Inspection on 06/12/06 for Amerind Grove

This inspection was carried out on 6th December 2006.

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

The inspector 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 17/06/08

Amerind Grove 28/08/07

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 6th, 7th and 12th December 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Amerind Grove DS0000020371.V321641.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.V321641.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amerind Grove Address Picador, Regal, Embassy, Capstan & Kingsway 124-132 Raleigh Road Ashton Bristol BS3 1QN 0117 9533323 0117 9533406 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Veronica Marsh Care Home 150 Category(ies) of Dementia (60), Dementia - over 65 years of age registration, with number (60), Old age, not falling within any other of places category (90) Amerind Grove DS0000020371.V321641.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. 1st August 2006 Date of last inspection Brief Description of the Service: Amerind Grove is a 150-bedded BUPA care home, situated in the residential area of Ashton, approximately four miles from the city centre of Bristol. The home is situated within walking distance from the local shops, and is on a local bus route. The home is a purpose built care home, designed specifically to meet the needs of elderly and disabled residents. The home is split up into five houses, each with 30 beds and their own character. The five houses are each of bungalow design with level access, via their own entrance. The home manager, administrative and ancillary staff, all work from the main part of the home. Car parking for visitors is available in front of all houses. Three of the houses are registered for nursing care and two for Elderly Mentally Infirm nursing care. All bedrooms are for single occupancy. The manager has been in post since May 2005, having previously been the registered manager of a smaller, BUPA care home in the Bath area. The cost of placement at the home ranges between £348-620 per week and is based on individually assessed needs. Additional charges for a number of items are listed in the home’s brochure. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This second key inspection was unannounced, undertaken by three CSCI Inspectors, including the CSCI Pharmacist, and took place over two days. After the previous key inspection in August 2006, 17 requirements were issued and six recommendations of good practice were made. The home have made significant improvements in a number of areas that affect the outcomes for residents, and of the 17 requirements, 16 have been complied with and the outstanding requirement is considered as being partially met. Evidence for this report has been gained from:• the homes improvement plan, drawn up after the last poor inspection • CSCI survey forms completed by some residents • a tour of all five houses • speaking with a number of residents in each house • speaking with some relatives • speaking with three of the house managers and the one acting house manager • speaking with the registered home manager • speaking with care staff, ancillary staff and registered nurses • looking at the home’s records • looking at residents’ records. The overall analysis is that the home now provides a good service, with significant improvements being made to comply with the Care Standards Regulations and the National Minimum Standards. What the service does well: The home has recruited another Activity Organiser who will work specifically work on the dementia care unit. A range of different activities is arranged between the five houses, and residents are assisted to move between the houses to attend those sessions that they wish to. The home has a Complaints Procedure that is well publicised and the manager maintains clear records to evidence what measures were taken to bring about a resolution to any complaints or concerns made. There have been no serious complaints raised with the CSCI since the last inspection. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 6 Residents live in one of five houses. They are each comfortably furnished and equipped, and there is an ongoing rolling programme of redecoration and refurbishment. Residents are encouraged to bring in any items of furniture they want and to make their private bedroom their own. All bedrooms are for single occupancy. New “specialist” beds are to be provided for each room, in the next couple of weeks, in recognition of the increasing frailty of the residents. The homes provide a good induction programme of training for all new recruits, overseen by an experienced house manager. This means that the residents will benefit from staff who are aware of their role and what is expected of them. The service has taken on board the many requirements made in the last report and have put improvements in place to address the bad practices. This evidences that the home is serious about providing a good service for the residents and their families. They must ensure however, that standards remain of a high level. What has improved since the last inspection? Following the last inspection, the home was issued with a large number of requirement notices. The home has worked hard to improve practice and have evidenced compliance with the CSCI requirements. The admission of new residents into the home has restarted. The homes assessment processes have been tightened up and will ensure that any new resident who is admitted into the home, can be assured that their needs will be met. Procedures have been put in place that will ensure that full information is obtained about the care that person will need. Each resident now has a plan of care that details out his or her individual needs and states what actions the care staff need to take. Where specific healthcare monitoring is required this is now done in a meaningful manner. Registered nurses are supervising the day-to-day work of the care staff and providing guidance and support where necessary. Care planning reviews are generally satisfactory but in some cases, this needs to be more carefully undertaken. The home has reviewed the individual management arrangements, of the five houses. There has been an increase in the number of supernumerary management hours in each house – this means that there will be improvements in the monitoring of the residents care, working practices and staff performance. A new house manager will start in the New Year to fill the current vacancy on Kingsway. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 7 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.V321641.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.V321641.