Inspection on 07/11/06 for Amberley Nursing Home

This inspection was carried out on 7th November 2006.

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

The inspector 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 11/09/08

Amberley Nursing Home 11/09/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Amberley Nursing Home Off Cedar Close Eckington Sheffield Derbyshire S21 4BA Lead Inspector Marie Bonynge Unannounced Inspection 7th November 2006 10:30 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 Nursing Home DS0000002035.V318939.R02.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 Nursing Home DS0000002035.V318939.R02.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 Mrs Angela Newall 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.V318939.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2006 Brief Description of the Service: Amberley House Nursing Home provides nursing and personal care for up to fifteen older persons with learning disabilities - aged over 65 years and for up to 5 persons with learning disabilities – aged under 65 years. The home is situated on the edge of the north-east Derbyshire boundary within the village of Eckington. It is close to shops, a post office and all local amenities and near to direct bus routes to both Chesterfield and Sheffield. The home aims to provide a holistic approach to care and to promote individuals dignity, choice and a good quality of life for service users within a friendly and homely environment. The home provides single bedroom accommodation and this is all on ground floor level. There is one large lounge/dining room. An additional lounge area has been built that provides a quieter area for residents. There is adequate toilet and bathing provision, with suitable adaptations and equipment provided. There is access to a garden/patio area with seating provided for service users. 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 Registered Manager is also a Registered Nurse Learning Disabilities. The fees for this home range from £940.00 per week. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 7th November 2006 and covered the late morning, lunch time and afternoon. During this time the Inspector spoke with residents, the registered manager, and staff. Many of the home’s residents have communication difficulties, the Inspector therefore observed the daily routines and the quality of the interaction between staff and residents as part of this visit. Other inspection methods used included the examination of the care records of 3 residents selected as part of case tracking, the medication systems in place and staff training records. A brief tour of the building also took place to assess the general cleanliness and hygiene of the home. Out of 10 CSCI resident surveys sent out 7 completed surveys were received the findings of which have been included in the main body of the report. 4 requirements were made at the last inspection visit in January 2006, 3 of which have been met and the timescale has been extended for the remainder to take account of the relevant training having been arranged but not completed. What the service does well: What has improved since the last inspection? The main lounge areas and toilet areas adjacent to the lounge have been painted and the plasterwork made good. NVQ training has been promoted and an internal NVQ assessor is to be appointed to further improve this area. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 6 A quality audit of all aspects of the service has begun. 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. The summary of this inspection report can be made available in other formats on request. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 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 Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessment processes contribute to ensuring that residents needs are understood, recorded and met. EVIDENCE: Senior staff at Amberley House, (usually the manager) undertakes assessments of residents prior to their admission to the home. A pen picture of each person is completed to capture personal information about them that helps to inform staff of the specific needs of individuals. Some examples are a record of the persons likes and dislikes, their social and family history and preferred daily routines. Information is also gathered from relevant health care and social services professionals that assists in ensuring that residents’ health and personal care needs can be met. Staff say that they use the care plans as an everyday working document to assist in the delivery of care. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes care planning system assists in ensuring that residents assessed needs are met, although a lack of regular reviews could pose a potential risk to some residents. The privacy and dignity of residents is respected and promoted by staff who are person centred in their approach. EVIDENCE: In 7 completed CSCI resident surveys all 7 respondents replied that they thought that staff treated them well and all the respondents said that the carers listened and acted on what they said. One resident commented that staff are very person centred and make sure we are respected and treated as individuals’. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 10 This home uses a person centred approach to care planning that details how the person prefers their care to be delivered. Nutritional and skin integrity assessments are completed that indicate when a resident may be at risk. These have not always been reviewed on a regular monthly basis in accordance with good practice and reccommended guidelines. This could result in a potential risk to residents, especially when residents may be frail and their health may be compromised. The manager is aware of the need to complete an audit of the care plans to establish where shortfalls lie. A requirement is made in respect of this. Falls are being monitored and appropriate action is taken where a risk is identified, however a falls risk assessment is not in operation. Again the senior nurses have identified this gap and are in the process of introducing a falls prevention programme. A recommendation is made in respect of this. Health care needs are well met with access provided for specialist health care screening, dentistry, chiropody and the optician. Changes are being made to the way in which staff work via the implementation of key workers and a named nurse system. This is said to be effective in improving the quality of care provided, an evaluation of this is in progress. Observations of the way in which staff interact with residents indicats that staff are polite and patient in their attitudes and know the needs of individuals well. Assessments are noted to take into the ability of the resident to access care records. Medication systems are generally in good order. Qualified nursing staff are employed on a 24 hour basis and they are responsible for the administration of medication. There are procedures for the recording of the receipt, administration and returns of medicines. A controlled drugs book is in use and all entries are signed by 2 members of staff. A drugs fridge is provided for cold storage, however the maximum and minimum temperatures are not being monitored, the digital thermometer isnot working and requires renewal or repair. This could result in the incorrect cold storage of some medicines. A recommendation is made in respect of this. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of recreational opportunities are provided and family contacts are in place to ensure that the preferences of residents are met. EVIDENCE: Of 7 completed resident surveys, 5 respondents say that they can do what they want to do during the day, in the evening and at the weekend. 1 respondent commented that they were restricted by their particular health needs and one respondent felt that they could not always do what they wanted because of varying staffing levels or the needs of other residents. Staff do their best to accommodate the needs of individuals and acknowledge that people want to do different things. Activities and outings are also organised as a group, these are generally planned and include day trips to the sea side or shopping trips. Recreation within the home takes place such as art and craft, knitting, watching films and board games. The cultural and religious needs of residents are identified and met for example with a resident being supported to attend a faith and light group each month. One to one support Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 12 is provided for attendance at appointments. (See standard 27 for comments regarding staffing levels). Family and friends are encouraged to visit and to take an active part in care reviews and in the life of the home. Residents have been enabled to visit relatives who cannot get to the home The meals are appetising and are said to be good. The kitchen is well stocked with fresh produce. Staff observed at the lunch time meal give discreet assistance individually to those residents who need help, Meals are generally taken in the communal dining area that is pleasantly decorated. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. The policies and procedures regarding protection of residents serve to assist in safeguarding those who live in the home, however this may be compromised where there are gaps in safeguarding adults training. EVIDENCE: A complaints procedure is in place with a system for recording minor complaints or suggestions. A pictorial complaints leaflet is available and has been given to each resident. In completed comment surveys 2 residents say that they do not know how to make a complaint but do know who to speak to if they are not happy. It is reccommended that the way in which the complaints procedure is explained to residents is reviewed. Formal care reviews are held at least every 6 months where concerns and complaints are raised as part of this process. 5 residents said that they did know how to make a complaint. No complaints have been received by the home or by the CSCI since the last inspection visit. A policy and procedure is in place regarding the safeguarding of adults and staff access training regarding awareness of abuse and what to do if they have concerns regarding the welfare of a resident. The manager has a place booked to attend Derbyshires training regarding safeguarding adults, a requirement has previously been made in this area and the timescale has been extended to Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 14 take account of the training arranged. It is noted that it has been some years since many of the staff have received updates in training in the area of safeguarding adults and it is reccommended that staff have regular refresher sessions. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Amberley House provides a clean, comfortable and homely environment that residents say they like. EVIDENCE: Amberley house is generally well decorated and maintained with comfortable furnishings that are domestic in style. The bedrooms are tastefully decorated with input from residents where possible. The furniture is arranged in accordance with the needs of each person to accommodate any special equipment such as beds and wheelchairs. Bedrooms contain personal effects of the resident such as photographs and ornaments. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 16 There is a summer house to the rear of the building that residents use in good weather, this provides somewhere to sit that is sheltered and is in pleasant surroundings. Pre inspection information indicates that there are systems in place for the control of Legionella and infection control. The areas of the home viewed on this visit included the communal areas of the lounge, dining room and conservatory. Both requirements made at the last inspection regarding painting of the lounge and toilet areas have been met. The home is generally clean and hygienic and free from offensive odours. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels meet the assessed care needs of residents but this could be compromised where additional pressures are put on the service. The management and staff are committed to providing good care for residents, however the training programme does not underpin this. EVIDENCE: There are 14 residents accommodated with 6 residents who have high dependency needs, 6 residents who have medium dependency needs and 2 residents with low dependency needs. Some residents have complex and specialist needs such as dementia and challenging behaviour. This can put additional demands on staff at busy times of the day such as during meals and taking residents out on activities. Staff commented that they would like to be able to do more individual, ad hoc activities with residents and some residents commented that staffing levels sometimes restricted them in doing what they wanted to do especially at weekends because of the level of support that they needed. There are a number of staff vacancies, some of which have been recruited to but are waiting for all the necessary pre employment checks to be made before Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 18 they can start work. Residents feel that they are well cared for, however the addition of staff at busy times of the day would benefit residents in terms of quality of life. A requirement is made in respect of this standard. There are policies and procedures in place for the recruitment and employment of staff that are largely adhered to. Criminal record bureau checks and POVA checks are completed prior to staff commencing their work and 2 written references are sought. Not all records required by regulation are kept on the staff files such as proof of the persons identity, including a recent photograph. A requirement is made in respect of this standard. A comprehensive staff training programme is in place and staff say that this is good. Updates in training do not always take place and there are gaps in the records of some staff, these include key areas such as moving and handling. This could place residents at potential risk if staff are not up to date. A requirement is made in respect of this standard. Individual training profiles are in place and a commitment has been made for the achievement of NVQ although the minimum ratio of 50 has not yet been achieved. The appointment of an internal NVQ assessor should assist in this. A recommendation is made in respect of this standard. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 19 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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This home is run with the interests of residents being central to the ethos of staff. Where shortfalls are identified an action plan is developed to identifiy the steps needed to address these issues. EVIDENCE: The registered manager who is a qualified nurse has been in post for some years and is experienced in the care of people with a learning disabilty. A deputy manager is now appointed and this assists in many aspects of the service having been reviewed and audited for quality. This highlights many of the areas that are identified in this report as needing development and an action plan is being drawn up to address these. Until the action plan is put into Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 20 effect there remain some deficits in the areas of training (particularly safeguarding adults and moving and handling) and staffing deployment. A quality assurance process is established that seeks to take into account the views of residents and their representatives and to give feedback on the results. Systems are in place for the handling of residents personal monies. A requirement has been in made in standard 30 regarding staff attending updates in all areas of mandatory training. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 21 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 2 8 3 9 3 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 22 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. 1. Standard OP7 Regulation 12 1 a 15 2b Requirement The residents’ care plan must be kept under review in accordance with the recommended guidance - specifically risk assessments relating to nutrition, falls and skin integrity. The manager must attend relevant local interagency training in the protection of vulnerable adults. Previous timescale 30/04/06. Staffing numbers must be reviewed to take account of busy times of the day and the provision of activities especially at the weekend. All of the required records must be kept in respect of persons working at the care home including proof of the person’s identity – a recent photograph. Staff must attend updates in training in all of the mandatory areas particularly moving and handling and safeguarding adults. Timescale for action 01/01/07 2. OP18 13 6 18 1 i 01/03/07 3. OP27 18 1 a 01/02/07 4. OP29 Sch 2 19 1 01/01/07 5. OP30 18 1 c i 01/03/07 Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 23 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. Refer to Standard OP7 OP9 OP18 OP28 Good Practice Recommendations A falls risk assessment and falls prevention programme should be implemented. The maximum and minimum temperatures of the drugs fridge should be recorded daily and lie within the recommended range. All staff should receive regular updates in safeguarding adults training. A minimum ratio of 50 trained members of care staff NVQ level 2 should be achieved. Amberley Nursing Home DS0000002035.V318939.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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.V318939.R02.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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