Inspection on 01/08/06 for Amerind Grove

This inspection was carried out on 1st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Amerind Grove 07/01/09

Amerind Grove 17/06/08

Amerind Grove 28/08/07

Amerind Grove 06/12/06

Amerind Grove 26/01/06

Amerind Grove 04/07/05

Amerind Grove 25/01/05

Amerind Grove 09/08/04

Amerind Grove 23/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Amerind Grove Picador, Regal, Embassy, Capstan & Kingsway 124-132 Raleigh Road Ashton Bristol BS3 1QN Lead Inspector Vanessa Carter and Melanie Edwards Key Unannounced Inspection 1st – 4th August 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amerind Grove Address Picador, Regal, Embassy, Capstan & Kingsway 124-132 Raleigh Road Ashton Bristol BS3 1QN 0117 9533323 0117 9533406 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) www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Veronica Marsh Care Home 150 Category(ies) of Dementia (60), Dementia - over 65 years of age registration, with number (60), Old age, not falling within any other of places category (90) Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Embassy House may accommodate up to 30 persons aged 65 years and over receiving residential care or nursing care. Staffing Notice dated 13/8/1998 applies Picador House may accommodate up to 30 persons with Dementia (DE or DE(E) aged 50 or over The Manager must be a Registered Nurse RN1 or RNA on the NMC register The Registered Nurse in charge of Picador Unit is appropriately qualified to meet the mental health needs of service users who reside there. Capstan House may accommodate up to 30 persons with Dementia (DE or DE(E)) aged 50 or over The Registered Nurse in charge of Capstan Unit is appropriately qualified to meet the mental health needs of Service Users who reside there. 26th January 2006 Date of last inspection Brief Description of the Service: Amerind Grove is a 150-bedded BUPA care home, situated in the residential area of Ashton, approximately four miles from the city centre of Bristol. The home is situated within walking distance from the local shops, and is on a local bus route. The home is a purpose built care home, designed specifically to meet the needs of elderly and disabled residents. The home is split up into five houses, each with 30 beds and their own character. The five houses are each of bungalow design with level access, via their own entrance. The home manager, administrative and ancillary staff, all work from the main part of the home. Car parking for visitors is available in front of all houses. Three of the houses are registered for nursing care and two for Elderly Mentally Infirm nursing care. All bedrooms are for single occupancy. The manager has been in post since May 2005, having previously been the registered manager of a smaller, BUPA care home in the Bath area. The cost of placement at the home ranges between £348-620 per week and is based on individually assessed needs. Additional charges for a number of items are listed in the home’s brochure. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced, undertaken by two CSCI Inspectors and took place over four days. The CSCI Pharmacist had previously visited the home, and a separate report has been prepared in respect of medication procedures. There have been a number of concerns raised by families of some residents, social services and hospital staff, concerning standards of care at the home, therefore the visit to the home was brought forward to ensure that the home is complying with the Care Standards Regulations and the National Minimum Standards. As a result of this inspection a number of requirement notices and recommendations have been issued. A number of additional visits have been made since the last inspection. Evidence has also been gained from:• a tour of all five houses • speaking with a number of residents in each house • speaking with some relatives • speaking with four out of five of the house managers • speaking with the registered home manager • speaking with care staff, ancillary staff and registered nurses • looking at the home’s records. The home varies considerably throughout the five houses, with different management styles, staff attitudes and quality of care being provided to the residents who live there. Where significant shortfalls in one house have been highlighted, the quality rating for that standard or outcome area has been based upon this, and applies to the whole home. The overall analysis is that the home provides a poor service with a number of areas of serious concern. During the inspection one of the fire exits in Picador House was temporarily blocked off, but this was promptly resolved. Seventeen requirements have been made along with this report. An improvement plan will be requested with the aim of raising standards and stamping out bad practice. What the service does well: Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 6 The home has a designated team of Activities Organisers who work between the five houses and provide a range of activities. Residents are assisted to move between the houses to attend those sessions that they wish to. The home has a Complaints Procedure that is well publicised and the manager maintains clear records to evidence what measures were taken to bring about a resolution to any complaints or concerns made. Whilst this is good, there have been an increasing amount of concerns of a serious nature raised directly with CSCI. This has been referred to throughout the body of the report. Residents live in one of five houses. They are each comfortably furnished and equipped and generally well decorated and carpeted. Residents are encouraged to bring in any items of furniture they want and to make their private bedroom their own. All bedrooms are for single occupancy. There is a rolling programme or refurbishment and Kingsway house is to be redecorated and re-carpeted next. The homes provide a good induction programme of training for all new recruits, overseen by an experienced house manager. This means that the residents will benefit from staff who are aware of their role and what is expected of them. What has improved since the last inspection? What they could do better: Three requirement notices were issued following the last inspection, but the home has failed to consistently meet each one. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 7 Whilst each resident has an individually prepared plan of care, omissions in the plans for each person has the potential to mean that they may not get all of their needs met. A notice requiring that each resident must have a comprehensive care plan, covering all identified needs, detailing what actions the care staff need to take has been issued to the home on two previous occasions. Further non-compliance with the Care Standards Act could lead to further enforcement action. The home must address the problems of malodour in parts of the home. This was particularly noticeable in Picador House, however Kingsway was unclean in some of the bedrooms and some parts of the communal areas. The quality of record keeping remains inconsistent. Records maintained by the staff must be accurate and appropriate. There were examples of entries made in the wrong resident’s notes, vague statements about the care being provided to a resident on a day-to-day basis, inaccurate recordings where healthcare needs are being monitored, and care plans containing meaningless statements. In addition to the improvements required in these areas, 17 other requirements notices have been made. The home must improve their pre-admission assessment processes and ensure that they have all the necessary information about the person, to ensure they can meet all care needs appropriately. The home must improve the quality of service they provide, particularly for very poorly residents, as family, social services and the health authority have raised concerns of a serious nature, on many occasions. Between the five houses there is an inconsistency in the level of supervision provided on a daily basis to the junior members of staff, who provide the “hands-on” care for the residents. The home must ensure that when ‘end of life’ care needs have been identified, there has been appropriate communication between the resident/family/GP/home, and that clear and detailed records are maintained. These shortfalls have the potential to place the residents at risk from not having their health care needs met appropriately or adequately. Residents are not always cared for with respect to their dignity and privacy and the attitude of some staff members has been questioned by relatives who have made complaints to the home. Improvements must be made in the way the residents are cared for and in order to do this, the home has already recognised the need for “Customer Care Training”. The management style in each of the five units is different as would be expected, however whilst Capstan and Regal benefit from strong leadership, the other houses do not have the benefit of such. Kingsway house is disorganised and chaotic, and CSCI has previously dealt with concerns about both Picador and Embassy, where the competence of the Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 8 house managers has been questioned. On these three units there was a noticeable lack of supervision of the care staff and the delivery of care to residents. These shortfalls have the potential to place the residents at risk from not having their health care needs met appropriately or adequately. 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. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 9 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 Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 10 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): 1, 3, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information about the home and should be able to make an informed choice about where they want to live. Improvements are required to pre-admission assessment processes, and the information they obtain to ensure care needs are met. EVIDENCE: The Statement of Purpose has not been changed since the last inspection and remains a true reflection of the services and facilities at the home. Residents are provided with a Service Users Guide, and copies were seen, placed in BUPA Care home folders, in most of the bedrooms. There were copies of the last CSCI inspection report, placed in the main reception area and the entrance area of each unit. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 11 The home receives copies of social services and healthcare assessments, where appropriate, as part of their information gathering process when they are assessing prospective residents suitability for placement. A BUPA Care homes pre-admission assessment tool is used and this is comprehensive, ensuring that a full understanding of each person’s needs is determined. Either the home manager or any of the house managers will complete these assessments. The home must ensure that these assessments are signed and dated by the person who has completed them to validate when they took place. The home must always be provided with a “hospital discharge summary”, including a list of the current medications prescribed, for newly admitted residents. This will ensure that their healthcare needs are met appropriately. Since the last inspection, the home admitted a person without the appropriate information and this led to a medication error being made. The records of one other person were examined, who had recently returned to the home following a period of hospitalisation, and again no discharge summary was provided. This is not good practice on the part of other parties, however the home must ensure that their subsequent actions do not endanger the resident. The home provides placement for those with general nursing needs or specific dementia care nursing needs. Residents with a dementia will be looked after in either Picador or Capstan, but may well be looked after in the general nursing units, (Regal, Embassy or Kingsway), if their nursing needs outweigh their mental health needs. Relatives are encouraged to look around the home before placement is offered and where possible, the prospective resident themselves. In most cases however, people move into Amerind Grove directly following a hospital stay. Placements are always offered on a one-month trial basis with a review meeting held at the end of this period. Some residents will need longer than this to decide if the home is right for them, and on occasions an extension of the trial period is required. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 12 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): 7, 8, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are major shortfalls in the home’s care planning processes and delivery of service to it’s residents, meaning there is the potential that residents will not have their care needs met. EVIDENCE: Whilst each resident has an individually prepared plan of care, omissions in the plans for each person has the potential to mean that they may not get all of their needs met. A sample of plans was studied on each unit. In Capstan each plan addressed the physical and psychological health care needs of that resident. Care plans had been written based on information obtained from the individual’s assessment. There was clear information stating how to assist with specific needs. In Regal the plans were detailed and gave clear instructions and guidelines for the staff to follow. For one resident there was a very clear plan about what procedures must be followed when the person was eating. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 13 However, in Kingsway, a resident had been in the home for a week but had no care plans whatsoever, and no ‘baseline observations’ had been recorded. For another resident their wound care documentation was kept in an alternative file but there was no indication of this in their main file. This same resident had no plan regarding specific pressure area care despite them being at very high risk of developing further sores. In Embassy, one person had no continence plan despite having obvious needs. The plan for one resident had recently been audited, by the BUPA quality and development manager – this plan was in order and gave clear instructions on how the care needs should be met. One plan required updating as the resident had just returned from hospital and their needs had changed significantly. In Picador, the plans lacked specific details about the resident and the levels of confusion and what assistance was necessary. The care plans did not include clear, easily understood information to inform staff what actions they needed to take. There were no strategies in place to deal with any challenging behaviour. Alongside the care planning documentation, risk assessments are completed in respect of the probability of falls, nutrition, likelihood to develop pressure sores and manual handling procedures. From the manual handling assessments a safe system of working is devised – there was a lack of consistency, even within the house, about where these ‘safe systems’ forms are located. Staff spoken to were uncertain and said “we just know who needs hoisting and who doesn’t”. There was no evidence when the systems of work are reviewed. This shortfall has the potential to place residents at risk from being moved in an unsafe manner. Care plans had in general been reviewed and updated on a regular basis, apart from on Kingsway where the task had fallen by the wayside. Some of the recorded comments were perfunctory – “care plan remains appropriate” for instance, whereas others were more detailed and evidenced that thought had been given to what was being written. A daily record is maintained for each resident. The quality of daily recordings varied considerably – whilst some detailed the person’s daily health and welfare, others said “all care needs met”. For one person who has only lived in the home for 1 day, it was recorded they were having a “usual day”. A record is kept for each resident, of GP and other healthcare professional contact, the reason for the referral, and any outcomes from this, such as what treatment may be required. Examples include chiropody, dentists, opticians and dieticians. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 14 Where the home needs to monitor certain health care functions, for example diet and fluid intake, urinary output, bowel function, and weight, this is not consistently undertaken. On Kingsway, those residents who were having their fluid intake and output monitored, had no recordings made overnight and no “actual” amounts of urine output recorded. This is very poor practice and shows a lack of basic nursing skills and care. CSCI have recently undertaken an investigation on Embassy unit and determined that the staff were not adequately monitoring the health care needs of very poorly residents. There was also evidence that the home failed to monitor, or take appropriate action when a resident’s health deteriorated. The home must improve the quality of service they provide, particularly for very poorly residents, as family, social services and the health authority have raised concerns of a serious nature, on many occasions. Between the five houses there is an inconsistency in the level of supervision provided by registered nurses on a daily basis to the junior members of staff, who provide the “hands-on” care for the residents. During this inspection, supervision was only evident on two houses – Capstan and Regal. The CSCI Pharmacist has recently visited all five houses and looked at