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 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the pre-admission assessment processes, and this will ensure that the home will meet identified care needs. Prospective residents are provided with detailed information about the home, enabling them to make an informed choice about where they want to live. EVIDENCE: The Statement of Purpose has not been changed since the last inspection and remains a true reflection of the services and facilities at the home. Residents are provided with a Service Users Guide, and copies were seen, placed in BUPA Care home folders, in most of the bedrooms. There were copies of the last CSCI inspection report, placed in the main reception area and the entrance area of each unit. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 10 Of the 12 CSCI survey forms completed by residents, eight stated that they had been provided with a contract, whilst four residents had not answered the question. The manager confirmed that all residents are provided with a statement of terms and conditions, as part of the welcome pack, upon admission, but it is generally the relatives who deal with this aspect. 11 residents reported that they had been provided with information about the home prior to making a decision to live there. The home had voluntarily agreed to suspend new admissions whilst they addressed the major shortfalls and therefore it was not possible to inspect the pre-admission assessment processes for new residents. However, the home has a comprehensive assessment tool and has put procedures in place to ensure that full information is obtained about health and personal care needs, and medications. These processes will also ensure that any new resident comes into the home with a complete set of information about them, including a list of medications, a full medical history and a discharge summary if coming out of hospital. Some of the long-term residents have been reassessed, evidencing that the staff have the necessary skills to undertake these assessment and use them to develop a plan of care. Amerind Grove DS0000020371.V321641.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 adequate. This judgement has been made using available evidence including a visit to this service. Improvements in the care planning processes and the monitoring of service delivery, means that residents will receive the care they need. Improvements are still required in some of the medication systems and the way in which some residents may be cared for. EVIDENCE: A number of care plans were looked at in each of the houses in order to determine how the resident’s needs are assessed and how their care is then planned. Each of the plans were person-centred, detailing the specific needs of the residents and what actions the care staff were to take to meet those needs. Some of the plans were very wordy and repetitive, and the home should consider making these more concise and ‘user friendly’. The manager explained that the whole ‘care planning’ process will be overhauled with the introduction of Quest documentation, in 2007. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 12 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. The assessments and care plans had been reviewed and updated on a regular basis. The risk assessments in respects of falls, for those residents on Embassy unit had not been completed properly. Two residents who were bed bound were referred to as “needing mobility aids” and “having an unsteady gait”. Risk assessments should be undertaken by staff who have the necessary competencies and the monthly reviews should be meaningful. There are also risk assessments in place to support residents to demonstrate they are being encouraged maintain some independence, while still maintaining their safety. This should help residents to maintain independence despite experiencing varying levels of confusion that has an impact on their daily lives. There was also information in the care plans about how to support residents who may be confused, and experience significant memory loss. Care plans had been reviewed and updated on a monthly basis, throughout the five houses, and this helps to demonstrate residents changing needs are being monitored. Of the 12 CSCI survey forms completed by residents, all stated that they “always” receive the care and support they need, ten said staff were available when they needed them and ten said that they got the medical support they needed. One resident said that the staff were kind and caring, were attentive and worked very hard. One relative said that the staff should feedback to relatives when the doctor has visited. The home has significantly improved the systems in place where they need to monitor the healthcare of a resident. Fluid intake/output charts have been amended to show a daily analysis, and a monthly overall picture. Those looked at had been completed well. On the whole all residents will have their weight recorded on a monthly basis. A discussion took place with the home manager and the house manager on Embassy, regarding one resident whose weight was being monitored, and the fact that ‘food intake charts’ were discontinued after only one small increase in weight. Further changes however had not been addressed. The Home is supported by the several local GP services, who provide both planned and emergency healthcare support to the home. A psychiatric team supports those residents with identified mental health needs. As part of this inspection a visit was also made by the CSCI Pharmacist. A number of issues were noted of concern and these have been summarised as follows: • The choice by residents to have staff administer their medication should be recorded in the care plan for each resident. DS0000020371.V321641.R01.S.doc Version 5.2 Page 13 Amerind Grove • • • • • • • • Medication storage needs to be rearranged to accommodate the new blister packaging The storage areas are too warm for the safe storage of medications Staff must record on MAR sheets when a new supply of medication is started Staff must have available written guidance on the use of medication when this is prescribed, “when required”. The medicine fridges must be kept between 2-8 degrees. Staff must record when either one or two tablets have been administered Oxygen must always be stored properly and large numbers of cylinders should be avoided The CD register must always record drugs sent for disposal Generally the staff spoke to residents and helped them with their needs in a polite and courteous manner. However, two members of staff on Capstan were heard referring to residents inappropriately, and were observed putting aprons over residents heads without any explanation as to what they were doing. This could be particularly distressing for someone who may be confused, and also demonstrates a lack of respect. On the second day of the inspection the House manager referred to the fact that this member of staff was already facing disciplinary action because of their attitude. A requirement has been made in respect of this observation Residents and visitors spoke positively about the care and service they received. Examples of comments made by residents about the staff and the Home included, ‘they are lovely girls,’ `the staff are nice,’ and, `they do their best.’ One relative in Kingsway could not commend the staff highly enough for the care they show “at all times” towards their family member. Staff were observed assisting residents with their needs in a warm and friendly way, on both days of the inspection. The home must ensure that when ‘end of life’ care needs have been identified, there has been appropriate communication between the resident / family / GP and home, and that clear and detailed records are maintained. These shortfalls have the potential to place the residents at risk from not having their final wishes met appropriately or adequately. The home needs to look at their “end of life” care planning processes, as this will only be meaningful if it is relevant to that individual. The two plans referred to in the last inspection report remain in place - they were identical and had been ‘lifted’ straight out of some guidance notes. One persons plan stated, “their religious needs were to be met” with no indication of how this was to be achieved. The home should review whether these plans remain appropriate. The introduction of Quest will address this shortfall and will be monitored by future visits to the home. Amerind Grove DS0000020371.V321641.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 good. This judgement has been made using available evidence including a visit to this service. Residents are able to participate in a range of meaningful activities or spend their time as they wish, and are provided with well-balanced and nutritious meals. EVIDENCE: Since the last inspection an activities organiser has been recruited to work full time on Capstan and Picador House. They provide support for residents who may be confused to take part in a range of social and therapeutic activities. Discussion with the activities organiser demonstrated a genuine commitment to their work as well as a good understanding of the needs of residents. A range of social and therapeutic activities is provided for residents. On the first day of the inspection residents from Picador House were taking part in a gentle exercise ball game. Also residents are supported to go to the local shops and to the nearby pub. One resident went for a drink with the activities organiser on the first day of the inspection. One the second day, one resident went out shopping with the support of staff. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 15 On the second day residents’ were taking part in a baking session making Christmas cakes, and residents were clearly enjoying the activity. There are arts and crafts items on display made by people living at the Home. On Picador House the actives organiser has worked with residents to create their own `memory boxes’, which are a display of items and artwork about the person’s life before they lived at the Home. This is good practise as it informs staff about the life of the resident before they moved to the Home. Between the three general nursing wings there are two activities organisers, and again a wide range of different things are organised. Each house is having a Christmas party throughout December. On the first day of the inspection the majority of residents on Kingsway went for a Christmas meal with care staff and relatives, the funds having been raised by the staff team throughout the year. The house was buzzing as they all got ready to go out. Of the 12 CSCI survey forms completed by residents, six said there were activities they could take part in, two said usually and two said sometimes. One relative said they liked to visit when sing-along sessions are organised. One of the activity organisers said they like to do “room visits” each day to those who did not like the group work. On both days 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, they also said that there is a relaxed and flexible visiting policy. This benefits residents as this means they can keep in contact with family and friends. To find out about the quality of meals provided for residents a sample of the lunchtime meal on day one was tasted. The dish was roast beef and Yorkshire pudding with roast potatoes and a selection of vegetables. The meal was tasty, and satisfactorily cooked. There was an alternative available, as there is every day. Staff were observed helping residents to get ready for lunch and assisting residents with their meal. On the nursing units, a number of residents needed help with feeding, and this was done in a sensitive and unhurried manner. Staff were seen working hard to ensure residents were served their meals promptly and politely, but comments have previously been made about the conduct of two identified staff on Capstan. Some of the cutlery needs to be reviewed and replaced where necessary – the knifes in particular were useless in cutting up food and therefore do not help the residents maintain their independence. Of the 12 CSCI survey forms completed by residents, one resident commented that they loved having a cooked breakfast every day, and another said that the staff make every effort to encourage me to eat. During the inspection, one resident said they were given more than enough to eat. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 16 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 homes complaints procedure and adult protection procedures ensure that residents are listened to and are 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 managed at “house level” but are dealt with by the Home Manager. Examination of the complaints log evidences that the home has a system in place to log complaints and a protocol for recording the outcomes. The manager maintains clear records to evidence what measures were taken to bring about a resolution to any complaints or concerns made. Since the last inspection there have been just one complaint made direct to CSCI, but this was redirected to the home to investigate using their complaints procedure. The complaint was handled appropriately, and the complainant was fully informed of the outcome of their complaint. During the course of the inspection residents and relatives were asked about making complaints. One relative said they had had reason to raise a few grumbles but the matter had been resolved promptly. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 17 Of the 12 CSCI survey forms completed by residents, 11 stated that the staff listen to what they say and act upon what they are told. One added that the staff try and find the time to sit and listen. The 12 residents said that they knew who to speak to if they were unhappy about anything and were aware of 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 recently completed protection training for people with dementia and they will cascade their knowledge to the rest of the team. Discussions with staff evidenced that they are aware of their responsibilities to safeguard the residents from harm and are aware of any actions they should take. After one resident was admitted into hospital, healthcare professionals raised concerns about the care of the resident, but the home was able to demonstrate how they were meeting the needs and were able to allay the concerns. One of the house managers has recently demonstrated their awareness of POVA by following correct procedures when one resident alleged that they had been ‘harmed’. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 18 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 well furnished and the standard of cleanliness has been improved. This means that residents live in a much nicer and fresher environment. EVIDENCE: Amerind Grove is a purpose built care home and is arranged as five separate single storey houses for 30 people each. The service facilities are all located in a sixth building. The grounds are surrounded by walled gardens, and the entrance has large steel gates that are locked overnight. Fencing surrounds both dementia care units, enabling the residents to walk safely out in the gardens, without risk. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 19 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 home has an ongoing programme of redecoration. Kingsway has recently redecorated and re-carpeted the corridors and communal areas. A number of the bedrooms have also been fitted with new flooring. The front doors to each of the homes are secured with a keypad door entry system, and all fire exits are linked into the call bell system. This creates a secure environment for the residents. Each house has a large communal area consisting of a lounge and dining area. These areas were each nicely decorated with Christmas trimmings. Furniture and furnishings throughout the home are of a homely nature and in good condition. Each lounge has a range of different types of seating to meet the different needs of the residents. Picador has had new lounge furniture since the last inspection and there are rigorous cleaning schedules in place for them to be maintained in a clean condition. Toilets and assisted bathrooms are located throughout each of the five homes. None of the bedrooms have ensuite facilities, but commode chairs are provided for each bedroom. Each house has sluice room facilities, separate from the bathing facilities and these are kept locked. The home is well equipped with a range of equipment to enable the care staff to undertake their duties and to move residents safely in line with good manual handling techniques. The home is in the process of upgrading their hoists. Residents each have a single bedroom, with fitted wardrobes, chest of drawers and a wash hand basin. Residents are encouraged to bring in any items of furniture they want and to make their private bedroom their own. A nurse call bell system is installed in each bedroom and communal areas of the houses. The curtains in Kingsway House were all hung correctly and made the house looked tidy and cared for, a significant improvement on the last visit. The home is to take delivery of 140-150 new specialist beds within the next couple of weeks – these will have the ability to be lowered near to the floor and will safeguard those residents who may be restless at night. The home have recognised the increasingly frail nature of the residents and their need for more appropriate equipment. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 20 Each house has 10 hours allocated housekeeping support each day, and the housekeeper’s work under the supervision of a senior housekeeper. Since the last inspection the home have recruited a new senior housekeeper. This arrangement has been put in place to ensure that acceptable standards of cleanliness are maintained throughout each of the five houses. There are daily cleaning schedules for each unit. A walk around each of the houses evidenced much improvement however on day one of the inspection, there was a strong and unpleasant odour present in the lounge and entrance hall of Picador. On day three of the inspection, Picador was fresh smelling and clean. Each house manager, however, retains full responsibility for the standards of hygiene – the manager on Picador must ensure that good standards of housekeeping are maintained at all times. Of the 12 CSCI survey forms completed by residents, only four said that the home was “always” fresh and clean, with the other eight saying it “usually” was. One resident said that they hoped the introduction of a permanent housekeeper would bring about improvements. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 21 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 two registered nurses and four care assistants on daytime shifts, and one registered nurse and two care assistants over night. The care staff are supported in meeting the resident’s daily living needs by a team of administrative, housekeeping, catering, laundry and maintenance staff. Staffing levels are based upon the dependency levels of the residents. Since the last inspection the house manager position on Kingsway has become vacant and in the meantime is being covered by one of the homes experienced house managers. The home has recruited a new registered nurse to this post who will commence in the New Year. Other staff have joined the Kingsway team since the last inspection in an effort to provide a stable staff team for the residents. Agency use throughout the whole home is kept to the minimum, and if shifts do need covering this will be done with bank staff. This means that residents will be cared for by staff who are familiar with their needs and the policies and procedures of the home. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 22 Of the 73 care staff, 36 staff have already achieved at least an NVQ Level 2 qualification (49 ). A further 12 staff are to start their NVQ training in January. The home has shown a 9 increase in the numbers of trained members of staff since the last inspection. It is an expectation that all new staff will complete NVQ training upon completion of foundation training. The home operates a thorough recruitment procedure and expects written application and attendance for an interview. Two written references are obtained that verify any previous experience and CRB and POVAfirst are always completed prior to employment commencing. Three staff files verified these arrangements. The home provides a good induction programme of training for all new recruits, overseen by the experienced house manager, currently based on Kingsway house. The BUPA induction training programme has been updated in line with the new Skills for Care guidelines. One new staff member said that they felt very supported when they started working at the home, and were aware of the home’s policies and procedures. This means that the residents will benefit from staff who are aware of their role and what is expected of them. The manager maintains a database system that shows what training each member of staff has received and shows when update training is required in manual handling and fire awareness for instance. Much of the training is provided “in-house” via distance learning courses and covers a wide range of diverse and relevant topics. Examples of current training undertaken by the team include infection control, customer care training, deaf awareness, catheter care and tissue viability and end of life training. As previously referred to in the report, identified staff need to have ‘person centred training’ to ensure that they treat residents as individuals and with respect. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 23 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. Improvements in the management of the home have ensured that the home is a safer place and that the residents will be well looked after. EVIDENCE: The Home Manager Mrs Veronica Marsh has been in post since May 2005, having previously been a registered manager at a smaller nursing home in the Bath area. She is a Registered Nurse. Although maintaining overall responsibility for the home and the 150 residents who reside there, each of the five houses has a House Manager, who takes day-to-day responsibility of the clinical and staffing issues. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 24 Since the last inspection the home has increased the number of management hours for the house managers, in each of the five units. The house managers now dedicate a large amount of their work time towards work allocation, supervision of the staff team and overseeing of clinical issues. This means that staff will be better supervised and residents can be assured that their health and personal care needs will be met. During this inspection the care staff were supervised to a greater extent in their daily work and the registered nurses were observed giving direction and advice. One member of staff said, “we now know what we are doing and what is expected of us”. So that each house manager is able to gather the views and opinions of the residents and their relatives, each house will hold an informal meeting on a monthly basis. This may be a coffee morning or an afternoon tea session. 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. BUPA have just run a “Customer Care Survey” but the written report has not been published yet. The results of the survey will be shared with residents and relatives, and any other interested parties. 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. Improvements were also noted with the day-to-day supervision of the care staff, by the registered nurses. The quality of record keeping throughout the five houses has improved. This is particularly noticeable where healthcare monitoring is being recorded. 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 and health & safety. During the inspection safe moving and handling procedures were observed, using a variety of different aids, and with the care staff informing the resident what they were doing. No health & safety concerns were noted. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 25 Monthly environmental audits are completed in respect of hot and cold water temperatures, the nurse call bell system, hoists and all wheelchairs. The records were not inspected on this inspection, but the home has previously shown to have robust systems in place to ensure these are done regularly. All the necessary fire checks had been completed as recommended by the fire officer. The home has a number of fire officers who have completed “fire trainers training”. The maintenance person is qualified to undertake ‘PAT’ testing of all electrical equipment in the home, and there are plans for one other person to be qualified. This means that resident’s safety is maintained by not exposing them to unsafe electrical equipment. Amerind Grove DS0000020371.V321641.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 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 2 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.V321641.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 OP9 Regulation 13(2) Timescale for action The registered person shall make 12/03/07 arrangements for the safe keeping of medicines received into the home (all medicines must be stored in locked cupboards and at safe temperature, oxygen must be stored safely) The registered person shall make 12/01/07 arrangements for the safe administration of medicines received into the care home (Clear dosage information must be available for all medicines prescribed When required to ensure that they are given safely) Residents must always be treated with dignity and respect, and staff must maintain good personal and professional relationships. Identified staff must receive relevant training to ensure they meet the standard expected. 12/01/07 Requirement 2. OP9 13(2) 3. OP10 12(4-5) The previous timescale of 25/8/06 has not been met. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 28 4. OP11 12(2-4) When end of life care needs have 12/01/07 been identified, planning must involve all relevant parties and be specific to the resident’s wishes. The previous timescale of 25/8/06 has not been met. 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 OP8 OP15 OP33 Good Practice Recommendations Falls risk assessments must be meaningfully undertaken and where the risk is high or medium, an appropriate plan of care be devised. That the condition of the cutlery be reviewed and replaced where necessary. CSCI to be provided with a copy of the 2006 Customer Care Survey. Amerind Grove DS0000020371.V321641.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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.V321641.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!