Inspection on 28/08/07 for Amerind Grove

This inspection was carried out on 28th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Amerind Grove Picador, Regal, Embassy, Capstan & Kingsway 124-132 Raleigh Road Ashton Bristol BS3 1QN Lead Inspector Vanessa Carter Key Unannounced Inspection 28th – 31st August 2007 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.V340786.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.V340786.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 (CFC Homes) 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.V340786.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. 6th December 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, although space is currently very limited. Building works are in progress at the moment to provide an additional 10 beds for people with a dementia in Capstan House, 10 nursing beds split between Kingsway and Embassy, plus further communal living areas. The works are expected to be completed by the end of 2007 but the facilities will need to be registered before they can be used. Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 5 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. Mrs Veronica Marsh has been in this post since May 2005. The cost of placement at the home ranges between £360-£680 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.V340786.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection was unannounced and took place over four days. A combined total of 26 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 in the Annual Quality Assurance Assessment (AQAA) • Talking with the five house managers during the inspection, in particular the manager covering for the registered manager who was on leave • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the residents • A tour of each of the five houses • Case Tracking the care of a number of residents • Talking with a number of the residents • Talking with a number of visitors • Looking at some of the homes records • Information supplied by residents and relatives in CSCI survey forms • Information supplied by one GP surgery The requirements made from the last inspection have been met showing compliance with the relevant regulations. Two requirements have been made following this inspection about some of the homes risk assessment processes and wound care planning documentation. What the service does well: The homes admission processes and information made available about the home ensure that placement is made to those whose needs can be met. Residents can expect to have their needs met, will be well treated and will be looked after in the manner that they want. Medication systems are safe. Residents have the opportunity to take part in a range of meaningful activities or spend their time as they wish, and are provided with well-balanced and nutritious meals. The management of complaints made about the service and staff awareness of safeguarding issues means that any concerns will be listened to and they will be protected from harm. Residents live in houses that are safe, comfortable and are suitably furnished to meet their needs. The standards of cleanliness and freshness are good. Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 7 Residents are cared for by staff who have access to a range of relevant training opportunities, and are competent to do their jobs. Residents live in a home that is well run and ensures that their best interests are met. 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.V340786.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.V340786.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. The homes admission processes and information made available about the home ensure that placement is made to those whose needs can be 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. This document however will be being reviewed and updated, to reflect the impending changes in facilities. The residents are provided with a Service Users Guide, and copies were seen, placed in BUPA Care home folders, in most of the bedrooms. Soon after or on admission, residents are sent a welcome letter to the home. There were copies of the last CSCI inspection report, placed in the main reception area and the entrance area of each unit. Residents are each provided with a contract if funding their own placement or a statement of terms and conditions if the fees are part funded by the PCT and/or the local authority. These were not inspected on this visit however the home has consistently shown compliance with this regulation. Of the 13 Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 10 residents who returned a completed CSCI survey form, 12 said that they had received a contract and 11 said they had received enough information about the home. Comments were made such as “my family decided the placement and I trust their judgement” and “I received a brochure”. The pre-admission processes for a number of new residents in different houses were examined, to check on the procedures followed. A pre-admission assessment is always completed in either the prospective residents home or on the hospital ward. The documents seen, evidenced that these had occurred prior to admission. Care plans and health needs assessments are requested where appropriate – the home have previously been advised that it is in their best interests to always obtain a health needs assessment (called a CM7), to ensure that they have as much information as possible about a new resident. The home has taken note of this advice. Where possible, prospective residents or their representatives are encouraged to visit the home prior to making a decision about moving there. They would be shown around the houses, told what the home has to offer and given an explanation of how their needs would be met. The majority of residents are admitted in to the home following a hospital stay. Comments that residents wrote on CSCI survey forms included “best home and care. I looked at many”, “my daughter visited the home and thought it was right for me” and “my family chose this place as I was unwell. I am glad to be here”. All new placements are generally reviewed after a four-week trial period but this timeframe can be dependent upon individual circumstances. The home does not provide intermediate care however does offer respite placements, or short stay breaks when beds are available. Since the last inspection there have been a number of concerns raised following some short stay breaks. The home must ensure that they follow their own stringent preadmission processes on each admission if a resident is returning for another stay. This will ensure that any new healthcare needs are identified and planned for. This will be referred to again in the next section of the report. Amerind Grove DS0000020371.V340786.