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Inspection on 19/01/06 for Amberwood Nursing Home

Also see our care home review for Amberwood Nursing Home for more information

This inspection was carried out on 19th January 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff treat residents as individuals aiming to make their lives independent and fulfilling. Residents are encouraged to exercise choice as much as possible. All residents spoken with praised the care they received from the staff and said they were very happy living at the home. One commented "They do the best they can for you". Staff are keen to ensure the well-being and comfort of the residents and were observed treating them with great respect and kindness. A resident`s relatives praised all the staff at the home saying "they always have the time to spend with the residents and show great patience. They respect the residents and go to great lengths to maintain their dignity"

What has improved since the last inspection?

No residents are admitted before an assessment has been undertaken, to ensure that their care needs can be met at the home. Two baths have been replaced by walk in showers as the original baths needed replacing and also a number of residents had said that they would like to be able to have a shower. Areas of carpet which were showing signs of wear at the last inspection have been replaced by vinyl floor covering. Some residents said that they liked this and it "makes the house feel lighter".

What the care home could do better:

Staff have not received manual handling training. The home`s policy of not using a mechanical hoist, when residents need assistance with moving in the lounge, limits their choice and compromises residents` and staff safety. The quality of recording medications when received at the home is not consistent. Some changes are needed when ordering medication for residents. Documents required to be inspected during this visit were not available. Those required related to staff training, quality assurance audits and residents personal allowances. The manager does not have access to files and the provider was not able to come to the home to make them available. The Commission has requested that the documents are brought for inspection to their office in Exeter. Some practices within the home are unsafe potentially putting residents at risk. These include wheelchairs and other equipment being stored in corridors and the temperature of water from basin hot taps being excessively hot putting residents and staff at risk of scalds.

