Inspection on 17/09/09 for Amelia House

This inspection was carried out on 17th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Amelia House 09/10/07

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Amelia House Amelia House Coningham Avenue YORK YO30 5NH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 1 7 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Amelia House Amelia House Coningham Avenue YORK YO30 5NH 01325351100 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.southerncrosshealthcare.co.uk Trinity Care Limited care home 81 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Additional conditions: Date of last inspection Brief description of the care home Amelia House provides purpose built accommodation for up to 81 older people requiring nursing and personal care. Care for individuals with dementia is provided in two separate units, according to their dementia care needs. The home has three floors. Bedrooms, which all have en suite facilities, are on each level. There are well-tended gardens, easily accessible to people, and there is car parking at the front of the building. The home is situated in a residential area about three miles north west of the city centre. There are bus links to the city, with its major transport links. The manager told us on 17 September 2009 that the weekly fees range from £371.78 to £750.00. Additional charges are made for hairdressing, chiropody services and individual items like newspapers, and magazines. The service provides information about the home to people thinking of moving there. The Statement of Purpose and service user guide, which gives information about the home, is displayed in the reception area of the home. The manager should be approached for a copy of the most recent inspection report, completed by our predecessor, the Commission for Social Care Inspection. Over 65 Care Homes for Older People Page 4 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection for Amelia House was completed on 9 October 2007. This key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. A self assessment, called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comment cards returned by seven people living at the home, five health professionals who visit the home, and ten staff. We also received some written comments from relatives of those who live at Amelia House. Care Homes for Older People Page 5 of 36 A site visit to the home, carried out by two inspectors, over approximately nine hours, on 17 September 2009. During the site visit, several people living there, some relatives, some staff and the manager were spoken with. A number of care plans were looked at. We also looked at two staff recruitment files, some other staff records, and some records about health and safety. Care practice, and interactions between staff and people living at the home were observed. This was especially important on the first and second floors of the home, as some of the people living there find it difficult to tell us what it is like to live at Amelia House. The manager and her line manager were available at the end of the site visit, when we gave them feedback about our findings. Care Homes for Older People Page 6 of 36 What the care home does well: What has improved since the last inspection? There is a new manager in post, who wants to make improvements at the home, which should benefit the people who live there. There is a lot of work to do to build up a sense of trust after a difficult year, although her efforts are already being recognised by some. People admitted to hospital, whose plans were seen, had sent with them enough information about their current needs, so staff at the hospital knew enough to make sure that the person got the right care. People now have an assessment completed before safety rails are fitted to their bed. The rails are checked regularly to make sure they remain safe to use, and the risk assessment is also checked, to make sure that this equipment is still appropriate for the person. The staff have taken steps to reduce the risk from medication errors, which could affect peoples health, from occurring. Everyone seen was suitably dressed, and wearing socks or stockings. The home is trying to improve the activities programme. We were told the manager has talked to residents and relatives in meetings about where they would like to see Care Homes for Older People Page 7 of 36 improvements made. Extra signs are displayed on the bathroom and toilet doors on the dementia units, so those living there can recognise more easily where these facilities are. This will help to maintain their independence. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they are admitted to make sure their needs can be met at Amelia House. Evidence: People are assessed by the home before they are admitted. A key member of staff visits them, and asks questions about their current needs, and how they would like these to be met. They write this information down, so it can be shared with other staff. This helps to makes sure that people get the care they need as soon as they arrive. People and their families are also invited to visit the home before making a decision about whether it would be somewhere the person would like to live. This gives people the opportunity to meet staff, and people who they may eventually share their home with. Care Homes for Older People Page 10 of 36 Evidence: There is written information about the home which people are given a copy of. This tells them about the home, what it provides, and how. Providing this sort of information is good, because it allows people to look at this in their own time, without feeling rushed. Five of the seven people who returned their surveys said they were given enough information before they arrived, to decide whether the home would be right for them. The remaining two people did not know. The home does not provide intermediate care. Therefore standard 6 is not applicable. Care Homes for Older People Page 11 