Inspection on 17/04/08 for Amberley House

This inspection was carried out on 17th April 2008.

CSCI found this care home to be providing an Adequate service.

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 House 09/03/09

Amberley House 01/10/07

Amberley House 17/07/06

Amberley House 28/11/05

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Amberley House 44-48 Amberley Road London N13 4BJ Lead Inspector Jackie Izzard Unannounced Inspection 17th April 2008 09:40 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 House DS0000065136.V362436.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 House DS0000065136.V362436.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amberley House Address 44-48 Amberley Road London N13 4BJ 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) 020 8886 0611 020 8886 1436 dhunnoo@tiscali.co.uk Waterfall House Residential Home Patricia Susan Tatham Care Home 16 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (16) of places Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st October 2007 Brief Description of the Service: Amberley House is a privately owned care home for older people who are over the age of sixty five. The home is registered to accommodate sixteen older people, who may also have a diagnosis of dementia. There are fourteen single bedrooms and one shared room. There is a shaft lift and a chair lift. The dining room and lounge are situated on the ground floor overlooking an attractive garden. The home is situated in Palmers Green, with good bus and train links. All the amenities of Palmers Green are within a short distance, including restaurants, shops, churches and Broomfield Park. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The registered manager reported that the current scales of charges are from: - £500 to £550 per week. Additional charges are made for hairdressing, chiropody, private telephone and newspapers. At the time of this inspection there were 16 people living at Amberley House. Currently there are 14 women and 2 men in residence. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection lasted eight hours. I met the residents, inspected the personal files of five residents and three staff members, spoke with two staff, the manager and the owner of the home in private, looked around the home and observed interaction between staff and residents. I was also able to take a meal with residents. I met the visitors of one resident and spoke with nine residents individually. Some residents were able to give their opinion about the service provided at the home. For those residents who were not able to do this, I carried out observations and talked with them in order to assess their general well-being. Various records were inspected; including a selection of health and safety records and all records relating to food. What the service does well: The home is kept clean, comfortable and well maintained by the owner. Staff have formed a good relationship with residents and the residents say that staff are kind and helpful to them. The home welcomes residents’ visitors. Residents who are able to give their views say they are well looked after by caring staff and satisfied with the service provided to them. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Seven requirements made at the last inspection had not yet been fully met. Six of these requirements have been restated in this report. Unmet requirements impact on the health and safety of residents and must be complied with. Failure to do so may result in the Commission for Social Care Inspection taking further action to ensure compliance. These requirements were: • to ensure a full record is kept of all residents’ health appointments and the outcome of the appointments, Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 7 • • • • • to assess what support residents need with dental care and ensure this is recorded and carried out, to devise an activity programme which includes regular opportunities to go out into the community, to ensure all staff have supervision at least six times a year, to ensure kitchen doors are kept closed, to ensure that the fire alarm is tested on a weekly basis and records kept. Progress has been made with all of these requirements but none are yet fully met. Five new requirements are made as a result of this inspection. Further detail on these requirements can be found in the relevant sections of this report. There were two main areas of concern which were in the areas of staffing and food. Requirements have been made to undertake a review of the staffing levels and to ensure the manager does not have to cover a carer’s duties. Requirements are also made to improve the menu offered to residents. One requirement is made to produce a new menu which is more varied and nutritious and reflects residents’ choices. Another requirement is made to provide more fresh fruit and vegetables for residents. A requirement is also made to investigate and report to CSCI regarding an accident which was not recorded or reported properly. 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 House DS0000065136.V362436.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 House DS0000065136.V362436.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents’ needs are assessed before they move into the home so that they know the home is aware of their needs and can meet them. No intermediate care is provided. EVIDENCE: In order to assess these standards, I examined the assessments carried out on two male and two female residents, three of whom had been living at the home for a short period. From checking their files, it was evident that the manager of the home had visited each Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 10 resident in their previous placement to carry out an assessment before offering them a place at Amberley House. In each case the home had also acquired a copy of the assessment of needs carried out by each resident’s local authority. One assessment was not fully complete but the manager was in the process of completing this. I spoke with one resident to find out if he/she had made an informed choice to live at Amberley House. It was clear from talking to this person that he/she had made an informed choice to move to this home. The home is not equipped to provide intermediate care but does offer respite care at times. At the time of this inspection, one resident was receiving respite care while waiting for a place at another local home. I spoke with this resident who was fully aware of this situation. Amberley House DS0000065136.V362436.