Inspection on 20/06/06 for Amberley Hall Care Home

This inspection was carried out on 20th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 02/04/07

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 20th June 2006 10:00 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.V301716.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.V301716.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 vickie.hurlock@hallmarkhealthcare.co.uk Hallmark Healthcare (Gaywood) Ltd Mrs Victoria Hurlock Care Home 106 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (40), Old age, not falling within any other of places category (20), Physical disability (26) Amberley Hall Care Home DS0000065153.V301716.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. Curlew Crescent: Rooms 21 - 40 to accommodate twenty (20) services users with a physical disability who are under the age of 65 years. Dunlin Drive: Rooms 41 - 46 to accommodate six (6) services users with a physical disability who are under the age of 65 years. First Floor Avocet Avenue: Rooms 47 - 66 to accommodate twenty (20) service users with dementia who are under the age of 65 years. Lapwing Lane: Rooms 67 - 86 to accommodate twenty (20) older people with dementia. Sandpiper Street: Rooms 87 - 106 to accommodate twenty (20) older people with dementia who also require nursing care. Date of last inspection This is the home’s first inspection. 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. Mrs Hurlock confirmed that the current fees for this home range between £398:00 and £1500:00. Additional charges are made for some items and are Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 5 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.V301716.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. Not all of the National Minimum Standards were inspected on this occasion and, where a standard has been inspected, the complete range of sub elements, as set out in the National Minimum Standards, may not have been assessed. This inspection took place during the day of Tuesday 20 June 2006. This was the first inspection to be conducted at this home, following its opening in January 2006. Evidence was obtained from various sources. Prior to the inspection, the manager, Mrs Hurlock, completed and returned a pre-inspection questionnaire. Other information about the home was also sent. Questionnaires for residents and visitors to complete and return to CSCI were sent to the home but only 2 visitors and 1 resident completed and returned these. On the day of inspection, a tour of the building took place. Various records were also looked at and 3 staff spoken to in private. Lunch was eaten with residents and there was opportunity to chat about life in the home and also to look at how staff supported and cared for residents. Because of the size of this home and also the different needs that are catered for, it was not possible to look at all units in detail. On this occasion, emphasis has been placed on the care given to residents in the dementia units. At a future inspection, this emphasis will change. The overall findings from this inspection are that this is a good home provided very good care. Some practice seen was excellent and is referred to within this report. What the service does well: Some very good practice was seen during the course of this inspection for which staff are commended. Staff are well trained to meet the needs of residents and they receive training specific to the unit within which they work. Overall, the findings are that residents receive very good care in a modern, well developed home. The facilities at the home are excellent as is to be expected. The gardens are immature at this time but there is evidence that they will provide delightful places to sit and enjoy the outside once they are more grown. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 7 Staff are very motivated. Throughout the inspection, staff were working hard to provide good care in the right way. The interaction between staff and residents was watched and it was respectful and friendly. What has improved since the last inspection? 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. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 8 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.V301716.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive sufficient information about the home and the care it provides to enable them to make an informed decision to live at the home. All planned admissions to the home take place after a pre-assessment has been carried out. EVIDENCE: The home has a Statement of Purpose and Service User Guide that gives clear information about the home and the services it offers. The documents are well laid out and are given to potential residents and their representatives when they are shown around the home or on request. This document provides sufficient information to allow the potential resident and/or their representative to make an informed decision to enter the home. The home’s Statement of Purpose refers to a pre-assessment being carried out prior to admission to the home to ensure the person’s needs can be met effectively. Evidence of pre-assessments being carried out was seen in Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 10 resident’s files. During the course of this inspection, one of the senior staff was also out undertaking an assessment of a potential resident. Discussions with staff confirmed the value of this process. The home needs to ensure that the full range of potential needs, for example social and emotional needs, of each client group accommodated is reflected in the documentation used. The Statement of Purpose confirms that the home will accept emergency admissions only if certain criteria are met. Verbal pre-assessment information would be obtained and a full assessment would take place within 48 hours of admission. All residents and/or their representatives receive a contract of residence This home does not provide intermediate care. A recommendation has been made in respect of this outcome area. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans give good information about the physical and healthcare needs of residents and how they should be met. The care plans for the residents in the dementia units need more information about their social and emotional needs and how they should be met. The healthcare needs of residents are identified and clearly recorded. Residents are treated with dignity and respect. EVIDENCE: Two care plans from the dementia unit were looked at in detail and the care provided to each of the residents was looked at as part of this inspection. In addition, further care plans and daily records were seen in order to assess consistency of recording. Care practice was observed and staff, including the dementia care manager, Ms Sarah Rout, were spoken to. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 12 The care plans provided evidence that staff keep resident’s individual care under constant review. It was possible to read and understand the physical and healthcare needs of the resident’s and to know how these should be met. The care plans contained various tools to assist in assessing levels of dependency and Ms Rout confirmed that she audits these on a regular basis. The care plans included assessments for nutrition, pressure care, moving and handling, risk of falls and challenging behaviour. The assessment of daily living is used to identify any care issues that require care plans and is undertaken at least monthly in order that any changes are reflected accurately. Risk assessments were also seen on the files and clearly set out the risk and how it could be minimised. For example, one risk assessment seen related to risks associated with the resident when he went out of the building. The resultant care plan ensured that the resident’s independence was not compromised, whilst the wish to go out for a walk was supported. The risk assessments were also subject to regular review that was signed and dated with any changes clearly recorded. On this occasion, the main focus for this inspection was within the dementia units. It was possible to discuss the documents used for the pre-assessment and care plans with Ms Rout and it was agreed that the pre-assessment documents would have benefited from more information about the social and emotional needs of each person. The assessment also needs to be more holistic so that the person’s strengths can be identified and supported. This would lead to care plans that support the residents with dementia more effectively, taking into account their daily living skills, interests and emotional and social needs. The various models available were discussed with Ms Rout, and also with Mrs Hurlock at the end of the inspection. The healthcare needs are well recorded and showed that the home accesses all relevant health professionals in a timely way. Clear information was seen on the files that ensured staff were well informed of any health issues and how they were to be dealt with. The daily records were looked at and were well and clearly written. They would have been enhanced by more information about each resident’s daily occupation and events. The care and support given to residents was observed throughout the day. Staff were seen knocking on doors and speaking respectfully to residents, using their chosen name. Good practice was observed throughout. For example, two staff were observed using a hoist in one of the lounges. They were seen speaking quietly to the resident and explaining what they were going to do. When the resident objected, the staff moved away and returned later when the resident felt happy to agree. The situation was handled quietly Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 13 and discreetly, without causing embarrassment or distress to the resident or others in the lounge. The arrangements for the safe control, administration and recording of medicines is to be inspected by a specialist pharmacist inspector and the report will be available in due course and on request from CSCI. Two recommendation have been made in respect of this outcome area. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in activity and occupation that they enjoy. Choices are offered and respected and preferences are recorded in care plans. Visitors to the home are welcomed at any time. Residents receive a nutritious and varied diet in a pleasing environment. EVIDENCE: Evidence was obtained through looking at 2 care plans, observing activity and occupation within the dementia units and talking with residents and staff. Lunch was eaten with residents in one of the dining rooms in the dementia unit. As previously stated, the care plans provide information about the care to be given and how this should be done. The care plans provided evidence of choices and preferences being respected and recorded. For example, times to get up or go to bed and preferred drinks and food. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 15 There was less information about meaningful occupation for each resident and understanding these preferences and how to meet them would be enhanced by the completion of life histories for each resident. Some had been completed in part, but generally, the care plans seen and discussion with Ms Rout, confirmed that there is significant work to be done in this respect. Ms Rout stated that some families were providing information about the resident’s life, whilst others were more reluctant or unable to do so. Occupation and activity was seen throughout the entire home during the day. Residents were seen in various parts of the building. For example, residents living on the ground floor were seen accessing the gardens to enjoy the good weather. There was plenty of interest in the new aviary that had been completed the day before, with birds now in residence. A group from the local community was holding a meeting in the cinema and included people who use the home for respite care. Residents were also seen in the hairdressing salon, enjoying having their hair done. On the dementia units, staff were seen interacting with residents and were spending both group and 1:1 time. A group of residents had been flower arranging and 1 resident spoke enthusiastically about this, referring to how she always used to enjoy flower arranging. Another resident was playing a floor standing version of a well-known