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed to make sure peoples care is properly explained, so that staff deliver this care consistently, and describe it in a respectful way. Evidence: We surveyed some people, families, and professionals about the care and support provided by the home. The response was varied, and suggested that peoples experiences are not consistent. Although one person commented Good standard of care. And one spoken to on the day said the staff are generally very kind. Relatives commented My relatives key worker is good and caring, Amelia House does most things well. My relative always looks clean, smart and well cared for. More importantly they are content and feel secure. When asked what the home could do better, they said More feedback on medical issues and information to say what has been done. Health professional comments included Cope with a challenging client group. Could do better by communicating better between different floors of the home, and improve Care Homes for Older People Page 12 of 36 Evidence: communication of some staff members, Recent care plans I have seen have been very detailed and person centred, On the whole, I noticed that staff treated the residents with respect and dignity. Prior to peoples admission, the staff complete a draft care plan. Once people move in, more in depth assessments are completed, covering peoples physical and social needs and risks to them. From this, a care plan is developed, which is regularly reviewed. Peoples relatives attend periodic reviews. This helps to keep those involved in the persons life, up to date about any changes that may have been necessary to make sure that their needs continue to be met. Staff said that they read the care plans when they can. However, those spoken with were satisfied that they get a good report before they start their shift, so they know where peoples needs have change, and how. We made a recommendation at the last key inspection that the staff should consider gender preference when asking people how they would like to receive their care. Whilst staff gave us an example to show how this was taken into account, this preference is not yet included in peoples care plans. This should be done, so peoples choices are consistently known. On the dementia nursing unit, the care plan seen was good. The persons care had been reviewed by the care manager, who had no concerns about their care. Areas of risk had been discussed with other professionals, and this was being regularly monitored. We suggested that, at the forthcoming review, the staff should suggest dietitian advice, although professionals were already aware of dietary problems. This persons prevailing mental health needs need to be kept under review, so that staff can be sure that they are providing the right support. The middle floor provides personal care only for people with dementia. Information seen in the care plans did not say enough about the persons needs, or where they may need support. For instance, in one, the draft care plan was not completed properly, a moving and handling risk assessment had not been done, and the plan about mobility made no reference to the persons high risk from falls. Other identified areas of need had not been included in the persons care plan. For instance, in relation to their dementia, and nutritional risk. This could increase the chance of these needs being overlooked. There was a care plan which said that this person suffered pain, but there was no information about why, or where, and what signs staff should look out for which would tell them that the person may need pain relief. The persons emotional needs were not supported in the care plan. Care Homes for Older People Page 13 of 36 Evidence: The daily records were disrespectful. One of these read xxxx deserved an Oscar this morning, fainting in front of myself and xxxx. And xxxx has lost the use of her arm today. Needed to go to the doctor or to the hospital!. When the person had become distressed, there was sometimes no information in their notes as to how they had been comforted by staff to allay any fears or anxieties. Visiting professionals had asked for a nursing care assessment to be completed for a person, because this person had some regular nursing needs which they though would be better met by the home. Despite this assessment agreeing that funding for nursing care would be awarded, the person was still receiving this part of their care from care assistants. Although they had received some training, this is not appropriate when nursing staff are employed in the home. The manager has told us that this has now been put right. The care plans seen on the ground floor gave information about peoples needs and risks to them, although these could sometimes have been expressed in a more individual way, and in more detail. The instruction to assist with personal care as necessary, does not fully explain what help is needed, or preferred, for the person concerned. A visitor to this floor thought that the care was very good. Another said the care is generally OK, and commented For the money we pay, it is not as good as we expected. They said Were happy that xxx is warm and fed, and someone will pick xxx up if they fall. They felt that the service was adequate. They continued though that they cant fault individual staff, saying that the culture and attitudes of staff is good. Care staff on all floors spoke with people in a patient, supportive and respectful way. They made sure that peoples dignity was protected when offering help. This helps to uphold peoples self esteem. Since the last key inspection there has been one reported medication error. The information provided told us what steps had been taken to see how this error had occurred. Medication is now checked every day to make sure that the stock balance for each individual is correct. There are separate medication systems for each floor of the home. Medication is administered by nursing staff for those people