Inspection on 07/01/09 for Amerind Grove

This inspection was carried out on 7th January 2009.

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

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

Other inspections for this house

Amerind Grove 17/06/08

Amerind Grove 28/08/07

Amerind Grove 06/12/06

Amerind Grove 01/08/06

Amerind Grove 26/01/06

Amerind Grove 04/07/05

Amerind Grove 25/01/05

Amerind Grove 09/08/04

Amerind Grove 23/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 26/03/2009.

CARE HOMES FOR OLDER PEOPLE Amerind Grove Picador, Regal, Embassy, Capstan & Kingsway 124-132 Raleigh Road Ashton Bristol BS3 1QN Lead Inspector Vanessa Carter Unannounced Inspection 10:00 7 January, 9 -13 and 16th February 2009 th th th 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.V374184.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.V374184.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amerind Grove Address Picador, Regal, Embassy, Capstan & Kingsway 124-132 Raleigh Road Ashton Bristol BS3 1QN 0117 9533323 0117 9533406 marshv@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Post Vacant Care Home 171 Category(ies) of Dementia (70), Old age, not falling within any registration, with number other category (171) of places Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Dementia - maximum of 70 places (Code DE) The maximum number of service users who can be accommodated is 171. 17th June 2008 Date of last inspection Brief Description of the Service: Amerind Grove is a 171-bedded Bupa care home, situated in the residential area of Ashton, approximately four miles from the city centre of Bristol. The home is situated within walking distance from the local shops, and is on a local bus route. The home is a purpose built care home, designed specifically to meet the needs of elderly and disabled residents. The home is split up into five houses, but one house (Regal) is currently closed. The other beds are arranged as follows:Kingsway 38 Embassy 33 Picador 30 Capstan 40 The five houses are each of bungalow design with level access, via their own entrance. The home manager, administrative and ancillary staff, all work from the main part of the home. Car parking for visitors is available in front of all houses. Three of the houses are registered for nursing care (Kingsway, Embassy and Regal) and two for Dementia nursing care (Picador and Capstan). All bedrooms are for single occupancy. The management structure is that each house has a team of staff lead by a house manager, and a registered home manager has responsibility for the whole site. All but one of the managers posts are currently vacant and Regal House is completely closed. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 5 The cost of placement at the home ranges between £379-£697 per week and is based on individually assessed needs. The lowest amount is that charged for people who do not require nursing care – they will receive support with their personal care needs only (this used to be referred to as residential care). Additional charges for a number of items are listed in the home’s brochure. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection was unannounced and took place over five days. Two Regulatory Inspectors carried out the inspection, Vanessa Carter as Lead Inspector and Sandra Garrett, plus a Pharmacist Inspector, Sue Fuller. A total of approximately 50 hours were spent in the home. The first day the Pharmacist Inspector spent the time looking at medication systems in all four houses. Days two and three were spent in Picador, Capstan, Embassy and Kingsway. Days four and five were spent with the home manager, quality and compliance officers and senior members of the Bupa management team. Evidence to form the report is also based upon information gathered from a number of other sources:• • • • The Improvement Plan that was devised following the last inspection where the home was found to be providing a poor quality service to some of the people who lived there. Talking with registered nurses, care staff and ancillary staff who were on duty during the site visits Observations of staff practices and their interaction with the people who live in the home. On the dementia care units a Short Observational Framework for Inspection exercise (SOFI) was undertaken. This means using an indepth way of watching people living at the home. We did this for 2 hours in the dining rooms and recorded peoples experiences at frequent intervals. It included looking at their wellbeing, how they interacted with other people living at the home, staff members and the environment. A tour of each of the four houses. Case tracking the care of a number of people in each of the four houses. Talking with a number of the people who live in the home. Talking with a number of visitors to the home. Looking at some of the homes records. Information that was provided by members of the Bupa internal Quality and Compliance Team. Information supplied in our survey forms that we sent to the home. We sent 25 forms out but only had eight returned, from people who live in the home. Information that has been received by CSCI since the last inspection, from Adult Community Care Services and Healthcare professionals. • • • • • • • • Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 7 There has been an improvement in the standard of service provided to the people who live at Amerind Grove, but the lack of a stable management team is a barrier to seeing additional changes through. Bupa are in the process of an extensive recruitment drive to fill these posts. Some of the people who live in Picador House however do not have a good quality life, and further investment of time is needed to make both Picador and Capstan accessible and comfortable for people with dementia. Attention must be given to making sure that people live fulfilled lives. A further improvement plan will be requested. This will be in order to monitor how the service progresses to meet the required improvements, and to raise standards further. What the service does well: What has improved since the last inspection? Ten requirements and four recommendations of good practice were made as a result of the last inspection. All four recommendations have been taken on board. We received information that bereaved relatives had been well supported by staff on Kingsway, the number of call bell pagers for Picador had been reviewed and there was one more available. Bathrooms on all units were free from clutter and therefore usable and on a previous visit we saw that one specified bedroom carpet had been replaced. Of the 10 requirements, eight had been complied with and the other two still needed further work – these have been referred to in the next section. Improvements have been made in the management of medicines and these are now stored at the correct temperature. People told us that that are well looked after, they receive the healthcare support that they need, are helped as Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 8 they would like to be and are treated with respect and dignity. The management of complaints has improved and there are systems in place to analyse the trends of complaints so that action can be taken to prevent similar complaints being made. The actions of staff to safeguard people from harm means that people are safer. The numbers of staff on duty for each shift is now based upon the dependency levels of the people they have to look after this means that the staff will have enough time to devote to each person to meet their needs. There are now better systems in place to monitor the quality of the service and this has raised standards in a number of areas. 