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 good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have their needs met, will be well treated and will be looked after in the manner that they want. Medication systems are safe. EVIDENCE: Ten specific care plans were looked at throughout the five houses in order to determine how the resident’s needs are assessed and how their care is then planned. In addition, a number of other plans were examined to check up on particular information. The majority of the plans were person-centred, detailed the specific needs of the residents and what actions the care staff were to take to meet those needs. Further comments will be made about the care plans throughout the remainder of this report, as a number of improvements are required with the overall process. At the end of September 2007, BUPA will be introducing a new ‘care planning’ process called Quest – this has already been introduced successfully in other BUPA care homes. A recent complaint was made to CSCI regarding the care that a resident received when returning for a second short stay at the home. An investigation discovered that a new assessment of needs was not carried out by either the Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 12 home or the social service department, prior to the placement starting, therefore changes to that resident’s needs did not result in a plan of care being written. This is poor practice, and in this instance caused deterioration in the resident’s health. 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. For those residents who may have falls, a falls log is kept. This means that staff can monitor the frequency and nature of falls, and if possible, identify any trends and take preventative actions Staff must ensure that the “MUST” nutritional risk assessment tool (where the weight and body mass index determines the level of risk) is not used in isolation, as it may infer that there are no concerns where in actual fact concerns have been identified by other means. Examples of this were of one resident who had gained significant weight, another who showed a gradual weight loss despite a good dietary intake, and another who needed a great deal of encouragement to finish meals and take an adequate diet. Risk assessments may also be in place when specific needs have been identified, for example when the particular behaviour of one resident may affect another. On Picador one such risk assessment was not completed properly. As part of the process the likelihood of the behaviour is measured against the severity or effect of such activity, to determine the level of risk. In this particular case, the severity of such action was incorrectly determined. This shortfall has the potential to mean that the home’s risk assessment processes may not protect residents. This will be referred to again under standard 38. Wound care planning in general was of a good quality and was supported by photography and mapping but minor improvements were needed with some. The monitoring methods enable the nurses to monitor how the wound is progressing. The plans must always contain clear instructions on what actions are to be taken for example what dressing products are to be used and how often the dressing needs to be attended to. For some residents the dressings are to be attended to “as necessary” and in these circumstances, their plan of care must state this. Care plans had been reviewed and updated on a monthly basis, throughout the five houses, demonstrating that residents changing needs are being monitored. House managers undertake regular care plan audits to ensure that the documentation remains up to date and relevant. There was no evidence to support this process in Picador however in the other four houses this was so. The house manager on Picador must ensure that on care planning documentation the English language is correctly used – one resident had Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 13 written about them that they did not communicate “as a normal human being”. This remark is offensive and a request was made for this to be removed. The home has introduced new working practices since the last inspection. All new residents will have their fluid and diet intake monitored for the first three days after admission so that the home can have a baseline from which to work. This is good practice. Of the 13 resident survey forms returned to CSCI, seven said that they “always” received the care and support they need, whilst six said that “usually” did. Six residents said staff were available when they needed them – comments made included “ some one comes as soon as possible” and “at certain times of the day it is difficult to get help when you need it”. During the course of the inspection, residents expressed many comments about how hard working the staff are, and how they do their very best. Observations were made during the inspection that in general the residents were attended to promptly, but that at certain times there was delay in staff being able to provide immediate assistance. The home continues to have good systems in place to monitor the healthcare status of each resident. Fluid intake/output charts continue to be closely monitored with the registered nurses being responsible for checking these at the end of their shift. Each resident will have their weight recorded on a monthly basis, or more often if necessary. The home is supported by several local GP practices, who provide both planned and emergency healthcare support to the home. Two of the houses have regular “ward rounds” where the GP will visit and see all residents. Where this is happening, improved relations have developed between the staff and the GP. One GP wrote in a CSCI comment card “the main problem is the lack of available information when new residents are admitted and registered with us” and “discharge summaries on admission to nursing home would help”. Discussion with the house manager and knowledge of the home, evidences that the home do the very best to obtain as much information as possible about the residents and relay this to the GP, and register residents with the GP at the point of admission. The home cannot be held responsible for the length of time it takes for the GP notes of newly registered residents to be transferred to the practice. On previous visits the CSCI Pharmacist has also participated in the inspection process, not because of any particular concerns regarding the management of medications, but because Amerind Grove is a large care establishment. On this occasion the pharmacist did not attend. A number of issues of concern were noted at the last inspection and each of these has been addressed. Particularly of note is that air conditioning units are now installed in each of the five treatment rooms and this means that medications are stored at the correct temperatures. There are standard medication procedures across site in all five units but they were examined and discussed with just one house