Inspection on 09/07/07 for Amberley Hall Care Home

This inspection was carried out on 9th July 2007.

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

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

Other inspections for this house

Amberley Hall Care Home 15/01/08

Amberley Hall Care Home 02/04/07

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 9th July 2007 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.V345701.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.V345701.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 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.V345701.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 2nd April 2007 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.V345701.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.V345701.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 on Monday 9th July and Tuesday 10th July 2007. Because of concerns about practice in the dementia units, this inspection focused exclusively on these areas. Inspection activity has been significant at this home. All inspections have been unannounced and have taken place on 20th June 2006, 27th September 2006, 6th December 2006, 6th February 2007, 16th March 2007, and 2nd April 2007. The inspection of the medication standard was conducted simultaneously by pharmacist inspector Mr M Andrews. This follows two previous inspections on 26th January 2007 and 21st March 2007 when serious matters of concern were identified in relation to the home’s management of medicines. During this inspection the inspector looked at records relating to medicine administration in the dementia unit. The last inspection raised a series of concerns about the care provided at this home and the management arrangements in place. A notice to impose conditions was issued on 8th May 2007, preventing any further admissions to the home until improvement had been achieved. This inspection assessed progress against the requirements made on 2nd April 2007 and the action plan provided by Mr Davies on 16th May 2007. As with previous inspections, staff were working hard to provide the best possible care they could. They have continued to do this without the benefit of a unit manager who could provide advice, guidance and support and they are therefore commended. At the time of this inspection, the dementia unit manager, Ms Sarah Bull, had only been in post 3 days and was getting to grips with the working of the units. Mr Phillip Davies is the home manager but his application to be registered has not yet been received by the Commission. The appointment to the company of a Dementia Care Specialist, Mr Michael Broughton, is seen as a positive move. Mr Broughton was present on the second day of this inspection. As a result of this inspection, the Commission continues to have serious concerns about this service, particularly around the management of this home and the monitoring, supervision and support of staff. Evidence was obtained by looking at records, speaking with Mr Davies, Ms Bull and other staff, speaking with visitors and spending time observing practice and sitting with people who use the service. Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 7 A total of 24 requirements and 4 good practice recommendations have been made as a result of this inspection. What the service does well: What has improved since the last inspection? What they could do better: A significant number of requirements have been made at this inspection and the full range can be seen at the rear of this report. Several of the requirements are made as a result of unreliable records, resulting in no confidence in the information provided. Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 8 Care plans need to include all relevant information about the individual and essential documents such as GP and collaborative care records must not be archived. Information within care plans must be clear and the risk of contradiction removed. Staff are not receiving training that relates to the very specific needs of some people using the service. This compromises staff ability to provide effective and appropriate care. Staff need to ensure they provide good and enjoyable dining experiences for people, especially those who need help. It is not acceptable for 2 people to be fed by 1 member of staff at the same time. Records about complaints made are not up to date. Records about the maintenance and servicing of equipment and the environment are unreliable. Records about staff hours worked are also unreliable as duplicates are kept and these are contradictory. There remain several significant aspects of the administration of medication that still require some improvement. 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.V345701.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.V345701.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): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The above standards were not assessed on this inspection as no admissions have taken place since the last inspection. The judgement for this outcome group at the last inspection was adequate. Compliance with the outstanding requirement will be assessed at a future inspection. EVIDENCE: Mr Davies said that no admissions have taken place at this home since the last inspection in compliance with the notice preventing any admissions. Consequently, it was not possible to assess compliance with the requirement made at the last inspection. This will be reviewed at a future inspection. See requirements. Mr Davies confirmed that there have been no changes made to the Service User Guide or Statement of Purpose. Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 11 Mr Davies confirmed there were 58 people using the service in total but could not say how many were in the nursing units. Ms Bull confirmed there were 8 people in Sandpiper, 19 in Avocet & 17 in Lapwing. Mr Davies confirmed there have been no changes to the fees payable or additional charges since the last inspection. Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There were gaps in information about health care and day-to-day issues within individual care plans because documents were being archived too early. Staff had not received training to meet the specific health care needs of all people who use the service. Staff made every effort to protect the dignity of people when providing care and support. However, more effort is needed to ensure that each person’s appearance is as they would wish it to be. EVIDENCE: Three care plans were initially looked at in detail and a further care plan reviewed as a result of concerns about medication records. One of the care plans was in the original format and the rest had been changed over to new formats being introduced throughout the home. It is anticipated that the new care plans will help provide more holistic information about the person and their needs. However, it was difficult to have confidence in the care plans seen, as important information was being Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 13 removed from the working file too early. In addition, some care plans contained conflicting information. Information and guidance was at times inadequate and task orientated. The emphasis of the care plans was on the person’s deficits, with little or no consideration about what they could do and how staff could support people to retain their skills for as long as possible. More work needs to be done to ensure the care plans contain all the required elements such as photographs and personal details. The daily records did not contain enough information about how the person spent their day and aspects of their well and ill being. There was evidence that the quarterly monitoring of the care plans was not taking place consistently. Staff need to make sure that they establish end of life choices and record these. The requirement made at the last inspection has not been fully met. See requirements. Ms Bull had not been at the home long enough to be able to comment on the quality of the care plan documentation at the home. However, she spoke about her expectations and it is anticipated that she will drive up the standard of these important documents over the coming months. It was difficult to follow health and collaborative care interventions through to the care plan as these essential records, together with the daily record sheets, were archived at the end of each month. The archived documents were not automatically accessible as they were stored in a locked cabinet when the team leader was not in the office. Evidence was obtained that referrals are made to health professionals in a timely way, but it was difficult to confirm that instructions were being fully recorded and followed by staff. The nutritional needs of one resident were considered important enough to require daily recording of nutrition and fluid intake. However there is no confidence placed in the information being recorded as either staff had forgotten to complete these records at all times, or they had failed to ensure adequate nutritional and fluid intake. Staff stated that they had not received training specific to the healthcare needs of one person being cared for, having been told to treat his needs “as if he has MRSA”. See requirements. On considering the use of medicines of a psychoactive and potentially sedative nature for the management of psychological agitation the inspector again found concerns that most frequently these medicines are given to residents when there was no record of the circumstances in which they were used. Therefore their use may not be clinically justified. He also found examples of recently requested increases in doses where corresponding care records did not indicate a worsening psychological situation for residents. There was evidence of changes of medicine doses to that for regular use when previously prescribed for occasional use without documented prescriber authority to do so -see requirements and recommendations There were also found to be further medicine audit discrepancies where medicines could not be accounted for. This raises concerns that some Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 14 medicines may still not be given to residents in line with prescribed instructions-see requirements The inspector found that for members of care staff administering insulin to residents by injection there was no documentary evidence confirming that each had been provided specialist training and had been assessed as competent to give the injections -see requirements A full report on the findings of the pharmacy inspection has been sent to the registered provider and is available subject to request. As a result of this inspection and the home’s continued failure to resolve matters relating to medicine management the Commission has issued a Statutory Requirement Notice. Unless the necessary improvements in this area can be evidenced, this could lead to prosecution. One visitor spoken to described how she had arrived to take her husband out of the home, but his toenails were so long she had to cut them before she could fit his shoes on. This concerned her as her husband is diabetic and is meant to see the chiropodist regularly. Observations were made in Lapwing unit before lunch. Staff were seen using the hoist for two residents. Efforts were made to explain to the person what they were doing and ensure their dignity was protected. However, four ladies were sat in the lounge and were not wearing any stockings. It was also noted that one resident had very long fingernails that were encrusted with food and dirt underneath. The requirement about dignity issues made at the last inspection still has been fully met. See requirements. Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The routines were flexible and varied to meet people’s choices and preferences. Visitors were welcomed to the home. There was evidence that people can exercise choice in their day-to-day living. People received meals that were attractively presented. However, mealtimes were not as pleasurable for all people as they should be, with support being given in a rushed way. Meals were not ready to be served as soon as the person sat at the table, causing them to wait for their meal. EVIDENCE: Practice was observed throughout the 2 days. People were sitting in lounges, on seating in corridors and alcoves, and also in their own rooms. Those who were independently mobile were seen moving freely about the units. Various activities and occupations were seen. For example, staff were giving residents hand massages whilst talking to them; the activity co-ordinator was seen sitting with a resident going through the newspaper and talking about various articles; a kitchen assistant was seen sitting beside residents whilst they were drinking their coffee and giving assistance to the resident to drink. Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 16 A resident was seen being encouraged by a member of staff to help with drying dishes in the kitchenette. Not all the interaction was so positive. For example, two staff were seen doing a jigsaw with a resident. Although the resident had tired of this activity, the staff continued to do the jigsaw on their own whilst other residents were sat disengaged and unoccupied around the room. On the Monday afternoon, a musical entertainer visited the unit and the event was well attended. Residents were seen and heard joining in with the songs. There was also jovial interaction taking place with the entertainer. Lunchtime was observed across all units on Monday and just Lapwing on Tuesday. On Avocet, one resident declined lunch and was offered the choice of something else to eat. The resident asked for a sandwich, specifying her preferred type of bread and filling and this was given. In Lapwing on Monday, two staff were seen both of whom were feeding two residents at the same time. It was explained by staff they were short handed because a member of staff was attending a review that was running late. It was disappointing that there were no finger foods or bowls of fruit or biscuits available for residents to help themselves. Lapwing was observed on Tuesday. On arriving in the unit at 11:40, two residents were seen already seated at the dining table. Staff were gradually taking people into the dining room after providing personal care. Lunch was finally served at 12:10, once all residents were seated. Two visitors were feeding residents. Mr Broughton referred to guidance he had already given to staff regarding the seating of people at the table only when their food was ready to be served. Mr Broughton also described some of the changes he was implementing, such as rearranging the room to make it a more pleasurable experience, changing the crockery to help people see the food on their plates and also to make the dining room more accessible to people outside of mealtimes. Ms Bull said she had placed bowls of fruit in the units and instructed staff to offer biscuits to people more frequently. See requirements. The requirement made at the last inspection regarding choice of food has been met. Several visitors to the home were spoken with. One person said that things at the home had improved but still feels the activities offered are not always right. It was said there is not enough activity taking place and some of it was not appropriate, giving the example of daytime reality TV shows that are left on at quite high volume and cover subjects difficult for people to grasp. One visitor referred to the home offering accommodation to relatives from other parts of the country so they could be close to the resident during their visit. The visitor said the staff were “lovely” and “always do their best”. She said they were always welcoming. Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 17 Other visitors were seen. Two visitors spoken to together said the staff were “wonderful for what they do”. They were not happy about the laundry services and have complained about lost and ruined items. However, these visitors said later that they had no problems with the laundry on that day of inspection. Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and dealt with. Records of complaints received at the home were not up to date. People were protected from abuse by staff who had received relevant training. EVIDENCE: The complaints records for the period since the last inspection were looked at. Although the Commission during this time referred 2 complaints to the service, there was only a record for one of these in the complaints folder. Mr Davies said this was probably due to the report still being on the computer. However, Mr Davies wrote to the Commission on 4th May 2007 stating the matter was resolved to the complainant’s satisfaction. Both complaints were responded to in a timely way and the requirement made at the last inspection was met. See requirements. Staff were spoken to about their understanding of abuse awareness. They gave good responses that demonstrated a sound understanding of what constitutes abuse, what they need to do about it and also about the services whistle blowing policy. Training records confirmed that staff receive abuse awareness training. Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It was not possible to confirm that all areas of the home were well maintained as records provided referred to other homes and times prior to the opening of this home. For the most part the environment was safe although weeds in paths in the enclosed garden represent a trip hazard. The home was clean but a room and corridor were malodorous. The home does not comply with the new smoking laws. EVIDENCE: All areas of the home were clean and tidy and in a good state of decoration. There were odour problems noted in the corridor outside room 71 and this was traced to the room itself. Urgent consideration needs to be given to the flooring in this room, as deep cleaning has been ineffective. See requirements Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 20 The security switch between Lapwing and Sandpiper was broken and the door wedged opened as a consequence. Mr Davies said this would be repaired during the day and this was working fully on Tuesday morning. The home is possibly not yet compliant with the smoking laws introduced on 1st July 2007. The designated smoking area is on the ground floor by the rear lift. This is the way through for people from the dementia unit to gain access to the garden. The doors were open and smoke was permeating the corridor. Mr Davies said quotations have been obtained for the fitting of automatic doors. However, he was advised that this could still contravene the law, as other people would need to walk through the area. He suggested that residents from the 1st floor could access the garden through a ground floor lounge. However, this would mean going through an area used by people living on the ground floor and this may be intrusive. Mr Davies was advised to seek further guidance from the available websites and help lines. See requirements. All office doors were closed and no door wedges were seen. The garden used for the dementia units was secure. Weeds were growing between some of the paving slabs representing a trip hazard. There was no shaded area available for people to sit protected from the sun. There needs to be further development of this garden so that there is more sensory interest for people. Raised flowerbeds would encourage residents to take an active interest in the garden. Maintenance records were looked at but there was no confidence in the information provided. It appeared that records relating to other homes had been included. Some records seen were also dated 2004; prior to the home’s opening. Fire extinguishers had labels affixed showing the supplier had checked them. Ms Bull had not received fire instruction even though she was working her fourth day at the home. See requirements. Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There continues to be concern about the accuracy of information contained on the staff rotas. Staff are continuing to work excessively long periods without taking days off. The service is committed to ensuring staff work toward NVQ standards. Good recruitment procedures were in place. Staff receive induction training although this is not necessarily delivered in a timely way. Staff have access to good training although there are significant gaps in training related to specific care needs. EVIDENCE: Three staff files were looked at in detail. Each file referred to staff who had been employed at the home within the last 6 months. These showed that the service followed good practice when recruiting staff. Each member of staff also had a training profile in place that included training and qualifications gained before working at the home. Only 1 staff file contained a sealed envelope with a supervision record in place. Copies of the staff rota for June & July 2007 were obtained. Mr Davies had signed both and the June rota was notated “not to be changed”. There were two copies of the June rota on file and a total of 45 discrepancies were found between these 2 rotas. It was not possible to confirm which was the correct rota. There were also discrepancies in the total numbers of staff employed on Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 22 each shift. For example, on 4th June 2007, alterations to the rota suggest 6 staff were on duty during morning although the total at the bottom of the rota specified 8 were on duty The staff rota for July was seen displayed in the office on the dementia unit. Alterations had been made to this rota although Mr Davies was not aware of this. This rota showed that a team leader was proposing to work 16 days without a break between 5th July and 19th July. Ten of these shifts were of 14 hours duration. This was brought to Mr Davies’s attention and he said this would be dealt with. Mr Davies states in his action plan following the last inspection that “Monitoring of shift patterns & staffing hours is done via payroll and administration management systems”. He also states that this is a dual responsibility between himself and the home administrator. However, the monitoring is ineffective as staff continue to work excessively long periods without days off. There was evidence across June and July to show this is still happening. For example, one carer worked from 26th June to 9th July, a total of 14 days, without a day off. Another carer worked from 27th June to 7th July (11 days). It is difficult to establish how many days another carer worked without a break as the rotas for June were so inconsistent, however it is possible this was as many as 14 between 13th June and 26th June. See requirements. Mr Davies said that he expected the setting and monitoring of the staff rotas would become the responsibility of Ms Bull. He said staff were not meant to make changes without speaking to him. Mr Davies provided the monthly statutory training record dated June 2007. This shows that 14 care staff had achieved NVQ2, and 1 in NVQ3 across the whole home. “In training” records showed a commitment to NVQ training. Staff were also receiving training about food hygiene, fire safety, abuse awareness, health and safety and dementia care. Evidence obtained showed that the requirement made at the last inspection regarding statutory training has been met in part. Several staff were spoken to in private and all staff were seen who were on duty on the dementia