Inspection on 11/09/08 for Amberley Nursing Home

This inspection was carried out on 11th September 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 Nursing Home 11/09/07

Amberley Nursing Home 07/11/06

Amberley Nursing Home 09/01/06

Amberley Nursing Home 24/08/05

Amberley Nursing Home 10/02/05

Amberley Nursing Home 27/09/04

Amberley Nursing Home 02/03/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Amberley Nursing Home Off Cedar Close Eckington Sheffield Derbyshire S21 4BA Lead Inspector Janis Robinson Unannounced Inspection 11th September 2008 09:30 X10029.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 Nursing Home DS0000002035.V371407.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 and Care Homes for Adults 18 – 65*. 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 Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amberley Nursing Home Address Off Cedar Close Eckington Sheffield Derbyshire S21 4BA 01246 436850 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) Enable Care & Home Support Limited Mary Woulfe (not yet registered) Care Home 15 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (15) of places Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th September 2007 Brief Description of the Service: Amberley House Nursing Home provides nursing and personal care for up to fifteen Older People with Learning Disabilities, aged over 65 years, and for up to 5 people with Learning Disabilities aged under 65 years. The Home is situated on the edge of the northeast Derbyshire boundary within the village of Eckington. It is close to shops, a post office and all local amenities, and near to a direct bus routes to both Chesterfield and Sheffield. The Home provides single bedroom accommodation on the ground floor. There is a large lounge and one dining room and an additional smaller lounge area, to provide a quieter area for people. There is adequate toilet and bathing provision, with suitable adaptations and equipment provided. There is access to a garden/patio area with seating provided. Nurse cover is provided at all times by Registered Nurses (Learning Disabilities) and there is a team of care and domestic services support staff. The charges made for a room at Amberley House are currently £1181.00 a week. Written information about the home, in the form of a service user guide, and a copy of the Commission for Social Care Inspection (CSCI) latest inspection report are available from the home. Amberley Nursing Home DS0000002035.V371407.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 1 star. This means that the people who use this service experience adequate quality outcomes. This was an unannounced key inspection carried out by Janis Robinson regulation inspector. A site visit took place between the hours of 9.30 am and 4:30 pm on the 11th of September 2008. The manager, Mary Woulfe, was present for the majority of the site visit. Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Questionnaires, regarding the quality of the care and support provided, were given to people living in the home, and care staff. The Commission for Social Care Inspection (CSCI) received four questionnaires from staff. Comments from these have been included in this report. On the day of the site visit staff were observed interacting with people that live in the home. Opportunity was taken to make a partial tour of the premises, inspect a sample of care records and records relating to the running of the home. Five staff and two people living at the home were spoken with. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last inspection in September 2007. The progress made has been reported on under the relevant standard in this report. What the service does well: Communication difficulties meant that some people living in the home were unable to answer questions fully. However, staff interactions with people living at the home were caring and respectful. The two people spoken with said; Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 6 “Staff take care of me” “It’s good” Care plans were in place for all people living at the home. They set out personal, social and health care needs and recorded the staff action required to make sure all identified needs were met. People’s health care was monitored and access to health specialists was available. People said that they had a choice of food and that the food served was “fine”. There was a complaints procedure and adult protection procedure in place, to promote peoples safety. People said that they felt safe living at the home. Some training took place, to equip staff with the essential skills needed to carry out their duties. Systems were checked and serviced to maintain a safe environment. What has improved since the last inspection? What they could do better: Care plans and risk assessments must be reviewed more frequently to make sure they were up to date, and relevant information was available to meet people’s needs. Daily records should include more information so that staff were aware of peoples current state of health and well-being. Medication systems must be improved to reduce risk. Written instructions on the drugs held and Medication Administration Records must correspond so that Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 7 safe systems were in place. A system to monitor and check this information should be introduced so that medication is safely monitored. The activity rota on display should be accurate so that people are given correct information. Damaged decoration in some bedrooms and corridors must be repaired to maintain a pleasant living space. Staff supervisions should take place at least six times each year so that appropriate levels of support are in place. The manager must register with the CSCI and undertake a relevant qualification, to make sure she has the skills to carry out her role. The results of surveys should be published so that they are available to people. Staff must be provided with all aspects of mandatory training so that they have the essential skills needed to keep people safe. Hazardous substances must be securely stored at all times to keep people safe. A system to monitor staff attending fire drills should be introduced to make sure all staff participate at appropriate frequencies. Information to show appropriate Criminal Records Bureau (CRB) checks have been undertaken must be available to evidence safe procedures have been followed. 