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples needs are set out in an individual plan of care and they are treated with respect and dignity by staff. People living at this home are protected by procedures for dealing with medicine but cannot feel assured that their health needs are fully met as record-keeping in this area does not provide enough evidence of this. EVIDENCE: In order to assess these standards, I looked at five residents’ files in detail. I read their assessments, care plans, reviews of the care Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 12 plans, daily records and all health records relating to these five residents. The care plans reflected peoples needs and were reviewed on a monthly basis to see if the persons needs have changed in any way. The manager and deputy have trained staff to undertake care planning reviews, although most of this work is still undertaken by the deputy manager. Since the last inspection, staff have been given keyworker responsibilities and are more involved in the reviewing of residents’ care plans. Records are made daily on residents’ well-being, although on a few occasions records were not up to date. Risk assessments were in place and a sample of these were seen and found to be satisfactory. Health care records were not satisfactory for all residents. This was also found at the last inspection of the home six months ago. One resident’s daily records showed that he had had two medical appointments in the last six months which have not been recorded in the health records section of his file or the monthly review of the care plan. One resident of the five whose files were inspected had no record of being offered dentist or optician visits. I was told that this resident chose not to attend a dentist or optician but there was no written evidence to show that these services has been offered to the resident. I also followed up on a requirement made to ensure that residents’ dental care needs were assessed, recorded and met. One resident who had seen a dentist in September 2007 did not know the outcome of her appointment nor whether any treatment was necessary and staff were also not aware of the outcome of the appointment. At this inspection, the home had still not managed to find from the dentist what the outcome of the appointment was and whether the resident would be having any treatment. The care plan stated that the resident was to be encouraged to clean his/her teeth twice a day. It was not clear whether staff were actually assisting with this. The requirement is restated in this report as those residents with dementia and/or visual impairments may need more help with caring for their teeth. I spent time in the lounge observing the interaction between staff and residents and also talking individually with residents. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 13 I observed that staff assisted people with eating, going to the toilet, etc in a discreet and respectful way. I asked four residents for their opinions on this issue and they replied that, its all right here, the staff are all right,” “ they are very kind and helpful” and “ they look after me very well”. The fourth resident said that s/he felt embarrassed to have other people involved in personal care but that staff did carry out these duties in a respectful way. This feedback was very positive about the staff. One staff member told me that s/he felt it was important for residents to be as independent as they can with their own personal care and that s/he always encourages residents to do as much as they are able for themselves. Some residents prefer to be cared for by staff of the same gender and some do not mind whether they have a male or female carer. This is recorded. In practice, often in the evening, according to staff rotas seen, there are two males and one female on duty which does not reflect the fact that the majority of residents are female. This issue is addressed in the staffing section of this report. I looked at the medication stored in the home and a sample of one week’s medication and the medication charts all four residents. The medication was stored securely and appropriately to safeguard residents. The charts showed one error where a staff member had given somebody their prescribed medication and forgotten to sign the chart, but generally records were well kept. One resident receives insulin injections for diabetes and this care is carried out by the district nurse twice a day. There were no controlled drugs in home at this inspection. Staff who give medication have been trained to do so. None of the residents manage their own medication. I noted that one resident had an accident which had not been reported to CSCI and for which a proper accident record had not been recorded. Examination of the care notes showed that there was a significant delay between the time of the fall and the time the resident was taken to hospital for an examination. The daily records and incident report gave inadequate information to assess the reason why there had been such a delay. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 14 The resident had acquired grazing to the face and no explanation of how the injury had been sought. A requirement is made to investigate this accident and complete an accident report for the attention of CSCI. Amberley House DS0000065136.V362436.