procedures for the ordering, receipt, storage, administration and disposal of medications. A separate report has been written and a number of requirements have been made. One observation made during this inspection, concerned the lack of basic hand hygiene during a lunchtime medication round on Regal House. Residents are not always cared for with respect to their dignity and privacy and the attitude of some staff members has been questioned by relatives making complaints to the home. An outcome from a recent investigation highlighted that residents on Embassy are spoken with in raised voices “because they are deaf” - subsequently Deaf Awareness training has been arranged. One care assistant commented before attending that they had been told, “we have to attend”. Comments from residents spoken to during the course of the inspection were varied - “ they are all so good to me” and “the girls always know best and they won’t listen to what I want”. Observations made during the course of the inspection include a situation where a house manager interrupted a care assistant who had been sensitively attending to a resident and a conversation then proceeded over that resident’s head. Improvements must be made in the way residents are cared for and in order to do this, the home has already recognised the need for “Customer Care Training”. The home must ensure that a resident’s belongings are cared for, as part of the overall care service they are provided with. Residents must be provided with assistance when they need help to pack away their belongings. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 15 The home must ensure that when ‘end of life’ care needs have been identified, there has been appropriate communication between the resident / family / GP and home, and that clear and detailed records are maintained. These shortfalls have the potential to place the residents at risk from not having their final wishes met appropriately or adequately. The home needs to look at their “end of life” care planning processes, as this will only be meaningful if it is relevant to that individual. Two such plans looked at on Embassy unit were identical and had obviously been ‘lifted’ straight out of some guidance notes. One persons plan stated “their religious needs were to be met” with no indication of how this was to be achieved. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to participate in a range of meaningful activities or spend their time as they wish, and are provided with well-balanced and nutritious meals EVIDENCE: The home has a designated Activities Organiser who works between the five houses and provide a range of activities. Residents are assisted to move between the houses to attend those sessions that they wish to. Many of the residents expressed their wish not to participate in the activities preferring to spend their time reading or watching television in their own rooms. There was information displayed in the Home informing residents about forthcoming events and activities. The ‘music man’ visits the Home on a regular basis for recitals. The home has recently had its Summer Fete and friends, families and local residents attended. Some residents attend a local luncheon club on a weekly basis. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 17 Based on observations in both Capstan and Picador there is an insufficient amount of staff time allocated to meet all the residents recreational needs. The registered manager stated that they have recently recruited a new full time activities organiser to work specifically on the two dementia care units. This will clearly be beneficial for the residents, and will be monitored on further visits. Residents are asked what time they like to get up, go to bed and where they want to have their meals served. One person said they preferred to spend their time in the quiet lounge. Some residents choose to remain in their own rooms, preferring the quieter life. Residents were heard being asked where they wanted to go and what they wanted to do, and those residents who were able to, were moving independently around the home. The home continues to use a ‘Friends and Family’ form to record any communication between the home and family. They have changed the format of the form making its purpose clearer. The use of the recording tool however, is not consistent in all the units and this should be addressed. The home has a four-week menu plan, offering a choice of two main midday meals. Alternatives can be provided upon request. One resident’s care plan stated that they liked to have a cooked breakfast as it was the most important meal of the day and they confirmed they were provided with this. Meals are prepared in the central kitchen and trolleyed over to each house in heated cabinets. Residents in general were complimentary about the food and felt they were offered a good choice. Drinks and homemade cakes are provided mid afternoon. The blackcurrant squash served in Regal was very concentrated and one resident said it was strong – this was referred to the registered nurse for attention. In Kingsway it was noted that the dining room and lounge area was not tidied after the midday meal, and the carpet remained covered in food debris. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 18 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): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements in the way that all staff view complaints made about the home, will ensure that residents and their representatives feel they have been listened to and acted upon. Improvements in the standard of care delivered to vulnerable residents will ensure that they are safeguarded from any harm. EVIDENCE: The home’s complaints procedure is displayed in the reception area of each house and is included in the service users guide, kept in each bedroom. Complaints are not managed at “house level” but are dealt with by the Home Manager. Examination of the complaints log evidences that the home has a system in place to log complaints and a protocol for recording the outcomes. The manager maintains clear records to evidence what measures were taken to bring about a resolution to any complaints or concerns made. Whilst this is good, there have been an increasing amount of concerns of a serious nature raised directly with CSCI. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 19 Residents spoken with during the course of the inspection, who were able to express an opinion, felt that they were able to raise any concerns and that they would be listened to. However, a large number of the residents have to rely upon their families to speak on their behalf. One relative, who did raise concerns on behalf of a resident, had further reason to complain because of the resulting staff attitude towards them. One resident in Kingsway said they had had reason to complain and then staff were “off” with them. This does not evidence that the home takes any complaints made, seriously. CSCI have received eight complaints since the last inspection, because of concerns about the standards of care, staff competency in monitoring health care needs, cleanliness of some the houses and the attitude of some staff members. The home has cooperated with CSCI in putting together action plans and training programmes to resolve these shortfalls and progress will be closely monitored. Two of the complaints have been dealt with under Protection of Vulnerable Adults (POVA) protocols, involving social services departments and the health authority. The home has a POVA policy and clear guidance is available for the staff to follow if abuse is suspected, alleged or witnessed. A large percentage of the staff have completed a POVA training package prepared by BUPA. Discussions with staff evidenced that they are aware of their responsibilities to safeguard the residents from harm and are aware of any actions they should take, however a number of residents have not been safeguarded from harm, because of staff practices and poor clinical judgements. The manager has appropriately reported a number of situations under POVA through the correct channels, and subsequently taken the appropriate actions. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 20 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): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in houses that are safe, comfortable and well furnished but the standard of cleanliness in some areas must be improved to ensure that all residents live in a pleasant environment. EVIDENCE: Amerind Grove is a purpose built care home and is arranged as five separate single storey houses for 30 people each. The service facilities are all located in a sixth building. The grounds are surrounded by walled gardens, and the entrance has large steel gates that are locked overnight. Fencing surrounds both dementia care units, enabling the residents to walk safely out in the gardens, without risk. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 21 The houses are well maintained throughout and regular maintenance audits are undertaken. Each house has a maintenance log where staff can report any jobs that need attending to. A concern was reported to CSCI that repairs are not always completed within an acceptable time frame. The home has an ongoing programme of redecoration – the aim is to redecorate four bedrooms per month. Kingsway House is soon to have the corridors and communal areas redecorated and will be refurbished with new carpets. In addition five of the bedrooms will be re-carpeted and a number of rooms will have replacement lino flooring laid. The front doors to each of the homes are secured with a keypad door entry system, and all fire exits are linked into the call bell system. This creates a secure environment for the residents. Each house has a large communal area consisting of a lounge and dining area. Furniture and furnishings throughout the home are of a homely nature and in good condition. Each lounge has a range of different types of seating to meet the different needs of the residents. Toilets and assisted bathrooms are located throughout each of the five homes. None of the bedrooms have ensuite facilities, but commode chairs are provided for each bedroom. The care staff do not always replace the seat covers properly and one resident said they were embarrassed by this when friends visited. Each house has sluice room facilities, separate from the bathing facilities and these are kept locked. The home is well equipped with a range of equipment to enable the care staff to undertake their duties and to move residents safely in line with good manual handling techniques. The home is in the process of upgrading their hoists. Residents each have a single bedroom, with fitted wardrobes, chest of drawers and a wash hand basin. Residents are encouraged to bring in any items of furniture they want and to make their private bedroom their own. A nurse call bell system is installed in each bedroom and communal areas of the houses. The majority of curtains in Kingsway House were not hung correctly and looked unsightly. Each house has 10 hours allocated housekeeping support each day, all work under the supervision of a senior housekeeper. There are daily cleaning schedules for each unit however these are often referred to at the end of the workers shift. On each unit there is also a housekeeping log where notes regarding any specific housekeeping requests are made. During the inspection one room was noted to be particularly odorous, and there was an entry in the log for this carpet to be shampooed ten days previously. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 22 The home and CSCI have both received complaints about the standards of cleanliness. Despite there being systems in place for reporting matters that need addressing, and sufficient housekeeping support, there are major shortfalls, in some parts of the home. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 23 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): 26, 27 and 28. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are cared for by staff who have access to a range of relevant training opportunities, but have shown that they have not always been able to meet resident’s care needs appropriately. EVIDENCE: Each house is staffed with two registered nurses and four care assistants on daytime shifts, and one registered nurse and two care assistants over night. The care staff are supported in meeting the resident’s daily living needs by a team of administrative, housekeeping, catering, laundry and maintenance staff. Staffing levels have recently been increased on Embassy unit, in line with the rest of the home, and in order to reflect the increasing levels of dependency. Each house must ensure that residents’ care is not affected by staff-break arrangements. On Picador three staff took their breaks together leaving just one person ‘visible’ on the unit whilst the registered nurses were dealing with administrative functions. There has been a lack of a stable staff team on Kingsway and the use of agency staff has therefore been high. This has the potential to mean that residents will be cared for by staff who are not familiar with their needs or the policies and procedures of the home. This has been addressed by the home but the team have not yet established itself, and there was a lot of mistrust expressed about colleagues. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 24 Of the 73 care staff, 29 staff have already achieved at least an NVQ Level 2 qualification (40 ). A further 11 staff are on an NVQ programme at the moment and are expected to have completed the award by the end of September (68 ). The home operates a thorough recruitment procedure and expects written application and attendance for an interview. Two written references are obtained that verify any previous experience and CRB and POVAfirst are always completed prior to employment commencing. Three staff files verified these arrangements. Talking with a newly inducted recruit, their age was discussed and was found to be under the recommended age of 18 years, for providing personal assistance. The home must not allow any new recruit who is aged below 18 years of age, to provide personal care to the residents. The home provides a good induction programme of training for all new recruits, overseen by the experienced house manager on Regal house. The BUPA induction training programme is already in line with the new Skills for Care guidelines. One new staff member said that they felt very supported when they started working at the home, and were aware of the home’s policies and procedures. This means that the residents will benefit from staff who are aware of their role and what is expected of them. The manager maintains a database system that shows what training each member of staff has received and shows when update training is required in manual handling and fire awareness for instance. Much of the training is provided “in-house” via distance learning courses and covers a wide range of diverse and relevant topics. The home will also tap into PCT and Local Authority training courses where appropriate. Despite the opportunities available for staff and the amount of training each staff member has received, the need for further training in “Customer Care” “Deaf Awareness” and “Team Management” has been highlighted as a result of complaints that have been made. The home must ensure that the training delivered to staff members is effective and that the staff team have the necessary skills to meet the residents needs. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 25 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): 31, 32, 33, 35, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements must be made in the management of the whole home so that all the residents live in a home that is safe and run in their best interests. EVIDENCE: The Home Manager Mrs Veronica Marsh has been in post since May 2005, having previously been a registered manager at a smaller nursing home in the Bath area. She is a Registered Nurse. Although maintaining overall responsibility for the home and the 150 residents who reside there, each of the five houses has a House Manager, who takes day-to-day responsibility of the clinical and staffing issues. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 26 The management style in each of the five units is different as would be expected, however whilst Capstan and Regal benefit from strong leadership, the other houses do not have the benefit of such. Kingsway house is disorganised and chaotic, and CSCI has already dealt with concerns about both Picador and Embassy’s management, where the competence of the house managers has been questioned. On these three units there was a noticeable lack of supervision of the care staff and the delivery of care to residents. These shortfalls have the potential to place the residents at risk from not having their health care needs met appropriately or adequately. The home has some good systems in place for ensuring that any necessary tasks are completed but in practice they do not always work. For example daily cleaning schedules are not always referred to at the beginning of a shift therefore a specific domestic task listed may not be met. Recordings in the ‘housekeepers log’ had also been overlooked. The manager has put in place other healthcare monitoring systems as a result of complaints made when the delivery of an acceptable service has not met the required standard. The manner in which these forms are used is not consistent between the five houses. A copy of the last Care Home Resident Survey, completed in Autumn 2005 and