Inspection on 17/06/08 for Amerind Grove

This inspection was carried out on 17th June 2008.

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

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

Other inspections for this house

Amerind Grove 07/01/09

Amerind Grove 28/08/07

Amerind Grove 06/12/06

Amerind Grove 01/08/06

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Amerind Grove Picador, Regal, Embassy, Capstan & Kingsway 124-132 Raleigh Road Ashton Bristol BS3 1QN Lead Inspector Vanessa Carter Unannounced Inspection 17th, 18th and 19th June 2008 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.V368367.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.V368367.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 marshv@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd 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) Mrs Daisy Jean Finlay Matthews Care Home 171 Category(ies) of Dementia (70), Old age, not falling within any registration, with number other category (171) of places Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admisison to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Dementia - maximum of 70 places (Code DE) The maximum number of service users who can be accommodated is 171. 28th August 2007 Date of last inspection Brief Description of the Service: Amerind Grove is a 171-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 – originally each house had 30 beds, but a further 21 beds have been added across site. The house now have the following number of beds:Kingsway 38 Embassy 33 Regal 30 Picador 30 Capstan 40 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 (Kingsway, Embassy and Regal) and two for Dementia nursing care (Picador and Capstan). All bedrooms are for single occupancy. Each house has a team of staff lead by a house manager, but a registered home manager has responsibility for the whole site. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 5 Mrs Daisy Matthews has been in this post since November 2007. The cost of placement at the home ranges between £369-£700 per week and is based on individually assessed needs. The lowest rate, is that charged for people who do not require nursing care and only receive support with their personal care needs (this used to be referred to as residential). Additional charges for a number of items are listed in the home’s brochure. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This key inspection was unannounced, took place over three days, and was completed by two inspectors. The Lead Inspector Vanessa Carter who is well known to the service, was joined by Grace Agu, also a Regulatory Inspector. This service was not due to be inspected again until 2009; however, due to a high number of concerns being raised, the inspection visit was brought forward. A total of 35 hours were spent in the home. Evidence to form the report has also been gathered from a number of other sources:• Information provided by the Home Manager • Talking with the Home Manager and newly appointed deputy manager. • Talking with four House Managers (not registered managers) • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the people who live in the home • A tour of each of the houses • Case Tracking the care of a number of people in each of the houses • Talking with a number of the people who live in each of the houses • Talking with a number of visitors across site • Telephone conversations with two relatives who had asked to speak to the Inspector • Looking at some of the homes records • Information supplied in CSCI survey forms, completed by people who live in the home and/or their relatives • Issues in 14 separate concerns or complaints that have been reported to CSCI • Issues that have resulted from a safeguarding strategy meeting that dealt with three of these complaints. As a result of this inspection a number of requirement notices and recommendations have been issued. 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. An improvement plan will be requested with the aim of raising standards and stamping out bad practice. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in this home will be provided with information about the home so that they make an informed choice about moving in and robust preadmission assessment processes mean they can be assured that their care needs should be met by the service. EVIDENCE: The Statement of Purpose has been updated since the last inspection to reflect the change of manager and the increase in the number of beds. The statement sets out the services and facilities available at the home. A copy of this is available from the home and everyone who lives in the home is provided with a copy of the Service Users Guide - copies were seen, placed in BUPA Care home folders, in most of the bedrooms When a new person is admitted they are sent a welcome letter from the home manager, along with the Amerind Grove colour brochure. Nine relatives completed CSCI survey forms, saying they had received information about the home. Copies of previous Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 10 CSCI inspection reports are kept in the main reception area and the entrance area of each unit. After an enquiry about the home, and before placement is offered, a preadmission assessment is undertaken by either the home manager or one of the house managers. Since the last inspection BUPA have introduced a comprehensive individual assessment tool (QUEST) – this captures a complete picture of each person’s care needs and determines the person’s suitability for placement. The home also requests copies of any community care and healthcare assessments, as part of their information gathering process. The assessments completed for at least one person on each unit were examined, and we found them to be detailed and informative. Where a person is admitted from another part of the country, a telephone assessment will be completed, as much information gathered from other sources, and an admission assessment completed upon arrival. 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 visit and look around the home before any placement is offered. They will have been able to discuss with the manager, which of the houses is most suitable for their relative. Where possible the person themselves are encouraged to visit as well, but in most cases, 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 people 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.V368367.