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. Residents enjoy regular contact with their visitors who are made welcome by the home. They do not currently benefit from opportunities to go out of the home in the community. People’s nutritional needs and preferences are not fully met as the diet is not sufficiently varied and healthy. EVIDENCE: To assess these standards, I talked to the manager, home owner, two visitors and nine residents. I also examined the activity records, records of food eaten and purchased, and food available in the home. I ate a meal with residents and observed staff assisting Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 16 a resident with eating. I also sat in the lounge and dining room observing residents. There are some internal activities taking place in the home such as ball games, skittles and sing-along but very little opportunity to go out of the home except for those residents whose relatives are able to take them out. Despite a requirement made six months ago at the last inspection, to implement an activity programme which offers regular opportunities for people to go out in the community, there had been only one outing since then where approximately eight residents went to a party at a local school at Christmas. Residents are not able to go to shops, cafes, pubs or places of interest unless with their own families so those without families have limited contact with the local community. The manager said she is planning some trips, eg to a zoo, in the summer which is positive. The requirement is restated and I have asked for dates to be planned for trips out. I also advised the registered persons that when there are sufficient staff on duty , eg in the afternoons, that residents be offered the chance to go out locally either individually or in a small group. This would give people more opportunity for socialising and to maintain their previous interests. Some residents are happy to continue with their interests of reading, television and listening to music. Books are provided in the home. Others were no longer able to do these activities and would benefit from more stimulation. The manager said that approximately 50 of residents have regular contact with their families. I observed one resident talking to a relative on the telephone and another receiving visitors. Others said that they enjoyed regular visitors and that staff were welcoming to their visitors. The visitors spoken to during the inspection said that staff were welcoming and caring. One resident said she would very much like to find an old friend and the deputy manager agreed to speak to her social worker to see if this friend could be located. Residents can choose to manage their own money but in practice this is carried out by relatives or their placing authority. They are encouraged to bring their own personal items to the home and an Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 17 inspection of a sample of bedrooms showed that people had done so . Nine residents were asked about their favourite foods. Their preferences were compared to the records of food eaten and showed that residents’ preferences were not fully catered for. Feedback about the food was varied. Two residents were very positive about the food and the visitors spoken to also said they thought the food was good. Two others said it was “alright” and “not bad.” The others I spoke to were unable to give their view but were able to say what they liked. One person said that s/he never has fresh fruit or cheese. Records of food purchased recently did show that no cheese or fresh fruit has been bought. A resident told me that there was no menu. The current day’s lunch was recorded on a blackboard but there was no written menu offering a choice of meals. The record of food actually served was in insufficient detail and a requirement is made to keep daily records of food eaten. From the food records seen, examination of food invoices and inspection of food stocks, it was evident that there was insufficient variety in the meals served. A requirement is made to review the menu, produce a new menu and send a copy to CSCI. The new menu needs to include residents’ choices. Three residents told me their favourite meals and these were not on the menu which appeared to be the same each week. The tea menu for the week ahead showed that sausage and bean casserole was to be served three times in one week. This dish was seen and comprised cooked sausages in a casserole dish with baked beans. Other teatime meals were tinned ravioli with bread and sandwiches. No fruit or vegetables were to be served at teatimes in the following ten days according to the plan seen. I was told that at lunchtime frozen vegetables are served during the week but fresh vegetables are cooked at the weekend. There was a limited supply of fresh fruit and I was informed that a staff member had bought this for residents. I inspected two months’ green grocer bills and one month of supermarket receipts and saw that the only fruit purchased was cooking apples. This is of concern. A separate requirement is made to provide residents with a daily supply of fresh fruit and vegetables. One resident said Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 18 salad is never offered and neither is a fruit bowl. This resident said s/he would like to eat apples, pears, plums and grapes. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 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 clear complaints procedure which has been explained to residents. Recording of complaints needs to be improved to show evidence that the complaint was resolved. Residents are protected by staff trained in recognising abuse and this training is ongoing to ensure a consistent knowledge and practice. EVIDENCE: The home’ complaints procedure is displayed in the entrance so that it is visible to residents of the home and their visitors. Examination of the complaints book showed that there had been no complaints in the last six months, since the last inspection. I saw in the record of a residents’ meeting in November 2007, that the procedure for making a complaint was explained to residents. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 20 The last complaint did not have the outcome recorded in the complaints book and a requirement is therefore made to ensure that the action taken and outcome is recorded for every complaint. There have been no safeguarding alerts since the last inspection, which means that there have been no allegations of abuse. The policy and procedure were not inspected on this occasion. Some staff need refresher training on safeguarding procedures so that they know what to do if they had any disclosure or suspicion of abuse taking place. I saw that this is planned on this year’s staff training plan, which the home call the “workforce development plan.” For those residents who have bedrails fitted to their bed which prevents them from getting up at night, a record of why this decision was made and by whom was recorded in their file. I checked three of these and saw that these three residents had all fallen out of bed and the decision had been made for their safety. I spoke with one resident about this issue who confirmed that s/he had been consulted before the bedrails were fitted. This shows good practice. Residents said they were generally satisfied with service provided by the home as staff were kind and supportive to them. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, safe and well maintained. The residents say they are happy with the facilities. EVIDENCE: In order to assess these standards, I looked at all communal rooms and areas plus a sample of five individual bedrooms and the garden. The home was clean and tidy throughout and maintained to a satisfactory standard. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 22 A new shower which meets residents’ needs has been fitted and they are happy with this. Bedrooms are kept safe and tidy by staff and there was evidence that people have been encouraged to bring in their personal belongings and make the room more homely. One bedroom had knobs missing from the chest of drawers which was potentially dangerous so a recommendation is made to repair or replace this piece of furniture. The lounge has enough space for the number of residents and one resident sits in the entrance hall by choice. Some residents prefer to stay in their own room for greater privacy and this is also respected. The dining room does not comfortably sit all the residents but one or two people eat in the lounge where there is a small table . This was used for a resident who needed help with feeding and was a more relaxed and private environment for them. There is an attractive well maintained garden. Residents said they were happy with the home. There is a chair lift on one staircase which is not used as this staircase would be a danger. Residents of the first floor use a shaft lift which meets their needs. Four residents were asked for their views on the home and all said they were happy with the facilities and had no suggestions for improvement. One person said she was afraid of the bath but was happy to use the shower. Two people mentioned that they liked fresh air and liked to look out at the garden. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are cared for by staff who know their needs well and have formed good relationships with them. The registered persons need to review staffing levels in order to best meet residents’ needs. Staff are provided with training to undertake their duties. Some staff are not up to date with their training and will be brought up to date this year to ensure they have knowledge of best practice when caring for residents. EVIDENCE: Current staffing levels are two carers for most of the morning plus a cook and domestic staff and three carers in the evening. There is one staff awake at night and another asleep on call within the home. Examination of five recent weeks within the last three months of staff rotas showed that there were insufficient staff employed to cover the staff rota. The manager was on duty as a carer for the majority of her hours worked which is not acceptable as the manager’s hours are for management duties. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 24 For a few hours each day the manager was one of only two carers on duty. In addition it was noted that the deputy manager was working the hours of two people some weeks. The week of this inspection this staff member was rostered to work eighty-four hours. There are two full time carer staff and seven part time staff, three of whom work nights. Staffing was discussed with the manager and owner of the home separately. The owner said that he would recruit a new carer as soon as possible and that an ex staff member was willing to restart working at the home. The rota showed that often there are two males and one female staff on duty in the evening and it was not clear whether this meets the personal care needs of the residents, the majority of whom are female. Two residents mentioned to the inspector that they thought the home was short staffed. A third said, “ there’s not many staff here but I think there’s enough.” A requirement is made to remove the manager from the basic carer hours and to undertake a review of current staffing levels using an agreed formula, such as the residential care forum formula, to determine what the current staffing levels should be in order to meet the assessed needs of current residents. The training records for three care staff were inspected. Staff had attended training in the mandatory topics of first aid, fire safety, food hygiene, health and safety, medicines administration, dementia and NVQ 2. Some training had expired and refresher courses were needed. The manage was aware of this and showed that this had been planned in the training plan of this year. A requirement to provide further dementia awareness training has not been met but the manager said this training is booked for May. This should help staff in providing the best possible care for people with dementia. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 25 Staff recruitment practice was not inspected on this occasion as this standard was met at the last inspection and no new staff have been recruited since that date. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. The manager is sufficiently qualified and experienced for her post and has a good knowledge of residents’ needs. Residents say they are satisfied with the service they receive at the home. Their health and safety is adequately safeguarded. Regular supervision of all staff, including the manager and deputy, is not occurring and would promote consistency and best practice in caring for residents. EVIDENCE: Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 27 The manager has recently completed her Registered Manager’s Award and is now qualified. She has worked at this home as a senior carer and manager for many years so does possess the required experience. The registered provider visits the home on a daily basis and the manager is supported by a deputy manager. The manager has no contract nor job description for her role. The owner said he planned to rectify this immediately. From discussion with the manager and owner, it was evident that they both try to keep up to date with current developments nationally and by CSCI. The home has no annual development plan and the results of residents and