unit. Ms Bull had taken up her post as dementia unit manager on 5th July 2007. She said she was waiting to meet with Mr Broughton as she was unclear what duties she will be required to undertake. Ms Bull had not received any induction training beyond being shown around the home and being introduced to staff. She was still waiting to have the fire instructions explained to her. Ms Bull described how she will approach her role. She was keen to discuss the existing care plans as she has clear views about how they should be put together and what they should contain. Ms Bull also said she was making a point of introducing herself to all visitors as they arrived and she was seen doing this and spending time sitting and talking to Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 23 them. She also said she wants to provide good support to staff as she is keen to introduce good practice. See requirements. The activities co-ordinator was spoken to. She has worked at the home for 14 months and said she enjoys the job very much. She is currently working alone throughout the entire home but is expecting part-time help shortly. She said all activity is based upon what people prefer to do and this tends to be provided as 1:1 in the morning and group activity in the afternoon. The activity co-ordinator was working through completing “Pocket Full of Memories” with help from care staff.. She is also developing scrapbooks for each resident. This was in its early stages and she had only done 2 at the time of inspection. She has however, written to all relatives across the units requesting information. One of the team leaders was spoken to. She has worked at the home for 15 months. She is currently working towards NVQ3. She also said that she currently draws up the staff rota and hands this to Mr Davies to agree and sign. She tries to make sure all staff have 2 days off per week and alternate weekends off but this is not always possible due to sickness and not enough staff. She agreed that changes to the rota do occur after Mr Davies has signed it off. She said she did the Boots mediation training 3 weeks previous and her competence had only been assessed once and that was in March 2007. She said the training had improved of late and there was now plenty of training available. She said she enjoys her job and spoke about the atmosphere now being lovely and that she worked with “a brilliant group of carers”. She also said she has not received any formal supervision since starting at the home. Amberley Hall Care Home DS0000065153.V345701.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service manager is not yet registered. The service’s quality assurance summary and improvement plan remains unavailable. There was good practice that ensures people’s personal allowances are well managed. Staff were not receiving formal supervision in line with good practice. Maintenance records were poor and unreliable. EVIDENCE: The requirement made at the last inspection about the management of the home has been met in part. Mr Davies has not yet been registered to manage this home. He said that interviews were due to take place next week to fill the deputy manager post. Ms Bull commenced as the dementia unit manager on Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 25 5th July 2007 and had not commenced her induction training at the time of inspection. Mr Davies was asked about the Quality Assurance summary and improvement plan that had been discussed at the last inspection. He seemed not to be aware of what was required although this had been thoroughly discussed in April. He was again reminded and he made assurances that this would be dealt with and forwarded. See requirements. Confirmation was obtained from a member of the administration team, that 2 full signatures are obtained for all financial transactions made on behalf of residents. The records were not checked on this occasion as the last inspection showed evidence of good practice including regular audit. Mr Davies said that supervision was now taking place 6 times per year for all staff and some of this takes place as group supervision. The previous inspection obtained evidence that supervision of staff on the dementia units had taken place but not since the departure of the previous unit manager. Only 1 staff file had 1 supervision envelope. Staff questioned said they had not received supervision. Mr Davies said that he expected Ms Bull to be responsible for all supervision of the dementia unit staff. See requirements. A maintenance person was in post and was seen affecting repairs during this inspection. The previous inspection showed health & safety checks taking place. It was not possible to follow up on the compliance with the requirement made about water temperatures made at the last inspection, as there was concern about the authenticity of the records. Records were seen with names of different homes written on the top and one record was dated at a period prior to when the home opened. The requirement will be assessed at a later inspection and remains unmet. See requirements. Amberley Hall Care Home DS0000065153.V345701.