game with a resident. Staff also referred to a resident who enjoys cleaning and liked to vacuum the corridors with staff. Access to the garden from the dementia units was more problematic as the units are located on the first floor. However, staff were seen escorting residents to the garden via one of the lifts so they could enjoy the sunshine. Discussion with staff demonstrated a good knowledge of the need for people to be engaged in occupations that are relevant to them. Visitors were seen throughout the day but there was limited opportunity to speak with them. Two returned comment cards confirmed that relatives felt able to visit when they wished and this was in accordance with the home’s Statement of Purpose. Staff confirmed that visitors were always welcomed and refreshments were offered. Staff also said that visitors could make use of the kitchenettes in each unit if they wished. A meal was eaten with residents in one of the dementia units. Both units in use were inspected at this time. Residents were offered choices and meals exchanged where the resident changed their minds. Good practice was seen. For example, a member of staff was seen showing a resident what meals were available to help the resident make a choice. Discussion with the chef confirmed that fresh produce is used and sourced locally. Meals are prepared in the home and efforts made to keep the use of convenience foods to a minimum. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 16 The dining room was very attractively laid, with tablecloths and cloth napkins, flowers and glasses for drinks. The meals arrived plated up, having been served from the kitchenette. Residents enjoyed their meals and there was a great deal of chatter and laughter. This was clearly an important and enjoyed social activity. Where residents needed assistance to eat, staff sat quietly beside them and offered discreet assistance and guidance. It was noted that residents were taken into the dining rooms and most were seated before meals were served. Staff confirmed that some residents were reluctant to sit and wait for their meal and would therefore get up and leave the dining room. It was suggested to Ms Rout and Mrs Hurlock that it would be beneficial for some residents to be given their meal as soon as they sat at the dining table. This is recognised as good practice and helps to ensure a good nutritional intake as well as encouraging the resident to stay in the dining room and experience the social activity of meal times. A recommendation has been made in respect of this outcome area. Amberley Hall Care Home DS0000065153.V301716.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place that is known to most people living or visiting the home and that deals effectively with any expressions of concern or complaint. Staff are well trained in respect of adult abuse awareness and residents are protected also by the home’s whistle blowing policy. EVIDENCE: The home’s complaints procedure was displayed in the reception area and a copy contained with the Statement of Purpose and information pack. This clearly sets out the process used by the home when dealing with any expressions of concern or complaint. Returned comment cards confirmed that most people are aware of the home’s complaints procedure. Mrs Hurlock stated that she likes to keep her door open so that she is available for residents and visitors who may wish to speak with her. Mrs Hurlock advised that the home has received 2 complaints since January 2006. The records of the investigations and findings were seen during this inspection. There was evidence that the home complies with its complaints procedure and action as a result of any complaint received is taken without delay. The home has adult abuse awareness training in place. Staff spoke confidently about these issues and how they felt able to use the home’s whistle blowing Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 18 procedure if they felt necessary. The training manager, Ms Deanna Burns, provided comprehensive information about the training events arranged in respect of adult abuse awareness. This showed that staff are required to receive annual updates on adult abuse awareness. This is regarded as good practice. No requirements or recommendations were made in respect of this outcome area. Amberley Hall Care Home DS0000065153.V301716.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All accommodation is of a high standard and decoration and furnishing is well maintained. The internal and external environments are safe and easily accessible, particularly from the ground floor. Residents bedrooms are spacious and well laid out with various levels of personalisation seen. The home needs to comply fully with fire regulations and ensure that fire doors are not wedged open, thus compromising designated fire exit routes. The laundry is well equipped however consideration about storage restrictions and space need to be considered before the home is full. EVIDENCE: Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 20 A tour of the building was undertaken with Mrs Hurlock. The home is purpose built and opened in January 2006. As a result, all areas of the home were in a good state of decoration and maintenance. Mrs Hurlock confirmed that there were still some snagging issues to be resolved but these were in hand and not causing any difficulties. Not all of the areas of the home are yet in use as occupancy gradually builds up. An application to make changes to the registration has also been received that will allow the home to respond more effectively to demand from placing authorities. The company newsletter, a copy of which was obtained during this inspection, states that the building has won a design award. Whilst this is a very large home, accommodating up to 106 people with various needs, each of the 2 floors is divided into discreet units providing specialist care. As a result, the home does not feel excessively large whilst it still provides high standards of accommodation and facilities. Each unit is named as if a road or street so that residents have an “address” within the home. Each of the units is self-contained, with lounge, dining room, kitchenette, bathing and WC