living on the nursing units. On the middle floor, where people with dementia are admitted for personal care only, their Care Homes for Older People Page 14 of 36 Evidence: medication is administered by care staff who have completed medication training, so they know how to do so safely. At this site visit, the records were generally well managed, and the systems in place helped to reduce the risk from error occurring. A health professional said they had recently had concerns about the management of a particular medication. The manager said that she was already aware of this, and the records showed that action is being taken to make the management of this better in the future. Care Homes for Older People Page 15 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Steps are being taken to meet peoples social needs. More work is needed to make sure peoples choices are considered, and that the menu meets their requirements. Evidence: The home told us they have worked very hard over the last months to provide and improve upon a range of social activities that are advertised. These include arts and crafts, exercise games, musician, one to one time, outings to the supermarket and reminiscence. On the day of the site visit, some people on the middle floor played with a balloon, which was passed between them and the activities organiser. Some enjoyed a ride out into the grounds, to get some fresh air. The hairdresser visits the home regularly. We received a comment that the hairdressing was not particularly marvellous, and another that peoples hair was not always washed when they get their hair done. We observed that this was not the case of on the day of our site visit. The manager said this concern had already been raised with her, and that she has dealt with it. There are regular religious services held at the home. The staff member spoken to on the top floor was not certain that people from there attend the service, or were invited Care Homes for Older People Page 16 of 36 Evidence: to do so. Everyone should have the opportunity to have their spiritual needs met. People had mixed views about the activities on offer to them. One person who returned their survey said there are always activities. One thought there never was. Four said there sometimes are, and one said there usually is. One person said on the day that they spent a lot of their time sitting in the reception area. They said There isnt much happening. Relatives commented Regular activities have not happened, although some renewed efforts are being made, Because staff are under a lot of pressure, there is little time for them to engage residents in say, a simple game or something. When asked what the home could do better, they made comments like Better activities, although this is being resolved, Stimulation, sing songs, sensory/touch etc. A visitor said there was never much happening on a weekend. When they enquired, they were told that things would get better. However, they said that home was not there yet. However, people can have their visitors when they wish. Staff said they try to give people choices in their daily lives. They gave examples such as when people with to get up and go to bed, what they would like to wear, and what they would like to eat. A visitor said that their relative often refused a bath on a morning. They asked Why cant they (staff) do this on a night?. They have raised this at reviews, and have been told that things will improve, but tell us they dont think they have yet. Another said that their relative much prefers a bath to a shower, but said they have had been offered only two baths in two years. We had concerns as to whether a persons liberty was being restricted. They were locked out of their room during the day, and the door was kept locked at night when they were inside. Although we were told the person could unlock the door, their risk assessment for night time did not tell staff what to do in the event of a fire when the door is locked. We asked the manager to amend the risk assessment straight away, and to ask for a proper review of this person by the local authority, to make sure that this persons choices have been fully taken into consideration. We have been informed that this has been done. Another persons records told us that staff had removed their telephone from their room, without their permission. Staff should not be doing this, unless a formal assessment has been completed which explains why this action is necessary, as it stops people from maintaining contact with their family and friends. The menu choice is displayed on each unit. The mealtime we observed was relaxed, Care Homes for Older People Page 17 of 36 Evidence: and there appeared to be sufficient staff to assist those who needed help, so they were not rushed. The dining rooms were nicely set out. Some people had adapted cutlery so they could manage their meal more independently. People on the ground floor were offered wine with their meal, although a comment suggested that this is not a regular event. Peoples views about the meals differed. A relative said The food can be variable. And another said the food was atrocious, poorly cooked, and the meat difficult to cut. One person said that, although the food is now consistently hot, sometimes they do not get enough. On the day of the site visit one person had to ask for more. On one occasion, we were told someone had not been offered their tea time meal, and their family had to complain about this. A recommendation was made at the last key inspection that It would be good practice to regularly offer cold (or hot) drinks to people to make sure they are drinking enough each day. On the day of this site visit, people were offered between meals a choice of hot or cold drinks, including milk shakes, and snacks, cake and a small selection of fruit. There was also a supply of cold drinks in some of the communal areas. Though these were not used on one floor by lunchtime. One person said If theyre short staffed at 10am