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Inspection on 09/05/06 for Amberwood Nursing Home

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

This inspection was carried out on 9th May 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 as independent and fulfilling as they can. All residents spoken with praised the care they received from the staff and said they were very happy living at the home. One said "They look after us all very well". Staff are keen to ensure the well being and comfort of the residents and treat them with respect and kindness. A visitor and resident praised all the staff at the home saying, "exceptionally pleased with all services we have had to date and enjoy the ambience of the home- very friendly and helpful staff, very impressed" Another relative said that staff were very kind and helpful, knew just what her relative wanted and the home always contacted them if there was any change in the residents` health.

What has improved since the last inspection?

Some training has been provided for staff including an update in the medication procedure and moving and handling. A quality assurance audit had been undertaken before the last inspection but details were not available. The results of a survey of residents and relatives has been seen and the format for another to be undertaken this year. Records needed as part of the inspection procedure are now made readily available. The home works hard to meet residents individual needs. For example a resident has expressed their choice to be assisted by a male carer and this need has been met, another resident`s religious beliefs and observances have been met

What the care home could do better:

Before residents are admitted to the home an assessment of their health and social care needs must be undertaken. Residents or their representatives must be included in the initial drawing up of their care plans and in the regular review of their needs. Activities planned around residents` individual interests or previous hobbies and facilities for activities in relation to fitness must be offered. Staff training must be improved. Training needs of all staff must be evaluated, a training plan devised and a record of training and future updates maintained. All staff employed at the home must be aware of procedures and policies relating to the protection of vulnerable adults. The homes policy and procedure for staff recruitment must be improved to safeguard residents living at the home. Recruitment procedures and selection process for any volunteers involved in the home must be thorough and includes police checks. All newly recruited staff must receive foundation training within the first 6 months of appointment, which equips them to meet the assessed needs of the service users as defined in their plans of care. Staff must be available at peak times during the day for example meal times and times when social care needs can be focused on. Roles of responsibilities between the current registered manager and outside external management needs to be made clear. Risk assessments must be carried out for all safe working practice topics and significant findings of the risk assessments must be recorded.

CARE HOMES FOR OLDER PEOPLE Amberwood Nursing Home 231 Exeter Road Exmouth Devon EX8 3ED Lead Inspector 45 Michelle Oliver Announced Inspection 9/05/06 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.V289008.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.V289008.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.V289008.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. 19th January 2006 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. Information received from the home indicates that the current fees range from £575-£627 depending on the size of room and the level of care needed. Services not included in this fee are chiropody, hairdressing and incontinence pads. Amberwood Nursing Home DS0000026696.V289008.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 Tuesday 9th May 2006 over a period of 10 hours. The manager and one provider were present throughout the inspection. Some positive informative discussion and exchange of information took place. Two members of staff and fourteen residents were observed, consulted with and their views on the home discussed. A number of questionnaires, seeking peoples views about the home were sent out by the inspector before the visit. One questionnaire completed on behalf of a resident by a relative, six from GP’s, two from health care professionals and two from members of staff were returned. A tour of the building was made and a number of records were inspected. This included resident plans of care, fire log book and staff recruitment files. Since the last inspection the Commission has met with the providers of the home and the manager to discuss their concerns relating to issues raised at the previous inspection. More recently the Commission has been working closely with Devon Social Services Adult Protection team, a nurse who specialises in skin care and the providers concerning an issue of concern raised by the skin care specialist. The providers have been co operative, have provided some training and have a plan of improvement for the home. What the service does well: What has improved since the last inspection? Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 6 Some training has been provided for staff including an update in the medication procedure and moving and handling. A quality assurance audit had been undertaken before the last inspection but details were not available. The results of a survey of residents and relatives has been seen and the format for another to be undertaken this year. Records needed as part of the inspection procedure are now made readily available. The home works hard to meet residents individual needs. For example a resident has expressed their choice to be assisted by a male carer and this need has been met, another resident’s religious beliefs and observances have been met What they could do better: Before residents are admitted to the home an assessment of their health and social care needs must be undertaken. Residents or their representatives must be included in the initial drawing up of their care plans and in the regular review of their needs. Activities planned around residents’ individual interests or previous hobbies and facilities for activities in relation to fitness must be offered. Staff training must be improved. Training needs of all staff must be evaluated, a training plan devised and a record of training and future updates maintained. All staff employed at the home must be aware of procedures and policies relating to the protection of vulnerable adults. The homes policy and procedure for staff recruitment must be improved to safeguard residents living at the home. Recruitment procedures and selection process for any volunteers involved in the home must be thorough and includes police checks. All newly recruited staff must receive foundation training within the first 6 months of appointment, which equips them to meet the assessed needs of the service users as defined in their plans of care. Staff must be available at peak times during the day for example meal times and times when social care needs can be focused on. Roles of responsibilities between the current registered manager and outside external management needs to be made clear. Risk assessments must be carried out for all safe working practice topics and significant findings of the risk assessments must be recorded. Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 7 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.V289008.R01.S.doc Version 5.1 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.V289008.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op3 & 6 Quality in this outcome are poor. This judgement has been made using available evidence including a visit to this service. Improvement is required to ensure that assessments are completed, to accurately reflect service users’ needs before a resident decides to live at the home. EVIDENCE: The manager said that she, or the provider, visits potential residents before they decide to live at the home. Care plans of 4 residents admitted since February 2006 were looked at. None included a pre admission assessment that identified their care needs in sufficient detail on which a plan of care could be written. There is no information to identify, for example, does the staff rota need to be changed to meet care needs, is specialist equipment required, can specific individual dietary requirements be met, is the proposed room suitable and do staff need training updates in a specific field of expertise? Positive discussion took place with the manager and the provider as to the specific information needed and how this would be recorded. None of the residents who have moved into the home recently could recall the pre admission Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 10 procedure but did confirm that they had been visited and were made to feel very comfortable when they arrived at the home. The home does not admit residents for intermediate care. Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 7, 8 9 & 10. Quality in this outcome are poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in health care arrangements for residents have a potential to place them at risk. Medication is generally managed well but attention is needed in two areas. Residents are treated with respect and their dignity and privacy is maintained. EVIDENCE: All residents have a plan of care but these tend to concentrate on actions taken by staff after an issue has been identified rather than preventing an issue from arising.. Five residents care plans were looked at. There was no evidence of any achievable goals being set with the input of resident to maintain their independence or improve the social care needs. There was no evidence to suggest that residents, or their representatives had been involved in the development or review of their plans. Residents when asked were unaware of care plans and said they had not been involved with Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 12 them. Residents said they were happy with the care given at the home. Two care plans included a life history of the resident that had been written by their relatives. The provider discussed plans to improve the format of care planning, which will address the current deficiency, if complied with by all staff. Staff at the home have been working closely with a skin care specialist nurse recently and improvement was seen in plans of care relating to management of issues relating to some skin problems . A member of staff has made known her interest in becoming the home’s skin care link nurse and will be supported by the providers. This will ensure that practice undertaken in the home is up to date and linked to current research. During this visit records of drinks given to two residents were not kept up to date on fluid charts. This puts vulnerable residents at risk of dehydration, insufficient nutrition and poor oral care. Some drinks, one of which was a nutritional supplement were left on the resident’s table but were recorded as having been being given. A resident confirmed that she was thirsty