staff training in these areas. The area of most concern is fire safety. Staff need to have an understanding of appropriate fire procedures and how to implement them for each person living in the home to ensure people are safeguarded. People living in the home are able to suggest any improvements they think would move the service forward. The communal areas were decorated after consultation with the people living at the home. Meetings are held for the people living at the home to discuss issues important to them. Eight people attended the last meeting held in December 2007, where they discussed the menu and the choices available. As a result of the meeting more choices were made available at mealtimes. Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X 2 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 1 X 2 Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The records of the receipt, administration and disposal of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Timescale of 08/04/08 not met Appropriate information relating to medication must be recorded, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when required and PEG tube administered medicines so that all medication is administered safely, correctly and as intended by the prescriber, to meet individual health needs. Due to timescale not assessed at this inspection Where persons living in the home are unable to use the call bell or verbalise for help, and have ½ hourly visual checks to ensure their safety, a system needs to be introduced to ensure these checks are being made. DS0000024817.V364271.R01.S.doc Timescale for action 06/05/08 2. OP9 13(2) 01/06/08 4. OP18 12(2) 08/06/08 Amberley Court Nursing Home Version 5.2 Page 27 5. 6. OP18 OP30 18 18(1)(a) (c) 18(2) 8. OP36 9. OP38 18 Staff need to be made aware of the homes local policy with regard to safeguarding. Staff must receive the training they require to meet the individual and collective needs of people living in the home. A programme of formal documented supervision is to be introduced for all staff, to give them guidance and support, and to identify training needs. All staff are to be receive training in fire safety procedures and how individuals are to be evacuated in the event of a fire. 08/06/08 08/06/08 08/06/08 08/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Amberley Court Nursing Home DS0000024817.V364271.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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