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 Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 (Older People) Standards 1 and 2 (Adults 18-65) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home was not accessible to all people in order that they could make an informed choice about the service. Pre admission assessments made sure peoples needs could be met before they decided to move in. EVIDENCE: Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 10 The manager stated that work had commenced to improve the service user guide so that it contained all relevant information and was in a format that would be more easily understood by people who may wish to live at the home. The manager confirmed that people’s needs were assessed before they moved into the home; to make sure these could be met. She said that she visited people to gather relevant information. Relatives were always involved in the assessment as often people that may be moving into the home had communication difficulties. People could also choose to spend the day at Amberley, meeting staff and other people living there, having a meal and seeing the accommodation. This visit would form part of the assessment so that full information was obtained. The manager confirmed that people could visit the home as often as needed before choosing to move in. Pre admission assessments were seen in the three care plans checked. These had been fully completed and contained enough information to write a plan of care. Copies of social workers assessments were obtained where available so that all relevant information was provided. Copies of these were seen in the three care plans checked. Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 (Older People). Standards 6,9,16,18,19 and 20 (Adults 18-65) People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual care plans ensured that peoples health needs were well met. However, deficits in medication practices did not protect people. EVIDENCE: Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 12 Three care plans were checked. These contained information on all aspects of personal, social and health care needs. The plans included information on the staff action required to ensure assessed needs were met. The staff spoken with were aware of the contents of care plans and were knowledgeable about peoples individual needs. In their questionnaires, when asked if they are given up to date information about the needs of the people they support, 2 staff said “Always” and 2 staff said “Usually”. The care plans identified that a range of health professionals visited the home to assist in maintaining peoples health. Records showed that GP’s, dentists, opticians and chiropodists visited the home as requested. The care plans had not been updated on a monthly basis so that they always contained up to date information. The plans contained risk assessments so that people were safe and all risks were minimised. However, some had not been reviewed for over a year and potentially held out of date information. One risk assessment seen contained information that conflicted with the care plan. Care staff wrote daily records in care plans. These recorded very brief information, which did not fully reflect peoples well being or events of the day so that staff were fully informed. People said; “Staff are Nice” “They look after me” Medicines were securely stored in a locked trolley within a locked storeroom. The manager confirmed that a pharmacist audited medication systems alongside internal monitoring to keep people safe. Nurses administered medications. The morning medication administration was observed; staff administered safely and observed people whilst they took their medication. Medication administration records (MAR) sheets were checked, and were fully completed. Whilst no controlled drugs (CD) were kept at the home, appropriate CD storage was in place should this be required. Some procedures within the home did not fully protect people. Information on hand written MAR did not always correspond with the drugs held. Of the sample MAR checked, one recorded that medication had been given at 10pm, whilst the drug label stated administer at 8pm. A further record stated given at 9.30 pm, whilst the drug label said 6pm. Two drugs were recorded on MAR under different names to those on the drug containers. It is important that MAR sheets record precisely the drug to be administered and instruction labels contain the correct times of administration. These systems should be routinely checked as part of Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 13 the homes monitoring so that safe and full procedures that protect people are in operation. Staff spoken to were aware of the need to treat people with dignity and respect and were observed interacting in a friendly and pleasant way, and knocking on peoples doors before entering. Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 (Older People). Standards 12,13,15 and 17 (Adults 18-65) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples preferred lifestyles were respected so that they had choice. A wholesome and appealing diet, in pleasant surroundings, was provided so that people could enjoy meals. EVIDENCE: Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 15 The staff spoken with said that an activities coordinator organised all the activities. These included shopping, arts and crafts, theatre trips, baking and meals out. People were provided with holidays. Trips to Butlins and other seaside towns had taken place. Staff said that events had been organised for the next few months, such as pantomimes, birthday parties, a bonfire night party and a remembrance festival. The AQAA stated that an additional activity worker had been employed so that more choice could be offered to people. One person spoken with said they had been on holiday with staff and really enjoyed it. The activities timetable on display was not up to date and did not give people correct information about what choices were on offer. The two people spoken with confirmed that they could go to bed and get up when they chose to do so. Staff confirmed that there was an open visiting policy, relatives and friends could visit the home at any time. The AQAA stated that a recent relatives coffee morning had been very successful and well attended. People said the food was “Good”. The cook on duty explained that choices were always offered and snacks and drinks were always available. The kitchen was clean and well ordered. There were plentiful supplies of fresh fruit and vegetables for people to enjoy. Part of the mid day meal was observed. Staff were sitting with people and offering assistance in a quiet and dignified manner. The meal was not rushed so that people could enjoy this social opportunity. The cook stated that a fly screen to the outside door would enable her to have a more comfortable working environment. Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 (Older People) Standards 22 and 23 (Adults 18-65) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints and protection procedures made sure people were protected and felt listened to. EVIDENCE: The home had a complaints procedure, which was provided to people in a format that was easy to understand. This contained details of who to speak to at the home and who to contact outside of the home to make a complaint should people wish to do so. No complaints had been received since the last inspection. Staff spoken to were clear how to respond to and record any complaints received. An adult protection procedure was in place; this was seen to include local multi-agency and whistle blowing procedures so that full information was available. Staff had undertaken formal training on adult protection, which had Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 17 equipped them with the skills needed to respond appropriately to any allegations. People spoken to said that they felt safe living at the home. Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 and 26 (Older People) Standards 24 and 30 (Adults 18-25) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided a well-maintained and comfortable place for people to live. EVIDENCE: Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 19 A partial tour of the environment was made. Accommodation was provided on the ground floor, which included lounges, a dining room and bedrooms. A small secure garden was provided for people to enjoy, the AQAA stated that this had been updated since the last inspection. Staff said that people living at the home had decided on ornaments and planting so that they were involved in improving the environment. All of the bedrooms seen were well personalised with peoples own belongings so that they had some control over their personal space. Since the last inspection all beds had been replaced with new ‘Profile’ beds that better met peoples needs. Areas of the home had been redecorated to maintain standards. The majority of the accommodation was well decorated and well maintained, which created a homely and pleasant place to live. Some bedrooms and corridor areas had damaged paintwork. The inspector acknowledges that these areas had been identified in the maintenance plan for redecoration. All of the people asked said that they were happy with their rooms. Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Standards32, 34 and 35 (Adults 18-65) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff were provided to meet peoples needs. Staff training and recruitment procedures protected people. EVIDENCE: Staff rotas showed that there was sufficient staff employed to meet the needs of people. Staff said that there were usually enough staff on duty to meet peoples needs. Rotas showed that agency staff were used to cover current Nurse Assistant vacancies. Staff confirmed that all of the agency staff used knew people well and were aware of their needs. The inspector spoke with two relief staff, they confirmed that they had been providing cover for some time, Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 21 at regular intervals and knew all of the people that lived at the home well. Whilst Nurse Assistant vacancies had created gaps in permanent staff on the rota, it is acknowledged that some vacancies have recently been recruited to, and further recruitment is taking place. Staff said they worked well together as a team and enjoyed working at the home. Three of the four staff that returned questionnaires said that they had been given enough training that was relevant to their role, helped them understand peoples needs and kept them up to date with new ways of working. The training records seen showed that new staff were provided with induction training to equip them with necessary skills to do their job. A programme of National Vocational Qualifications (NVQ) was available to staff. Of the 19 care staff, 5 had achieved NVQ level 2 in care, and a further 3 staff were working towards this qualification. Three records of employment were checked. These included some of the required information, and included interview assessment, verification of identity, references, certificates of training, and application forms that recorded employment history. Whilst the manager confirmed that all staff had undertaken a Criminal Records Bureau (CRB) check, the records to confirm this had not been kept up to date. The existing records did not contain evidence to verify that checks had been done at an enhanced level. It is important that this information is kept up to date and made available so that safe procedures are adhered to. Whilst application forms recorded previous employment, some did not contain full dates. Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 (Older People) Standards 37, 39 and 42 (Adults 18-65) People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 23 People benefited from the appointment of a permanent manager. People were safeguarded by the financial procedures in operation. The health and safety systems, in the main, ensured people were kept safe. Gaps in staff training did not promote peoples welfare. EVIDENCE: Since the last inspection a permanent manager had been recruited. Whilst she had been in post for some months an application to register as manager with the CSCI had not been undertaken. The manager confirmed that she had still to undertake a qualification relevant to her management role so that she had the skills required to undertake her duties. The manager evidenced that she had acted on requirements made at the last inspection and had prioritised these. A quality assurance system was in operation. Surveys were given to people living at the home annually, to obtain their views. However, the results of these surveys needed to be published and made available to interested parties so that appropriate information was provided to them. The home handled money on behalf of some people. Three peoples financial records were checked. People received interest on their accounts. Spending money was available to people should they need it. The amounts kept tallied with the records and receipts were kept of each transaction to protect people. Formal staff supervision, to develop, inform and support staff had commenced since the last inspection. Whilst this improvement is acknowledged, staff were not receiving supervision at the recommended frequency to ensure they were fully supported. Staff meetings took place for staff development. Fire records seen and a tour of the environment evidenced that equipment at the home was serviced and maintained. Fire alarm checks took place each week to make sure they were in working order. Fire records showed that staff participated in fire drills so that they knew how to respond in an emergency. However, there was no system in place to make sure all members of staff participated in drills. Training records seen showed that whilst there had been an improvement in the provision of mandatory training, some staff had not undertaken moving and handling or food hygiene training at relevant intervals to maintain their skills and keep people safe. The training matrix to monitor this had not been kept up to date. Whilst the majority of the building appeared safe and well maintained, a cupboard containing hazardous substances was found unlocked, posing a risk. This was made safe immediately. Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 24 Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 25 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 2 X 3 3 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 3 36 2 37 X 38 2 Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 26 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 OP1 YA1 Regulation 5 Requirement The Statement of Purpose and Service User Guide must contain all of the required information so that this is available to people. (Previous timescale of 6/11/07 not met) Care plans must be regularly reviewed so that they contain up to date information. Risk assessments must be regularly reviewed so that they contain up to date information. Safe procedures for recording and administration of medication must be in operation to protect people. Drug labels and MAR must have corresponding information. Handwritten MAR must accurately record the name of the drug, as recorded on the label. The manger must register with the CSCI. Timescale for action 01/12/08 2 OP7 YA6 15 01/12/08 3 OP9 YA20 13 01/11/08 4 OP31 YA37 8 01/11/08 Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 27 5 6 OP31 YA37 OP33 YA39 9 24 7 8 OP38 YA42 OP38 YA42 13 18 The manager must undertake a relevant qualification to enhance and update her skills. The results of all surveys must be published and made available to people who use the service or are interested in the service. Hazardous substances must be securely stored at all times. All staff must be provided with moving and handling and food hygiene training, to keep people safe. (Previous timescale of 28/02/08 not met) 01/12/08 31/01/09 01/11/08 01/01/09 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 4 5 6 Refer to Standard OP1 YA1 OP12 YA12 OP15 YA17 OP28 YA32 OP29 YA34 OP29 YA34 Good Practice Recommendations A copy of the Service User Guide should be available in appropriate formats so that people can understand it. The activities timetable on display should contain accurate information so that people know what is on offer. Consideration should be given to providing a fly screen to the external kitchen door to benefit the cooks working environment. 50 of the staff team should be trained to NVQ level 2 in care to benefit people living at the home. Full dates of previous employment should be obtained so that any gaps can be identified. Records to evidence CRB disclosures have been carried out should be kept up to date so that this can be monitored. The records should state that an ENHANCED disclosure has been undertaken to evidence full procedures have been followed. Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 28 7 8 OP36 OP38 YA42 Staff should receive supervision at least 6 times a year. A system should be put in place to monitor fire drills so that all staff participate at regular intervals. Amberley Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AP 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 Nursing Home DS0000002035.V371407.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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