Inspection on 22/08/08 for Amberwood Nursing Home

This inspection was carried out on 22nd August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Amberwood Nursing Home 20/08/07

Amberwood Nursing Home 14/11/06

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 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Amberwood Nursing Home 231 Exeter Road Exmouth Devon EX8 3ED Lead Inspector Ms Rachel Fleet Unannounced Inspection 22nd August 2008 9.30 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 Amberwood Nursing Home DS0000026696.V367641.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.V367641.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 amberlinks@btinternet.com Alextour Limited Mrs Christine Mary Allsopp Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Amberwood Nursing Home DS0000026696.V367641.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 20th August 2007 Date of last inspection Brief Description of the Service: Amberwood is a detached house on a main road into Exmouth. It is registered to provide care and accommodation for up to 24 people over retirement age who have nursing needs. The home has on-site parking, and is on a main bus route. There is level access at its front entrance, and from the lounge and dining room into the garden at the rear of the building. There are passenger lifts as well as a stairlift between the two floors. Level access showers are sited on both floors. The weekly fees at the time of this inspection were from £500 - £700, depending on the size of room and the level of care needed. Additional costs to these fees are staff escort time away from the home (if needed) apart from outings arranged by the home, chiropody, hairdressing, continence pads if not provided by local health services, toiletries and newspapers for personal use. The most recent inspection report by the Commission for Social Care Inspection (CSCI) is available in the home’s entrance hall, and also on request from the care home. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place as part of our usual inspection programme. There were 16 people living at the home on the day of our unannounced visit to the home, which took place over 8 hours on a weekday. Mrs Christine Allsopp, the home’s registered manager, had previously returned a CSCI questionnaire about the home (the Annual Quality Assurance Assessment, or ‘AQAA’). This included their assessment of what they do well and any plans for improvement, as well as information about the people living at the home, staffing, policies in place, and maintenance of facilities. We had also sent surveys to the home for them to give to 10 people living at the home and to 10 staff. We received 4 back from people living at the home (all of who had been helped to complete them by relatives or friends), and 1 from staff. We received back 2 of 12 surveys we sent to community healthcare professionals supporting people at the home, although one said they had not completed it because they visited infrequently. We spoke to 12 people living at the home, with some observation of the care and attention given to them by staff. Two people were able to give us their views in detail; others were too frail to have a full conversation with us. We found out what it was like living at the home from the people we met, through our observations, talking with staff (the Activities Co-ordinator, the cook, and three care staff including an agency carer), and looking around the home. We ‘case-tracked’ three people living at the home, which meant we looked in more depth at their care. This group included men and women, someone new to the home, someone whose needs were changing, someone with communication difficulties, someone with few visitors, and someone with more complex needs. We did this by reading their care records and related information (medication records, personal monies records, etc.). We met with them, spoke to staff about their care and other related matters, as well as looking at the accommodation in relation to their needs. Staff recruitment and training files, quality assurance information and records relating to health and safety (such as accident and maintenance records) were seen. We ended the inspection by discussing our findings with Mrs Allsopp, the manager, and Sally Moyse, the Nursing Director for the registered provider, who was present for part of our visit. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 6 Information included in this report is from all these sources, and from communication with or about the service since our last inspection. What the service does well: What has improved since the last inspection? What they could do better: Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 7 More detail in some care records, with improvements in certain medication practices, would help to ensure that each individual living at the home receives appropriate care and treatment. Peoples’ independence and quality of life could be further promoted by provision of certain equipment and facilities. Further staff training in relation to peoples’ needs would help to ensure that peoples’ diverse or changing needs, and the aims of the home, are met. Being more proactive in improving the quality of the service – including timely staff training on safe working practices, and greater consideration of what improvements could be made – would help to assure people living at the home that the service is being run in their best interests, promoting their safety and welfare. 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. Amberwood Nursing Home DS0000026696.V367641.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.V367641.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. (The home does not offer intermediate care – St.6). Quality in this outcome area is good. The home gets good information about prospective residents’ needs, which helps to ensure that people who are then offered a place, and who choose to move in, can be cared for properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two people we case-tracked had been admitted to the home since our last visit. Although they were unable to tell us much about their admission, we saw senior staff from the home had assessed their care needs, and obtained some other information about them, before they moved into the home. Their preferred form of address, medications, allergies and some of their likes/dislikes and interests were recorded. One person’s view on their prospective admission into residential care was also recorded. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 10 Relevant information had also been obtained from Social services staff for someone who was funded through Social Services. We saw copies of letters, sent by the home to prospective residents, which confirmed that the home could meet their needs as identified at their preadmission assessment. Senior staff told us that they had declined to offer accommodation to some individuals because they knew the home could not meet their particular mental health needs. We saw copies of contracts given to the two people, kept in the home’s office. These included the room the person was to occupy, the fee level, and terms and conditions of their residency. Surveys from people living at the home all said they had been given contracts. They also said that they had received enough information about the home, before the person moved in, so they could decide if it was the right place for them. Amberwood Nursing Home DS0000026696.V367641.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. Quality in this outcome area is adequate. People who live at this home are treated respectfully, benefiting from a person-centred approach to care. However, a lack of detail in care records, with some weaknesses in the management of medications, creates a risk that some people may not receive appropriate care or medication consistently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All four surveys from people living at the home said they usually got the care or support they needed. Care plans we read reflected the views and preferences of the individual concerned, or input from their family in some cases. The care plans began with peoples’ social histories and interests in some detail, so staff could quickly get a picture of each person as the individual that they were. This also helped to promote peoples’ social needs as well as their Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 12 physical needs. There were individualised night care plans, reflecting people’s different preferences and requirements for getting as good a night’s rest as possible. However, it was not always clear from care plans exactly how staff were to meet peoples’ needs. One person was said to ‘need assistance’ with feeding, without saying the nature or extent of that help; their daily notes suggested staff left drinks with the person as though they could help themselves. And when care records indicated someone had problems with continence, guidance for staff read ‘Assist to the toilet when required’, which could be interpreted in various ways. There was no information to guide staff on appropriate care for someone who needed regular mouth care; a chart provided for mouth care to be recorded had not been completed recently, and they had a very dry mouth when we met them. A part of their care plan said they attended a social club, but staff told us this had not been the case for some months. Some records - such as reviews of peoples’ needs and care plans - were not signed or dated, so it was not clear who had collected or written the information, or how current it was. A health professional was positive about the service and support provided by the home, including that there were “good client-staff relationships.” The care assistants told us the nurses in charge listened to their views, with action taken if they reported concerns about people they had been caring for. There was information about what help people needed to move, the risk to them from any immobility with a view to preventing pressure sores, and assessment of individuals’ risk of falling. Two of the three people we casetracked had assessments intended to prevent malnutrition; the third who did not was prone to skin sores, when nutrition would particularly relevant to help healing. We heard staff coordinating their work as a team, to ensure people who needed help had mid-morning drinks even though staff were still busy helping people to get up for the day. A health professional said staff had a professional approach, and the home contacted doctors appropriately. Records showed people were enabled to have regular sight tests and chiropody. We saw people using pressure-relieving cushions and mattresses; specialist community nurses had been consulted about one person’s wound. Medications administration charts were completed properly regarding when and who had administered medicines, and included records of medications received by the home and any allergies individuals had. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 13 Medicines were securely stored and we saw that the administration of controlled medications was properly recorded, with appropriate storage of such medicines. Some people were prescribed skin creams/ointments for use when required; neither their medication administration charts or care plan clarified when and how these should be used to ensure they would be used appropriately. Staff we spoke with were unaware of foods to be avoided by people taking a certain medication; there was nothing in one such person’s care plan to tell staff about this. Staff had handwritten one medication chart, whilst awaiting a printed one from the home’s supplying pharmacist. Some information was not given (such as how many times a day the medication was to be taken), and it had not been signed and dated. It is good practice that this is done by two people, to verify the information. Although staff had recorded the minimum/maximum temperatures of the medicines fridge daily, as is good practice, these were 9-22°C in recent weeks. This is above recommended limits to ensure medication requiring refrigerated storage remains effective, but no action had been taken. All four surveys from people living at the home said staff listened and acted on what they said, though one added the comment - “Sometimes it takes a bit longer to get things done.” We heard staff offering assistance politely and pleasantly. Most toilets and bathrooms had privacy locks on the doors although two did not. We brought these to the manager’s attention, a matter that was raised at our last inspection. We discussed whether privacy signs on bedroom doors, curtains around bedroom sinks, etc. might be helpful, for people who do not want to be disturbed or who may not hear a knock at their door whilst washing, for example. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 14 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 – 15. Quality in this outcome area is good. Peoples’ quality of life is enhanced by continued or new links with their families and friends as well as with the community within and around the home. They are benefiting from improvements in the daily life of the home aimed at meeting their individual interests, choices and wishes. They are offered an appetising, balanced diet that meets their needs and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Surveys asked people who lived at the home if there were activities arranged by the home that the person could take part in. Two said ‘Always’ with a comment that this had improved in recent months; one said ‘Usually’ and one said ‘Sometimes’. An activities co-ordinator has been employed since our last visit, working at the home for eight hours on three days a week, with additional hours for socials, parties, trips etc. This time includes both group activities and one-toone time with people. Some outings have taken place - locally for people Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 15 needing a wheelchair, and further afield using hired transport. Staff had been fund-raising for the benefit of people living at the home - funds being used for events and activities, as well as for two powered wheelchairs to enable more outings for individuals. The AQAA said a local vicar visited on a regular basis, holding communion services for those who wish to attend, and one person told us they had attended a service very recently. A photo album available in the entrance hall showed people enjoying the home’s garden party in July; residents, their families, friends and the staff had been invited. Other photos were of a wedding anniversary celebration held at the home for a resident and her husband in the previous month. A trolley had been set up since our last visit, with sweets, toiletries and other items requested by people living at the home, so that they had a choice to make small purchases themselves rather than needing to rely on others. This was taken round the home during our visit. A book and greetings cards trolley was also available in the hall. Bedrooms were personalised with peoples’ own possessions. We saw a risk assessment for use of bedrails on someone’s bed included their views on the matter. Surveys from people who lived at the home said they usually liked the meals provided. One included that someone was always offered a choice at lunchtime, although their decision-making was affected by dementia. Menus showed a varied diet was offered; we saw fresh produce and fruit juice in the kitchen stores. During our visit, a lunch of fish, chips/mashed potato and peas was served, meals being plated in the kitchen and taken to people in the lounge or in their bedrooms. People appeared to be enjoying the food, and staff sat with those who needed help, giving them unhurried, individual assistance to eat. Teatime menus showed soup, a light meal, sandwiches and a dessert were offered daily, the cook confirming that people could have all four courses if they wished. He told us he was informed of peoples’ dietary likes and dislikes, showing us a list of special diets and individual requirements displayed in the kitchen. The dining room was being used for purposes other than its intended use, with little furniture in it, although it was part of the communal space that the home was expected to provide for people living at the home. The senior staff present during our visit agreed that it would be made properly available to residents again, offering the benefits of a proper dining room. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 16 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 good. Peoples’ concerns and complaints are listened to and acted upon, to uphold the rights of those living at the home and safeguard them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Surveys from people living at the home indicated people knew who to speak to if they were not happy and how to make a complaint. The AQAA said the home had not received any complaints. The complaints procedure was clearly displayed in the entrance hall. The manager agreed to make some amendments so that it had all the up-to-date information someone might need. One person living at the home told us that because staff did not have name badges, the person could not name individuals if they wanted to tell senior staff about any particular issues with members of staff. We brought this to the attention of senior staff at the home for their further consideration. Staff we spoke with were aware of what might be deemed abusive practices. They discussed, for example, the importance of offering and respecting peoples’ choices, that people were given enough to eat and drink, that they Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 17 were assisted to the toilet when they asked for help with this. They knew external agencies that were involved in safeguarding matters to whom they could report concerns to if they felt unable to raise them in their workplace. One safeguarding matter has arisen since our last inspection, which the registered provider dealt with properly. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 18 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, 22 & 26. Quality in this outcome area is good. People enjoy a pleasant, homely and clean environment. Although they will benefit from planned improvements, absence of some equipment and facilities currently limits peoples’ independence and quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The accommodation looked homely and comfortably furnished. Funds raised by staff had been used to buy special armchairs for more disabled people at the home, with the provider matching the money staff had raised. We saw a newly delivered large flat-screen television that staff said had been purchased for the lounge, freeing floor space. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 19 Bedrooms were very individual in size, nature and aspect, as well as being personalised to reflect the personalities or interests of the people who occupied them. People we asked were happy with their room and its facilities; no-one was sharing a room. The home had moved one person to a larger bedroom in order to meet their changed care needs properly, at no extra cost to the individual. Records were kept of monthly rooms checks that were intended to identify and address any repairs, hazards, or refurbishment needed. We saw a risk assessment and management plan in one person’s care records relating to a hazard from certain items in their bedroom. This had been discussed with the person and their relatives, to agree how risks could be reduced. Since our last inspection, the kitchen had been completely refurbished and refitted, and a new water tank and boiler had been installed. New beds, air mattresses (for pressure relief), bedroom furniture and carpets had also been purchased. The lounge had space for about 12 armchairs, and overlooked the garden which looked colourful, being visible through full-length glass windows and doors. The room was a thoroughfare between two parts of the home, with armchairs around the walls to allow access through it. Some people were thus sitting with their backs to the garden. Staff were very aware of the problems, and told us about plans to extend the room, but no date had been set for this work. There was a ramp from the lounge to the garden, onto paved areas where there were some raised flowerbeds. One person living at the home told me about plans to develop areas of the garden, for the benefit of the residents. One person living at the home pointed out that there was no call bell in the lounge. They said they had been told there was always someone around, but felt this wasn’t always the case – as reflected by some staff. We discussed this with senior staff. We have commented elsewhere in this report on the situation regarding the dining room, and the need to keep such a facility available to people living at the home. Staff said no-one used the dining room previously, but present arrangements removed opportunities for socialising and promoting independence in various ways (serving themselves at meals, etc.). There were two modern level access showers at the home. We saw one toilet adapted to help people with mobility problems to use it more independently. When asked what the service could do better, a staff survey said, “Keep up with modern equipment.” Staff we spoke with also raised this point, particularly with the current high level of needs for hoists at the home. One Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 20 hoist was being used solely for someone recently admitted who needed barrier nursing. One person who wanted the toilet was told she would have to wait until the hoist that was in general use was free. Someone else who required a hoist indicated to us that they thought a better hoist was needed. The responsible individual has since told us provision of a new hoist is under discussion. The surveys from people living at the home said the home was usually clean and fresh; one person thought their bedroom could be dusted more often. On the day of this unannounced visit, we did not note any malodours. The home looked clean throughout, including peoples’ wheelchairs, and the kitchen, where we were shown the cleaning schedules. The AQAA said all staff had had infection control training. There were supplies of disposable gloves and aprons, with disinfecting hand gels, around the home, which we saw staff make use of. We saw where particular cross-infection risks had been identified, equipment was not being shared between people living at the home. There were two new sluice machines for automatic washing and disinfection of bedpans, etc. The laundry had a new washing machine with appropriate programmes. Soluble laundry bags were available for handling and washing of foul laundry. The housekeeper present explained such laundry would be washed at higher temperatures, after the sluice cycle, and sheets went on a ‘boil’ wash to reduce cross-infection risks. Amberwood Nursing Home DS0000026696.V367641.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area is good. People living at the home are cared for by suitable individuals who, as a team, provide a safe level of care. They would benefit further if staff received more training related to the needs of the people they care for, to ensure that peoples’ more diverse or changing needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived, the manager was part of the care team as the nurse on duty for the morning, with five care assistants on duty also (including one agency carer). She explained this was an extra care staff to usual numbers, so that she was able to assist us during the inspection. There were five staff on duty in the afternoon – again, one more than usual - and two rostered overnight. This included a nurse on each shift. Housekeeping and kitchen staff supported care staff on most days of the week. Helpfully, the housekeeper also had a care qualification and thus assisted people at mealtimes when she was on duty, to ensure people had timely help. Staff told us there was not always a member of cleaning staff at weekends, so care staff did basic housekeeping duties. New staff were being sought to cover the vacancies. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 22 An agency carer we spoke with said they had not been given information about the people at the home when they came on duty, but confirmed they had been working with permanent staff. They felt people living at the home received a good standard of care, comparing their experience in different care settings. All four surveys from people living at the home said the staff were usually available when they needed them, and they usually got the care or support they needed. One added, “It does sometimes depend on the number of staff on duty and which staff are on duty.” During our visit, three people were still to be helped to wash, get up, etc. at 11am. We did not ascertain whether this was usual for them, although staff said it was not unusual that some people had to wait until 11.30am to get up. Peoples’ call bells were answered in less than five minutes; staff were polite, and stayed to deal with the reason for the