when asked. The fluid intake for another resident, according to the recordings, was very limited. This was discussed with the provider and a member of staff. It was confirmed that the error was most likely due to poor maintenance of the records rather that the resident not being assisted to drink. Residents have access to healthcare services that meet their needs including chiropody, opticians, dentists and specialist services such as diabetic and skin care specialist nurses. The management of medication has improved at Amberwood since the last inspection. Staff have recently undertaken training in the Safe Handling of Medicines in Care Homes. Although, during this training, the subject of the expiry dates of creams and ointments was discussed, during this inspection unlabelled creams with no expiry or date of opening were seen in two residents rooms. Creams and ointments deteriorate once opened. Current practice puts residents at risk of infection and decreases the effectiveness of the cream. Staff are aware of the home’s guidance on respecting residents privacy and dignity. Staff were seen respecting this during the inspection. Residents confirmed that most staff are friendly, kind and treat them as they wish to be treated. Throughout the visit staff treated residents kindly and there was a lot of laughter and chatting in the lounge. Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 12, 13, 14 & 15. Quality in this outcome are adequate. This judgement has been made using available evidence including a visit to this service. A varied balanced diet is provided served in a pleasant atmosphere. Some improvement is needed in developing activities which are based on individual residents needs or wishes. Residents are encouraged to maintain contact with their families or friends as they wish and their rights are recognised and respected within the home EVIDENCE: The daily routine, including getting up and going to bed and mealtimes, appeared to be flexible. On the day of the visit two residents said that they “felt like a lie in” and were confidant that staff would come to assist them when they wanted to get up. A resident has expressed their preference in relation to the gender of staff that attend them for specific care. This had been recorded and the need had been met. None of the residents spoken to were involved in local social and community activities. Residents’ interests and preferences had not been consistently recorded in their care plans. During the visit no recreational activities were planned or provided. No residents were encouraged or supported individually Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 14 to undertake any activities or interests. Many of the residents’ choice is to stay in their rooms. Many were seen enjoying watching TV or listening to music. Residents are supported to maintain their religious beliefs by staff at the home. During this visit a priest visited a resident and a visitor said she brought Communion to a resident. This information was recorded in individual residents’ plans of care. There is no restriction on visiting times and throughout the day visitors came to the home and were made to feel welcome. Staff greeted them in a kind, friendly manner and visitors confirmed that this was always the case. Some visitors chose to come during lunch to assist their relatives. Residents may choose where they want to spend time with their visitors, either in the privacy of their rooms, the quiet dining room or in the lounge. Some visitors said that although they come to visit their relatives they know so many of the other residents that they consider that they visit them all. Residents appeared to enjoy having visitors into the home. During the visit good quality, fresh, fruit and vegetables were seen and the midday meal was balanced and nutritious. The home caters for all dietary needs including vegetarian and diabetics. Residents said they usually enjoy the meals provided. The menus show a variety of meals on a four weekly rotation. However. it does not clearly show whether a good standard of nutrition is provided, as it does not list vegetables on offer. Menus are not easily accessible to residents and 3 residents said that they did not know what was on the menu. The menu does offer a choice of meal at both midday and evening. Three residents were heard to ask before lunch what they were having. They were told by staff but were not told there was a choice. Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 15 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): Op16 & 18. Quality in this outcome are adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints process. Staff have a good knowledge and understanding of the forms of abuse however improvement is needed in relation to procedures and staff knowledge of them. EVIDENCE: Records of incidents indicate that all issues are taken seriously and dealt with promptly. Residents confirmed that they feel comfortable discussing any concerns with staff at Amberwood There was nothing to suggest that residents are anything other than well cared for at Amberwood. A member of staff interviewed, and a questionnaire completed by another member, indicated that neither had been offered adult Protection training and both were unsure of the local guidelines, polices and procedures relating to the Protection of Vulnerable Adults. However, staff spoken with at the time of the visit could identify forms of adult abuse and all said that they would challenge and report any poor practice. Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 16 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): Op19 & 26. Quality in this outcome are adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a clean comfortable home. Consideration needs to be given to providing suitable facilities for the storage of some equipment at the home . EVIDENCE: Amberwood is well maintained, with homely and comfortable accommodation including pleasant lounge and dining room. During a tour of the building 3 wheelchairs and a walking frame were being stored in a toilet, effectively making the toilet unusable for residents. 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 DS0000026696.V289008.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 27, 28, 29 & 30. Quality in this outcome are poor. This judgement has been made using available evidence including a visit to this service. The number of staff on duty throughout the day and night does not always meet residents’ personal and health needs. Residents social care needs are at risk of not being met. Limited progress has been made 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. At the beginning of this visit a resident was frustrated at the time taken for staff to assist her, A call bell was not available, the resident told the inspector that staff knew her preferred routine but she was “always left her waiting”. Other residents spoken to were happy one saying “there are lots of people here and you can’t be first and last” The inspector saw staff responding to residents’ bells swiftly throughout the day. Residents and relatives confirmed that staff were kind and helpful. The staffing rota does not take into account the times of high and low activity. For example, many of the residents need assistance with eating. At mealtimes, especially the evening meal staff said that often residents had to wait for “a Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 18 while” before they could be assisted. Included in staff comment cards when asked if they could change one thing to improve the way the care home works was “ change hours of the shifts i.e. extra member of staff working 7-1pm every day,” “ laundry person to be employed”, “extra staff in the evening i.e. 5-10pm, and “ do not have enough staff on in the morning between 7-8 am, two staff have all the breakfasts, feeds and morning medication round to do”. The home employs a cook to work until 2pm daily. Care staff and a kitchen assistant are responsible for preparing residents’ evening meals. When feasible the evening meal is prepared by the cook during the morning so that care staff have only to undertake “final touches”. Throughout the day care staff are also responsible for ensuring that residents’ laundry is dealt with. There is little evidence of staff having sufficient time to meet residents social care needs. Staff confirmed this. During this visit no activities took place either in a group format or individually. The provider said that a volunteer sometimes visits residents, chats with them and plays games if they wish. Three carers hold an NVQ at level 2. Other training undertaken includes medication, fire safety, manual handling, risk assessment and Protection of Vulnerable Adults. Not all staff have received this training and therefore residents safety is not fully protected.. The provider is committed to drawing up a schedule of training needs, individual training records and to providing training for all staff. Staff at the home are eager to undertake training and were able to highlight their individual needs during this visit. Three staff recruitment files were looked at during this visit. The documentation was inconsistent with shortfalls in recording being evident. The provider is committed to improving the procedure and meeting the National Minimum standards to protect residents at the home. Individual shortfalls were discussed at the time of this visit. There was no evidence of checks being carried out for a volunteer who visits the home. Staff described their induction training when they started working at the home. This included the general layout of the home and meeting the residents. Since taking up employment manual handling training and fire training has been completed. Records of staff induction training were not available. Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 31, 33, 35 & 38. Quality in this outcome are poor. This judgement has been made using available evidence including a visit to this service. Training, development and supervision of staff is inconsistent and staff lack leadership. Lines of accountability within the home and with external management are not always clear. Some practices within the home are unsafe potentially putting residents at risk. EVIDENCE: The manager is a registered general nurse has experience in the management of nursing homes and who tries hard to work towards meeting National Minimum Standards. The lines of accountability within the home are not always clear. She plans the care at the home to be resident focused and works with residents’ families and health care professionals. Staff and relatives Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 20 confirmed that the manager is kind, caring and approachable and that she will do anything she can to make the residents happy and comfortable. The manager said that residents are consulted daily about the running of the home and that a survey of residents and relatives views has recently been undertaken, the results of which will contribute towards maintaining and continually improving the quality of care and nursing provided at the home. Staff do not currently have regular supervision at the home. This was discussed with the provider who discussed the planned process for this to be undertaken regularly for all staff. These sessions will cover issues such as identifying individual training needs, career development, philosophy of care and all aspects of practice at the care home. Records show that staff undertake regular training in the prevention of fire, fire alarms and emergency lighting are regularly checked, the maintenance person has recently undertaken a fire risk assessment for the home and a fire officer visited the home last week.