their representatives quality assurance surveys are not recorded. However, surveys are sent out and these are kept. The general outcome of surveys in January 2008 was that people were satisfied with the service provided. The owner reported that none of the residents manage their own money and that the home manage none either. He reported that all residents have their finances managed by relatives or care managers and that he receives no cash at all in respect of any resident. Fee invoices were inspected for a sample of residents and these did not include personal allowance for the resident. The owner said that this is paid separately to relatives in all cases who use it to buy what the resident requests. Improvements have been made to keep up to date with the required standard of ensuring all staff receive at least six supervision sessions per year. Of the three files inspected, two of the staff were not up to date with their supervision. The manager and deputy manager are not receiving supervision. A requirement is made to ensure supervision is carried out, as this helps to promote best practice and consistency in caring for residents. Some of the training in health and safety topics for staff was out of date but this has been addressed in the staffing section of this report. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 28 A sample of health and safety records were inspected. The owner has employer liability insurance for the home which is covered until August 2008. The emergency lighting was inspected in January 2008. The fire book showed there have been four fire drills in the last six months and these have been recorded. Tests of the fire alarm system were being recorded weekly but were not up to date at the time of this inspection. None had been recorded since 24 March. Neither the manager or owner were aware that these tests were not up to date. They agreed that this testing would be monitored by a senior staff from now on. A requirement made at the last inspection to provide paper towel in the kitchen wash hand basin has been removed as the owner did not purchase paper towels and advice from the local Environmental Health Department indicated that a handtowel was sufficient if changed frequently during the day. A requirement to keep kitchen doors closed for pest control and fire safety reasons has not been met. Doors were seen to be propped open during the inspection. It is acceptable to have these doors open when food is served but during cooking they should be closed. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 29 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 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 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 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1 OP8 17 The registered persons must 17/05/08 schedule ensure that a record is 3(m) made of all residents’ health appointments with doctors, nurses, dentists, etc and the outcome/treatment recorded. This is evidence that their health needs are known by the home and addressed. This requirement is restated. Previous timescale of 30/11/07 not met. The registered persons must 17/05/08 assess what support, if any, residents need with their dental care and ensure any required assistance with cleaning is recorded in the care plan and carried out. This requirement is restated. 2 OP8 12(1)(a) (b) Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 31 3 OP8 37(1)(f) 4 OP12 16(2)(m )(n) Previous timescale of 30/11/07 not met. The registered persons must 17/05/08 investigate and report to CSCI regarding an accident where a resident had a delay in receiving medical treatment and where inadequate recording was carried out. The registered persons 17/05/08 must, after consultation with residents, devise an activity programme which includes regular opportunities to go out into the community and implement this programme. A copy of the programme must be sent to the CSCI. This requirement is restated. Previous timescale of 30/11/07 not met. Dates of planned outings should be recorded in the programme. The registered persons must, after consultation with residents, devise and implement a new menu which provides residents with a varied, wholesome and nutritious diet which reflects their choices. A copy must be displayed for residents and CSCI to inspect. 5 OP15 16(2)(i) 17/06/08 Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 32 6 OP15 7 OP16 8 OP27 9 OP36 Records of all food provided must be kept for inspection purposes. 16(2)(i) The registered persons must introduce fresh fruit and vegetables to residents on a daily basis at all meals, following healthy eating guidelines. 22(3)(8) The registered persons must ensure that any complaints are fully recorded, including the action taken in response. 18(1)(a) The registered persons must undertake a review of staffing levels using a recognised formula and send the outcome of to CSCI showing how staffing levels are satisfactory to meet residents’ assessed needs and any action planned. The manager must cease working as a carer for the majority of her hours. 18 (2) The registered person must ensure that supervision is completed at least six times a years for all staff and evidence of this is kept on file. This requirement is restated. Previous timescale of 30/08/06 and 31/12/07 not met. The manager and deputy manager must also receive 17/05/08 17/05/08 30/05/08 17/07/08 Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 33 10 OP38 13(4)(c) supervision. The registered persons must 17/05/08 ensure that kitchen doors are kept closed for fire safety and pest control purposes. This requirement is restated. Previous timescale of 18/10/07 not met. 11 OP38 23(4)(v) The registered persons must 17/05/08 ensure the fire alarm is tested on a weekly basis and records kept of the tests. The fire logbook must also be kept up to date. This requirement is restated. Previous timescale of 31/10/07 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Standard 1 OP24 The chest of drawers in one resident’s bedrooms should be repaired or replaced for safety and aesthetic reasons. Amberley House DS0000065136.V362436.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 House DS0000065136.V362436.R01.S.doc Version 5.2 Page 35 - 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. 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