facilities. Corridors are long but good practice has been applied, with small screens installed to break up the long corridors into less daunting lengths. Some areas of corridor needed better lighting, especially where the lights had been switched off. There were heavy shadows across the corridors as a result that can cause difficulties for people with impaired vision and/or dementia. The shadows were exacerbated where bedroom doors had been left open, allowing bright sunshine to flood small areas of the corridor. All communal space was well equipped and furnished. Residents were able to sit in small groups to talk or join in group activity. Dining rooms were spacious and well laid out, with tables that were attractively laid for lunch. Assisted bathing and WC facilities were of a high standard and relevant to the needs of the people to be accommodated within the unit. All bedrooms are of a high standard. At the time of inspection 46 Dunlin Drive was unoccupied and the opportunity was taken to look in this room in detail. The room is located in the area of the home providing stroke and rehabilitation care within the nursing floor. The room was bright and airy with colour coordination throughout. The en-suite also contained a shower and the area was spacious and well thought out to maximise the space. All bedrooms have profile beds that allow residents to adjust the bed to provide maximum comfort. These also assist staff where personal care or manual handling is required without detracting from the efforts to ensure bedrooms are domestic and personal in character. Bedrooms had been personalised to varying degrees. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 21 All areas of the home were clean and tidy. There were no unpleasant smells detected throughout the day. There were some issues discussed with Mrs Hurlock and Ms Rout around the premises. For example, the need to ensure corridor lights are left on throughout the day and night as detailed above. The amount of natural light filtering into the corridors is minimal and artificial lighting needs to compensate for this. The development of a themed period lounge in the dementia unit was discussed. This would aid reminiscence and encourage meaningful occupation, as well as providing a familiar environment for residents. Access to the gardens for residents on the first floor was discussed. Ms Rout said that staff accompany residents to the gardens if they wish and staff were observed doing this during the day. Unfortunately, the residents on the first floor do not have easy access to the external environment and their ability to spend time in the garden is subject to staff availability. Mrs Hurlock stated that the decision to accommodate people with dementia on the first floor was taken with a view to the substantial physical needs of some residents currently living on the ground floor. The laundry was seen as part of this inspection. The room is well equipped and staff are employed to deal with the home’s laundry. It was clear that storage space within the laundry was at a premium and the difficulties that are likely to be faced once the home is full were discussed with Mrs Hurlock. It is suggested that the provision is looked at to ensure that there is sufficient space to meet the demand once the home is full. Currently there are no health and safety concerns but these need to be kept under review as the workload in the laundry grows. The home has the most up to date fire detection and protection equipment fitted. It was disappointing to note however that staff are wedging doors open with wedges or chairs even though the doors are clearly designated as fire doors that must be kept closed. This was discussed with Mrs Hurlock and the fitting of automatic closures on these doors needs to be considered. Please see standard 38. Three recommendations have been made in respect of this outcome area. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is employing staff in good numbers that meet the needs of residents. There is a good skill mix of staff on each shift. The home’s recruitment procedures are based on good practice and protect residents. The home has excellent training opportunities for staff that are relevant to the needs of the residents at the home. EVIDENCE: Staff rotas for the month of inspection were provided. These showed that staff are employed to work on a specified unit, with each unit having its own rota. Mrs Hurlock stated that the home is using ratios to determine staffing levels on each unit. These are currently 1:8 during the day and 1:10 during the night on the dementia units; and 1:6 during the day and 1:8 during the night in the nursing units. These current levels meet the needs of the residents as each unit is fully staffed. It is however recommended that staffing levels are kept under review as more residents are accommodated in the home. There is evidence of good skill mix on each shift. Ancillary staff are also employed, including laundry, catering and housekeeping staff. The home also employs maintenance staff, administrators and receptionists. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 23 Ms Burns provided up to date information about NVQ training. The home currently has 18 staff now qualified to NVQ at level 2 and 4 staff at NVQ level 3. A further 6 staff are working towards NVQ at level 2 and 4 staff towards level 3. Two staff have commenced NVQ at level 4. The home also has 3 NVQ assessors. This equates to 48 of staff having either achieved or currently working towards NVQ. This is very significant, given that the home opened in January 2006. The home is commended. Two staff files were looked at in detail. Both staff were also interviewed in private. In addition, other staff were seen and spoken to throughout the inspection. The staff files contained all the necessary elements, including application form, 2 written references, employment details, supervision records and training certificates and profiles. Each file also contained Criminal Records Bureau and Protection of Vulnerable Adults disclosures. At the time of the inspection, the training manager, Ms Burns, and another senior member of staff were conducting interviews. On commencement, new staff