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.V374184.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with information about the home prior to making a decision about whether the service can meet their needs. They would have had their care needs assessed before placement is offered, but if this was done more thoroughly, it would ensure that individual’s would then receive a person centred approach to having their care needs met. EVIDENCE: The Statement of Purpose remains a reflection of the service although details regarding the management structure will need to be updated as and when there is team of managers in place. The statement sets out the services and facilities available at the home. A copy of this is available from the home. Everyone who lives in the home is provided with a copy of the Service Users Guide - copies were seen, placed in BUPA care home folders, in most of the bedrooms. The service users guide states “the most recent copy of the inspection report is available in the main reception area…” and it is expected that the previous CSCI inspection report is made available for any one who wants to read the report. Normally the reports are displayed in the main Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 11 reception area and the lobby entrances into each house however on this visit no reports were available. The registered person should ensure that the most recent inspection report is available. No new placements have been made into the home since Bupa voluntarily agreed to stop admissions in October 2008. This was because the home had a poor quality rating and needed to get the service right before offering a service to any new people. However, we know that the home uses a comprehensive individual assessment tool (QUEST) to complete pre-admission assessment. This document should capture a complete picture of each individual’s care needs to determine a person’s suitability for placement. The home has always requested copies of care needs and healthcare assessments, as part of their information gathering process. This same document is also used to assess the needs of current individuals who are already residing at Amerind Grove, and these were seen during the course of the inspection. In general, very little was recorded on the form to give clear information about a person’s individual care needs, and they were completed in a tick-box manner. For example, the assessment may indicate that a person needs support with eating and drinking, but the comment boxes are generally not completed to record a specific reason why. They may need help with having their food cut up, or would not sit down to take a meal for instance. If this sort of information was recorded it would be easier to case track that the person receives the level of care and support that they need. This assessment document is used as a basis for the care planning documentation and it is difficult to track the process through. The home provides placement for those with general nursing needs or specific dementia care nursing needs. Residents with a dementia will be looked after in either Picador or Capstan, but may well be looked after in the general nursing units, (Embassy or Kingsway), if their nursing needs outweigh their mental health needs. At the present time, Regal house is closed. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. Care planning processes are not always person centred and this could mean that people might not be cared for in the way that they want to. They will be well treated with respect and dignity. The records kept and auditing of medication stock levels is not consistently good enough and potentially puts people at risk. EVIDENCE: Care plans are prepared for each person using Quest documentation that consists of a comprehensive assessment tool, risk assessment forms and personal care plans. A total of 11 plans were looked at in the four houses. The quality of the plans varied considerably between the four houses. Care plans in general were not written in person-centred ways and we were told that ‘care planning guidance notes’ are used when preparing plans. Those who are writing care plans are lifting information from the guidelines and incorporating this into people’s care plans. This means that the actions recorded for staff to follow may not always be appropriate to the individual. For example one person who was poorly and confined to bed was Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 13 unrealistically expected to be encouraged to drink two litres of fluid per day (the recommended daily amount for a fit and healthy person). For another person, although it was recorded in the review of the care plan that the way in which the needs were met had changed, the plan of care had not been changed. Their plan said that their continence was managed with a catheter but this had been removed some months before. This could potentially mean that this person would not receive the actual care that they needed. We saw that each separate part of people’s care plans is checked monthly and changed if necessary. Some records had no information that showed people had been asked about the care they want. Relatives had given information, but it wasn’t clear if people had been asked how they wanted care to be given and what they wanted to happen to them. Some care plans and records showed what help people needed but weren’t particularly meaningful as regards an outcome. Other plans were extremely wordy and again had been lifted from the guidance notes. There was a lack of person-centred care planning in Picador and sometimes no evidence to show how specialist needs would be met. However in Capstan we saw good examples of person-centred care plans that were very detailed about people’s wishes and choices. One person’s care plan about eating was good and matched what we saw happening at lunchtime. Another part of the plan had been changed after information from their relative that helped staff meet the persons care needs more discreetly. The language in this plan was personcentred and referred to preferences, likes and needs. This is good practice. Along with the care plans, risk assessments are completed in respect of the likelihood of developing pressure sores, nutritional needs, the probability of falls, and to identify the risks involved in any manual handling procedures. From the manual handling assessments a safe system of working is devised – these were detailed and gave clear instructions to staff on what they needed to do. We looked at wound care planning documentation for two people and saw that there were good plans in place that detailed how often dressings were to be changed and what products were to be used. Monitoring records are completed each time the wound is attended to. We were told that the deep wounds one person had (on admission from hospital) when we visited in October 2008 have been completely healed. We could also see where the Tissue Viability Nurse has been consulted for advice and are aware that tissue viability training has already been arranged for registered nurses and some care staff. A record is kept for each person, of GP and other healthcare professionals contact, the reason for the referral, and any outcomes from this, such as what treatment