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 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 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 X 1 Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(a) Requirement Staff at the home must 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. This requirement was set on 2/4/07 & will be assessed when admission resume at this service. Care plans must be written so that the information is clear and not contradictory. This will ensure that staff deliver care as needed and in a consistent way. Important information about health and daily living must be kept on care plans for longer than 1 month so that significant about the persons ill and well being is not lost. Care plans must contain all the elements as set out in Schedule 2 of the Care Homes Regulations 2001. This will ensure that all relevant information is held and available to staff. Details of GP and collaborative care visits must be maintained on the person’s care plan and DS0000065153.V345701.R01.S.doc Timescale for action 01/01/08 2. OP7 15(1) 13/08/07 3 OP7 15(1) 13/08/07 4 OP7 15(1) 13/08/07 5 OP8 12(1)(a) 23/07/07 Amberley Hall Care Home Version 5.2 Page 28 6 OP8 12(3) 7 OP8 18(1)(a) 8 OP9 13.2 13.4 not archived. This will ensure that staff and health professionals have access to all relevant information about the person’s health needs. Staff must complete all health related documents correctly and in accordance with instruction. This will ensure that confidence can be placed in the care provided to people. Staff must receive training that is relevant to specific health needs and their competence regularly assessed. This will ensure that health care delivery meets individual needs. People who use the service must have medicines of a psychoactive and sedative nature prescribed on a PRN (as required) basis safely administered to them by staff only when their use is clinically justified. This must be demonstrated by record-keeping practices. People who use the service must have increases in doses of medicines of a psychoactive and sedative nature supported by documentary evidence justifying requests for prescriber increases People who use the service must have changes made by staff to prescribed instructions for medicines of a psychoactive and sedative nature only when authorised by prescribers and supported by documentary evidence. People who use the service must have their medicines administered in line with prescribed instructions at all DS0000065153.V345701.R01.S.doc 23/07/07 13/08/07 03/08/07 9 OP9 13.2 13.4 03/08/07 10 OP9 13.2 13.4 03/08/07 11 OP9 13.2 13.4 03/08/07 Amberley Hall Care Home Version 5.2 Page 29 times and this can be demonstrated by record-keeping practices 12 OP9 18.1(c)(i) People who use the service must have their medicines administered by staff who have received adequate training provision and are regularly assessed as competent to undertake all medication-related tasks. This must be confirmed by documentary evidence. Staff must ensure that people’s appearance is in accordance with their wishes and expectations. This will enhance their sense of well-being. Mealtimes must be arranged so that staff are not feeding more than 1 person at a time. This will ensure that mealtimes are more pleasurable for the person Records of complaints received at the service must be kept up to date. This will ensure that information about complaints is readily available for inspection purposes. The service is not complying with smoking legislation introduced on 1st July 2007. Full compliance is needed without delay. This will ensure that people can enjoy access to a smoke free environment if they wish. Odour problems in 1 bedroom need to be dealt with promptly. This will ensure the resident can enjoy a pleasant environment and have his/her dignity protected. Records about the maintenance and servicing of equipment and the environment must be kept up to date and available for inspection. This will ensure that DS0000065153.V345701.R01.S.doc 03/08/07 13 OP10 12(4)(a) 13/08/07 14 OP15 16(2)(i) 13/08/07 15 OP16 22(8) 13/08/07 16 OP19 13(4)(a) 13/08/07 17 OP26 16(2)(k) 13/08/07 18 OP26 13(4) 13/08/07 Amberley Hall Care Home Version 5.2 Page 30 19 OP27 18(1)(a) 20 OP27 18(1)(a) 21 OP30 18(1) 22 OP33 24(2) 23 OP36 13(2)(a) 24 OP38 13(4)(a) people who use the service and those who work and visit the service are safe. Better control, recording and monitoring of staff rotas is needed as conflicting information was seen. This will mean that there can be confidence placed in information provided. Staff must be employed in sufficient numbers so that staff are not working excessive hours or long periods without time off. This will reduce risk to the welfare of people at the home and staff. This requirement was set 2/4/07 and is repeated. Not all staff are receiving essential elements of induction training in a timely way and this must improve. This will ensure that important health & safety practice is known to new staff on their first day of employment. The service must provide a copy of its quality assurance summary and action plan to the Commission and also to all stakeholders. This will give people information about how the service is responding to their views about the quality of care provided. Staff must receive formal supervision at least 6 times per year. This will ensure that staff feel well supported. Investigations and repairs (where necessary) to hot water outlets where temperatures are too high must be completed without delay. This requirement was set 2/4/07 but it was not possible to confirm compliance. This requirement is therefore repeated. DS0000065153.V345701.R01.S.doc 13/08/07 13/08/07 23/07/07 13/08/07 17/09/07 23/07/07 Amberley Hall Care Home Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans need to consider the skills and abilities of people as well as their difficulties so that staff can support people to retain their skills for as long as possible. The manager needs to monitor the quality and content of care plans on a regular basis. This will ensure that standards within the care plans are improved and then sustained. Weeds growing between paving slabs in the secure garden represent a trip hazard and should be removed. This will ensure the environment is safe. 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 2 OP7 3 4 OP19 OP9 Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 32 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. Extracts may not be used or reproduced without the express permission of CSCI Amberley Hall Care Home DS0000065153.V345701.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!