manager Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 14 during this inspection. The home has safe procedures in place for the ordering, receipt, storage, administration and disposal of medications. Observations of the staff interaction with the residents in each of the house evidenced that they are assisted in a polite and courteous manner. A number of issues have been raised with both CSCI and social services departments where there have been concerns about how some residents have been spoken to or dealt with. The home has addressed each of these concerns appropriately using their complaints investigation processes. The staff on both Picador and Capstan House all showed a great deal of patience in dealing with resident’s repetitive behaviour, although there was a much “jollier” atmosphere on Capstan with the staff embracing the individual residents behaviour patterns rather than attempting to stop or distract them. One such example of this was allowing a resident to wander out to look at the flowers (under discreet supervision) as against hearing the words “no you cannot be in this room, I am talking”, whilst hastily ushering the resident out of the room. Residents said that the care and attention they received was generally good. Examples of comments made on CSCI survey forms, by residents about the staff and the home included, “I always get the things I need”, “the staff are brilliant”, “my relative could not receive better care” and “the staff are committed, caring patient and fun”. On previous inspections there have a number of concerns expressed about the homes ‘end of life’ care planning processes. A number of staff have attended training in this issue, and the communication procedures between one resident, their family, GP and the home, prior to the recent death of a resident were discussed with two of the house managers. Clear and detailed records were maintained and an appropriate plan was put in place. These improvements mean that those residents who are at the end of their life will have their wishes respected, and the staff will be able to advocate if necessary on their behalf. Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to take part 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 employs three activities organisers. One is employed specifically for Capstan and Picador House and this person has the appropriate skills and many years experience of working with people with dementia. Unfortunately it was not possible to meet up with this person during this inspection however during the previous inspection had demonstrated a great enthusiasm for her work. Currently activities are arranged in one or other of these houses with the possibility for residents from Capstan to join whatever is going on in Picador and vice versa. In practice this does not often happen. Building works are already in progress to provide an activity centre between the two units and then all the residents from both units will have “full time” access to this. This will enhance the level of service for those residents with dementia. Residents from the other three houses are also able to join in the activities based in the dementia care units. Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 16 The house manager on Capstan has introduced a “Night Owl Club”, an activity session that is arranged in the evenings and encourages social interaction between the residents and the staff. The club was named by a group of residents – they may watch TV, discuss matters or have something to eat. There is no set time for it to finish. One positive outcome has been that residents who had previously resisted going to bed seem to be more settled and their sleep pattern has improved. This is commendable. Between the three general nursing wings there are two activities organisers, and again a wide range of different things are organised. At various time during the course of the inspection quizzes, discussion groups and an arts and crafts session were observed to be going on. Those in charge of these sessions must ensure that music is not played at too higher a volume. On one occasion the residents were clearly agitated by the music and once this had been changed to gentler classical music, they calmed. This incident occurred just prior to the lunchtime meal – greater awareness must be shown by the activity organiser to the effects that music can have upon some residents. One of the house managers expertly dealt with this situation once she was aware of what was happening. In one other of the houses, one resident said they were having difficulty obtaining help from the staff as “they can not hear me calling over the sound of the music”. This person said their preferred place to sit was tucked around the corner in the lounge, where there is no call bell, and normally they can obtain assistance by calling out. The home must consider how to address this problem and ensure that all residents have access to assistance when they are not near a call bell. Of the 13 CSCI survey forms completed by residents, seven said there were “always” activities they could take part in, three said there “usually” was whilst two residents said there “sometimes” was. Comments included on the forms included “I enjoy playing dominoes and watching the old video’s of Bristol “, “I love chatting to the other residents and the staff”, “I don’t join in the group activities but I am looking forward to the outing to Weston” and “I choose not to take part”. On each day of the inspection residents in each of the five houses were receiving visits from family and friends. Visitors said that staff are welcoming and friendly to them, and that they are offered refreshments. One relative said “me relative is contented in Capstan. They feel loved and cared for and I enjoy visiting this house”. Another relative said “the staff go that extra mile”. Plenty of evidence was available during the inspection to show that residents have a say in what they do, where they spend their time and what they have to eat. One resident has his lunch-time meal served at 2.30pm each day as this is his choice. One day one of the inspection, a group of residents were joined for the lunchtime meal. A choice of two meals was served – there was a fish pie or a pork Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 17 and apple casserole served with vegetables. Both meals were tasty, and satisfactorily cooked. Some resident were offered a small sherry before their meal. Staff reported that alternatives will be made available if neither choices are acceptable. Staff were observed helping residents to get ready for lunch and assisting residents with their meals. Tea-time meals were also observed at other times during the inspection. In all the houses a number of residents needed help with feeding, and this was consistently done in a sensitive and unhurried manner. Staff were particularly patient with the residents on the dementia care units and gently encouraged and prompted each resident to take an adequate diet. Where residents have specific dietary requirements (for example diabetics) this information should not be displayed on notice boards in communal areas. A request was made for this information to be removed in Embassy and a more discreet staff reminder be used. Since the last inspection a “Night Bite” service has been introduced. This means that a variety of foods and snack meals are available, and staff can prepare food for residents who want to eat outside of ‘normal’ meal times. Of the 13 CSCI survey forms completed by residents, nine residents stated that they “usually” liked the meals. Comments included “I am a fussy eater but I get what I like to eat”, “the roast dinners are lovely” and “I need help with feeding but the staff never let the food go cold”. Amerind Grove DS0000020371.V340786.