CARE HOMES FOR OLDER PEOPLE Amberwood Nursing Home 231 Exeter Road Exmouth Devon EX8 3ED Lead Inspector Michelle Oliver Unannounced Inspection 19th January 2006 9:00 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.V268375.R01.S.doc Version 5.1 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.V268375.R01.S.doc Version 5.1 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 Mrs Mary Josephine Matthews Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 13 May 1997 The Manager must successfully complete the Registered Managers Award by December 2006. 25th July 2005 Date of last inspection 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. Nursing assistance is provided on an individual basis with the emphasis on encouraging residents to take part as much as possible according to their capabilities and choice. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Thursday 19th January 2006 over a period of 6 hours. The manager was present throughout the inspection. Four members of staff and twelve residents were observed or spoken with during the visit. Two comments cards were received from residents before this inspection. Both confirmed that they liked living at the home, felt they were well cared for, and treated well by the staff. Neither wanted to be more involved in decision making in the home and one felt that suitable activities were not provided at the home. A tour of the building was made and a number of records were inspected. This included residents’ plans of care, fire log book and risk assessments. Other files required during this inspection were not available. The owner will be asked to bring the required files to the Commission’s office. What the service does well: What has improved since the last inspection? No residents are admitted before an assessment has been undertaken, to ensure that their care needs can be met at the home. Two baths have been replaced by walk in showers as the original baths needed replacing and also a number of residents had said that they would like to be able to have a shower. Areas of carpet which were showing signs of wear at the last inspection have been replaced by vinyl floor covering. Some residents said that they liked this and it “makes the house feel lighter”. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 6 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. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 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 Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3 Residents are secure in the knowledge that their needs can be met. EVIDENCE: Three pre admission assessments were inspected. Residents admitted through the care management process have a full assessment of their needs undertaken by the referring professional; the registered provider will visit people at home or in hospital prior to admission. The home has a comprehensive assessment tool however the quality of the assessments inspected was inconsistent depending on the person who had undertaken them. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 9 & 10. The systems for the administration of medication are generally good with clear and comprehensive arrangements in place to ensure residents’ medication needs are met. However this is not followed consistently by staff. The procedure for ordering medication needs some minor adjustment. EVIDENCE: None of the current service users manage their own medication. Registered nurses administer medicines within the home and two interviewed were aware of relevant guidelines and code of practice. The management of medication has improved at Amberwood however practice is not consistent thereby potentially putting residents’ safety at risk. Examples of the inconsistencies include two signatures not being obtained for hand written medicines, a record not always kept of medicines received at the home and records of medicines given to residents not always being signed. After submitting requests for repeat prescriptions the prescriptions are sent to the supplying pharmacy from doctors’ surgeries and not returned to the home. It is considered essential for the designated person to see the prescriptions to check them against the items ordered and to sign the exemption declaration on the back of the prescription form on behalf of the resident, if the resident is unable to do this themselves, before it is submitted to the pharmacist. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 10 Throughout the inspection staff were seen to address service users in a respectful and friendly manner. Residents said that all staff were very kind and helpful. A resident’s privacy and choice were not respected when a member of staff was seen to enter a resident’s room without knocking or waiting to be invited in. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12 & 15. Social needs and meals are generally well managed. Some improvement is needed in developing activities for residents who lack capacity and providing residents with the opportunity to exercise their choice. EVIDENCE: 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 cook visits residents who choose to stay in their rooms to tell them what is on the menu. Residents’ daily routine, including mealtimes, appeared to be flexible. The manager said that a variety of group and individual activities are provided including arts and crafts, games and gentle exercise sessions. Two residents spoke about playing cards, which they enjoy. Entertainers also visit the home and all residents spoke of how much they enjoy “a sing song”. Some residents who lack capacity or who presented other challenges were not seen to undertake any activities during the inspection. Several residents who have limited mobility, and need to be transferred with the assistance of a mechanical hoist, were sitting in the lounge in wheelchairs. When asked they said that although they were sitting on pressure relieving Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 12 cushions, if given the choice they would much rather sit in a comfortable sitting room chair. Staff confirmed that they would rather residents were given the choice but that the policy at the home was not to use the hoist in the lounge as this could compromise residents’ dignity. Staff have not undertaken manual handling training [refer to Standard 38]. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 18. Service users are protected by the staff knowledge and understanding of the forms of abuse. EVIDENCE: This standard was not fully assessed at this visit. A requirement was made at the last inspection that all staff receive training in prevention of abuse. The manager confirmed that all registered nurses had received training in 2004 and all carers in 2005. Staff could identify forms of adult abuse and all said that they would challenge and report any poor practice. There was no evidence to suggest that residents, at the time of this visit, are anything but well cared for at the home. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 14 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. Procedures are in place to ensure that a safe environment is maintained. EVIDENCE: The property is well maintained, with homely and comfortable communal spaces. The home offers a lounge and dining room. The home employs a maintenance person. A book is kept where staff write any tasks that need to be done. Redecoration and refurbishment has been undertaken since the last inspection. Areas of carpet have been replaced with laminate flooring as the original carpet was worn and tired looking. Two baths have been replaced with walk in showers, as the baths needed replacing. The manager said that a number of residents wanted showers to be fitted. Residents’ rooms were personalised with sentimental items, photographs and small pieces of furniture. Residents expressed their satisfaction with the accommodation provided. There is outdoor space available including a large terraced balcony, which appears to be enjoyed by many of the residents. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29 & 30. The number of staff on duty throughout the day and night meets residents’ personal, health and social care needs. There has been limited progress with staff training since the last inspection. EVIDENCE: Staffing levels were satisfactory on the day of the inspection. the manager aims to have a registered nurse on duty 24 hours a day, 4 carers between 8am-2pm, 3 carers between 2pm-8pm and 1 carer between 8pm-8am. Residents spoken with confirmed that their needs were generally met in a timely way. The inspector saw staff responding to residents’ bells swiftly throughout the day. Residents and relatives confirmed that staff were kind and helpful. Domestic and other ancillary staff are employed in sufficient numbers to ensure that standards relating to food, meals and cleanliness are maintained. Residents confirmed that their needs were generally met in a timely way. Staff training files were unavailable at the time of this visit. One carer holds an NVQ level 2 and the manager said that another is currently undertaking NVQ training. The manager discussed the difficulty in finding a training provider to undertake NVQ training at the home. Staff said they had not undertaken any training since the last inspection. A requirement was made at the last inspection that the home undertakes a robust recruitment procedure. Recruitment files were unavailable at the time of Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 16 this visit. The owner will be asked to bring the files to the Commission’s office in Exeter. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31, 33, 35 & 38. Staff receive very clear guidance and direction from the manager in relation to health and welfare. It is not clear whether the home seeks residents, relatives or health care professionals views. Some practices within the home are unsafe potentially putting residents at risk. EVIDENCE: The manager was registered with the Commission in November 2005. As part of the registration process the manager has to complete a Registered Managers Award by December 2006.The manager said that she does not have sufficient time to undertake managerial duties at the home. She said she needs “protected” time to enable her to fulfil her job description. The lines of accountability within the home are not always clear. The manager did not have access to some of the files required during this visit. The manager gives a clear lead and direction to staff. Residents said that she was approachable, always ready to listen and nothing was too much trouble for her or her staff. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 18 The manager said that residents are consulted daily about the running of the home. There was no evidence of a system being in place to review and improve at regular intervals the quality of care and nursing provided at the home. The manager does not deal with residents’ finances. Personal allowances are kept for some residents. Records of residents’ personal allowances were not available at this visit. A requirement was made at the last inspection that manual handling training was provided to ensure that a safe system for moving and handling residents was provided at the home. Staff follow the home’s policy of not assisting residents to transfer with the aid of a hoist whilst in the lounge as this procedure may compromise residents’ dignity. Staff said that they did not agree with this policy and would sometimes transfer residents without the use of a hoist. This compromises the safety of residents and staff. Records show that staff undertake regular training in the prevention of fire and are due for an update this month. Fire alarms and emergency lighting are regularly checked. On the day of the inspection hot water temperatures from the hand basins in three residents’ bedrooms exceeded 55oC. This places vulnerable people at risk. Some areas of carpet have been replaced with vinyl flooring. No environmental risk assessments have been undertaken since this change. Assessments of the risk of falls for individual residents have not been reviewed since the carpet has been replaced. Wheelchairs and other equipment were stored in corridors throughout the home. This puts residents at risk. The home was clean and free from offensive odours throughout. Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 1 X X 1 Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 20 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 OP9 Regulation 13[2] Requirement Timescale for action 2. OP12 12[3] 3. OP29 19[b][1] Schedule 2 The registered person shall make arrangements for the recording of medicines received into the care home. 15/02/06 [This relates to not all medication received at the home being recorded] The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account 15/02/06 their wishes and feelings. [This relates to residents not being given the choice of sitting in conventional sitting room chairs as opposed to wheelchairs.] The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person the information and 20/02/06 documents specified in paragraphs 1 to 7 of Schedule 2. [This is the 2nd time this requirement has been made. Documents were unavailable at the time of this visit.] DS0000026696.V268375.R01.S.doc Version 5.1 Page 21 Amberwood Nursing Home 4. OP33 24[1] 5. OP38 13[5] 6. OP37 17[3] 7. OP38 13[4] 8. OP38 13[4][c] The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the home including the quality of nursing. The registered person shall make suitable arrangements to provide a safe system for moving and handling service users. [This is the 2nd time this requirement has been made] The registered person shall ensure that the records referred to in Schedule 3 & 4 are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. [This relates to wheelchairs and other equipment being stored in corridors] The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and as far as possible eliminated. [This relates to hot water temperatures from the hand basins in three residents’ bedrooms exceeding 55oC.] 20/04/06 20/01/06 20/02/06 20/02/06 20/02/06 Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 22 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 OP9 Good Practice Recommendations It is recommended that for all hand written entries made on the MAR sheet, there should be two signatures- one making the entry and one of a second competent person who has checked the medication and entry. Adequate storage areas should be provided for aids and equipment, including wheelchairs. 2. OP22 Amberwood Nursing Home DS0000026696.V268375.R01.S.doc Version 5.1 Page 23 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.V268375.R01.S.doc Version 5.1 Page 24 - 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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