call. The AQAA said that everyone currently living at the home needed two staff to help them with their care. A staff survey said there were usually enough staff to meet peoples’ individual needs, but felt afternoon levels should be the same as in the morning to achieve this. Staff told us that, with the usual level of three carers in the afternoon, this left one staff member unable to help people when they wanted help unless the nurse in charge was free to assist also. We looked at recruitment records for three staff who had been recruited since our last inspection in various roles. Improvements in procedures were evident in that references had been obtained from individuals’ last employer as is recommended, new basic or full police checks had been obtained before they began working at the home, and records now indicated that individuals had been given job descriptions. We noted one had an unexplained 15-month gap in their employment history, however. Services are required to obtain a full employment history and a satisfactory written explanation of any gaps in employment, for anyone working at the home. All had experience relevant to their new job, and the carer had a recognised care qualification. The home had checked the nurse’s registration status to ensure that she was able to practice as a nurse. A staff member currently undergoing induction said it was useful, and confirmed it included observation by senior carers to assess their work. They said that they would be commencing a care qualification course once their induction was completed. The AQAA said that of 23 care staff employed in total, 19 had a care qualification equivalent to an National Vocational Qualification at Level 2 in Care, or higher – exceeding recommended targets for ensuring a basic safe level of care. One staff member was working to achieve a qualification. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 23 One person living at the home said some staff were very good at looking after them, and others were not. Someone we case-tracked had impaired sight; staff we asked confirmed they had not had training about sight problems, and thought it would be useful. We checked training records for the previous 12 months, for nine care assistants. Four had had some training on the needs of people living at the home; two others had undergone induction as new staff in that time. A significant proportion of people living at the home had dementia; one staff member we spoke with had relevant experience from previous jobs, but no staff had attended dementia care training or updating in the last year. Staff training on safe working practices was not up to date (See ‘Management and administration’ section). Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 24 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. People who live at this home can be confident that it is managed by a suitable person. A more proactive approach to improving the quality of the service – including staff training – is needed before people can be confident that the service is being run so as to promote their best interests, as well as the health and safety of everyone at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Christine Allsopp, the manager, is a Registered Nurse who also has a recognised management qualification, and who has been the registered Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 25 manager of another care home. She has attended training about the Mental Capacity Act, and on infection control, in this last year. When Mrs Allsopp was registered by CSCI, as home manager, in February 2008, we recommended that she attend an appropriate safeguarding course, which dealt with the action she, as a manager, should take if an allegation of abuse was made. She has since attended in-house training and been involved in a safeguarding investigation, but has not been able to access a relevant external course yet. We agreed she would attend such a course within three months of our visit. Staff told us they met with the manager regularly, and had had supervision sessions with her to discuss their work and performance. She worked alongside the care staff regularly as the nurse in charge of some shifts each week, and thus felt able to monitor staff and give close guidance. Information in the AQAA gave a reasonable picture of the current situation at the home, and reflected a person-centred approach. However, there was very little detail about the areas where the home still needs to improve, with little supporting evidence to show how the home is planning to improve. Surveys were provided annually to residents, relatives and visiting professionals by the home for their quality assurance programme. We saw a box in the home’s hall for people to put completed surveys in, with a deadline in July 2008. We saw some surveys that had been returned, with a very brief summary of the information gained from them. Sally Moyse confirmed this would be developed further, to provide meaningful feedback for those who had been surveyed as well as for development of the service based on peoples’ views. The manager had not yet been involved in this aspect of quality assurance. We were told results of the surveys would be given to people living at the home and posted to their next-of-kin or main supporter, in the same way that people were notified about residents/relatives’ meetings. The next such meeting was taking place soon after our visit. There was evidence that matters raised at the last meeting - as recorded in the minutes – had been addressed. These included purchasing of a wheelchair powerpack and arranging for people to be able to receive Holy Communion. We were told that the home did not act as appointee for anyone, but they held some personal/spending money on behalf of some people. The accounts we saw for three such people had clear records of deposits and withdrawals. We were told that the home sent a copy of these records to those responsible for individuals’ finances, when the balance was running low. Related receipts were available where we checked at random. There was more cash held for one person than shown on their record, due to an addition error. We noted only Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 26 one person signed to verify transactions; senior staff agreed to involve two