or 3pm, then you dont get a drink. Another said Im dying for a cup of tea. You can have a cold drink if you want one. In one persons room, although they had a jug of water, they had not been given a glass. Staff must remember to offer drinks to people regularly during the course of the day, so those who may not recognise that they are thirsty, can be well hydrated. The supper time menu states that people will be offered sandwiches. One person said they had never been offered these, and that their family brings them in snacks, to make sure they are not hungry. The kitchen staff confirmed that sandwiches were not made any more, because they were being thrown away. Everyone should be offered supper, so that the gap between tea, and breakfast the following morning, is not too great. The main meal of the day was not served on a full sized plate. The manager said that people are offered three cooked meals a day, so are provided with plenty of food. She did not feel that there was anyone with problems caused by weight loss. However, the size of the plates may cause problems for people with limited dexterity, who may find it more difficult to cut up their food, and move their meal around on the plate easily, and independently. Care Homes for Older People Page 18 of 36 Evidence: We visited the kitchen, and spoke to the cook. There was plenty of fresh vegetables, and some fresh fruit in stock. We were told that daily deliveries are made to the home of fresh meat. The cook said they put extra nourishment in meals for people who have problems with their nutrition. However, thy did not know that there were people living at the home with diverse religious needs, who may have special dietary preferences in order to meet their faith. The manager said one such persons choices had been discussed with their relatives. People themselves should be consulted wherever possible, to check they do not have any dietary preferences. Care Homes for Older People Page 19 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot yet be assured that the home will act consistently in response to complaints and allegations. Evidence: All seven people who returned their surveys said that they knew who to speak to if they were not happy. They all said that they knew how to make a formal complaint. Of the health professionals who returned their surveys, one said the home always responded appropriately if they had raised concerns about the service. Three said this was usually the case. People get a copy of the complaints procedure in the service users guide. This procedure is also displayed at the home, so people can be reminded about what course of action will be taken if they raise any concerns about the service. There have been twelve complaints made to the home since November 2008. These involved issues around care, shortfalls in staffing, poor communication from the home, whether people received enough to drink, disputes over fees, (sometimes where it was felt the service people got did not reflect the rise in fees), lack of equipment, and the fact that one persons room was found to be dirty more than once. Some of these complaints had been responded to. Others had not, as one complainant in further correspondence to the home has pointed out. A more recent complaint, Care Homes for Older People Page 20 of 36 Evidence: received at the time that the new manager was formally taking over, had not been responded to at all by the company. The commission has also received information, which we have referred to social services, sometimes where complainants, who have originally gone to the home, have not been satisfied that their concerns have been taken seriously and acted upon. On the day of the site visit, a visitor told us they had complained to the manager a few weeks earlier, but no record had been made in the complaints file. We were told they had not yet received a response. This approach to complaints is not satisfactory, and will stop people from having faith in the company, and will make people believe that their concerns are not being taken seriously. Our predecessor, the Commission for Social Care Inspection, completed a random inspection in February 2008, after we received a complaint about shortfalls in care and concerns about lack of staff. We asked the home to take action in some areas where shortfalls were found. There has been a number of meetings held by the local authority since the beginning of 2009, after they have been alerted about allegations about abuse, or where issues have arisen, between people living at the home where their actions towards each other have caused them harm or upset. These meetings continue, to discuss how, and if, people are being properly safeguarded. Staff have not been consistent in when they report, and who they report to. This has the potential of slowing down any investigation, and making sure that immediate action is taken to protect people. A health professional who responded to their survey said Amelia need to be very clear on what to do should there be a safeguarding incident - ie who to inform, when and why. Staff have received training to help them understand what constitutes abuse, and what action they should take should they believe that someone living at Amelia House has not been treated properly. The majority spoken with knew that they had a responsibility to report issues straight away. Although one staff member said that they would report the matter depending upon the level of seriousness, and another suggested they may examine the person before reporting the incident. This is not a decision for staff to take, who must be clear that they must report all matters, whatever they have been told, or whatever they have observed. Care Homes for Older People Page 21 of 36 Evidence: Some staff were not sure about the role of the local authority, who they can report to at any time, should they not wish to pass this information to a member of the management. And a trained member of staff was not entirely