may be required. However where out of hours doctors are called for advice about healthcare needs, the records written by staff didn’t always show actions taken or what advice had been given. Examples of healthcare Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 14 professionals involved in peoples care include chiropody, dentists, opticians, continence advisors, specialist diabetic nurses and dieticians. The care plan for one person needed to be clearer about how their specific needs were to be met and the GP had stated that this needed to be done in conjunction with other healthcare professionals. By the end of the inspection this matter had been addressed. People living at the home are registered with one of the local doctors practices. Nursing staff request medicines from the doctors and the prescriptions are sent directly to the pharmacy to be dispensed using a monthly blister pack system. The pharmacy sends copies of the prescriptions with the medicines so that staff can check that the correct medicines have been received. Picador had some excess supplies of medicines, which staff told us they had not requested. Action should be taken to ensure that only medicines that are needed are ordered and supplied. At the time of this inspection no one living in Amerind Grove looked after their own medicines, apart from a small number of people who look after their own inhalers. We talked to one of these people who said that they were satisfied with how staff looked after their medicines and liked to have their inhalers with them. We spoke to another person who told us that they had not been able to look after their own medicines when they first moved to the home due to ill health but had not been given the opportunity to do this once they felt better. We discussed this with staff at the end of the inspection. A homely remedy policy is available but staff told us that whether these were used depended on the doctor visiting the unit. We saw the nurse giving morning medicines on Picador unit. These were given after breakfast so that they did not interrupt the meal and deter residents from finishing their food. This means that some medicines are not given until late in the morning and care is needed to ensure that medicines are given at appropriate time intervals. Nursing staff sign the medicines administration record when they give medicines. Some medicines have been prescribed with a variable dose, for example one or two for some pain relief tablets, but the amount given was not always recorded. This means that it is unclear how many tablets a person has been given in a day. The administration records had very few gaps apart from the records for some prescribed creams and ointments that had not been completed. It was not clear whether this was because these preparations had not been used or whether they were applied by care staff and not recorded. Action must be taken to make sure that the use of all prescribed medicines is recorded when administered or a record made of why it has not been administered. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 15 We checked a sample of medicines on Picador and looked at the administration records to see if these agreed with the amount of medicine taken. We found that on some days staff had taken medicines from the wrong space on the blister pack so they did not coincide with the administration record. We looked at two of the record sheets used to check medicines supplied in standard packs. We found that the way they had been filled in did not demonstrate that medicines had been given as recorded. Action is needed to make sure that staff complete these records consistently. If discrepancies are found when stock balances are checked these should be investigated to check that residents have been given their medicines safely. On other units the audit sheets had been filled in differently and were more accurate. Some units have a system for auditing the medicines supplied in standard packs and this should be used consistently through the home. We looked at six people’s care records. There was space for recording current medication but this had not always been updated. Three people prescribed medicines to be given “when required” did not have clear information for staff about how these should be given. This means that these medicines may not be given appropriately or consistently. One person having regular blood tests for a medical condition did not have clear guidance for the acceptable upper and lower levels or any action that should be taken as a result of the tests. Action has since been taken to address this. During the period of this inspection this person has been seen by a number of health care professionals to ensure that they have appropriate treatment. This has resulted in a large number of care plans to cover changing needs, which could cause confusion for staff. Information about the best way to give medicines to this person should be available with their administration record sheet. This is to ensure that medicines are given safely. Records for three people receiving pain relief on one unit showed that this had been reviewed with the doctor. Each unit in the home has medicines storage facilities including medicine trolleys, a medicines fridge and suitable storage for controlled drugs (medicines needing additional security). Records are kept of the controlled drugs. These showed that on Capstan unit staff had been disposing of these medicines incorrectly. Action has since been taken to make sure that these medicines are disposed of safely. Previous inspections found that medicine storage areas were too warm but action has been taken to address this so that medicines are kept at safe temperatures. Daily records are kept of fridge temperatures showing that these are suitable for storing medicines. Since the last inspection when there were concerns that people were not always treated with respect, dignity and privacy, there has been an investment in staff training to get things right. A Dignity Champion will be registered with the Department of Health (the member of staff who is likely to be this person discussed the role) and some others have already attended workshops, organised by a Quality and Compliance Officer. Posters about Dignity in Care were displayed in the offices of each house and staff made reference to them. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 16 We saw staff doing their best to preserve peoples dignity but on one occasion, the person did not want to have a blanket placed over their knee’s and made this very clear. On the whole people looked well cared for and were nicely dressed. Those that were in bed looked comfortable and well covered by bedding. There is still further work to do in respects of “end of life” care planning. We saw care plans where they were not needed. For example one person had an end of life plan that stated that the person’s physical condition was satisfactory and therefore management had not been considered. This is totally unnecessary but evidences a lack of understanding about what is needed. For another person whose health was deteriorating, the person’s wishes in respects of their care had not been considered. It is our opinion that the care planning guidelines that staff follow when preparing care plans are responsible for this and again evidence a lack of a person centred approach to care planning. Discussion with a GP who was visiting the home evidenced the need for the staff to be having discussions with people, their relatives and the GP, at the appropriate time, about end of life issues and ‘do not resuscitate’ decisions. A written record must be kept where such decisions are made, signed by the GP and completed on an individual basis. One ex-relative who had completed one of our survey forms wrote “in the last few days of my Dad’s life, the home provided comfort, cleanliness and privacy and supported us in our sadness”. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. People who live in the home may not always have their social care needs met in a fulfilling and meaningful way. Activities that are arranged are not always suitable for people with dementia. People are provided with a well-balanced and nutritious diet but how they let people with dementia know about menu choices is inconsistent. EVIDENCE: The home has three Activity Organisers, two of them cover the dementia care houses and the third works between the two other houses. We were told that Bupa are in the process of recruiting a Senior Activities Organiser so that the range of activities is more co-ordinated and will bear in mind the needs of people with dementia. Activity staff do need more support and supervision from a manager to help them plan their time better. We gave advice about contacting the local Mental Health In-Reach team that supports staff in all care homes. This is essential in view of the fact we were told “we are left to our own devices”. In each house there is a displayed notice about the activities that will happen that week. In Embassy and Kingsway the programme for the week consisted of four sessions of ‘room visits’, cooking, ‘valentine decorations’ and bingo. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 18 Activity record sheets were seen for the previous month but contained very negative comments for example “room visits to 12 people, six were sleeping so no interaction”. Discussion with one activity organiser evidenced that what was arranged was more about what they thought people wanted to do, rather than any expressed preferences. Where meaningful 1:1 work had happened this had involved a trip to the shops but appears to only be done with a few select people. One person told us that they were desperate to visit Weston super Mare (and was aware that a group of people from another unit had previously gone on a trip) but had been told “it was too expensive and would take time away from other people”. We spoke to staff and activities coordinators and it was clear that activities are organised and done mostly by activities staff, and that care staff have very little involvement in meeting people’s social needs. One staff member said that they liked to sit and chat with a particular person whenever they have the time and this is good however the comment “he is one of the few you are able to have a sensible conversation with” was disappointing. Some “activity” tasks that have been arranged in the past have meant the staff do things rather than involve people in the task. Pictures have been put up on bedroom doors but the topic of the picture did not always relate to the person. One person said “I don’t even like dogs. My family are going to get me something nicer to look at”. We did see a ‘Map of Life’ sheet included in people’s care files in each house. This gives staff the opportunity to find out more about a person and their past life, and should be used to plan their care and activities. However, those we saw were only filled in sketchily with lots of blank spaces. This is a missed opportunity for staff to be able to give truly person-centred care. One relative we spoke with did tell us that they had been asked to give more history about the person being cared for – this evidences that they do see a persons past life as being important in the care planning process. We were told that people will be assisted to go along to activities that are based in other houses if they wish and can choose not to participate in some or all of the activities. One person said “I am self-sufficient and I plan my own free time. The girls pop in and see me regularly”, whilst another said “I prefer to spend my time quietly in my own room”. People are asked what time they like to get up, go to bed and where they want to have their meals served, and those spoken with in Embassy and Kingsway said that in general staff helped them as they wanted to. From our observations of people in Picador there was very little meaningful activity. In both Picador and Capstan the lounge/dining areas and in peoples bedrooms, daytime TV programmes were on regardless of whether people were watching them. Some people being nursed in bed were asleep yet the TV was left on. Staff told us that some people do like the TV on, and sometimes talk to each other about programmes such as ‘Eastenders’. However we saw no evidence of this. We suggest that if music from their generation was played, they may join in and take more of an interest. The use of TV could further Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 19 confuse people as they may only hear it as voices in the background that they can’t understand. On looking around the lounge/diners we didn’t see any picture books or photo albums that people could look at. No thought had been given to furniture, ornaments or decorations from days gone by that might jog people’s memories. There were no rummage boxes with things in for people to handle and talk about. Some people in Picador were seen walking about aimlessly with little expression on their faces. People sitting in the lounge also lacked facial expression however when we spoke to them they were bright and animated. From watching them we saw that some people showed signs of positive wellbeing whilst others were passive or withdrawn. On a positive note, those people who live in Capstan are able to attend the ‘Night Owl Club’. This was set up to engage with, and occupy people in the early evening and night- time period. Food is provided and time devoted to provide positive interaction between people and their carers. The home has a four-week menu plan, offering a choice of two main midday meals. Alternatives can be provided upon request. Meals are prepared in the central kitchen and wheeled over to each house in heated cabinets. Examples of the lunches that were served during the course of the inspection include a pork casserole, a fish dish, salads and a pasta meal. People in general were complimentary about the food and felt they were offered a good choice. The days menu is displayed on the wall of the dining room, however the print is small and may be difficult for people with dementia or who are visually impaired, to see or read. In Picador the menu displayed was for a previous day. Menus themselves are traditional English dishes that are meat based. Fish dishes are offered three times a week and curry three times a month. It wasn’t clear what vegetarian choices are offered although a meat-free salad is offered once a week. People were however, offered something different if they didn’t eat the meal they were given and staff said that snacks are now being left out throughout the day for people to pick up. This is good practice for those who like to eat on the move or don’t sit down long enough to eat a proper meal. However we only saw chocolate biscuits rather than more nourishing finger food left out. The chef will visit any person where there are concerns about their dietary intake or when they have asked for specific types of food to be provided. One person said that they had seen the chef and that their wishes had been taken on board but that their family still brought in meals for them. The chef caters for soft diets, pureed diets, diabetic diets and would see people if they had specific cultural diet needs. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 20 We saw staff helping people to eat in all four houses. Whilst some staff were good at talking with people, giving them eye-contact, not rushing them and helping at the person’s own pace, others were distracted by their colleagues or did not engage with the person they were assisting. One relative told us that the staff help with their parents meals and they do chat to the person and don’t rush them. White plastic aprons are used to protect people’s clothes but no-one was asked if they wanted the apron. The use of coloured or patterned wipe-clean tabards for people to wear would look less institutional and more dignified. Meal tables were laid with tablecloths, cutlery and vases of flowers – those in Picador were very tall and stopped people from being able to see one another. No serviettes were available or offered, but we saw thick cleansing wipes being used - but these were too stiff for people to use properly to wipe their hands or mouths. Some people were assisted to clean themselves up after their meals. We sampled meals on both days. They were tasty and nutritious and had been well presented. The Chef and Hotel Service Manager spent some time in Kingsway watching how the staff were serving meals and we discussed some of the observations they made. People told us or showed that they enjoyed their meals and most finished what was on their plates. We checked food and fluid charts for people that don’t eat much. These show different portions to tick e.g. quarter, half, three quarters eaten. Whilst this is good it does not accurately show what people did eat. We saw that a person at risk of malnutrition ate most of the meal but not all of it. However staff had ticked ‘whole plate’ for the amount eaten. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Management of complaints has improved meaning that people can have greater assurance that they will be listened to and their concerns will be acted upon. Some people have not been protected from harm but improvements have been made with safeguarding procedures and staff awareness of what to do to report concerns. EVIDENCE: The home’s complaints procedure is displayed in the main reception and the reception area’s of each house and is also included in the service user guide. Some of the posters contain out of date information about how to contact the Commission, and this needs to be updated. We were told that complaints management training for unit managers has been put on hold for the moment until these posts have been filled. A member of the Bupa Quality and Compliance Team is currently overseeing the management of any complaints being made about the service, although the interim home manager is fully informed of the issues that are raised. We have been told that all concerns however trivial are currently being logged as complaints, to ensure that no issues go unanswered. It is evident that the management of complaints has improved since the last inspection and this means that the service will be able to identify any trends in the complaints that are raised, and then be able to put appropriate measures in place to resolve situations. Surveys were returned to us from only eight people and each person indicated that they were aware of the complaints procedure. Those people spoken with Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 22 during the course of the inspection were able to confirm that the staff do listen to them, and the following comments were made. “care staff always do as I ask” and “ if I raise issues things change. Sometimes I have to say again though”. One person we spoke to said that they had never had to make a complaint but would know how to do so if necessary. However this same person had made comments to us about not being treated with dignity or respect, therefore it was not clear if they had been supported to raise these concerns with the staff. Suggestion Feedback boxes, and a supply of forms, have been placed at the entrance to each house - this is newly introduced initiative. The home has a protection of vulnerable adults policy (POVA) and clear guidance is available for the staff to follow if abuse is suspected, alleged or witnessed. Despite the majority of staff having already completed a POVA training package prepared by Bupa, a rolling programme of ‘refresher training’ is being arranged for all staff. Since the last inspection we have been notified of seven occasions where the safety and welfare of individuals or groups of people has been compromised. Some serious concerns have been raised after people have been admitted to hospital, others by healthcare professionals and others by relatives. Discussions with staff on all four units evidenced that they are aware of their responsibilities to safeguard people from harm and are aware of the actions they should take. The staff team, via the home manager are now reporting issues to the appropriate authorities and have taken the appropriate actions. We are still working with the Planning & Commissioning Team from the local authority and healthcare staff from the Primary Healthcare Trust to ensure that people are safe. Staff who were spoken with during the inspection told us that they have been provided with details about a dedicated ‘Whistleblowing’ telephone line that has been set up so staff could talk through any concerns they may have, without fear of reprisal or victimisation. Posters were also displayed on staff notice boards. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. People are cared for in houses that are safe, comfortable and generally well furnished. The environment could be better for people with dementia by making the facilities more accessible and user-friendly. EVIDENCE: Amerind Grove is a purpose built care home and is arranged as five separate single storey houses, each accommodating between 30 to 40 people. One house is closed for the foreseeable future. The service facilities are all located in a sixth building. The grounds are surrounded by walled gardens, and the entrance has large steel gates that are locked overnight. Fencing surrounds the two dementia care units (Picador and Capstan), enabling these people to wander safely out into parts of the gardens. Other parts of the garden are in the process of being revamped following the building works that were completed last year. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 24 Each of the houses are similarly laid out, decorated and furnished. Despite this the environment in Picador was completely different to that of Capstan. In Picador the bedrooms were bland and looked soulless. Very few personal things were seen apart from photographs. Some of the furniture particularly bedside drawers, looked ‘tired’ and/or tatty. The result was that Picador looked more like a short stay centre rather than home. Staff told us that rooms look like this because personal things are put away to stop other people coming in and taking them. We suggest that if people had more things to look at and occupy them in communal areas they wouldn’t need to go into peoples rooms and take things. Some people have a type of dementia which affects their ability to see objects clearly and as they really are. Environmental issues that affect them could be heavily patterned carpets, shiny floors and mirrors. One of the quality managers said that an assessment of the environment in both Picador and Capstan will be done by a specialist dementia care organisation. This needs to happen quickly as people aren’t leading full and stimulating lives in the houses at present and may be at risk because the environment may not meet their specialist needs. Aside from the comments about some of the furniture, the houses are well maintained throughout and regular maintenance audits are undertaken. Each house has a maintenance log where staff can report any jobs that need attending to. The front doors to each of the homes are secured with a keypad door entry system, and all fire exits are linked into the call bell system. This creates a secure environment for the residents. Each of the houses were in good decorative order however the environment in the dementia care units isn’t fully accessible for people with dementia. In Picador toilet doors had large yellow signs with toilet symbols on. This is good practice. In Capstan however, the black and white signs just said ‘WC’. Toilet doors were the same as all other doors including bedrooms. This made them indistinguishable and therefore harder to find when people need them. In Picador corridor pictures were faded or bland although one large poster frame had photos and postcards from the nineteen forties. The corridors and some bedrooms are carpeted throughout although some have vinyl flooring. Each house has a large communal area consisting of a lounge and dining area. In Capstan and in Kingsway, the larger of the units, the new building works included a second lounge area. Furniture and furnishings throughout the communal rooms are generally of a homely nature and in good condition. Each lounge has a range of different types of seating to meet the different needs of the people who live there. Toilets and bathrooms are located throughout each of the houses. The bathrooms are fitted with bath hoists or other types of specialist bathing equipment. The hoist chairs in Picador and Capstan were in need of a thorough deep clean as the undersides were dirty - this task should be added to the weekly housekeeping job sheet. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 25 Each house has sluice room facilities, separate from the bathing facilities and these are kept locked. The lock needed to be repaired on the sluice room door in Embassy. Each of the houses are well equipped with a range of equipment to enable the care staff to undertake their duties and to move residents safely, in line with good manual handling techniques. All beds are electric profiling beds, have integral bed rails and the ability to be lowered close to the floor. There is a plentiful supply of pressure relieving mattresses, between the houses. Care must be taken to ensure that the equipment is always used as it should be. A pressure-relieving cushion was observed placed incorrectly in one person’s chair. A nurse call bell system is installed in each bedroom and the communal areas of each of the houses, and calls for assistance are registered on pagers carried by some of the staff team. Despite additional bleeps being provided in Picador staff were of the opinion that more were needed bearing in mind the needs of the people they are looking after. All bedrooms are for single occupancy, have fitted wardrobes, a chest of drawers and a bedside cabinet with lockable drawer (comments have already been made about the bedside cabinets in Picador). The 150 original bedrooms have a wash hand-basin in the room and a commode is provided where needed. The 21 new bedrooms have an en-suite room toilet and wash handbasin. People are encouraged to bring in items of furniture to make their bedrooms their own, but bedrooms in Picador were stark. In Capstan the bedrooms were bright and homely and people were engaged with the objects around them. Some of the bed linen looked faded and worn, however replacement linen has already been provided and more is on order. Since the last inspection, boxes with glass fronts have been screwed to the walls. These are ‘memory boxes’ and should ideally be fixed on outside walls in the corridors to help people find their rooms. Some of the boxes were fixed over the beds, making them difficult to access or look at if lying down. Many of them were empty. Relatives should be encouraged to help find things that are dear to people to put in the boxes so that people can find their rooms easily. Each house has at least 10 hours of housekeeping support each day. Each unit has one full time housekeeper, plus two part time workers, or two full time workers, who cover shifts during the day and the evening. Since the last inspection the Hotel Services Manager has taken up their full duties, and we were told that housekeeping cover is now consistently available and only on occasions are shifts covered by care staff. All housekeepers and laundry staff work under the direct supervision of the Hotel Services Manager and they reported that they were well supported. During the course of the inspection, all houses were noted to be clean, tidy and free from any unpleasant smells. The survey forms that were returned to us all stated that the home was either “always” or “usually” fresh and clean. Each house has a linen cupboard where clean linen is stored but some items were stored on the floor. Items should not be stored on the floor as this is not hygienic. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff receive the relevant training, and their training and development needs are met, but the lack of a stable staff team means people could often be looked after by staff who are unfamiliar with their care needs. Safe recruitment procedures ensure that unsuitable workers will not be employed. EVIDENCE: Each house should have a team of registered nurses and care staff who will work under the leadership and management of a house manager. Only one house manager post (Capstan) is filled at the moment and the vacant positions are having a significant impact upon the ability of the service to fully implement the changes that are planned and to raise standards further. There has been a significant change in the staff team since the last inspection with some of the long-term staff having left and been replaced with new recruits. Interviews have already been set up to recruit replacement house managers and Bupa are aware that it is essential that they recruit people who will provide strong leadership. Because of the lack of permanent managers there is an unsettled feel amongst staff and relatives, with people who live in the home feeling there is a lack of continuity. One visitor said “you just get used to the person in charge and then there is a change” and comments made by several staff was in the same vain. In the meantime Bupa have arranged for some staff to “act up to house manager level”, arranged fixed term agency cover or brought in senior staff from other care services. We are assured that Bupa are taking serious steps to address this. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 27 Shifts in each house are covered by both registered nurses and care assistants. We were shown a “staffing tool” that is used to work out the staffing numbers required for each shift, and is based upon the dependency levels of the people who live in the house. We were told that some of the information is going to be removed from the form so that staff complete the exercise without being able to determine the outcome. We were also told that each house will complete this exercise every month but that it can be reviewed if significant changes in peoples needs increase the level of support that they need. These measures show a commitment to getting staffing levels right so that peoples care needs can be met. Staff we spoke with during the inspection said that because fewer people are in residence, they are able to meet peoples need better with the number of staff on duty each day. Staff confirmed that they felt staffing levels were appropriate. Although staff were observed going about their duties and were busy, there was not the frantic feel to get everything done that had been so obvious at the last inspection. Whilst there is an improvement in the way in which staff work together to meet people’s needs, there is further work to be done. Trained nurses were seen giving out medicines, serving meals and doing more administrative work. Care staff stated that registered nurses spent most of their time in the office and only a small amount of time meeting people’s needs, or working alongside care staff in a supervisory capacity. This was backed up by what we saw during the inspection. One member of care staff said that they had never worked with a nurse, whilst another said “some nurses are more helpful than others and will help us out with getting people into bed in the evenings”. The interim home manager is aware of the need to increase the level of day-to-day supervision of care staff to monitor performance and people’s care. Care staff are supported in meeting the peoples daily living needs by a team of administrative, housekeeping, catering, laundry and maintenance staff. The numbers of care staff who have achieved at least an NVQ Level 2 in Care qualification currently stands at approximately 27 (previously at 70 ). This reduction in the number of trained members of staff has been as a result of staff changes and newly recruited staff who are working through induction or foundation training. Some care staff have achieved NVQ level 3 as well as the Level2. One care staff member with NVQ Level 3 is trained to do medical tasks such as taking blood pressures and doing wound dressings. Another staff member said she has started NVQ but been unable to finish due to the assessor being unavailable. Another said she had wanted to do NVQ training but had never been ‘put through’ to do it. Other staff had similar experiences, however have now been told that everyone has to complete the training. We were told that a new reliable NVQ training provider is now contracted and the next cohort of staff to start the course will be towards the end of March. The home follows a thorough recruitment procedure and expects written application and attendance for an interview. Two written references are Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 28 obtained, with one reference being obtained from a previous employer. CRB disclosures and POVAfirst clearance is always completed prior to employment commencing. Home Office paperwork was all in order where necessary. Six staff files were checked and two new recruits were spoken with during the inspection and these arrangements were verified. The home provides a good induction programme of training for all new recruits and the new members of staff spoken with during the inspection said that they felt well supported when they first started, and that they had worked with a senior carer. They said they had to complete a workbook and “had to get things signed off”. We were provided with a copy of the current training matrix that shows what training courses each staff member had attended. Mandatory training includes manual handling, POVA and fire awareness, but staff will also complete health & safety, food hygiene, infection control, nutrition and understanding dementia. All of the training is provided in-house via distance learning courses with a workbook to be completed. There was no evidence to show that care staff had done training in person-centred care and activities for people with dementia. We saw that registered nurses had done training in person-centred care planning but results of this training were patchy and hadn’t yet changed the way care plans are written particularly in Picador. Some staff we spoke to were not clear about the meaning of the term ‘person-centred’ and couldn’t give examples of what this meant for the people they care for. Examples of training that is due to be happening soon include tissue viability, end of life training with St Peter’s Hospice and dignity in care. There is a great need for the activity staff to undertake training, particularly in relation to supporting people with dementia to have a meaningful life. This would help them provide more appropriate activities that would meet individual’s needs. We were told that Bupa have recently held an activities conference but that neither of the activity organisers had attended despite being asked to do so. We would have expected this to be followed up by the organisation. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 29 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, 33, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made in the management of this service although hampered by many of the leadership posts being vacant. Further work is needed to ensure that the home is run in the best interest of all people who live in the home. EVIDENCE: The Home Manager post has been vacant since November 2008, but an ‘interim home manager’, seconded from within Bupa is currently managing the home. Subsequent to this inspection we have been advised that this person will be taking up the post of Home Manager and will therefore be making application to the Commission to be the registered manager. She has previously been a registered manager at another nursing homes in the local area and is a Registered Nurse. There are still other posts within the current Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 30 management structure also vacant, namely three of the four house manager posts, and the Centre Manager post for the dementia care units – the recruitment process to fill these posts is already underway. Posts that are filled include a Hotel Service Manager, a Chef, Maintenance, gardening and administrative support. The home manager has overall responsibility for the home and the care of up to 171 people who can reside at Amerind Grove. Since the last inspection of this service, there has been a significant presence of senior managers and quality and compliance staff and Bupa have demonstrated a real commitment to getting things right and raising standards. Bupa complete an annual Care Home Resident’s Survey, in order to measure how their service is doing. The last survey was completed at the end of 2008 and the results are still in the process of being analysed. In response to shortfalls identified at the last inspection an improvement plan was devised and the management team and staff have been striving to complete the necessary actions. A number of the improvements have been hampered by the lack of a stable management team, however things have improved and there will be ongoing work to achieve full compliance. In addition to formal quality assurance measures, a number of audits are completed on a regular basis. These include