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite good care-planning processes, people may not necessarily receive the care and support that has been agreed, to meet their individual needs. They may not be treated with respect. Medication procedures are in line with good practice, but storage arrangements must be improved. EVIDENCE: Since the last inspection BUPA have introduced new care planning documentation (QUEST). Following a comprehensive assessment, care plans are prepared for each person. At least three plans were checked in each house, evidencing that plans are in place for all people who live at Amerind Grove. However, the quality of the plans varied considerably between the five houses. The plans that were looked at in Embassy House contained sufficient information, and provided instructions for staff on how care needs were to be met. One relative in Kingsway told us “new information we pass to the staff about our relatives specific communication needs, does not get incorporated into his care plan”. The plan for one person in Capstan provided no instructions for the staff on how they could meet the persons social care needs, but only Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 12 detailed what the person had done during their life. The plans in Picador were written in a generic style and did not take into consideration each person’s individual needs. For example the instructions for one immobile person who could not walk, was that they should wear ‘proper fitted shoes’. These few examples evidence a lack of understanding in person centred planning which is further supported by comments made by relatives – “I have had to battle to make sure that Mum is looked after how she would want” and “I have to continually remind staff that my relative should be dressed smart, have her hair done and be able to wear make up”. Alongside the care planning documentation, risk assessments are completed in respect of likelihood of developing pressure sores, nutritional needs, the probability of falls, and to identify the risks involved in any manual handling procedures. From the manual handling assessments a safe system of working is devised – these were detailed and gave clear instructions to staff on what they needed to do. Despite these measures, we have been informed that some staff knowingly take shortcuts and do not follow agreed methods of moving people. An early morning visit by a team of inspectors was undertaken in January and evidenced that there are occasions when staff use unsafe methods to move people, that may not only harm themselves, but also the person being moved. A requirement was issued at this time, and the manager has stated that this poor practice has been stamped out. Care plans had in general been reviewed on a regular basis. Where a review identifies a change in care needs these should be clearly reflected in the plan of care, as an additional or amended need. A daily record is completed for each resident - the quality of what was written was generally good and informative. A record is kept for each person, 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, continence advisors and dieticians. One relative had reason to contact us and say that they were concerned that they had to instigate the involvement of the GP and hospital services, when their relatives had had a fall. This was investigated and resulted in the service needing to take some action. Despite all staff working extremely hard, there is plenty of evidence to show that the home need improve the quality of service they provide. New staff members felt that there was a “lack of attention to detail” and that work was arranged in a “task orientated way”. There is an inconsistency in the level of support given by registered nurses to the care staff on a day-to-day basis. One relative commented “the registered nurses do not do any of the hands-on care” and this was backed up by observations made on both Regal and Kingsway Houses. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 13 The medication systems in all five houses were looked at to determine the procedures in place for the ordering, receipt, storage, administration and disposal of medications. Safe systems are followed. We were told at the inspection in August 2007 that in order to comply with a previous requirement, air conditioning units had been installed to ensure that medications were stored at the correct temperature. On this inspection we are advised that these units have never functioned and were only just in the process of being connected, ten months later. This is unacceptable and evidences poor compliance with instructions from the CSCI pharmacist. People may not always be cared for with respect to their dignity and privacy – one person was seen to be wandering around with his trousers falling down and staff just commented “he has lost his belt. He keeps hiding it”. Not only does this mean that staff are not identifying risks, but also that they do not see the need to maintain someone’s dignity. Another person was observed, with their urine drainage bag exposed and over full. On the other hand other people were seen looking very well cared for and nicely dressed. Some people on Kingsway and Regal, and one other relative, commented that the attitude of some staff members was poor. Comments from people spoken with during the course of the inspection varied from positive to negative - “mother looks well cared for, clothes are clean and she looks comfortable” and “I am made to feel a nuisance”. Improvements have been made with the homes “end of life” care planning processes and this means that people are more likely to have their final wishes met. A record is kept of communication between the person (where appropriate) / family / GP and the home, and that clear and detailed records are maintained. CSCI received a complaint from a relative who was bereaved who commented that the staff handled the death insensitively and that they were not in any way supported during this difficult time. Their complaint was upheld. Relatives who were visiting in Kingsway expressed this same view to us. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for the people who live in the home to have their social care needs met in a meaningful manner are not consistent, and only available for some. Their ability to make choices can be limited by staff working practices. They will be provided with a well-balanced and nutritious diet. EVIDENCE: The home has three designated Activities Organiser who work between the five houses and organise a range of activities. One works in the dementia care units and divides her time equally. It is unrealistic for one person to meet the social care needs of up to 70 people and an additional 20 hours is currently being advertised for. This worker was observed spending 1:1 time with a number of people during the space of one afternoon and this was good, but time was limited for each person. Two activities organisers cover the other three houses. Information is displayed in each of the houses about the particular activities that are organised for that week. Despite what was advertised upon the activities programme, there was little evidence of the activity in either of the houses. One activity organiser was very busy moving fish from one tank to another but this did not involve any participation from people, who were just sat around in the lounges. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 15 As part of the care planning processes a social history is obtained for each person and a plan prepared to show how each person would like to be supported to meet their social care needs. For one person this support plan just detailed what the person had done in their life. There was no indication what the staff could do for this person. For another, their plan just stated what time they liked to get up, and that they must have their walking frame with them at all times. We were told that people will be assisted to go along to activities that are based in other houses if they wish and can choose not to participate in some or all of the activities. We were told that musical entertainment is arranged on a regular basis, that the homes Summer Fete is due to happen at the beginning of July. Friends, families and local residents usually attend this. In the statement of purpose the home says that regular trips are arranged; however, in reality, these are infrequent and only appropriate for a very few people to attend. Photographs were displayed of the trip to Weston-s-Mare last summer. We were told that any trips arranged depend heavily upon funds raised by the care staff. The new home manager is keen for “trips out” to be more person centred rather than group activities. One relative said in a CSCI survey form that festivals and birthdays are always celebrated, but other comments included “there needs to be more 1:1 activities for people in their own rooms”, “residents who can not participate in activities, spend long periods of time sitting around” and “activities are only arranged for certain people”. People are asked what time they like to get up, go to bed and where they want to have their meals served, however in reality, there is plenty of evidence to suggest that people’s wishes and choices are ignored and they have to fit in with staff working practices. One relative who completed a CSCI survey form wrote “I hear staff say “residents must all have…….” and this does not take into account individual needs”. An early morning inspection visit by CSCI in January 2008 found that some people are got up very early in the morning, washed and dressed, despite their care plan saying they don’t want to get till 8am/9am. One person spoken to during the course of the inspection said they had been got up at 5am that day. Listening in upon a staff meeting on one unit evidenced that staff view their role in a task-orientated manner with little regard being paid to people’s choices. The new unit manager has already identified this and will be working with the team to change their attitudes. The home has a four-week menu plan, offering a choice of two main midday meals. Alternatives can be provided upon request. Meals are prepared in the central kitchen and wheeled over to each house in heated cabinets. Examples of the lunches that were served during the course of the inspection include fish pie or gammon with vegetables, spicy meatballs or roast pork. People in general were complimentary about the food and felt they were offered a good choice. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 16 A relative commented in the CSCI survey form that the meals for people who needed a soft or pureed diet were always the same, whilst another said “good and varied food is provided”. Drinks and homemade cakes are provided mid afternoon. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live in this home may not be protected or safeguarded from harm. Any concerns or complaints they, or their relatives may have, may not be addressed adequately. 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 generally managed at “house level” but are dealt with by the Home Manager. Discussions with house managers evidenced that they do deal with concerns that are raised with them, but formal record may only be made on the “relative communication sheet”. This means that the service may not always be identifying any trends in the complaints that are raised. CSCI have been directly contacted on many occasions since the last inspection. Concerns have been raised about inadequate staffing levels, standards of care, and the attitude and competence of some staff members. A further nine complaints have been reported regarding “institutional” staff working practices, poor standards of care, lack of monitoring of peoples health needs, lack of respect for the people being looked after, scant regard for manual handling and staff incompetence. Three of the complaints have been dealt with under Safeguarding or Protection of Vulnerable Adults (POVA) protocols. This has Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 18 involved meetings with the Safeguarding Adults Officer and others from adult community care departments, the Health & Safety Executive, and very senior personnel from BUPA. The