clear about how urgently an allegation brought to their attention should be passed onto the on call manager, if the incident happened out of hours. Although they knew about the role of the local authority, their contact number was not readily available. To keep people protected from harm, all staff need to know how and when to report any allegation of abuse, so that all safeguarding alerts are passed on quickly and professionally in all situations, and the appropriate measures taken. Care Homes for Older People Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment meets peoples needs. Evidence: Three of the people who returned their survey said that the home is always fresh and clean. Three said this is usually the case, and one that it is sometimes the case. One person commented that the home was clean, smart and tidy. A health professional commented that Amelia House provided good accommodation. The accommodation is on three floors. The ground floor provides general nursing care. The first floor provides personal care only for people with dementia. And the second floor provides nursing care for people with dementia. There is a choice of communal sitting areas, and a dining area on each floor. A visitor to the top floor commented The cleaner keeps the floor spotless Everyone has their own bedroom, which has their name on the door, and a door knocker, which suggests to staff and visitors to knock before they enter the room. All rooms have an en suite with a walk in shower facility. This means that people do not have to leave their own room when they receive their personal care. On the dementia units, there are sometimes pictures of the person, or their family, on the persons bedroom door. This helps to make it more easy for people to recognise Care Homes for Older People Page 23 of 36 Evidence: their room independently. There are a range of communal bathrooms and toilets, and equipment for staff available to help move people who are unable to manage themselves, more easily. The laundry systems were good. Staff working there are provided with equipment, such as disposable gloves and aprons, to protect themselves, and also to reduce the risk from cross infection. Linen is delivered by each unit, and washed separately. This helps to stop peoples clothing from going missing. Care Homes for Older People Page 24 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Efforts being made to make sure there are enough staff to provide consistent care are not being recognised by everyone yet. Improvements to the recruitment process are needed to assure people they will be protected from unsuitable workers. Evidence: People, and the staff who care for them, had mixed views when asked in their surveys whether there were sufficient staff to meet peoples needs. One said that staff were friendly and helpful, but that the home could do better if they were to increase the number of staff, and improve continuity of staff to ensure staff are familiar with patients. On the day, one person said There were more staff when I first came than there are now. When they needed help, this person said they normally shout, because they are unable to reach the call bell, but that they (the staff) dont always hear. Staff made comments like The home could do better if the sickness among the staff was reduced, especially at the weekends, Reassess residents according to dependency levels and maybe look into the staffing levels, and More staff needed to assist residents. We also spoke to staff on the day. One staff member said that there were now more staff, and that the shifts were running a lot more smoothly. Another said there were a lot more staff than last year. Relatives said things like Im not sure there is enough back up when staff are ill, and Care Homes for Older People Page 25 of 36 Evidence: Friendly staff, usually, unless they have been working a lot of shifts with no days off, then they are disgruntled. When asked what the home could do better, relatives made comments like Better recruitment of staff. A cleaning member of staff could be cleaning one day - a care assistant the next, and More staff, more training. One visitor spoken with wondered whether there were sufficient staff available at night. Another reported a lot of staff changes. Whilst a third said that, although things were improving, this improvement was not always consistent. They told us about one day recently which they described as a dreadful day. No staff. We were told by the manager that staffing at the home has been increased. She said that she also plans to have an extra member of staff on duty at night. She said five extra care assistants and a qualified nurse have been recruited, and she awaits clearance following the necessary employment checks, to make sure that these people are suitable workers. She confirmed that agency staff are being used much less than previously. This will help to keep care more consistent. We looked at the duty rotas, which show that, on the whole, staffing levels are maintained at the level set by the company. However, the company must consider whether the large number of incidents which have been reported the the Care Quality Commission and the local authority, where people have presented with behaviour which has challenged others, or affected their welfare, could be avoided with better staffing levels. Staff who returned their surveys all agreed that they were properly recruited before they started to work at the home. But their views about the quality of their induction after they started differed. However, most thought that they were being provided with relevant training, and that the manager gave them enough support, and that she met with them regularly. We looked at two recruitment files for two recent recruits. These showed that some improvements are needed, to make sure people are properly protected from unsuitable workers. In one case, a trained member of staff had been allowed to work at the home unsupervised before their full police