published in February 2006 was supplied. As a result of the survey the manager had put together an action plan to resolve the main issues, which were about the range of activities, communication with relatives, and the quality of the meals service. The last two issues have featured in complaints dealt with by CSCI. The home looks after personal monies for some of the residents and maintains good computer records of all transactions in and out of the accounts. The quality of record keeping remains inconsistent. Records maintained by the staff must be accurate and appropriate. There were examples of entries made in the wrong residents notes, vague statements about the care being provided to a resident on a day-to-day basis, inaccurate recordings when healthcare needs are being monitored, and care plans containing meaningless statements. Care must be taken to ensure that confidential information about residents is not left unattended, and could potentially be accessed by any visitors to the home. The manager generally ensures that all staff follow safe working practices and everybody will be routinely instructed in safe moving and handling techniques, the fire systems and procedures to follow in the event of a fire. Three senior personnel have attended a fire course that will enable them to instruct staff with regard to fire safety. The fire log was up to date and evidenced that all the necessary checks had been completed. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 27 In Picador lounge, the food trolley blocked the fire exit during the lunchtime period. This is an obvious fire safety hazard. Staff were advised that the exit must be free from obstacles at all times and immediately removed the trolley. During the inspection safe moving and handling procedures were observed, using a variety of different aids, and with the care staff informing the resident what they were doing. Monthly environmental audits are completed in respect of hot and cold water temperatures, the nurse call bell system, hoists and all wheelchairs. The maintenance person is now qualified to undertake ‘PAT’ testing of all electrical equipment in the home. This should ensure that resident’s safety is maintained by not exposing them to unsafe electrical equipment. . Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 1 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 1 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 3 3 3 3 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 3 X 3 X 1 2 Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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) Requirement Timescale for action 25/08/06 2. OP3 14(2) 3. OP7 15(1) The pre-admission assessment processes must evidence they have been completed prior to offering placement at the home. The home must obtain all current 25/08/06 information regarding new residents and those returning to the home from hospital, to ensure that care needs are met appropriately. 25/09/06 Each resident must have a comprehensive care plan, covering all identified need, detailing what actions the care staff need to take (Previous timescales of 08/10/05 and 26/02/06 have not been met). 4. OP7 15(2) 5. OP8 12(1) 6. OP8 12(1)a Each residents care plan must be 25/09/06 meaningfully reviewed and revised where needed, and evidence who has been involved in the review. The home must monitor 25/08/06 resident’s health status and make appropriate clinical judgements and take appropriate action to meet assessed needs. Ensure that food and fluid intake 25/08/06 records are consistently maintained. DS0000020371.V305936.R01.S.doc Version 5.2 Page 30 Amerind Grove 7. 8. OP9 OP10 13(2) 12(4-5) 9. OP11 12(2-4 10. OP16 22 11. OP18 12(1-5) 12. OP26 23(2)d 13. 14. OP27 OP32 18(1)a 18(2) 15. OP37 17(1)a Medications must always be administered by staff who have clean hands. Residents must be treated with dignity and respect for their privacy, and by staff who maintain good personal and professional relationships. When end of life care needs have been identified, planning must involve all relevant parties and be specific to the resident’s wishes. When dealing with complaints and concerns, the home must ensure that residents feel they are listened to and taken seriously. The home must be conducted to meet residents needs and to safeguard them from harm, caused by their actions or inactions The home must address the problems of malodour in some parts of the home. All areas of the home must be kept clean tidy and fresh smelling. Safe staffing levels must be maintained at all times Registered Nurse must supervise the day-to-day work of care staff and ensure that service delivery is appropriate to the needs of the residents. Residents’ records must be accurately and appropriately kept, in line with NMC “good record keeping guidelines”. (Previous timescale of 26/02/06 has not been met) 25/08/06 25/08/06 25/08/06 25/08/06 25/08/06 25/09/06 25/08/06 25/08/06 25/08/06 16. 17. OP37 OP38 17(1)b 13(4)c Residents’ records must always be kept secure. Fire exits must always be kept clear 25/08/06 04/08/06 Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP15 OP15 OP21 OP24 OP27 OP27 Good Practice Recommendations The dining areas should always be cleaned after meal times to ensure that residents live in a clean and tidy home. That blackcurrant drinks be served more diluted or at least to an individual’s preferred taste. Care staff should take care to replace commode covers properly. The curtains in Kingsway need to be re-hung properly. Staff breaks should be staggered so that residents are not left unsupervised or without anyone to assist them. Care staff who provide personal care should be at least 18 years of age. Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Amerind Grove DS0000020371.V305936.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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