Inspection on 02/04/07 for Amberley Hall Care Home

This inspection was carried out on 2nd April 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Amberley Hall Care Home 15/01/08

Amberley Hall Care Home 09/07/07

Amberley Hall Care Home 20/06/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Amberley Hall Care Home 55 Baldock Drive King`s Lynn Norfolk PE30 3DQ Lead Inspector Mrs Geraldine Allen Unannounced Inspection 2nd April 2007 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Amberley Hall Care Home DS0000065153.V337494.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 Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amberley Hall Care Home Address 55 Baldock Drive King`s Lynn Norfolk PE30 3DQ 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) 01553 670600 phillip.davies@hallmarkhealthcare.co.uk Hallmark Healthcare (Gaywood) Ltd Mr Phillip Davies (not yet registered) Care Home 106 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (20), of places Physical disability (26) Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The layout in the home will be: Ground Floor Fulmer Way: Rooms 1 - 20 to accommodate twenty (20) Older People who require nursing care. Curlew Crescent: Rooms 21 - 40 to accommodate twenty (20) services users with a physical disability who are under the age of 65 years who require nursing care. Dunlin Drive: Rooms 41 - 46 to accommodate six (6) services users with a physical disability who are under the age of 65 years who require nursing care. First Floor Avocet Avenue: Rooms 47 - 66 to accommodate twenty (20) service users with dementia who do not require nursing care. Lapwing Lane: Rooms 67 - 86 to accommodate twenty (20) older people with dementia who do not require nursing care. Sandpiper Street: Rooms 87 - 106 to accommodate twenty (20) older people with dementia who do not require nursing care. Date of last inspection 20th June 2006 Brief Description of the Service: Amberley Hall is a care home providing care and accommodation for up to 106 people of varying age and need. These include nursing care, dementia care and people who may be aged under 65 years who have a physical disability. The home is owned by Hallmark Healthcare (Gaywood) Ltd, which has its registered office in Billericay, Essex. The home is located in the town of King’s Lynn, close to the town centre with all amenities. The home was first registered on 9 January 2006 and consists of a two-storey building that is purpose built. All the rooms are single with en-suite facilities. Fourteen bedrooms on the ground floor and 12 bedrooms on the first floor have en-suite showers. The home is separated into distinct units, each with their own communal lounge, dining and bathing facilities. Two shaft passenger lifts are installed. There is access to gardens from several points on the ground floor. A hairdressing salon and cinema are located off the main reception. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 5 Mr Davies confirmed that the current fees for this home range between £393:00 and £1532:00. Additional charges are made for some items and are set out in the Service User Guide. The home’s Statement of Purpose and Service User Guide is given to prospective residents or their representatives when they are initially shown around the home. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the day of 2nd April 2007. Two inspectors, Geraldine Allen and Maggie Prettyman, conducted the inspection. Additional information about medication standards inspected by a pharmacist inspector, Mark Andrews, are also included. Information was gathered from various sources. Before the inspection, the manager Mr Davies completed and returned a questionnaire that provided information about the day-to-day running of the home. Although the Commission provided questionnaires for residents and visitors to complete, it was disappointing that only 3 completed questionnaires have been received. On the day of inspection, information was gathered by looking at various records and documents, talking with people using the service and visitors to the home including health professionals. Time was spent speaking with Mr Davies and staff at the home. Practice was observed and a tour of the premises took place. The last full inspection took place on 20th June 2006. Further unannounced inspections took place on 27th September 2006, 6th December 2006, 6th February 2007, 16th March 2007 and 21st March 2007. Two of these inspections were in respect of medication concerns and were conducted by a pharmacist inspector. Because of continuing concerns about the care and welfare of people living at this home, the Commission has issued a Notice which proposes to stop further admissions to the home until sustained improvement has been achieved in the number and competence of staff. There is evidence that some improvements have taken place at this home and also that the experience for people living in the younger physically disabled and Nursing Units is better than for those in the dementia units. The appointment of a manager to the home is a positive step, however steps need to be taken to ensure that the experiences of the people living on the 1st floor matches those living on the ground floor. Staff are working very hard and are dedicated to doing the very best they can for people living at the home. But, staff in the dementia units are working excessively long hours and are tired. Difficulties such as these existed in the younger physically disabled and Nursing Units and have been resolved. The same effort is required to reduce the hours worked by staff in the dementia units. Thirteen requirements and 14 recommendations around good practice have been made as a result of this inspection and the inspection conducted by the pharmacist inspector. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? There has been some improvement in the management of medicines. The plans of care for people living in the dementia units have improved but still contained significant gaps about important information around daily living. The plans need to include more information about the person, their life history, important anniversaries and dates and their preferred way of living. Activity organisers were seen during the day and were engaged in entertaining residents with walks in the garden during the morning and a film in the cinema during the afternoon. There is a programme of activity in place. However, staff need to ensure that people are not excluded from activity because of physical or other impairment. Staff spoken to were able to demonstrate a good understanding of adult protection matters. However, recent referrals to the Adult Protection Unit (one was made by the home) continue to give rise to concern about the level of understanding of all staff. There has been a significant improvement in the number of complaints made about this service. However, the Commission has recently been made aware by complainants who claim that the manager is not responding to their concerns in a timely way. The appointment of a manager at the home is welcomed. It is anticipated that Mr Davies will submit an application to be registered shortly. Other key Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 8 management roles remain to be filled and it is hoped that these essential posts are staffed by suitably qualified people without delay. Falls training has been completed by staff at the home and this has resulted in a decrease of more than 80 in the incidence of falls. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Amberley Hall Care Home DS0000065153.V337494.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 Hall Care Home DS0000065153.V337494.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are not admitted to the home until a pre-admission assessment has been undertaken. However, the assessment must be completed in full, dated and signed in all cases to ensure the information is accurate and up to date. This will assist staff at the home to be aware of all the care needs for each person. EVIDENCE: Ground floor In the younger physically disabled and Nursing Units, service users confirmed that the home met with their expectations upon admission. Service user files demonstrated that pre admission assessments are undertaken by the home. This information is supplemented by details supplied by social workers and external health care professionals. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 11 First floor Evidence was seen that the home undertakes pre-admission assessments and seeks information from other agencies as necessary. The pre-admission assessment for 1 resident was not fully completed, was unsigned and undated. The home’s assessment did not therefore give full and accurate information about the person’s needs before they moved into the home, although information from other agencies was thorough. The manager confirmed that intermediate care is not provided by the home. Amberley Hall Care Home DS0000065153.V337494.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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The care plans provide information about the needs of each person and are reviewed and updated. Most care plans need life histories to be included so that significant events and anniversaries are known. Daily record sheets must be retained on the care plan for more than 1 month so that patterns and important information are not lost. Concerns expressed by health professionals continue to be raised but have reduced in number over recent months. The competence of staff to provide appropriate care remains in doubt due to staffing levels and training needs. See standard 27. There was evidence that the privacy and dignity of residents is not being supported in all cases and better practice must be ensured. The home has made some improvement in its management of medicines for people who use the service. However, the service is failing to ensure medicines of a psychoactive nature are safely managed to safeguard the health and welfare of residents. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 13 EVIDENCE: Ground floor In the younger physically disabled and nursing units, examination of service user records demonstrated that detailed, updated and reviewed care plans are in place for each person living there. These plans are signed by the person themselves or their representative as appropriate. An informal handover record system compromises data protection requirements. Evidence from files and healthcare professional records showed that people’s healthcare needs are being met. A visiting GP confirmed that he has no concerns about the standards of healthcare offered there. Discussion with service users confirmed that they feel treated with respect and dignity. Observation of interaction between staff and service users during the inspection showed warm and trusting relationships. Service users confirmed that they have freedom of choice in expression of personal taste, that their name of choice is used