Inspection on 14/11/06 for Amberwood Nursing Home

This inspection was carried out on 14th November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Amberwood Nursing Home 22/08/08

Amberwood Nursing Home 20/08/07

Amberwood Nursing Home 09/05/06

Amberwood Nursing Home 19/01/06

Amberwood Nursing Home 25/07/05

Amberwood Nursing Home 25/01/05

Amberwood Nursing Home 06/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Amberwood Nursing Home 231 Exeter Road Exmouth Devon EX8 3ED Lead Inspector Michelle Oliver Key Unannounced Inspection 14th November 2006 08:45 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 Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amberwood Nursing Home Address 231 Exeter Road Exmouth Devon EX8 3ED 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) 01395 263540 01395 263540 amberwood@btconnect.com Alextour Limited Mr Robert Henry Gunn Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 13 May 1997 Date of last inspection 9th May 2006 Brief Description of the Service: Amberwood is a detached house standing in well-tended gardens situated on the main road to Exmouth and is on a main bus route. It provides care and accommodation for 24 older people with nursing needs. The home has level access to the front of the house and from the lounge and dining room into the garden at the rear of the building. Amberwood provides a family style of care home, and has a friendly and homely atmosphere. The home’s statement of purpose and service user guide, which includes details about the philosophy of the home and details about living at the home, is available on request as is the home’s most recent inspection report. Information received from the home indicates that the current fees range from £575-£627 depending on the size of room and the level of care needed. Services not included in this fee are chiropody, hairdressing and incontinence pads. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Tuesday 14th November 2006 over a period of 9 hours. One of the company directors and the deputy matron were present throughout the inspection. During the inspection plans of care for residents were looked at in detail. This helps the Commission to understand the experiences of people using the service. A number of other residents were met and spoken with during the course of the day. The inspector also spent a considerable time observing the care and attention given to residents by staff. Several staff were spoken with during the day, including care staff, nursing staff the manager and a visiting relative. Prior to the inspection 19 surveys were sent to residents to obtain their views of the service provided; 6 were returned. Comments were in the main positive. Twenty staff were sent surveys in order to hear their confidential views; 2 were returned. Thirty three health and social care professionals were also contacted prior to the inspection, responses were received from 19. Response from 4 relatives were generally positive apart from some comments relating to staffing levels. The inspector toured the premises and a sample number of records were inspected including care plans, medication records, staff recruitment files, fire safety records and a record of accidents. The outcome of the inspection was discussed with one of the Company Directors who is keen to work towards the improvements necessary to ensure that all residents receive the care they need. What the service does well: Residents’ health care needs are met by the home working closely with other health and social care professionals. Relatives said that they feel welcome at any time and that the home had a “friendly” and “homely” atmosphere. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 6 Residents and relatives felt that staff do a good job, comments included, “My grateful thanks to Amberwood and everything they do” and “Amberwood is a very good nursing home”. Residents able to communicate said that staff listen and act on what they say. The environment is good; the home is kept extremely clean, well maintained and furnished with quality fittings. Although there is a good provision of essential equipment it is a homely and comfortable environment. Hygiene and the prevention of cross infection are well managed. Residents praised the quality and variety of the meals served at the home. What has improved since the last inspection? What they could do better: Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 7 Before residents are admitted to the home an assessment of their health and social care needs must be undertaken. Residents or their representatives must be included in the initial drawing up of their care plans and in the regular review of their needs. The homes policy and procedure for staff recruitment must be improved to safeguard residents living at the home. Recruitment procedures and selection process for any volunteers involved in the home must be thorough and includes police checks. Risk assessments must be carried out for all safe working practice topics and significant findings of the risk assessments must be recorded. The home must ensure that procedures are in place to ensure that medication administration protects all residents inasmuch as changes in instructions for medication should be clearly and safely recorded. 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. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3 &6 Quality in this outcome are adequate. This judgement has been made using available evidence including a visit to this service. Improvement continues to be required to ensure that assessments are completed, to accurately reflect service users’ needs, before a resident decides to live at the home. EVIDENCE: It is considered essential that an assessment of health and social care needs is undertaken before a person is admitted to a care home to ensure that their individual health and social care needs can be met by the home. The deputy matron said that she, or the manager, visit potential residents before they decide to live at the home to introduce themselves, give details about the home and undertake an assessment of individual health and social needs. Three residents care plans were looked at during this inspection; one included a pre admission assessment that identified care needs in sufficient detail on which a plan of care could be written. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 10 It was suggested by the deputy matron that no records of needs assessments were available for one person who was originally admitted to the home for a few days respite, and no assessment was considered necessary. The Inspector was told a resident admitted from another home had been visited by the manager, and the deputy, before their admission but no details of an assessment had been recorded. One of the residents confirmed that no assessment of their needs had been undertaken before they moved to the home. Letters confirming that the home could meet the residents’ needs were seen in their files. A relative responding to a questionnaire stated “we were dealt with very professionally by the care staff and matron” before choosing Amberwood for their loved one. The home does not admit residents for intermediate care. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8, 9 &10. Quality in this outcome are adequate. This judgement has been made using available evidence including a visit to this service. There has been improvement to the care planning process and further development of these plans will ensure that all residents’ health and personal care needs continue to be met. Residents’ health care needs are generally well met by good monitoring and close working with other professionals. There are some good systems for managing medication, but attention is required in three area which could compromise residents’ safety. Residents are treated with respect and their dignity and privacy is maintained. EVIDENCE: Six residents responding to the CSCI survey said that they “always” receive the care and medical support they need; three resident felt that they “usually” Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 12 received the support they required. Most residents were unable to comment on the care they received due to communication difficulties. Three relatives were satisfied with the overall care provided and one said that they would like their relative “to be up from bed more often”. One wrote “the staff at Amberwood are marvellous and really work hard”. A visitor told the inspector that they were happy with the progress and improvement achieved for their relative. The care planning records and risk assessments of three residents were looked at. Social histories including some information about residents’ past lives and occupations are documented in some residents’ care records, which gives a sense of who this person is. Information relating to residents’ previous interests or activities enjoyed by them before moving to the home should be included in their plans of care. This is to ensure that they can be encouraged and supported to continue them if they wish. Care plans outlined residents’ general care needs, such as personal care but did not always provide enough detail about communication needs and certain behaviour. For example a resident was described as “aggressive” but no details of strategies for managing any aggression were recorded. One resident, whose file was looked at in detail, has bed rails attached to their bed to prevent them falling. Bed rails are an effective means of preventing falls and of reassuring residents who may have either fallen, or are concerned that they may fall, from their bed. However, bed rails can present a risk to some residents, for example some may try to climb over the rails and if not fitted correctly it may be possible for limbs to become caught between the rails or between the rails and the bed. An assessment of risks presented by their use must be undertaken to ensure that unnecessary risks to the health or safety of residents are identified as far as possible eliminated. Although the home has developed a risk assessment tool no assessment of the risks presented by the rails had been undertaken which potentially puts residents at risk of injury. Plans of care should be reviewed regularly to ensure that all information is current, any changes have been recorded and information relating to planned care is comprehensive and easily available to staff. This is to ensure that residents care needs are met and that care is individualised. Not all residents spoken to were aware they had individual plans of care and those who were aware could not recall being involved in their reviews. The provider discussed this and was very positive about plans to involve residents if they choose to. Details need to be recorded so that they can be monitored and to ensure all staff are aware of changes. This will further ensure that individual, person centred care is a priority at the home. Since the last inspection a registered nurse has been allocated time to review care plans and the provider said Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 13 residents and relatives will be involved as a result of positive discussion which took place during this visit. Despite these shortfalls staff are to be commended for the improvement in the care planning process since the last inspection. The provider and deputy matron are aware of the need to continue the improvement of care plans and positive discussion about recording information in such a way that all staff are able to understand, contribute to and refer to were discussed at the time of this inspection. Administrative assistance and some registered nurse time, have been increased to ensure that documents are kept up to date. Information received before the inspection indicated that residents have access to healthcare services that meet their needs including chiropody, opticians, dentists and specialist services such as dietician, diabetic and skin care specialist nurses. This was confirmed by residents and recorded in plans of care. Comments made in questionnaires returned from health care professionals were generally positive. Since the last inspection a member of staff, who has a particular interest in skin care, has become the home’s link nurse and works closely with nurse specialists and attends specific training related to this area of care. The management of medication was looked at; trained nurses administer all medicines. Appropriate records had been kept for controlled drugs, and stock held correlated with totals recorded. Unused or unwanted medicines are disposed of correctly. No clear guidance was available for the use of medicines to be given “as needed”. For example one resident had been prescribed medication to be given if they “did not settle”. No details relating to the residents normal night routine or any patterns of sleep were recorded to inform staff of what “not settle” actually meant. This instruction, without a care plan, leaves a lot to individual staff interpretation and could result in inconsistent care being given. Details