This inspection was carried out on 25th July 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.
CARE HOMES FOR OLDER PEOPLE
Amberwood Nursing Home 231 Exeter Road Exmouth Devon EX8 3ED Lead Inspector
Michelle Oliver Unannounced 25 July 2005 09:30hrs 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 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 D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Amberwood Nursing Home Address 231 Exeter Road Exmouth Devon EX8 3ED 01395 263540 01395 263540 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alextour Limited Mr Nicholas Thomas Higgins Care Home 24 Category(ies) of OP Old age (24) registration, with number of places Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 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 25 January 2005 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 in. 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 D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was the first statutory inspection of the current year and took 4 hours to complete. There were 22 residents living at Amberwood on the day of inspection and the inspector saw the majority of them. The home has a large number of residents who have a dementia related illness and some do not have the capacity to communicate fully or understand the inspection process. The inspectors spoke at length with 3 service users and 4 members of staff. The inspector toured the premises and inspected a number of records. The nursing and care staff were friendly and professional throughout the inspection and helped where they could. What the service does well: What has improved since the last inspection? What they could do better:
Resident’s safety is not protected by some of the homes procedures. Staff have a good knowledge and understanding of the forms of abuse however not all staff have completed appropriate training. The procedures for the recruitment of staff are inconsistent and do not always ensure the protection of people living in the home. Two references, police checks and POVA checks must be obtained for all staff before taking up employment at the home. Medication is generally managed well; however some attention is needed to ensure that records are accurate in order to minimise risks for residents. When medication is administered to a resident and has been taken the medication record chart must be signed at the time. Some improvement is required to ensure that assessments are completed, before a resident decides to live at the home, to accurately reflect service
Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 6 user’s needs. A comprehensive plan of care must be based on an assessment of residents before they decide to live at the home. This ensures that all potential residents can be confident that their assessed needs can be met by the home. 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 D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 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 standard(s) 3 &6. Some improvement is required to ensure that assessments are completed, before a resident decides to live at the home, to accurately reflect service user’s needs. EVIDENCE: The manager said that he, or an appropriately trained member of staff, visits potential residents before they decide to live at the home. There was inconsistent evidence in residents care plans to confirm this. Care plans of 6 residents admitted since April 2005 were looked at. Shared care assessments were included in 2 care plans. There was no evidence in the other 4 care plans. The home does not admit residents for intermediate care. Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 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 standard(s) 7, 8, &9. Individual care plans have been developed and all aspects of health; personal and social care needs are identified or planned for. Medication is generally managed well; however some attention is needed to ensure that records are accurate in order to minimise risks for service users. EVIDENCE: The staff are to be commended for the work that has been undertaken to improve the care plans at the home. They are comprehensive and provide all information to enable staff to meet residents identified care needs. None of the current service users manage their own medication. Two signatures had not been obtained on hand written Medicine Administration Records (MAR) charts. A record is not kept of all medications received at the home. Medication given to residents was not always signed as being given. Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 10 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 standard(s) 13, &14. Residents are encouraged to maintain contact with their families or friends as they wish and to take control of their lives whilst living at Amberwood. EVIDENCE: Residents confirmed that they are encouraged to make choices about all aspects of daily life. Visitors can visit at any time and are always made welcome by the staff. Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 11 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 standard(s) 16 & 18 The home has a satisfactory complaints process with evidence that complaints are listened to and acted upon. Staff have a good knowledge and understanding of the forms of abuse however not all staff have completed appropriate training. EVIDENCE: The home has received a complaint since the last inspection, which they are currently investigating. Steps have been taken to resolve some of the issues raised and at all times the residents’ best interests and wishes were of the greatest importance. Records of incidents recorded indicate that all issues are taken seriously. Residents confirmed that they feel comfortable discussing any concerns with staff at Amberwood. 9 members of staff have received prevention of abuse training and 10 staff are yet to complete this. There was no evidence to suggest that residents at the home are anything but well cared for at the home. Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 12 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 standard(s) 26 The standard of the environment within the home is very good providing the residents with an attractive and homely place to live. EVIDENCE: The home was clean and free from offensive odours throughout. The laundry facilities were well organised and met the National Minimum Standard. Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 The procedures for the recruitment of staff are inconsistent and do not always ensure the protection of people living in the home. EVIDENCE: Three staff recruitment files were looked at. One included only one reference, which was verbal, no police check and no contract of employment. Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Some practices within the home are unsafe potentially putting service users, staff and others at risk. EVIDENCE: Inspection of records indicated that regular fire alarm tests and maintenance were undertaken. Staff have not received the necessary manual handling training. Liquid soap and paper towels were available in communal bathrooms and in individual residents rooms. Staff confirmed that gloves and aprons were always available. The home has a copy of current infection control guidelines. Risk assessments relating to health and safety issues were completed. Following the inspection an immediate requirement was issued in relation to manual handling. The Commission awaits a satisfactory response from the provider stating the action taken to achieve compliance. Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x 1 Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 16 No 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 14[1][a][ b][c] Requirement Timescale for action 25.08.05 2. op9 13[2] 3. op18 13[6] 4. op29 19[b][1]S chedule 2 The registered person shall not provide accomodation 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. The registered person shall make 25.08.05 arrangements for the recording of medicines received into the care home.[ This relates to not all medication being recorded when received at the home and recoirding when medicines are administered to residents[ The registered person shall make 25.08.05 arrangements, by training or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse.[ this relates to ensuring that all staff have received training] The registered person shall not 25.08.05 employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in
Version 1.40 Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Page 17 paragraphs 1 to 7 of Schedule 2. 5. op38 13[5] The registered person shall make 25.08.05 suitable arrangements to provide a safe system for moving and handling service users. 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 For all hand written entries on the medication chart the person making the entry should sign and date and then a second person should check and sign the entry. Amberwood Nursing Home D54 D06_s26696_amberwood_v235860_250705 stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection 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
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