service states strongly that the information we are given is incorrect and have failed to acknowledge the seriousness of some of the complaints, despite some issues being raised on more than one occasion. Three inspectors made an early morning inspection visit to the home in January 2008, and two parts of one complaint/safeguarding issue, were found to be true. For some other complaints BUPA have commented that they can not investigate complaints unless given the full facts, for examples, names dates and times. We do recognise that some of these complaints are based upon historical facts, however BUPA’s response has not been helpful or demonstrated that they take complaints seriously Examination of the complaints log evidences that the home does has a system in place to log complaints and a protocol for recording the outcomes. Most of the complaints recorded in this log had been directed from CSCI and have been referred to above. People spoken with during the course of the inspection, who were able to express an opinion, felt that they could raise any concerns – “the girls do their very best” and “it’s OK if it’s regular staff but the bank staff do not tend to take things seriously”. All of the CSCI survey forms recorded that the people who live in the home or their relatives are aware of the homes complaints procedure but negative comments were made about how complaints are dealt with – “ we report things and nothing is done until it has to be done”, ”complaints are pushed aside”, “I have had many complaints regarding Embassy House. Things were put right eventually but I was made to feel a nuisance” and “I have contacted BUPA head office when I was desperate but it was not satisfactory”. One relative who made one of the nine complaints said the person who lived at the home feared repercussions if they complained. This, along with other information does not evidence that the home view complaints seriously. 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, but some staff on Kingsway and some bank staff said that they have not had any POVA training for up to three years. Discussions with other staff members evidenced that they are aware of their responsibilities to safeguard people from harm and are aware of any actions they should take, however, since the last inspection, a number of people have not been safeguarded from harm, because of staff practices and poor clinical judgements. Discussions with staff and observations of the way they work evidence that their working practices are institutional, and task related, with little regard for individual choice. The manager has also appropriately reported a number of situations under POVA through the correct channels, and subsequently taken the appropriate actions. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each of the houses that make up Amerind Grove are safe, comfortable and well furnished. The standards of cleanliness can be variable and the laundry service does not meet everybody’s needs, but the home is addressing these issues. Improvements in both these areas would ensure that people who live at Amerind Grove are satisfied. EVIDENCE: Amerind Grove is a purpose built care home and is arranged as five separate single storey houses, each accommodating between 30 to 40 people. The exact numbers for each house have been referred to in the summary of this report. 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 the two dementia care units (Picador and Capstan), enabling these people to wander safely out into parts of the Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 20 gardens. Some parts of the garden have yet to be revamped following the building works, but this is in hand. 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. 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 of the houses were noted to be in good decorative order, and carpeting has been replaced in a number of bedrooms. Each house has a large communal area consisting of a lounge and dining area. In Capstan, where 10 of the extra beds have been added, a second lounge area has been provided. 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 people who live there. Toilets and assisted bathrooms are located throughout each of the five homes. None of the 150 original bedrooms have en-suite facilities - they do have a wash hand-basin installed in the bedroom and a commode is provided where necessary, but the 21 new bedrooms each have an en-suite room of a toilet and wash hand-basin. Some of the bathrooms, particularly two in Regal House were being used to store ‘old’ armchairs. The home manager stated that these were waiting for disposal however in the meantime they were limiting the available space and could potentially cause difficulty with manual handling procedures. Each house has sluice room facilities, separate from the bathing facilities and these are kept locked. All were noted to be in working order. Each of the houses 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. All beds are electric profiling beds, have integral bed rails and the ability to be lowered close to the floor. There is a plentiful supply of pressure relieving mattresses, between the five houses. A nurse call bell system is installed in each bedroom and the communal areas of each of the houses – when the cords are pulled, bleeps carried by some of the staff team are activated. Concern was expressed by staff in Regal that there was no system of summoning help from colleagues in an emergency and that on occasions, pull cords do not register with the bleep system quickly enough. This was demonstrated during the inspection and the bleeps were not activated for approximately five minutes. Not all staff who are on duty will have access to a bleep and those in Picador were of the opinion that this is inadequate bearing in mind the type of person they are looking after. All bedrooms are for single occupancy, have fitted wardrobes, a chest of drawers and a bedside cabinet with lockable drawer. People are encouraged to bring in any items of furniture they want and to make their private bedroom Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 21 their own. Some bedrooms have patio doors leading out into courtyards or garden area. Each house has a minimum