check had been returned, and without having received a reference from their current employer. In the second, the care staff member had been allowed to work at the home before their full police check had been returned, and without any formal supervision arrangements having been put into place. This persons application form showed unexplained gaps in their employment history, which had not been explored. Gaps should always be checked, to confirm whether these gaps could preclude them from Care Homes for Older People Page 26 of 36 Evidence: being suitable to work with vulnerable people. Care staff receive some training to help them understand peoples needs. Some have received training in dementia care, and how to approach behaviour which challenges others. A staff member spoken with said they get supervision, and awaited their forthcoming appraisal, when they would be discussing future training opportunities to help them in their work. There is also a rolling programme in place for staff to achieve national Vocational Qualifications in Care. This is good, because it will help staff to work consistently, to the same agreed good standards. Trained nurses have also received some training to help keep them up to date with current good practice. One confirmed they had attended training in wound management, special feeding techniques, and blood taking in the past year. Although comments from health professionals included that The staff have appeared to have lost their confidence and I feel need to be more supported by their managers, and There seems to be a lack of commitment from the homes management with regard to providing training for nurses in areas such as catheter management, nutritional assessment and management of syringe drivers. Care Homes for Older People Page 27 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems at the home are showing signs of improvement. However, people will need assurance over time so they can be confident that these systems will be sustained. Evidence: There have been some concerns raised about how the home has been managed, since the beginning of 2009. These have been discussed at meetings attended by the local authority, the Care Quality Commission, and also the company which owns Amelia House. There is now a new manager in post, who has held this position since March 2009. She is a qualified nurse, with previous experience in the management of care homes. She must apply to be registered with the Care Quality Commission, so people can be assured that she has been assessed as being a suitable person to run the home. She wants to make improvements to the home, but still has work to do to satisfy people that Amelia House provides a safe and consistent service for those who live Care Homes for Older People Page 28 of 36 Evidence: there. One relative commented There are lapses when there are management/staff changes, and when key staff are not in. Another thought that the home needs to improve communication between the home and us, and let us know whats going on. But, they felt that since the new manager took up post, there were more notices around the home. The evidence in Complaints and Protection section shows that more work is needed to restore peoples faith in the service. However, the majority of feedback about her contribution to the smooth running of the home was more positive. We spoke to a relative on the day, who thought that things at the home had improved since this manager took up post. They said she had made a difference, was always there, that issues are dealt with quickly, and that communication has improved. Other comments included The new manager is implementing new ideas and strategies to make improvements, The manager is supportive, and its good that a deputy has been appointed, and The home has monthly residents meetings where issues can be raised. A person living at the home said Improvements seem to be taking place. Very pleased with the new deputy manager who is enthusiastic and keen to improve the systems. Another said New staff and manager fitting in really well. Approachable. Staff were asked about the manager, and what changes they had seen since she took up post. We were told real improvements,I feel, since change of management they are addressing issues and improvements to the home are in progress, shes concerned about the residents, very good, nice to talk to, and always walking around, approachable. One staff confirmed that there was now good communication between staff and managers. Another said I feel, since change of management they are addressing issues and improvements to the home are in progress. A relative said that, unless they seek answers, then nobody updates them. However, we were told that a more senior member of management visits the home regularly, to check the progress that is being made there, to support the manager, and to make sure that standards do not slip. The manager now holds relatives and residents meetings. The records from these meetings suggested that there have been no specific issues of concern raised recently. Relatives have also completed satisfaction surveys. The manager had displayed her feedback from the most recent survey to areas which relatives thought could improve. These were around staffing levels, and the activities. Care Homes for Older People Page 29 of 36 Evidence: People living at the home have not been surveyed. Their views are more important than anyone elses, and should be sought, so they can be assured that the home is running in their best interests. The key areas where this should be focused are around staffing, activities, choice, and the provision of fluids and menu. Visiting professionals should also be formally asked their views, as their input may also identify areas of excellence, or where improvements are needed, in the running of the home. The home will manage peoples personal allowance on their behalf if this is requested. The records kept by staff about peoples accounts were clear. In addition, people