signatories, to make systems more robust as well as helping to avoid errors. There were recent records of health and safety checks relating to bedrails in use, hot water to baths, etc. Windows were restricted where we checked them. A safety poster in the staff office alerted staff to potential dangers associated with the use of bedrails. Bedrail risk assessments were detailed as to what staff should consider in the assessment. The AQAA and information seen during our visit indicated routine servicing of hoists was due. Mrs Moyse told us they had been serviced recently, although a certificate confirming this had not been provided. The Responsible Individual has since informed us that this has been obtained. A piece of medical equipment was overdue a service, which the manager said she was aware of. Kitchen freezers and fridges were running at temperatures within the recommended limits for safe food storage, although the cook said one was to be checked by engineers because of concerns about it. Food portions in fridges were covered and dated. At our last inspection, we made a requirement that the home must ensure people could receive appropriate first aid. On this visit, we were told that two staff were suitably trained first aiders - a third having just left the home’s employment. No risk assessment had been carried out to decide the service’s first aid needs and to thus ensure appropriate arrangements were in place. The home is therefore expected to have someone who has a suitable first aid at work qualification, on duty at all times (‘Guidance: Qualified First Aiders’ CSCI, June 2006). Someone working in the kitchen had not had fire safety training, according to training records we were shown. But an agency carer on duty confirmed she had been told about the home’s fire procedures. There was evidence the home’s fire risk assessment had been reviewed in July 2008. The AQAA said everyone living at the home required two or more staff to help with their care; the manager confirmed this was because they had impaired mobility. One person thought a very small minority of staff mishandled them, causing them some discomfort; senior staff felt their discomfort was due to their medical condition, which was to be reviewed by their GP on the day of our visit. We made a recommendation at our last inspection that all care staff must receive up to date training in relation to moving and handling. Where it appeared from training records that at least 11 staff had not had manual handling training in the last 12 months, the Responsible Individual has told us that most had had this training in their induction. However, senior staff agreed that staff training on safe working practices was not up to date, saying they had difficulty getting suitable training. They told us Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 27 that manual handling training was to take place in the next two months, with a fire lecture due in November 2008. Care staff also told us that they were due to attend some training sessions in the coming months. Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 28 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 29 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 15 Requirement You must ensure that each person’s care plan is sufficiently detailed and up to date, providing clear guidance on the care they require from staff In order that peoples’ health and welfare needs are met, in a person-centered, safe and consistent way. 2 OP9 13(2) You must ensure that there are appropriate policies and procedures for the recording, safekeeping and safe administration of medicines. This includes Ensuring that there are clear directions available to staff on how and when medicines (including skin creams or ointments) prescribed to be used “when required” are to be used by staff, considering general guidance available to staff & guidance in individuals’ care records. Ensuring staff are aware of any Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 30 Timescale for action 31/10/08 30/09/08 possible interactions between diet or drinks and peoples’ medication. Establishing systems for verifying the accuracy of handwritten entries on medication administration sheets, to ensure all required information is included in the directions for staff, & that the information is accurate. Safekeeping of medication by following manufacturers’ instructions with relevant guidance in the medication policy, especially regarding storage temperatures. You must make suitable arrangements for the training of staff in first aid, based on assessment of risks to people living at the home So that the service can provide appropriate first aid when people need it. Timescale of 20/10/07 not fully met. 4 OP38 13(5) You must make suitable arrangements to provide a safe system for moving and handling people, including that all care staff must be kept properly updated in relation to moving and handling skills So that people living in this home are supported safely and in the way that they need. 31/10/08 3 OP38 13 (4) 31/10/08 Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 31 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 OP15 Good Practice Recommendations You should ensure that people are able to have their meals in a congenial setting that promotes their choice, wellbeing and independence as much as possible. You should ensure that people have the facilities or equipment they need, such as hoists available and accessible call bells in every room, to maximise their dignity, independence and safety. You should ensure staff can meet the aims of the home as indicated in its Statement of Purpose and safely meet the changing needs of people living at the home, by providing a staff training & development programme that includes the anticipated and any diverse needs of the people living at the home. You should ensure the AQAA has sufficient detail about the areas where the home still needs to improve, with supporting evidence to show how the home intends to achieve this, to continue improvement of the quality of the services provided in the home. 2 OP22 3 OP30 4 OP33 Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Amberwood Nursing Home DS0000026696.V367641.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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