of 10 hours allocated housekeeping support each day, but this has been reviewed in Capstan and Kingsway, the larger of the houses. Each unit has one full time housekeeper, plus two part time workers, who cover during the day and the evening. Since the last inspection we have been advised that the management structure has been revised and a ‘Hotel & Services Manager’ has been appointed. This person however is only partially in post and is still doing her previous job role. The person is likely to be able to devote her full time to this post from mid to end of July. All housekeepers work under the direct supervision of the Hotel and Services Manager. During the course of the two-day inspection, all houses were noted to be clean, tidy and free from any unpleasant smells. Both positive and negative comments were made about the standard of cleanliness in CSCI survey forms – examples are “the home looks neat and tidy, there are no unpleasant smells”, and “cleanliness is often lacking especially in bedrooms”. Comments made to the inspectors, during the course of the inspection, from both visitors and staff, was that the number of housekeepers on duty is very often “not this good”. From looking at staff rota’s for previous weeks on Kingsway, it seems as if housekeeping cover is not always available and that shifts may be covered by care staff. Staff on Regal also confirmed this but the home manager stated that care staff were not taken away from care duties to cover housekeeping and they would only be used when care staff numbers were above minimum levels. Further comments regarding staffing numbers have been made in the staffing section. During the inspection, Embassy House was being “deep cleaned” by external contractors. The other houses have either been deep cleaned or are due to be done. One bedroom in Regal was noted to be odorous, but the housekeeper had already shampooed the carpet. Consideration should be given to replacing this carpet. Concerns were expressed in CSCI survey forms and in discussions with people who live at the home and their relatives, regarding the laundry service. “My father’s clothes do not get returned to his room. We have lost a lot of items”, “the laundry service is very poor” and “my relatives take my washing home now”. The home manager is hoping that the appointment of a senior laundry worker will address some of these issues. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are cared for by staff who have access to a range of relevant training opportunities, but some staff have shown that they do not always meet care needs appropriately. Staff will always be recruited properly following robust procedures, that will ensure unsuitable workers are not employed. EVIDENCE: Staff are allocated to work in a specific house but there is currently lack of a stable staff team on both Kingsway and Picador – most recently long-term staff have left their jobs. A House Manager manages the staff team in each of the houses – since the last inspection a new house manager has been appointed for both Regal and for Kingsway. There is no house manager for Picador and this post is currently being advertised - there is also no permanent registered nurses covering this unit. In the interim, staff are being provided from other teams, or by bank nurses, and the house manager from Capstan is ‘overseeing’ the day to day running of the house. There was a very unsettled feel in this house and there is lack of continuity of care. All shifts in each house are covered by registered nurses and care assistants. From discussions with staff and from observations made during the course of the inspection it is evident that there is plenty of disharmony with the various staff teams– this may be between registered nurses and care staff, or between day and night staff. Relatives reported that some staff are being rebellious, and that “the regular girls are amazing but the bank nurses don’t know my relatives needs. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 23 If you ask them something, you get referred on to someone else. It is very unsettling”. Staffing levels are not arranged to take into account the dependency levels and care needs of the people who live in each house, rather they are arranged with a “resident to staff” ratio. There is no process to determine the dependency level of each individual and this is essential in view of the increasing dependency levels of the older and frailer people who live in the home. The following comments were made on CSCI comment cards – “improvements are needed with staffing levels. There is no staff presence in the lounges”, “after a weekend (bank staff) things are upside down. Staff do not know the residents as well” and “my relative usually gets the care and support that they need, but this is limited by staffing levels”. Staff breaks should be organised so as not to affect people’s care. In Regal the care staff went on break leaving everyone who was in the lounge without access to assistance - one person had slipped in their chair and was calling out for help and two others had been left sitting in the middle of the room in their wheelchairs. This is unacceptable practice. Care staff are supported in meeting the resident’s daily living needs by a team of administrative, housekeeping, catering, laundry and maintenance staff. The numbers of housekeeping staff has been significantly increased since the last inspection, with each house having their own team of staff. Records evidence that approximately 70 of the care staff have either already achieved at least an NVQ Level 2 qualification or are working towards the award. Some care staff have achieved an NVQ level 3. 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 POVA1st are always completed prior to employment commencing. Ten staff files were checked and verified these arrangements. The home provides a good induction programme of training for all new recruits. The BUPA induction-training programme is in line with the new Skills for Care guidelines. The manager maintains a database system that shows what training each member of staff has received and shows when update training is required in the mandatory courses such as manual handling and fire awareness. Much of the training is provided “in-house” via distance learning courses and covers a wide range of diverse and relevant topics. Despite the training opportunities for staff and the amount of training each staff member has received, the need for further training in “basic nursing care” has been identified. 