have a locked drawer in their room, so if anyone wished to keep valuables, they have somewhere safe to lock them away. The information provided before this site visit showed that the home is kept maintained. We looked at a sample of records at the site visit. These identified that in house checks are also performed regularly, to make sure that the environment remains safe for people. The fire officer visited in June 2009, and found the fire safety systems at the home were satisfactory. Some recommendations made by them were acted upon quickly. The Environmental Health Officer has also visited, and again, all minor requests for improvement have been actioned. Staff receive a range of compulsory training so the know how to work in a safe way. For instance, in the case of fire, or where people need help to move. We looked at the training records which showed some gaps in this training, which the manager said were being addressed. However, the majority of staff had received an update this year. The sluice on the top floor of the building was unlocked. The hot water in there is not regulated, so is very hot. The staff locked this straight away, so people living there who should not have access to the room, cannot enter. This will help to keep them safe from scalds. A designated staff area on the top floor, which should be kept secure, was also unlocked. Behind this door, there was equipment left on the floor, which posed a trip hazard. The staff member moved the equipment at the time, and locked this area. This should remain locked so risk to people is minimised. People taken out from the home in the wheelchair did not have their feet correctly placed on the footplates. This could have caused an accident should the persons feet have become trapped. Staff must make sure that this equipment is used safely. Care Homes for Older People Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Peoples care plans must 30/11/2009 include all areas of identified problems, and risk to them. They must explain how staff must approach the persons care so this is done consistently. This will help to make sure that people are kept safe from avoidable risk. 2 10 12 Staff must never be disrespectful when writing peoples personal records. This will help to make sure that a philosophy of respect and dignity is fostered towards people at all times. 31/10/2009 3 14 12 In the absence of a proper professional assessment to assess the persons capacity, staff must not make decisions about peoples care which affect their liberty. 31/10/2009 Care Homes for Older People Page 32 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is so that peoples rights to exercise choice and control over their lives is not compromised. 4 15 15 People must be provided with a regular supply of hot and cold drinks of their choice. This is so they do not get thirsty, and remain well hydrated. 5 16 22 All complaints must be responded to, and a record kept of the action taken by the home in respect of the information provided. This will assure people that their complaints are taken seriously and acted on. 6 18 13 Staff at all levels must 30/11/2009 receive more training, in line with local authority guidelines, about what constitutes abuse, staff responsibilities in reporting this, and to whom. This will help to make the reporting of allegations of abuse better, quicker, and more consistent. This action will help to protect people. 31/10/2009 31/10/2009 Care Homes for Older People Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 27 18 The staffing levels must be reviewed, taking into account peoples dependency, and their views. This will make sure that there are sufficient, suitably qualified staff available at all times of day and night to meet their needs successfully. 30/11/2009 8 29 19 Full and proper employment checks must be completed before prospective staff are allowed to provide care to people. This will help to protect people from potential unsuitable workers. 30/10/2009 9 38 13 Areas of the home which, if accessed by the people living there could cause them harm, must remain locked. This is so people live in a safe environment. 31/10/2009 10 38 12 Staff must make sure that peoples feet are properly positioned on their wheelchair footplates. This is to prevent the risk from avoidable accidents. 31/10/2009 Care Homes for Older People Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Further advice should be sought at the forthcoming professional review of the person discussed at the site visit, to check whether input from the dietitian may be useful in supporting this persons prevailing nutritional needs. People assessed as having nursing needs should have these needs met by qualified nursing staff. This is so they can be assured that these staff have been formally assessed as being competent, and that they will be able to identify where further advice is needed. 2 10 Peoples choice about whether they would rather have personal care by someone of the same sex should be considered as part of their care plan, and applied more consistently, so that their wishes are met. Peoples personal choices should always be considered, and every effort made to meet these. For instance, about making sure people get a bath regularly, rather than a shower, if this is their choice. The views of people about the meals should be sought, to check that they are satisfied with the choice and quantity on offer, and to seek their views about the supper time menu. People whose religion may affect their dietary requirements and choices should be asked what the home needs to do to meet these needs, which should then be met. 3 14 4 15 5 33 People who live at the service should be asked about their views in relating to the way the home is run, as should those of visiting professionals. Their views should be considered when deciding how the home should be run in peoples best interests. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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