of instructions from a doctor, reducing the dosage and frequency of a medication, were recorded in a residents’ plan of care. However, the changes had not been recorded on the medication administration record. This record is the document referred to by staff when medication is given to residents. It informs staff of the name of the medication, its dosage, frequency and how it is to be given. This is to ensure that residents are kept safe and are protected from receiving the wrong medication. This omission of recording correct up to date instructions could put the resident at risk of being given medication not as prescribed by a doctor. The deputy matron said that staff knew of the changes and none had been given to the resident. Details recorded in a residents plan of care indicated that when they moved to the home they chose to look after their own medicines. However, there was no Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 14 evidence of an assessment of the residents understanding or ability to manage the medication being undertaken by staff to promote the residents’ safety. When spoken to the resident said they had looked after their own medicine when they first moved into the home but did not currently because they were told there were no lockable facilities in their room. This was discussed with the director and deputy matron who both agreed that lockable facilities would be provided for residents who chose to look after their own medicines. Staff spoken to during this visit were aware of the home’s guidance on respecting residents privacy and dignity Privacy and dignity issues were managed extremely well, for example good consideration had been given to ensuring that important family relationships were maintained. Some staff, including the manager, are very competent when relating to residents and some positive interactions were seen. Some staff skilfully communicated with residents when delivery care and addressed them by their preferred name. One resident was referred to by her Christian name when it was clearly recorded in her care plan that they wished to be referred to by their title. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12, 13, 14 & 15. Quality in this outcome are good. This judgement has been made using available evidence including a visit to this service. Social care, including activities, could be improved with meaningful care planning to ensure that residents’ individual preferences, potential and diverse needs are met. Residents benefit from the good relationships the home has developed with their relatives and representatives. A balanced diet is provided, meals are wholesome and nutritious, taking account of the likes and dislikes of individuals. EVIDENCE: One of the six residents responding to questionnaires said there were always activities arranged by the home that they could take part in, three said usually one sometimes and one never. Reasons for some of the responses included “because of disabilities unable to do activities”, “ I prefer my own company, I receive library books and read a lot” and “ due to my age I am limited in what I can do”. A response from a relative included “ I feel that sometimes, due to Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 16 staff shortages, patients are left in their rooms for too long on their own. People in their position sometimes need more stimulation and to have other people around them not just left with a television set. I do not blame the hardworking staff who are most concerned for their patients. Various activities are laid on which I feel are extremely beneficial”. Group and individual activities are organised and on the day of the inspection several residents were enjoying exercising to music in the lounge. Carers engaged several residents in the lounge with music and general chat throughout the day. Information received before this visit indicated that activities provided at the home include music and movement, sing-along, donkey visits, TV, DVD, CD, theatre group visits, books, magazines, radio, clothes shows, large print books, library, stroke club, focus club, dance club and individual shopping trips. Residents’ hobbies and interests had been briefly explored but little detail of how to meet residents’ social needs was described in care plans. For example in one care plan it stated that the resident had been a librarian but no other information regarding what the resident would like to do or be involved in. When spoken to the resident said they were often bored. Details in their care plans indicated that they did take part in art classes and exercises. During the inspection this resident spent varying periods of time unoccupied apart from when receiving care. The home has established good relationships with relatives and visitors to the home. There is no restriction on visiting times and throughout the day visitors came to the home and were made to feel welcome. Staff greeted them in a kind, friendly manner and visitors confirmed that this was always the case. Residents may choose where they want to spend time with their visitors, either in the privacy of their rooms, the quiet dining room or in the lounge. A relative stated “the matron and all the staff are very kind and treat visitors in the same way.” Residents’ preferences regarding daily routines and choices were not consistently recorded to identify what time people like to get up or go to bed or how and where they spend their day. During observation it was evident that all staff support residents to make choices. Although some residents were seen to move freely around the home, choosing where to sit and who to speak with, others who were totally dependant sat in their “usual” chairs according to staff. Staff said there were no routines in the home, time spent with a resident depended on their wishes and tended to be more person focused than task orientated. A variable, nutritious diet is provided at the home. This was confirmed by residents who said that they “thoroughly enjoy the food” and from the meal on the day of the visit. A menu is displayed close to the lounge to enable residents to know what will be served that day. The inspector was present Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 17 when lunch was served; the meal was well presented and nutritious. Staff were seen supporting residents, needing assistance with eating, sensitively and discreetly. Comments made by residents included “More than enough food and variety” Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16 &18. Quality in this outcome