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of complaints made about the service and staff awareness of safeguarding issues means that any concerns will be listened to and they will be protected from 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 generally managed at “house level” although can be in some circumstances. The Home Manager usually deals with any complaints. 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. Since the last inspection there have been a number of complaints made direct to CSCI – these will have been raised either by the social services department or by relatives. Some of these complaints have been redirected to the home to investigate using their complaints procedure and CSCI have been notified of the outcome. The home has co-operated in this process, complaints have been handled appropriately, and the complainant is fully informed of the outcome of their complaint. Other complaints have been dealt with under safeguarding adult protocols and again the home has cooperated in the information gathering process. Thirteen residents returned survey forms to CSCI and all said they knew how to make a complaint and knew who to speak Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 19 to. Residents and relatives who were spoken with during the course of the inspection were also satisfied with the homes complaints procedure. The home has a Protection of Vulnerable Adults (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. Two of the house managers have completed protection training for people with dementia and one of them confirmed they were cascading their knowledge to the rest of the team. Discussions with both care staff and registered nurses evidenced that they are aware of their responsibilities to safeguard the residents from harm and are aware of any actions they should take. A number of safeguarding issues have been raised since the last inspection, by healthcare professionals and social services and the home have cooperated in the investigations that have subsequently followed. One of the house managers followed agreed protocols when a member of bank staff used the ‘whistleblowing procedure’ to report what she felt was poor practice. The outcome of the investigation did not support the workers concerns. Amerind Grove DS0000020371.V340786.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. 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. Residents live in houses that are safe, comfortable and are suitably furnished to meet their needs. The standards of cleanliness and freshness are good. EVIDENCE: Amerind Grove is a purpose built care home and is currently arranged as five separate single storey houses for 30 people each. At present building works are in progress to provide a total of 20 additional beds and further communal living areas. It is expected that these facilities will become available at the end of 2007. 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, however there is a more relaxed approach with the residents in Capstan, where the front door is not kept locked and residents are able to wander out to the garden area “under supervision”. Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 21 The houses are well maintained throughout and regular maintenance audits are undertaken – these records were not inspected on this visit however the service has consistently shown that good systems are in place to maintain the upkeep of the buildings. Each house has a maintenance log where staff can report any jobs that need attending to – examination of these showed that jobs recorded are attended to promptly. The home has a continual programme of redecoration and since the last inspection Kingsway has been redecorated and re-carpeted in the corridors and communal areas. The front doors to each of the homes are secured with a keypad door entry system (see previous comments regarding Capstan), 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. There are plans to provide a sensory area in the quiet room on Capstan, and staff are busy raising the funds necessary to do this. 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 en-suite facilities, but commode chairs are provided for each bedroom. Each bedroom does have a vanity unit, and is furnished with wardrobes, chest of drawers and a lockable bedside cabinet. 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. Since the last inspection all 150 beds have been replaced with electrically operated specialist profiling beds – these have the ability to be fitted with integral bed rails and have the ability to be lowered near to the floor, safeguarding those residents who are restless at night, and for whom bed rails are not appropriate. Residents are encouraged to bring in any items of furniture they want and to make their private bedroom their own. The majority of bedrooms were seen during the inspection, were clean and tidy. All but one bedroom was fresh smelling, and the measures that are in place to address this were discussed with the relevant house manager. A nurse call bell system is installed in each bedroom and communal areas of the houses – this has been upgraded since the last inspection and the care staff are now issued with bleeps that they carry around with them and alert them to those ringing for assistance. Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 22 Each house has 10 hours allocated housekeeping support each day, and the housekeeper’s work under the supervision of the house manager and a senior housekeeper. During a walk around each of the five houses acceptable standards of cleanliness were apparent. There are daily cleaning schedules for each unit, and housekeeping support is provided between the hours of 8.30am to 6.30pm each day. One resident commented on a CSCI survey form that “care staff sometimes do the cleaning”- this was acknowledged as being true however staff are not taken away from caring duties to do this, and would only be as temporary cover arrangements. Of the 13 CSCI survey forms completed by residents, seven said that the home was “always” fresh and clean, with the others said it “usually” was. Amerind Grove DS0000020371.V340786.