CARE HOMES FOR OLDER PEOPLE
Amberley House Care Home The Crescent Truro Cornwall TR1 3ES Lead Inspector
Diana Penrose Announced Inspection 8th November 2005 09:30 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 Care Home DS0000008885.V253196.R01.S.doc Version 5.0 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 Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Amberley House Care Home Address The Crescent Truro Cornwall TR1 3ES 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) 01872 271921 01872 260137 amberley1@btconnect.com Dove Care Homes Limited Mrs Lindsay Gail Pugh Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30), Terminally ill (30) of places Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to 30 adults of old age (OP) Service users to include up to 30 adults with a terminal illness (TI) Service users to include up to 30 adults with a physical disability (PD) Date of last inspection 24th May 2005 Brief Description of the Service: Amberley House is a Care Home owned by Minster Care Limited. The property is a large house, situated in a quiet residential area on the outskirts of Truro. The City centre is about ten minutes walk away but is not on the level. The home provides nursing and residential care for up to thirty elderly people some of whom may have a physical disability or terminal illness. Accommodation is provided in 16 single bedrooms and 6 shared bedrooms. All bedrooms have a hand washbasin but only one single bedroom has en-suite facilities. There is a large lounge on the ground floor that is also used for dining. The home has a small front garden with limited parking facilities. The Home has undergone some structural changes and developments over the years and there are further plans for redevelopment and upgrading of facilities. Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Amberley Nursing Home on the 08 November 2005 and spent six hours at the home. This was an announced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirement identified in the last inspection report dated 24.05.05. In addition the inspector focused on the following key areas of care: choice of home, assessment and care planning, death and dying, leisure, complaints, some of the environment and some management areas. On the day of inspection 27 residents were resident in the home; one was receiving respite care. The methods used to undertake the inspection were to meet with a number of residents, staff and the registered manager to gain their views on the services that Amberley offers. Amberley’s records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. Minster Care Management Ltd has recently purchased the home but this has not disrupted the smooth running of the home and comments made were positive. What the service does well:
The Registered Manager has been in post for eleven years and is very competent in her role. Both staff and residents spoke highly of her. She has information about the home available to give to prospective residents and their family. This information is also available in the hall. Prior to admitting any resident the Registered Manager tries to visit them to carry out a needs assessment. This is very thorough and recorded on a specific form. Assessments from other professionals are also sought to ensure the home can fully meet the needs of the individual. A personalised care plan is compiled from the initial assessment; this covers all personal, health and social care needs. The plan is reviewed every month and updated as necessary. Several risk assessments are undertaken for each resident to ensure their safety and welfare. Day and night records are kept and are informative. Residents said their care needs are met and the staff are all very kind. Residents said their privacy and dignity is upheld at all times and there are curtain screens in the shared rooms. There is a policy for death and dying and records show that appropriate care is given when a residents is dying. Appropriate assistance is requested from external healthcare professionals when needed. Activities take place and one member of staff is responsible for organising these; records are maintained Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 6 Residents said they can exercise choice in how they live their lives, the daily routines are flexible and they have their own possessions with them. The home has not received any complaints but there is a suitable policy in place and a method for recording. The amount of compliments received shows that the standards are good and that the staff and management are appreciated. The environment is well maintained, warm clean and homely. Residents can access the communal areas and the grounds. There are two stair lifts in the home. There were sufficient staff on duty and no negative comments were made regarding staffing from residents or staff. There is a qualified nurse on duty at all times and some care staff have achieved NVQ qualifications; others are in the process of NVQ courses. The home provides appropriate training for staff to help them be competent in their roles and staff receive payment for attending statutory training. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 7 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 Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Prospective residents are given information about the home enabling them to make an informed decision. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide adequate care. EVIDENCE: There is a new statement of purpose and residents guide that contain all of the required information. The Registered Manager said that the final touches are being made before a copy is sent to the Commission. Prospective residents are issued with a welcome pack when they enquire about the home. A master copy of the pack is in the hall. The Registered Manager said she visits prospective residents whenever possible to assess their needs prior to admission. She said she also seeks to obtain assessments and information from other health care professionals. There was little evidence of assessments from outside professionals in the files inspected. The assessment form used is detailed. There is some evidence of the residents’ involvement. Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 10 and 11 Individual care plans are generated for each resident that inform and direct the staff in their care provision. Systems are in place to ensure that residents are respected and their privacy is upheld at all times. Residents are treated with care, sensitivity and respect at the time of their death, and staff take into account individual wishes, cultural and religious beliefs. EVIDENCE: Each resident has a care plan, which is reviewed monthly. Risk assessments include Waterlow scoring, nutrition, moving and handling, falls and Barthel scoring. There is a page for the GP to write notes when visiting. There are daily care records written by the nurses and care staff. The care documentation is comprehensive and informative. The resident or their representative is involved with the compilation and review of the care plan if they wish and there is space for them to sign as agreeing the care plan. Residents’ privacy was upheld during the inspection. Residents said they are treated with respect and their privacy is upheld at all times. Shared rooms are provided with appropriate screens. There is a policy for respecting resident’s privacy and dignity.
Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 10 There is a policy in place for dying and death. The Registered Manager said that at the time of a residents’ death the staff would treat them and their family with kindness and respect. She spoke with empathy of residents recently deceased. The notes of residents who had died were inspected and the daily care records are detailed. General Practitioners, District Nurses and specialist therapists visit when required and family and friends visit and can stay if the resident wishes. Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13 The home provides a range of activities and aims to offer a lifestyle that meets individual residents needs. Links with family, friends and the community are good and allow residents the opportunity to socialise. EVIDENCE: The home has one member of staff who organises activities and entertainment. Social interests are recorded. There is a record of those attending activities. Activities include bingo, board games, jigsaws, manicures, singing and movies. Hand massage was taking place during the inspection and residents were enjoying it. The Registered Manager said it is difficult to organise outings due to the dependency of the residents however small numbers of residents are taken to late night shopping for example. There is a record of visitors to the home and there were visitors in the home during the inspection. Residents said they could receive visitors in private and at any time. Visitors spoken with said they are always made welcome in the home and can call in when they like. Residents said the telephone arrangements in the home are suitable for their needs. Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. EVIDENCE: There is a suitable complaints policy in the home and a method for recording complaints, the action taken and the outcome. There have been no complaints. Thank you letters and cards are kept. Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 The home and grounds are well maintained providing a safe environment for residents, staff and visitors. There is comfortable communal space for residents but a separate dining facility would be beneficial if all residents wish to eat together. The home is clean and free from offensive odours; controls are in place to prevent the risk of infection. EVIDENCE: Residents live in a safe well-maintained environment, which is well decorated, clean, homely and comfortable with no offensive odours. The home has an ongoing maintenance programme and residents can be involved in the choice of decoration in the home. The home would benefit greatly from the installation of a shaft lift as not all residents can manage the stair lifts. Residents can access the communal areas and the grounds. There have been no changes to communal space since the last inspection and there is no dining facility that can accommodate all residents if the need should arise. It is recommended that this take a priority in any future plans for the home. The home generally operates a no smoking policy but residents can smoke under supervision in their room if needs be.
Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 14 The Registered Manager said the laundry facilities are adequate with two washers and two driers. Protective clothing is supplied for staff and they were seen wearing aprons and gloves. Hand washing facilities for staff are adequate and alcohol hand cleansing gel is provided. Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 Staffing levels meet the needs of the residents and staff morale is good. Recruitment procedures are not robust enough to offer maximum protection to the residents. The home provides appropriate training for staff to help them be competent in their roles. EVIDENCE: The Registered Manager is a qualified nurse and she said the home incorporates a skill mix to meet the resident’s needs. Normally there are 5 care assistants on duty in the mornings, 3-4 in the afternoons and 2 at night. There is a registered nurse on duty at all times. There are designated housekeeping and catering staff. Staffing levels are flexible and changed according to the needs of residents. There is a recruitment policy. Staff files inspected lacked interview records and some had only one written reference. Some CRB and POVA disclosures had been applied for but not received. Staff awaiting receipt of their disclosures were working under supervision. Staff must not commence work in the home until a POVA disclosure has been received; an immediate requirement was issued. Staff receive statutory training as required. There is a six-week induction programme for new staff that is extended as necessary. A foundation programme follows this. Training needs are identified during the interview process for new staff, staff meetings and general conversation. The Registered Manager has commenced a training matrix and records of all training are maintained. Recent training topics include POVA, depression, syringe drivers
Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 16 and the use of benzodiazepines. Staff spoken with said they would benefit from training in dementia awareness and the Registered Manager said she was looking into this. Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 and 38 The Registered Manager is a person of good character and fit to run the home. The management approach of the home is open, positive and inclusive and both residents and staff benefit from this. Appropriate training and safety checks are undertaken to ensure the health safety and welfare of residents and staff. EVIDENCE: The Registered Manager is a qualified nurse and is undertaking the Registered Managers’ Award. She has managed the home for eleven years and was the deputy for two years prior to that. She said she keeps up to date by using the Internet and reading the nursing press. She has the role of link nurse for continence, tissue viability and osteoporosis and she attends updates in these subjects. The management approach is open and positive, staff and residents are involved in decision-making. Staff said the Registered Manager is good to work for and has an open door. They also said she is always willing to ‘muck in’, she
Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 18 is a workaholic. Residents said she goes to see them every day and she runs a good ship. The management endeavour to ensure that working practices are safe. Relevant service checks take place as required. Staff receive statutory training regularly and records are kept. Action must be taken to ensure that all staff attend statutory fire training sessions. There is a person trained in first aid on duty at all times. The kitchen staff have all received basic food hygiene training and one at intermediate level. Accident reporting complies with data protection and the Registered Manager audits accidents in the home. Health and safety risk assessments have been undertaken. Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 2 Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No 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 2 3 Standard OP29 OP29 OP38 Regulation 18,19 Requirement Timescale for action 07/11/05 07/11/05 20/02/06 Staff must not commence work in the home until a POVA disclosure has been received. 17, 18 (4) Staff must not work in the home Sch 2 unless two satisfactory references have been obtained 18.1(c)(i) Action must be taken to ensure 23.4(d)(e) that all staff attend statutory fire training sessions RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP22 OP28 OP29 Good Practice Recommendations It is srongly recommended that a shaft lift is installed in the home to access the first floor 50 of care staff (including agency staff) working in the home should achieve the NVQ 2 in care as minimum Interview records should be maintained for prospective employees Amberley House Care Home DS0000008885.V253196.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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