are good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from the home’s complaint procedure. Residents are protected from abuse by the homes’ policies and procedures. EVIDENCE: No complaints have been made to either the home or the Commission since the last inspection. All residents responding with surveys knew how to make a complaint and who to speak with if they were not happy, one wrote, “Never had to make a complaint”. Residents confirmed that they feel comfortable discussing any concerns with staff at the home although some were unable to confirm that they had seen the home’s written complaints policy. A copy of the home’s complaint procedure is included in the service user guide and statement of purpose. There was nothing to suggest that residents are anything other than well cared for at the home. Residents said that staff were very helpful, respectful and that nothing was ever too much trouble for them. Staff have undertaken Adult Protection training and were able to discuss different forms of abuse. They all said that they would not hesitate to report any suspicion of poor practice. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19 & 26. Quality in this outcome are good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a home that is very clean, fresh and where hygiene is well managed. EVIDENCE: Amberwood is well maintained, with homely and comfortable accommodation including a pleasant lounge and recently redecorated dining room. The home is extremely clean and well maintained both inside and outside of the building. The laundry facilities were well organised has equipment, which should effectively reduce the risk of cross infection. All residents were well dressed at the time of this visit and several said that their clothes are well looked after. Staff had knowledge of infection control Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 20 issues such as MRSA. There are gloves, paper towels and liquid soap around the home, to promote good basic hygiene. The home was warm and comfortable at the time of this visit. The home has an open, welcoming reception area. Décor is of a good standard, and refurbishment is on-going. On the ground floor there is a lounge and a separate dining room. All residents’ rooms visited during the inspection were well maintained. They are individualised and provide ample space for residents to bring personal possessions and items of small furniture with them when they decide to make Amberwood their home. A passenger lift ensures that all areas of the home are accessible to residents. Seven residents who responded to questionnaires stated the home was always or usually fresh and clean. The grounds and gardens are accessible and attractive and the home is maintained and upgraded to a high standard. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27, 28, 29 & 30. Quality in this outcome are adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers are generally sufficient to ensure that residents’ general care needs can be met. The home’s recruitment policy is robust but is not complied with consistently thereby potentially putting residents at risk. EVIDENCE: Residents said they were satisfied with the care they receive and that their needs are generally met. According to information received before this visit the home currently employs seven registered nurses, ten care staff and eight ancillary staff. The manager is generally on duty from 9am-5pm and aims to have the following number of staff on duty: a registered nurse on duty 24 hours a day, 4 carers between 8am-2pm, 3 carers between 2pm-8pm 1 carer between 8pm-8am. The home also employs a chef, kitchen assistant, a domestic and a maintenance person during the day. The domestic is to be commended for the standard of cleanliness achieved at the home. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 22 A relative in response to a survey commented “I am very satisfied with everything regarding Amberwood, except sometimes shortage of staff”. A resident commented “Usually staff available when needed” and “they are very busy and very short staffed owing to recent resignations”. The director and deputy matron were happy with the current staffing levels and said the team were “working well together”. Residents spoken with during the inspection said that staff were “kind” and “lovely”. Three staff recruitment files were looked at during this inspection. The documentation was inconsistent. The home had not received Protection of Vulnerable Adult (POVA) checks or Criminal Record Bureau (CRB) checks for one member of staff prior to them starting work at the home. This practice potentially puts residents at risk, as only people who have undergone a robust procedure should be employed to work at their home. This was discussed with the director who responded positively to the situation and has applied for the relevant documentation since the inspection as a matter of urgency. Two staff confirmed in questionnaires that they had all undergone a thorough, robust recruitment procedure. Currently 25 of staff have achieved a nationally recognised qualification in care (NVQ 2 or above), which falls short of the expected standard. The new training programme will encourage and support staff to attain these qualifications. Training provided during the last 12 months include food hygiene, manual handling, wound management, advanced medicines, fire training and tissue viability. Staff spoken with had not received specific training in relation to dementia but expressed enthusiasm for training and felt that it would improve their skills and the general care of the residents. The director told the inspector that training for dementia is due to be undertaken. The home has a clear ‘overview’ of training, which ensures that staff training needs are identified and updated when necessary. Providing relevant training and encouraging staff to undertake the training works towards ensuring that residents are cared for by a competent team of staff which promotes person centred care and safety. Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 23 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): OP 31, 33, 35 & 38. Quality in this outcome are good. This judgement has been made using available evidence including a visit to this service. The home is generally well managed. The homes’ quality assurance measures need to be further developed to form effective means of monitoring systems and work towards maintaining and improving the quality of care provided at the home including the quality of nursing care. Residents benefit from living in a home where safety issues are generally well looked after. Attention is needed in some areas surrounding assessments of potential risks. EVIDENCE: Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 24 Residents, relatives and staff benefit from the friendly and open management at the home. A manager has been appointed to run the home and is undertaking the process of registering with the CSCI. This is to ensure that the home is run and managed by a person who is fit to be in charge, of good character and able to carry out their responsibilities fully. Administrative assistance has been increased, by employing another member of staff, and time has been increased for some staff to be involved in care planning to allow the manager more time to supervise nursing practice. A quality assurance audit has been undertaken since the last inspection to ensure that the home is run in the best interests of residents. This has been undertaken by residents and family being asked to give their opinion on certain aspects including attitudes of staff, activities, the environment and facilities provided at the home. The results have not yet been collated or made available to current and potential residents. This was discussed with the director who said that the results will be included in the home’s statement of purpose to enable residents, potential residents and other interested bodies to be aware of how the home is meeting the aims, objectives and statement of purpose. The director discussed plans to obtaining feedback which would work towards maintaining and improving nursing standards at the home. Some resident’s look after their own financial affairs; some deposit money with the home for safekeeping. It is stored securely, managed correctly with accurate records kept. The home is well maintained. Individual risks to residents are assessed and generally well managed however risk assessments are not routinely undertaken for those residents who have rails fitted to their beds to prevent them from falling and for residents who may wish to look after their own medicines. [refer to narrative in standard 8 and 9]. Records show that staff undertake training in the prevention of fire, and fire alarms and emergency lighting have been carried out regularly. The director plans to have a comprehensive review of all potential environmental hazards undertaken by a member of staff recently recruited with experience in Health and Safety. A copy of this, together with appropriate assessments of the risks presented, and strategies for reducing risk to residents, will be sent to the Commission when completed. Amberwood Nursing Home DS0000026696.V312720.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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 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 3 X X X x X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 x 3 X X 3 Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 141abc Requirement Timescale for action 15/12/06 2. OP7 152c d The registered person shall not provide accommodation to a service user at the care home unless the needs of the service user have been assessed by a suitably qualified or suitably trained person; the registered person has obtained a copy of the assessment. [This relates to assessments of residents health and social care needs not consistently undertake, or recorded before they decide to live at the home] This is the 3rd time this requirement has been made. 15/01/07 The registered person shall, where appropriate and, unless impracticable to carry out such consultations, after consultation with the service user or a representative of his, revise the service users plan and notify the service user of any such revision. [This relates to residents not being included in the planning or review of their care plans.] This is the 2nd time this requirement has been made. DS0000026696.V312720.R01.S.doc Version 5.2 Amberwood Nursing Home Page 27 3. OP8 13[4][1] The registered person shall 15/12/06 ensure that unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. (Risk assessments must identify behavioural, situational and environmental risks i.e. bed rails.) The registered person shall make arrangements for the safe 15/12/06 recording and administration of medication in the care home. [The home must have clear guidelines available for the administration of “when required” medication. MARS must be up to date and clear instructions recorded for the administration of all medication Assessments must be undertaken for residents who choose to look after their own medicines] The registered person shall not 15/12/06 employ a person to work at the care home unless he/she has obtained in respect of that person information and documents specified in paragraphs 1 to 7 of Schedule 2. (This refers to the need to ensure that CRB or POVA first checks are obtained for each new employee before they start working at the home.) 4. OP9 13[2] 5. OP29 19[1][a][ b] Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 28 6. OP31 8[1][a] The registered provider shall appoint an individual to manage the care home where there is no registered manager in respect of the care home. [the appointed manager is due to submit an application to the CSCI] 15/01/07 Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that all care plans include preferences with regards to social & personal care needs. Care plans and associated records should contain adequate detail to ensure that staff know what action to take to meet residents’ needs. The service users, following assessment to be able to self administer medication, should have a lockable space in which to store medication, to which suitable trained, designated staff may have access with the service user’s permission. Resident’s interests are recorded and they are given opportunities for stimulation through leisure and recreational activities in and outside the home, which suit their needs preferences and capacities. The home continues to work towards achieving 50 of all care staff achieving an NVQ level 2 or equivalent. The home should continue to develop effective quality assurance and quality monitoring systems, based on seeking the views of residents to measure success in meeting the home’s aims, objectives and statement of purpose. 2. OP9 3. OP12 4. 5. OP28 OP33 Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 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 Amberwood Nursing Home DS0000026696.V312720.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!