receive a welcome pack that provides information about their employment terms and conditions. A copy was provided at inspection and clearly sets out the employee’s responsibilities and copies of relevant policies operated at the home. The home employs a training manager who is also the home’s deputy manager. The home has an expectation that staff will avail themselves of training opportunities in line with the home’s ethos. Staff know the home’s visions and values and these include a pro-active approach to staff training and development. The training provided at the home is based upon the training projection for 2006/07, prepared by Ms Burns. The aims and objectives are clearly thought through and the action plan is realistic and achievable. The projection covers all statutory training as well as the more developmental training events that add knowledge and skill in dealing with specific needs. Ms Burns provided the training schedule for the month of July 2006. This included Moving and handling (4 sessions), dementia (2 courses), induction (23 staff), skills for care (13 staff). The home has trained 4 staff to provide manual handling training and the possibility of a member of the catering team being able to undertake training to provide food hygiene training in the home was discussed. The home is commended. The home is currently seeking to achieve the Investors In People award and a copy of the home’s action plan to achieve this was provided. No requirements or recommendations were made in respect of this outcome area. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is well qualified and experienced. Staff understand and work to the ethos and vision of the home. The home has quality audits in place although it is yet to undertake a full quality assurance audit that will include all residents and relatives. The home does not look after any money on behalf of residents. Staff receive training and supervision to ensure they are well supported. The home generally has good practices in place that safeguard the health and safety of residents, staff and visitors to the home. EVIDENCE: Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 25 The manager, Mrs Hurlock, is well qualified, experienced and competent. She has appropriately delegated to unit managers and her deputy to ensure the home runs smoothly. The ethos of the home is well understood by staff, who each have a copy of the values and vision of the home. Staff described feeling valued and well supported. The manager operates an “open door” policy and this was seen in action. Regular staff meetings take place, with action plans being generated as a result, and staff are also given the opportunity to express their views during supervision. The arrangements for the home’s quality assurance audit were discussed. The company operates an annual audit that is conducted by its head office. This will occur in due course, with the results being made available to the home once complete. Mrs Hurlock described some of the quality audits undertaken at the home to ensure good practice is consistently applied. These include a monthly managers audit, monthly audits regarding medicines and also infection control. The home is also receiving monthly inspections by a designated responsible person although copies of these reports are not currently being forwarded to CSCI. The home had not advised CSCI of all events affecting the health, safety and welfare of the residents. These notifications were discussed and the occasions when they are required agreed. The home has policies in place regarding the handling of resident’s money. Information within the pre-inspection questionnaire shows that the home is not holding any money on behalf of residents. Where residents do not have relatives to act on their behalf, solicitors are required to undertake this responsibility. All residents have lockable facilities in their rooms in which they can keep any money or valuables. As previously stated, staff wedging open designated fire doors compromised the fire safety in some areas of the home. Other than this, all areas of the home and gardens were well maintained and safe. The home has schedules of servicing and maintenance in place. A requirement was made in respect of this outcome area. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 X X 4 4 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 27 N/A 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 OP38 Regulation 23(4)(a) Requirement The registered persons must ensure that no designated fire routes or safety areas are compromised by fire doors that have been wedged open by either wedges or chairs. Timescale for action 04/07/06 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 OP3 OP7 OP7 Good Practice Recommendations It is recommended that all personal needs are assessed before a person is admitted to the home, including social and emotional needs. It is recommended that the care plans are developed to ensure that they reflect the needs of residents holistically. It is recommended that daily records include information about how the resident has spent their day, any meaningful occupations undertaken and any significant events that may have occurred. It is recommended that the practice in the dementia units at meal times is reviewed so that residents who do not wish to wait are given their meal on arrival in the dining DS0000065153.V301716.R01.S.doc Version 5.2 Page 28 4 OP15 Amberley Hall Care Home 4 5 OP19 OP20 6 OP26 room. This will help to divert them from getting up from the table and leaving the room before eating. It is recommended that corridor lights are left on throughout the day to enhance the limited natural light that is available. It is recommended that consideration is given to the development in the dementia unit of a lounge decorated and furnished in period style to aid reminiscence and meaningful occupation It is recommended that the current facilities for the laundry are kept under review to ensure they are adequate to meet the needs of the home once full occupancy has been achieved. Amberley Hall Care Home DS0000065153.V301716.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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