[The inspector was told that no requirements or recommendations were made.] Residents are therefore well protected by these measures. An assessment of identified hazards and associated risk relating to the environment has not been undertaken. This potentially puts residents at risk if potential hazards are not identified and action is not taken to minimise the risks. On the day of the inspection hot water temperatures from the hand basins in a bathroom exceeded 55oC. This potentially places vulnerable people at risk of scalds. The provider said that a problem with the circulation of hot water had been identified and remedial work is to be undertaken. For example some radiators in hallways and bathrooms are not guarded and no risk assessments to prevent scalds have been undertaken. This was discussed with the provider who agreed that this would be undertaken by 31/12/06. The manager does not deal with residents’ finances. Some money, for such things as newspapers, hairdressing, chiropody is kept for some residents. Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 N/A 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 1 Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 22 Yes. 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 01/06/06 OP7 2 15[2][c ] [d] 3 OP8 12[1] 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. 01/06/06 The registered person shall, where appropriate and, unless impracticable to carry out such consultations, after consultation with the service user or a representative of his, revise the service users plan and notify the service user of any such revision. [This relates to residents not being included in the planning or review of their care plans.] 01/06/06 The registered `person shall ensure that the care home is conducted so as to promote and make provision for the health and welfare of service users. [This relates to maintaining consistency and good practice in relation to personal and oral hygiene] DS0000026696.V289008.R01.S.doc Version 5.1 Amberwood Nursing Home Page 23 4 OP12 16[2][n] 5 OP18 13[6] 6 OP27 18[1] The registered person shall 01/07/06 consult service users about the programme of activities arranged by and behalf of the care home and provide facilities for recreation including activities in relation to recreation, fitness and training. The registered person shall make 01/06/06 arrangements, by training staff 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 not all staff employed at the home having ungertaken appropriate training and not being aware of procedures and policies relating to the protection of vulnerable adults] 01/08/06 The registered person shall ensure that at all times suitably persons are working at the home in such numbers as are appropriate for the health and welfare of service users. [This relates to staff being available at assessed peak times during the day i.e. meal times and times when social care needs can be focused on] 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 documents specified in paragraphs 1 to 7 of Schedule 2. [This is the 3rd time this requirement has been made.] The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service DS0000026696.V289008.R01.S.doc 7 OP29 19b1 Schedule 2 01/06/06 8 OP29 12[1] 01/07/06 Amberwood Nursing Home Version 5.1 Page 24 9 OP30 12[1] 10 OP38 13[4][c] 11. OP38 13[4][c] 12 OP38 13[4][c] users. [This relates to the recruitment and selection process for any volunteers involved in the home is thorough and includes police checks.] The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. [This relates to ensuring that all newly recruited `staff receive foundation training within the first 6 months of appointment which equips them to meet the assessed needs of the service users as defined in their individual plan of care.] 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 ensuring that risk assessments are carried out for all safe working practice topics and significant findings of the risk assessments are recorded] 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 a bathroom exceeding 55oC.] 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 ensuring that all radiators are guarded] 01/07/06 01/07/06 01/07/06 31/12/06 Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP15 Good Practice Recommendations Date of expiry, or opening, should be recorded on medication when opened. [This relates to creams not being dated when opened.] The registered person ensures that a detailed menu, offering a choice of meals in written or other formats to suit the capabilities of service users, is given, read or explained to service users. Adequate storage areas should be provided for aids and equipment, including wheelchairs. The home continues to work towards achieving 50 of all care staff achieving an NVQ level 2 or equivalent. There are clear lines of accountability within the home and with any external management. 3 4 5 OP22 OP28 OP31 Amberwood Nursing Home DS0000026696.V289008.R01.S.doc Version 5.1 Page 26 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.V289008.R01.S.doc Version 5.1 Page 27 - 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. 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