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. 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, and are competent to do their jobs. EVIDENCE: Each house is staffed with their own staff team however there is some movement of staff between the houses when leave and sickness cover is needed. Since the last inspection the staffing situation on Kingsway has improved, a house manager has been recruited and a stable team of registered nurses and care staff has been formed. Staffing levels on each of the units are based upon the dependency levels of the residents, and the amount of care and support they need. The care staff are supported in meeting the resident’s daily living needs by a team of administrative, housekeeping, catering, laundry and maintenance staff. Agency use throughout the whole home is minimal, and if shifts do need covering this will be done with bank staff or staff taking extra shifts. This means that residents will be cared for by staff who are familiar with their needs and the policies and procedures of the home. At the time of the previous inspection in December 2006 the home had a 49 ration of care staff who had achieved at least an NVQ Level 2 qualification. A number of these staff have left however further staff have achieved the award and a further cohort are due to start next month. The home are fully Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 24 committed to ensuring that all their staff hold NVQ qualifications. In addition a number of staff have also got NVQ level 3 in care. 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. A selection of staff files verified these arrangements. The home provides a good induction programme of training for all new recruits, overseen by one of the house managers. There have been some changes since the last inspection in that a group of new recruits will now be started at the same time, and will work through the induction process together. The BUPA induction training programme is in line with 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. They expressed great enthusiasm for their work and this was refreshing. This training programme 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 mandatory 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. Examples of training being organised include infection control, basic dementia care awareness, nutrition and basic food hygiene. Staff also participate in ‘Personal Best’ training and in this will undertake a task that enables them to ‘feel’ what it is like to be a resident. This is more prevalent in some houses than others. Amerind Grove DS0000020371.V340786.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well run and ensures that their best interests are met. EVIDENCE: The Home Manager Mrs Veronica Marsh has been in post since May 2005. 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 in their house. Each house manager has designated ‘supernumerary hours’ each week to attend to management tasks and staff supervision. The house manager will also spend some time “working on the floor”. This means that they will know the residents and their care needs and can observe staff work performance. Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 26 Each house holds informal meetings, a coffee morning or tea and cakes, on a monthly basis. This enables the staff to meet with residents and relatives in an informal way, a deal with any issues that may come up. Staff meetings are held on a regular basis, in each of the houses and also at manager level with the home manager. The home completes a number of monthly audits to monitor service delivery. Examples include care plan audits, falls and accidents, health & safety, medication charts and comments received by staff, residents and relatives. As previously stated the care plan audits were not evidenced on Picador. BUPA last completed a “Customer Care Survey” in December 2006 and have published the findings in a report. The results were shared with residents and relatives. 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 records were not inspected on this visit however have previously met the standard. Staff confirmed that they have regular formal supervision with a senior member of staff, and records are maintained in each of the houses. These were only checked in one of the houses. Care staff are supervised on a daily basis by the registered nurses, and also by the senior carers. The quality of record keeping throughout the five houses was good. The healthcare monitoring forms evidenced a good level of recording. All the homes records that were examined were in order. Each member of staff will complete mandatory training in respects of safe manual handling techniques, health & safety and fire awareness. During the inspection safe moving and handling procedures were observed, using a variety of different aids. No health & safety concerns were noted. Monthly environmental audits are completed and on previous inspections the home have been able to provide all the documentation necessary to evidence the processes they have in place. The records were not looked at during this inspection but the maintenance person confirmed all was in order. All the necessary fire checks had been completed as recommended by the fire officer. The records were checked on one house only. The home has a number of fire officers who have completed “fire trainers training”. House managers must be vigilant at all times, to ensure that fire exits do not become compromised by the activities of the builders who are on site. Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 27 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 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Where care planning is supported by risk assessment processes, these must be accurate, properly recorded and have a meaningful purpose. Wound care documentation must include exact instructions for staff to action. Timescale for action 31/10/07 2. OP8 12 31/10/07 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. Refer to Standard OP3 OP7 OP8 Good Practice Recommendations Robust pre-admission processes must apply for those residents returning for further respite stays. Care plan auditting must take place on Picador and the house manager must supervise staff performance accordingly. Falls risk assessments must be meaningfully undertaken and where the risk is high or medium, an appropriate plan of care be devised. Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection 4th Floor, 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. Extracts may not be used or reproduced without the express permission of CSCI Amerind Grove DS0000020371.V340786.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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