and that they are given personal care in their own rooms. The medication system for the ground floor was inspected and found to be well managed, with records up to date and accurate. Observation of a medication round demonstrated professional administration, and that PRN medication is offered appropriately. A service user who is self-medicating has risk assessments in place, and was observed being given appropriate support. First floor The care plan folders for 3 residents were looked at in detail. These showed an improvement in the information kept. However, there were significant gaps in some of the care plans. For example, a life history had been completed in only 1 care plan and a close relative of the resident wrote this. The care plans contained good on-going assessments although these were not completed in all cases. For example a care plan for skin condition was in place but the risk assessment with regard to pressure ulcers was not completed. For another resident, a nutritional assessment completed 11/06 had shown the resident at high risk but there was no review seen on the file. The care plan for a resident stated that she walked unaided, however the falls risk assessment said she was at very high risk. As previously stated, the pre-admission assessment completed by staff at the home was not completed in full, dated or signed in all cases. There was good information about health professional visits. Social activity records were last completed on 17/01/07 for 1 resident. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 14 One care plan for a resident who has verbal communication difficulties was also looked at. The communication care plan did not identify the use of aids to assist communication. The mental state care plan suggests that her condition is causing her to be “argumentative & aggressive”, although it does acknowledge the build up of frustration. The care plan refers to using deescalation techniques but these are not specified. There was evidence that care plans are subject to regular review. Concerns have been raised by visiting health professionals previously about the standard of care and these have continued but to a lesser extent. Issues about healthcare concerns were last discussed with Ms Dunagan at an inspection on 6th December 2006. The last concern raised by health and social care professionals was dated 09/03/07 from the Complex Cases Team regarding staff competence and possible abusive practice. Discussions with staff and the perusal of the staff rota raised serious concerns about the ability of staff to meet all the care needs of residents. All staff on duty were spoken to and 3 were spoken to in detail. Staff spoke about having no time to give anything other than physical care. On the day of inspection, staff were not taking their breaks and explained this was because the units would be left with only 1 carer present, even though some residents needed 2 staff to move and handle them. This has implications for the timely provision of care and also for the safety of residents and staff. One team leader also spoke about the need for staff to receive more training about dementia as she felt some had significant gaps in their knowledge and understanding. Many of the staff spoken to referred to feeling very tired as a result of the hours they were working. This also has implications for the welfare of residents and staff. See also standard 27. One visitor to the home said she feels she needs to visit the home regularly to make sure that her relative is alright. She said she has needed to ask staff to give her relative a bath and also to wash her hair and cut her nails as this was not happening. The visitor said the staff were very good but there were not always enough of them on duty. The inspection of the medication standard was conducted by Mr M Andrews (Pharmacist Inspector) on 21/03/07 following serious issues raised during a complaint investigation on 26/01/07. His inspection was conducted in the dementia units on the first floor. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 15 Mr Andrews found that the home has improved some areas of medicine management in particular the availability of prescribed medicines and recordkeeping practices to enable medicines to be accounted for. However, further concerns were identified in relation to the provision of medication training of care staff where one member of staff was found to be handling and administering medicines without training and another without evidence of adequate training. In addition, further concerns were identified in relation to the use of medicines of a psychoactive nature for the management of psychological agitation. In his report sent separately to the registered provider he has requested that an investigation is conducted in relation to the management of such medicines for two people using the service. During the course of this inspection, two different members of staff were observed entering resident’s bedrooms without knocking on the door. On one occasion, the resident was in bed and there was a relative visiting her. The resident was wearing her nightdress inside out and the relative confirmed the resident had been put in her nightdress by a carer. Staff were observed throughout the day. The interaction between staff and residents was good. However, on one occasion a member of staff spoke irritably to a resident and was trying to make her move faster than the resident wished. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The activity organisers arrange various activities but on the day of inspection some residents were excluded from these due to mobility difficulties. More meaningful occupation needs to be encouraged both inside the home and also in the garden. Relatives said they were able to visit when they wished. Staff do their best to offer choices and respect preferences, however there were examples where they had fallen short of this. On the first floor, two of the three units were well staffed during lunch however it was necessary for residents to wait before they could be assisted on Sandpiper as only two staff were on duty. Residents enjoyed their lunch which was well presented in a pleasing environment. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 17 EVIDENCE: Ground floor In the younger physically disabled and nursing units discussion with service users spoken to confirmed that the lifestyle of the home meets their expectations and preferences. They described having flexibility of regime and that their personal and social relationships are supported. Activities workers organise group trips out and support individual activities. At least two service users have paid privately to have internet access in their own rooms. One person said how helpful the home had been in helping to set this up. Service users also expressed their appreciation for staff coming in on days off to support group and individual outings. Discussions with some service users demonstrated that they regularly go out from the unit to local shops, libraries and leisure facilities. Visitors are made welcome and can visit at any reasonable time. Some local community groups are also involved in activities at the home. Service users said that they have made complaints about the quality and variety of food offered by the home. They said that this has led to improvements in the service provided. The lunch available during the inspection had two choices, with alternative dishes offered to two service users who did not want either option. Soft diet food was carefully prepared and attractively presented. Inspection of the kitchen showed that not all units in the home are providing daily meal choices for service users to catering staff. Menus were not displayed in service user areas. Service users are not generally consulted about the overall content of the homes’ menus. One service user said that they wished to be vegetarian, but that this food option was very limited. Two service users commented that food is often not hot, or has been kept stored for too long before it is served. First floor On the day of inspection, activity organisers took some residents to the garden to enjoy the sunshine for a while. In the afternoon, a film was shown in the cinema on the ground floor. A good number of residents attended although staff were heard being instructed to take only those residents who could walk with minimum assistance, thus excluding residents with mobility difficulties. This was disappointing as shaft lifts are available and residents should have been given the choice of whether or not they would like to attend. Only one resident was seen engaged in meaningful occupation during the day and she was drying up crockery in one of the unit kitchens. A Care Dog was seen in the home during the afternoon. A television showing a cookery programme was on in the corner of one lounge whilst a carer at the other end of the room Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 18 put on the cd player at the same time. Various publications about events at the home were seen in the reception area and copies obtained. There was a newsletter for March that listed activities that took place during March 2007. The activities were for the whole home and included visits to The Old Gaol House, Owl Centre and a planned trip to the Sea Life Centre. Events within the home included Red Nose Day and Mothers Day. Planned events for April were also included in the newsletter. A copy of the NAPA Living Life guide was available in the reception hall. Two visitors were seen during the course of the day and spoken with. Visitors said they were able to visit when they wished and staff made them feel welcome. Both visitors felt there were not activities taking place and also said there were times when there were not enough staff on duty. Staff said they were aware of resident’s preferences and tried always to meet these. One carer referred to most residents being up and dressed by 08:30 although some residents preferred to lay in later and have breakfast in their rooms and these preferences were complied with. One concern made known to the Commission refers to a resident who has been wearing other people’s clothes when the family visit on some occasions. Lunch was observed on Avocet and Lapwing units. On Lapwing, lunch was served by a ward orderly. There were also 3 carers and 2 activity organisers present assisting with the meal and feeding residents. On Avocet, there were only 2 carers present and 1 was serving lunch as there was no ward orderly available. Most of the residents on this unit were able to eat independently. A carer was washing up cups and saucers by hand as there were insufficient to allow her to use the dishwasher. Staff were spoken to on Sandpiper unit after lunch. Three residents on this unit need to be fed by staff but on the day of inspection only 2 staff were on duty and there was no ward orderly available to assist with serving the meal. One resident chose to eat her lunch later and this was kept for her until she was ready to eat. On both units seen at lunchtime, the tables were laid attractively. The meal was well presented and those residents needing a soft diet received their meal with the ingredients softened separately rather than combined. The dessert looked less appetising than the main course and suggested that pastry was perhaps not the cook’s forte. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure in place that is known to people. There is some concern that not all complaints raised with the manager are being dealt with effectively and in a timely way. Staff spoken to have received training about adult abuse awareness and said they were confident they understood these issues. There are adult protection issues currently under investigation by the Adult Protection Unit that are not yet resolved. EVIDENCE: Ground floor In the younger physically disabled and nursing units, service users commented that their complaints are usually listened to and action taken to resolve problems raised. Staff working on the younger physically disabled and nursing units have been supported to work effectively with behaviour that challenges. Additional staff have been employed for support in particular circumstances. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 20 First floor Relatives said they were aware of the complaints procedures. The complaints procedure is well displayed. Mr Davies provided information about the number of complaints received and investigated by the home in the last 12 months up to 12th March 2007. Thirty-five complaints were received by the home, of which 16 were substantiated. Mr Davies stated that all complaints were resolved within 28 days, however complainants, stating they have had difficulty receiving responses from Mr Davies in answer to their concerns, have contacted the Commission. This matter of concern was also raised by the Adult Protection Unit, who were concerned by delays in response to a request for an investigation about alleged adult abuse. There have been some referrals to the Adult Protection Unit, one of which was referred by the home and the most recent by the Complex Cases Team. These referrals have raised concerns about staff understanding of what constitutes abuse. Staff spoke about their understanding of adult protection. A member of staff described the course content that included signs of abuse, whistle blowing and what to do if there were concerns. Staff said they felt confident they understood about adult protection and said update training on this matter was due shortly. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are some issues in relation to general maintenance of the home. Signage on the dementia floor needs to be improved and pieces of paper on bedroom doors containing the resident’s name need to be replaced. The manager needs to ensure that the home complies with safe fire protection practice. EVIDENCE: Ground floor In the younger physically disabled and nursing units a tour of the premises demonstrated that these units are accessible and meet individual needs in a comfortable way. The gardens are attractive and accessible to people living on the ground floor. Issues exist in relation to general maintenance. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 22 The younger disabled and nursing units are generally clean and pleasant although several bins were noted to have lids missing, which compromised the general standard of tidiness and hygiene. The laundry area was untidy with large numbers of clothes unsorted and in piles. Staff commented that the laundry area is too small, and that this hampers sorting and storage. Service users complained that clothes often go missing or are spoilt by too high temperatures during the drying process. A previous report raised concerns about the size of the laundry and its organisation. Mr Davies said he was arranging for a housekeeper from another group home to visit and assess the laundry and its operations. Previous reports have raised concerns about the use of door wedges, particularly for the manager and deputy manager doors. The manager’s door was again wedged open and Mr Davies was advised that he must arrange for a self-closing device to be fitted if he wished to keep the door open. First floor This home is purpose built and provides accommodation that meets the needs of the residents. There have been some concerns on previous inspections about corridor lights being switched off, resulting in hazards for people who were walking about the home. On the day of inspection, all corridor lights were on and the area well illuminated. Some signage on the dementia units needs to improve. For example, bits of paper were fixed to bedroom doors to denote whose bedroom it was. All bedroom doors need to have good signage that will aid orientation for the person. There was an unpleasant odour on Lapwing that was difficult to locate but once the source was found it was dealt with immediately. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are not employed in sufficient numbers to ensure that there are able to get their days off. Staff are also unable to take their allowed tea and lunch breaks as to do so would leave the units understaffed. Staff are being left in charge of dementia units although they have not yet attained a minimum of NVQ at level 2. Staff need to be supported by more training that considers specific issues around person centred dementia care to ensure they understand the full range of needs and how they should be met. EVIDENCE: Ground floor In the younger physically disabled and nursing units, discussion with service users and staff demonstrated that staff shortages are usually covered by overtime. In the past this has led to people working excessive hours, and not taking days off. Staff confirmed that the working overtime hours is voluntary. More recently, staff have been unable to work excessively because of particular challenges, and extra staff have been employed. This will benefit both staff and service users. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 24 Examination of staff files demonstrated that basic recruitment standards are being met. During the inspection staff shortages meant that not all staff engaged in preparation of food to have food hygiene training. First floor The staff rota for the week of inspection was requested on arrival at the home. During conversation with Mr Davies, it became apparent that the rota provided was not accurate and another one was obtained. On arrival at the dementia units, it was established that the second rota was also incorrect as it did not reflect those staff on duty. A third rota was then obtained that showed the correct information about those staff on duty and the actual hours worked. The rota also included all the extra shifts undertaken to ensure there were sufficient staff on duty. There is concern about how the manager is able to ensure sufficient staff are on duty given that 3 rotas were in use at the time of inspection and all were different. Shift patterns are 06:45 – 14:00; 13:45 – 21:00; 20:45 – 07:00. Staff are divided into 2 teams across the 3 units. Sandpiper One the day of inspection, there was a team leader and 1 carer. The team leader was working 06:45 – 21:00. The team leader was also responsible for the dispensing of medicines. Of the 7 residents present, 2 require a hoist and 1 a lifting belt. In each case 2 staff were required. Three residents also need to be fed. Staff confirmed that if any of the 3 residents needing 2 staff were receiving personal care, that the remaining 6 residents would be unsupervised. The team leader was due to take a 30 minute lunch break. When questioned, she confirmed she had taken only a 10 minute break on the unit as she would have left only 1 carer on the unit if she had taken her full lunch break. The staff rota for the 2 team leaders over April shows they are both working long days alternating with each other. Avocet/Lapwing The rota shows 4 team leaders although 1 was on sick leave at the time of inspection. Two team leaders were on duty, 1 of whom was working a long day. The rota showed there were 7 care staff working in the morning and 6 in the afternoon, 1 of whom was working a long day. Two of the late shifts had been covered by a nurse from the nursing unit and a carer on her day off. Staff said they were expected to help out in other units if they were short staffed. Two of the team leaders said they had been the only team leaders available to cover these units for approximately 6 weeks and had worked together, working alternate long days to ensure the units were covered adequately. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 25 Unsurprisingly, all staff spoke about working very long hours and gave examples of 85 hours in 1 week and 230 hours in 1 month. Staff confirmed that the rotas supplied on the unit reflected the hours being worked and staff complete any extra hours they can work. When asked why they were working such long hours, the response was they had spoken with Mr Davies about needing more staff and also agency staff but these had not been forthcoming. Staff did not want to leave the home understaffed so were picking up extra duties as a result. There was significant concern about the proposed working hours for some staff in order for the units to be covered. One member of staff said she expected to be working 25 days without a day off, with 5 of these days being long. The rota suggested she would only have 2 days off throughout the month. A carer was expecting to work 21 seven and a quarter hour shifts and 4 fourteen and a quarter hour shifts during April. The 2 team leaders on Sandpiper were expecting to work long days alternating with each other. These rotas were shown to Mr Davies who seemed unaware that staff were working such long hours. He was advised that these arrangements were unacceptable and he undertook to look at the rotas and arrange for agency cover as necessary. One of the outcomes of these long hours was that staff were very tired and 1 carer appeared irritable and impatient with a resident. All staff referred to their inability to get their proper breaks and to the number of extra shifts they were working. These comments are supported by those made by visitors to the home. Visitors said that staff do their best but there are not enough of them and they are rushed. One visitor said that staff are not always about and assumes they are with residents in their bedrooms. Previous inspection reports have raised concerns about the knowledge of staff to meet the needs of the residents living at this home. In response to the last requirement made on 16th March 2007 regarding this, Mr Davies has responded by saying that “All team leaders currently working on the dementia unit in question hold or are working towards a minimum of NVQII standard”. Discussions with staff confirmed that not all team leaders have attained NVQ at level 2, although they are being left in charge of up to 2 units with as many as 37 residents. NVQ’s are now available that refer specifically to care staff who work in homes providing dementia care. These now need to be made available to all staff. Staff are also needing to care for some people who have behaviour that challenges. For example a resident who is unable to communicate verbally becomes quite challenging at times. Some staff have been trained in deescalation techniques, but there appears from the care plan to have been no thought given to trying different ways to communicate, thus negating the need to de-escalate a challenging behaviour. Some team leaders said they felt carers needed more training about dementia and how care should be given. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 26 Some staff have completed the course “Yesterday, Today & Tomorrow”, however this should only be regarded as a baseline and further training in person-centred care is needed. Previous reports have also referred to the need for the home to ensure a member of staff is trained to a significantly higher standard to ensure that practice is of a good standard. It is unclear when this may now occur as the unit manager has left. Mr Davies was due to undertake a 5-day workshop entitled “Leadership Matters in Person Centred Dementia Care”. Whilst this is welcomed, it does not compensate for the lack of a staff member trained to Certificate or preferably Diploma level in Dementia Care. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an experienced manager in post and an application to be registered is anticipated. Other key management posts remain unfilled and the appointment of suitably qualified staff to fill these rolls is needed. There are quality auditing procedures in place and a quality summary and improvement plan needs to be produced. The home operates good, safe practices in respect of resident’s personal allowances. There are good practices in place regarding health & safety although these have not been kept up to date due to the illness of the maintenance worker. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 28 EVIDENCE: Mr Davies has been appointed the home manager as of 16th March 2007. Mr Davies is a Registered General Nurse with 12 years experience of managing care homes. He is about to commence a 5-day workshop entitled “Leadership Matters in Person Centred Dementia Care”. At the time of inspection, the application for registration had not been received and Mr Davies said it would e forwarded in the very near future. The management plans for the home were discussed. Mr Davies said that one of the qualified nurses would be responsible for staff training. External candidates, preferably a Registered Mental Nurse, will be appointed as deputy manager with responsibility for the dementia units. It is then intended that unit managers for each floor will be recruited. At the time of the last inspection, Mr Davies undertook to do a skills analysis of staff, especially in the dementia unit, but this had not been started at the time of this inspection. Mr Davies confirmed that he is undertaking quality audits and does a different area each month. Personnel audits were last completed 08/01/07; infection control 28/01/07. Mr Davies also said that accidents, medication and pressure ulcers were audited monthly. Mr Davies said he constantly seeks the views of people using the service although accepts this is not necessarily done formally. He attends resident’s meetings and invites relatives to residents meetings also. Mr Davies said he goes around the home 3 to 4 times a day although he is spending more time on the dementia units. He said he ensures he is accessible at all other times and likes to feel he is a point of reference. The need for a quality audit summary and improvement plan were explained to Mr Davies during feedback. The way the home looks after resident’s money was looked at in detail with an administrator. Good practice was seen. The money held for a resident was checked randomly against the cash held and this was correct. There was evidence of regular checks to ensure monies held were correct. Two people initial each transaction but the process would be more robust if they used full signatures. Examination of staff records demonstrated that a system of supervision is being introduced by the home. Staff confirmed that they had received formal supervision from the dementia unit manager but she has now left the home and they were unclear what the future arrangements would be Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 29 Some health & safety records were looked at as part of this inspection. The home’s maintenance worker who normally has responsibility for maintaining fire safety in the home is currently on long-term sick leave. As a consequence, fire alarms had not been checked. Mr Davies said this had been noticed on an audit the previous week and arrangements had been made for a maintenance worker from another group home to take on this task. It was noted that there was more than one fire safety folder in use and this caused confusion. These folders therefore need to be reorganised to ensure all information is held in one place and is easy to retrieve. Fire training was in place and there was evidence this was up to date. Water temperature records were looked at, with the last check taking place in February 2007. The records showed that seven bedrooms exceeded the maximum 41oc although no action had been taken to rectify the high temperatures. Mr Davies said these were due to be dealt with in May 2007. Other health and safety checks included electrical safety (02/07), bed rail safety (02/07), décor condition report (02/07). There was also a call out log for all contract servicing. Environment risk assessments were in place and last reviewed 5/01/07. Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 30 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 31 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 OP3 Regulation 14(1)(a) Requirement Timescale for action 31/05/07 2 OP7 15(1) 3 OP9 13.2, 13.4 4 OP9 13.2, 13.4 It is required that staff at the home complete a full assessment of a person’s needs before they move into the home so that there can be confidence all needs will be met. It is required that care plans 31/05/07 include full life histories including significant dates and events so that the person’s care and welfare needs are appropriately met. The registered person must 18/05/07 ensure medicines requiring refrigeration are stored within the correct temperature range at all times. The registered person must 18/05/07 ensure medicines prescribed on an ‘as required’ basis are administered only when their use is clinically justified - Repeat requirement Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 32 5 OP9 13.2, 37 6 OP9 13.2, 18.1.c 7 OP10 12(4)(a) 8 OP15 16(2)(i) 9 OP16 22(4) 10 OP27 18(1)(a) 11 OP30 18(1) The registered person must undertake an investigation determining the exact circumstances surrounding identified incidents relating to the use of psychoactive medication. The registered person must ensure members of care staff have received adequate training and are competent to undertake medication related tasks. The registered person must ensure that staff respect the person’s right to be treated with dignity and to have their privacy protected. It is required that the home provides a more responsive and varied diet for service users, that food is prepared promptly before serving, and that more consultation is made to ensure that the food provided by the home reflects the choice and wishes of service users. The manager must ensure that all expressions of concern or complaint are responded to appropriately and within 28 days of receipt. Staff must be employed in sufficient numbers so that staff are not working excessive hours. This will reduce risk to the welfare of people at the home and staff. It is required that all staff engaged to work in the home have the appropriate mandatory training for their duties. 31/05/07 31/05/07 07/05/07 31/05/07 07/05/07 07/05/07 31/05/07 Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 33 12 OP31 18(1) 13 OP38 13(4)(a) Qualified and competent persons must be responsible for the dayto-day running of the home, including the dementia unit. This will ensure that people receive person centred care that reflects their individual needs. Investigations and repairs (where necessary) to hot water outlets where temperatures are too high must be completed without delay. 29/06/07 07/05/07 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 OP7 OP7 OP9 Good Practice Recommendations It is recommended that, if the home requires a handover system, that it is formalised and recorded in such a way that individual records are not compromised. It is recommended that daily record sheets are maintained in the care plan for longer than 1 month so that patterns and important information are not lost. It is recommended that Medicine Administration Record (MAR) chart medicine entries for medicines not supplied in MDS containers are clearly highlighted to ensure the medicines can be safely selected from non-MDS containers. It is recommended that care plan guidance is developed for all residents prescribed psychoactive medicines on an ‘as required’ basis ensuring staff are informed of a safe strategy for managing psychological agitation. It is recommended that members of staff receive further assessment on their competence related to medication management tasks on a regular basis. It is recommended that people are not restricted from attending events in the home based on their physical or other disabilities. 4 OP9 5 6 OP9 OP12 Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 34 7 OP12 8 9 OP19 OP19 It is recommended that a programme of meaningful occupation is developed for each person in the dementia units, based upon knowledge of their life history, choices and preferences. It is recommended that the home improve its level and standard of general maintenance. It is recommended that the pieces of paper used to define bedrooms should be replaced with better bane plates so that people are able to find their rooms without the need for assistance from staff. It is recommended that the homes plans to extend and reorganise the laundry be implemented as soon as possible. It is recommended that the home places a cap on maximum worked hours, and that all staff take at least one day off a week. It is recommended that the good recruitment practice guidelines outlined in “Safe and Sound” be adopted by the home. It is recommended that all financial transactions made on behalf of people at the home are signed using full signatures rather than initials. It is recommended that fire records are reviewed and kept in one folder if possible so that information is easier to retrieve. 10 11 12 13 14 OP26 OP27 OP29 OP35 OP38 Amberley Hall Care Home DS0000065153.V337494.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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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