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 care needs. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People may not always be receiving the best service and the home is not consistently run in their best interests. EVIDENCE: The Home Manager Mrs Daisy Matthews has been in post since November 2007, having previously been a registered manager at other nursing homes in and around the Bristol area. She is a Registered Nurse. Although maintaining overall responsibility for the home and the 171 residents who reside at Amerind Grove, each of the five houses has a House Manager (one post is currently unfilled), who takes day-to-day responsibility for the people who live in that house and any staffing issues. Two of the House Managers are newly appointed and have only just begun the process of settling into the homes routines and have yet to establish their management style. In addition to the Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 25 House Managers, there is a management structure consisting of a Hotel & Service Manager, a Chef, maintenance, gardening and administrative support. Two of the houses, Capstan and Embassy, have a settled feel about them and there was better outcomes noted for the people who live there and for any relatives spoken with. BUPA complete an annual Care Home Resident Survey, in order to monitor the quality of their service. In addition to this they complete a number of audits on a regular basis. They have also put together action plans as a result of any issues that have been raised during complaints and during safeguarding investigations. Despite all these measures the quality of service provision is not consistently good, and “customer satisfaction” is mixed. The home will be asked to prepare an improvement plan as there are many shortfalls in meeting the national minimum standards and regulations of the Care Standards Act. 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. These were not checked during this inspection, but the home has previously demonstrated clear and accurate accounting procedures. During the inspection safe moving and handling procedures were observed, using a variety of different aids, and with the care staff informing the person about what they were doing. However, we were advised in January 2008 by an anonymous member of staff (a whistleblower), that some staff knowingly do not follow agreed safe systems of moving and handling, when managers are not around. For this reason an early morning inspection visit was made which found evidence that supported what we had been told. The manager must ensure that all staff continue to follow safe working practices at all times. Monthly environmental audits are completed in respect of hot and cold water temperatures, the nurse call bell system, hoists and all wheelchairs. The fire log was up to date and evidenced that all the necessary checks had been completed. The maintenance person is qualified to undertake ‘PAT’ testing of all electrical equipment in the home. Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 X 3 X X 2 Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure that care plans are person-centred, and based upon individuals need. They must be updated as and when necessary The registered person must ensure that each person receives service from other health care professionals as necessary. The registered person must ensure that all medications are stored at temperatures below a maximum of 25 degrees. The registered person must ensure that the care home is conducted in a manner that respects people’s dignity. The registered person must ensure that there is an adequate programme of activities, that is available for every one who wishes or is able to participate. The programme must be based upon individuals needs. Timescale for action 07/08/08 2. OP8 13(1)b 07/08/08 3. OP9 13(2) 07/08/08 4. OP10 12(4)a 07/08/08 5. OP12 16(2) m,n 07/09/08 Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 28 6. OP14 12(2) The registered person must ensure that people are enabled to make decisions with respect to the care they are to receive. People must be supported according to their needs and not when staff routines dictate. A previous timescale of 29/02/08 was set for a similar requirement regarding people’s ability to choose how they are cared for. 07/08/08 7. OP16 22 The registered person must 07/08/08 ensure that all complaints made under their complaints procedure are fully investigated. The registered person must ensure that staff safeguard the people who live there at all times, and that they prevent people from being harmed or suffering abuse, or being placed at risk of harm or abuse. The registered person must ensure that at all times staffing numbers are at such levels to be appropriate for the health and welfare of the residents. The numbers of staff on duty must be based on the assessed care needs of all residents (dependency levels). The registered person must ensure that there is robust system in place to monitor the quality of care. An improvement plan must be prepared to show how the service will address the shortfalls and improve outcomes for the people who live in the home. 07/08/08 8. OP18 13(6) 9. OP27 18(1)a 08/08/08 10. OP33 24 17/09/08 Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP11 Good Practice Recommendations The registered person should ensure that the staff team are able to support bereaved relatives, and those who are visiting very poorly people. Bathrooms should not be used to store items of equipment that are waiting for disposal, and should be kept accessible and available for use at all times. The registered person should consider a review of the number of pagers for care staff, particularly in Picador House. The carpet in room 12 in Regal House should be replaced. 2. OP21 3. OP22 4. OP24 Amerind Grove DS0000020371.V368367.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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