lessons learnt from complaints management, health & safety checks and the environment, medication audits and specific care related audits. A relative’s forum is in the process of being set up, but the first meeting has been delayed. It is hoped that this meeting will capture the views and opinions of people who do not want to use the complaints procedure yet have valid concerns or suggestions to make. There will be no staff presence at this meeting, and the ‘lead relative’ will then feedback information to the home manager. From our observations in Picador though, it was clear that this house is not being run in the best interests of people living there. We have made this judgement because there is a lack of access adjustments, a lack of joined-up working between staff groups, lack of meaningful activity and lack of staff training and supervision in person-centred care, dementia and activities. In both dementia care houses, some people’s wishes and dignity are respected yet others are not. Our judgement is that the lack of permanent, trained and experienced managers able to support and supervise staff is key to the low quality of life that the people living in Picador currently have. We did not assess the administrative procedures that were in place where the home looks after people’s money despite this being a key standard. However, at previous inspection they have demonstrated good administrative and auditing procedures. Staff on both Embassy and Kingsway said that they received regular formal supervision and monthly house meetings. Staff in Picador told us that they don’t get regular supervision but that staff group meetings have a supervisory element and these are held once a month. We spoke to the acting house Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 31 manager but no meeting records could be found for us to see. Care staff said that the acting house manager was approachable and supportive and gave them positive feedback and ‘keeps us on our toes’. Staff in Capstan said they get regular monthly staff meetings although these had only restarted recently. They told us that they felt ‘everything is improving’. The interim house manager holds regular weekly meetings with ‘heads of department’ and 1:1supervisory meetings with individual staff. Housekeeping staff told us that they have a meeting at the beginning of each morning shift with the Hotel Services Manager and are told of any specific tasks that need to be completed, for example rooms that need to be deep-cleaned or carpets that need a shampoo. During the inspection safe moving and handling procedures were observed, using a variety of different aids, and with the care staff informing the person about what they were doing. Staff told us that they would not be allowed to use any hoisting equipment if they hadn’t been trained, and that they do receive regular training. New recruits told us that they had had manual handling training when they started work at the home. We were told that the records kept about each manual handling training session have been evaluated and will now show exactly what instruction has been given. These measures were put in place after an incident when Bupa asked their health & safety representative to investigate what had happened. All staff spoken with confirmed that they have had or are due to receive manual handling training. Monthly environmental audits are completed in respect of the water supply (hot and cold water temperatures), the nurse call bell system, the lifting and moving hoists and the bath hoists and all wheelchairs. The fire log was up to date and evidenced that all the necessary checks had been completed. There is a system for staff to report any maintenance issues in each of the houses and this appears to work well with tasks being completed promptly. In the New Year there had been problems with the central heating system and we were told what measures were put in place to keep people warm and comfortable, but this had only been after concerns had been flagged up by a relative of someone who lives in Kingsway. Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 3 Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 33 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 OP3 Regulation 15(1) Requirement The registered person must ensure that assessments of peoples needs record individuals holistic care needs. This is so that care-planning processes can be person centred and based around individual’s specific needs. 2 OP7 15(1),(2)c The registered person must ensure care plans are personcentred and based upon individual need. They must be updated as and when necessary. This is so that people will always receive the care and support that they need. The previous timescale of 7/08/08 has not been met and the timescale has been extended. Timescale for action 16/04/09 16/04/09 3 OP9 17 The registered person must ensure that records are kept of the administration of all medicines, including creams and ointments. This is to show that these medicines have been given as DS0000020371.V374184.R01.S.doc 01/04/09 Amerind Grove Version 5.2 Page 34 prescribed. 4 OP12 16(2) m,n The registered person must ensure that there is an adequate programme of activities, that is available for every one who wishes or is able to participate. The programme must be based upon individuals needs. 16/04/09 The previous timescale of 7/09/08 has not been met and the timescale has been extended. 5 OP30 18(1)a The registered person must ensure that staff in Picador and Capstan, receive training in person centred care and person centred activities for people with dementia. This is so that people are cared for with dignity, respect and their rights and choices respected. 16/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations A copy of the most recent inspection report should be made available. This is so that people who live in the home and any visitors are able to read the report. It is recommended that each unit have a system in place to allow them to accurately audit medicines supplied in standard packs. This is so that staff can check that medicines have been given correctly. Ways should be found for both activities and care staff to DS0000020371.V374184.R01.S.doc Version 5.2 Page 35 2 OP9 3 OP12 Amerind Grove work together in planning and doing activities with people so that the range of activities is broader and more readily available. 4 OP15 Ways of telling people about the menu choice for each day must be done consistently and be more accessible for people with dementia . This is so that people are able to have the meal they choose. An assessment of the environment in both Picador and Capstan should be done by a specialist dementia care organisation as soon as possible. This will make sure people with dementia are able to use the home safely and without adding to their difficulties. All bathing equipment should be checked and cleaned particularly the undersides of bath hoists. This will make sure people are kept protected from risk of infection. All staff should have supervision on a six weekly basis and records must be kept of the meeting and available for inspection. This will make sure that staff are working with the peoples best interests in mind and that any training needs are identified. 5 OP19 6 OP26 7 OP36 Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Amerind Grove DS0000020371.V374184.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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