Inspection on 22/07/05 for Ampersand House

This inspection was carried out on 22nd July 2005.

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

Other inspections for this house

Ampersand House 17/07/07

Ampersand House 31/08/06

Ampersand House 17/01/06

Ampersand House 19/01/05

Ampersand House 30/09/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Ampersand House 164/166 Frindsbury Road Frindsbury Rochester Kent, ME2 4HP Lead Inspector Sally Hall Unannounced 22 July 2005 10:00 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 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. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ampersand House Address 164/166 Frindsbury Road Frindsbury Rochester Kent, ME2 4HP 01634-724113 nil nil Mrs. Ravichandran Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Antionette Lawrence Care Home 31 Category(ies) of Care Home only - 31 registration, with number of places Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: nil Date of last inspection 19 January 2005 Brief Description of the Service: Ampersand House is a care home registered to provide residential care and accommodation for a maximum of thirty-one older people. The home is a large detached property set in pleasant grounds. It is situated in a residential area of Frindsbury and is approximately one mile from Strood town centre. Motorway links are close by. The home is near a bus route and Strood mainline railway station is approximately one mile away.The accommodation is set out over three floors and has a passenger lift serving the upper floors. There are two lounges, one of which is a designated no smoking area, there is also a conservatory and dining room for use by service users. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection at Ampersand House took place on 24th May 2005 at 10am. The Inspector agreed and explained the inspection process with the Registered Manager. Documentation and records were read, including care plans. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. A full tour of premises was not undertaken. The focus of the inspection was to assess Ampersand House in accordance to the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. What the service does well: What has improved since the last inspection? What they could do better: The laundry was found in a dirty state and needs not only to have an in-depth clean but needs to be decorated. Staff supervision needs to be initiated on a regular basis. The home needs to ensure that medication administration storage and recording follow The Royal Pharmaceutical Society Medication guidelines for care homes. More inclusion in the local community and outings from the home need to be encouraged. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 6 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. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1-5 Service users have the information they need to ascertain whether the home can meet their needs. Service users rights are protected by a written contract / statement of terms and conditions. Prospective residents have the benefit of a trial period at the home to assess whether the home can or cannot meet their needs. EVIDENCE: There is a Statement of Purpose and Service Users Guide in place. These have been reviewed and contain the information required for service users and their families to make an informed decision about the choice of home. The service users are provided with contracts that are clearly written and contain the required information including the fee payable and who is responsible for that payment. A pre-assessment is completed for all new service users coming in to the home. The manager and/a senior visits the service users at home or in hospital and start to complete the assessment. The assessment is completed when the Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 9 service users visits or comes in to the home for the trial period. The home also ensures that the home receives the care manager’s assessment / care plan before assessing if they can meet the service users needs. The home develops a plan of care from the assessments in order to ensure that the service users need’s will be met. The recording in the daily logs did cross reference generally with these plans. The staff also receive training to ensure that they can meet the service users personal needs. All prospective service users are offered a chance to spend at least a day at the home prior to becoming a resident at the home. The families are also encouraged to visit and ask questions before the service user is admitted. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-9 The care of residents is compromised by the inadequate care planning procedures used by the home. The health of service users is protected by the home’s health monitoring procedures. The residents are put at potential risk by the home’s inadequate policy and procedures with regard to the administration and dispensing of medication. EVIDENCE: Service users files contain a care plan, which was based on the assessment done on and prior to admission. Staff are reviewing the plan each month but are not recording any outcomes, or reviewing with the service users and/or family on a six monthly basis. Service users’ assessment needs still need to be reviewed every 6 months or before if there are significant changes, with a new plan of care being agreed with the service user. There was no evidence seen that service users are involved in the formation of these plans and this was discussed with the manager. The inspector also discussed the content of the daily report, which did not detail all the care and input service user received Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 11 through the course of the day although they had improved. The entries did not contain the times that events and when the care provided happened. Health problems were seen recorded in the daily report, along with the follow up action. The home facilitates visits from the optician, dentist and the chiropodist as required if service users are not able to visit them. The Manager has monitored the accidents and taken action where Service users are at risk. The manager understood the need to inform RIDDOR for certain injuries etc. There was also evidence seen of the pressure area care as directed by the district nurse. The home always tries to provide an escort for planned hospital visits, if the family are not available. The medication storage, administration and recording was checked. There have in the past been problems and the manager has put in systems to ensure these have been addressed. However there does remain a problem with the Medication Record Sheet not showing the total amount of medication held in the home at the beginning of the period, or that has come in during the period. Medication was also seen being put in to the old blue trays for some service users. This is medication that has come in to the home mid way through the cycle and is not in the dosage system supplied by the chemist or warffin. Double dispensing is not permitted and the home was advised. It was also noted that some medication is kept in a cupboard that is not solely used for medication. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 Service users benefit from a range of activities arranged by the staff at the home. Residents maintain their independence and exercise their right to choice and control and are encouraged to maintain contact with their family and friends. The dietary needs of residents are well catered for in pleasing surroundings at convenient times. EVIDENCE: The activity programme was seen on the notice board. The service users confirmed that there is activities arranged in the home that they can choice to take part in. The home also has entertainers coming into the home, which the service users spoken to said they enjoyed. One service users spoken to explained that she likes to spend a lot of time in her room. She said this is not a problem the staff respect her choice to do this but they always keep her informed of what is going on. Outings are not going well. The manager said that she has tried to encourage service users to go out but gets little response. The home does not have its own transport and this also makes matters difficult. The home did take some service users to the theatre recently which had an old time musical on the bill. Families and friend s are encouraged to visit and are offered refreshments. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 13 The home offers choices to the service users throughout the day and this was observed during the inspection process. There was some choice documented in the daily report but this needs to be expanded upon. Service users spoken to said that they are always asked what they want to do, i.e. time for getting up/going to bed etc. The mid-day meal was well cooked and very tasty. The food was arranged in an appetising way and the service users were given a choice of meal. Staff also noted if the service users had enjoyed their meal and recorded the amount that was eaten in a daily report. The service users spoken to said they all enjoyed the meals at the home, that it was usually home cooked and there was plenty of it. The menu showed balanced meals with plenty of variety. The manager explained that this is one of the topics of the regular service users meetings; they encourage service users to have an input to the menu. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Service users know that their concerns and complaints are taken seriously and that they will be dealt with by the home. Whilst service users are protected from the risks of abuse the home’s current Adult Protection policy needs updating and staff need training in this area. EVIDENCE: The complaints file showed that there had been no recorded complaints since the last inspection. The complaints procedure matched the requirements and had been reviewed. The manager had not seen the new adult protection protocols from the local authority and it was suggested that the home secure a copy. The home’s policy and procedure needs updating in light of the changes. Staff need Adult Protection training. The home has a whistle blowing policy. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-22, 24-26 Whilst service users benefit from living in a clean, safe and well maintained and well equipped environment suited to the needs of service users, the home’s laundry urgently needs cleaning and redecorating. EVIDENCE: The home has a warm homely feel, and there is choice of lounges. The home is of a good size, safe and well maintained. The home has a large garden which is accessible to service users, however attention needs to be directed at the weeds that are coming through the pavers which could be trip hazard. There is a conservatory, which is very popular with service users in the home. The home has a lift and stairs to the first floor, were there are mainly bedrooms. The first floor also has a small visitors room and the manager’s office. The home has adequate toilet, washing and bathing facilities. There are twelve WCs, four bathrooms and one shower. Toilet facilities are situated close to both the communal areas and private accommodation Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 16 Service users have access to all areas of the home via a passenger lift. There are grab rails in areas of the home, as well as hoists. Call systems are available in every room. The manager said that if a service user did have a specific mobility problem, then the occupational therapist would be consulted for advice via the GP. Some rooms in the home are under the desirable size. However, the new registered owners informed the inspector that the home will be addressing this and the number of shared rooms once they have investigated the best options for expansion. The screens in shared rooms are now suitable and fit for the purpose ensuring adequate privacy for service users. The previous inspection highlighted the need for covers on the radiators; these have now been fitted. The sinks in the home are fitted with thermostatic control valves. The lighting with in the home is domestic in nature and with the natural light this is sufficient. The areas of the home that were visited by the inspector were found to be generally clean and comfortable with no offensive odours detectable. Laundry facilities were found to be dirty and the recent purchase of a washing machine with a sluicing facility has meant the sink has been removed. The home is still not using the red sack system. The home has been asked to address this as a mater of urgency since the whole area is not adhering to infection control. The laundry need not only to be cleaned it also needs to be decorated and a sluice sink needs to be fitted. There are paper towel dispensers in all the communal toilets and the staff toilet. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-29 Service users needs are met by the home having sufficient staff with the required skills mix and experience. Service users are supported and protected by the home’s recruitment policies and practices. EVIDENCE: Staffing levels remain the same with four care staff, a senior, cook, domestic and the manager on duty in the morning. Given that service users feel that their needs are catered for and they said that there are always staff about, this appears to sufficient at this time. Three staff recently passed their NVQ level 2 brings the total for the home to nine, the home has twenty-four staff. The home is working towards the 50 of staff it needs, with another three booked to start the course soon. The staff files sampled did not contain all the ID required. These tended to be the files of staff who have been at the home for some years. The files do now contain the other information required, i.e. CRB checks, references. It was evident that the recruitment procedure is now being followed for all new recruits. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,37 Service users benefit from living in a home that is well managed. The quality of care offered is compromised because staff are not in receipt of regular supervision. Service users can be confident that the home’s record keeping systems safeguards their rights and best interests. EVIDENCE: The manager is now registered, but due a failing by the training organisation she was with she has had to start her Registered Managers award again with another organisation. As well as a nursing qualification the manager has a number of years experience in residential care of the elderly. Service users said all the staff including the management is very approachable, it was apparent that there is a very open atmosphere in the home. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 19 There was evidence that there has been some staff supervision, however the manager has not been able to keep up with the on average two monthly time scales. The home is to train the seniors so they can take on some of this task. Most information in the home is kept up to date. All confidential information is kept securely in the home, including the service users care plans that the home has brought a lockable trolley for. Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 1 14 3 15 2 COMPLAINTS AND PROTECTION 3 x 3 3 3 3 3 1 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 3 x x x 1 3 x Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 schedule 3.1(b) Requirement A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. ensure entries and events in the daily log is timed with more detail of the care delivered. The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users’ preferences. The premises including the laundry are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with Timescale for action 30th September 05 2. OP9 13(2) schedule 3.3(i),(k) 1st September 05 3. OP13 22, schedule 4.11 30th September 05 4. OP26 13,16,23 1st September 05 Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 22 5. OP36 18(2) relevant legislation and published professional guidance. The registered person ensures that supervision arrangements are put into practice, recorded and happening six times per year.. ongoing 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 OP15 Good Practice Recommendations The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that a choice is offered at each meal. It is recommended that the Hoemes ploicy and procedure is reviewed and changed to meet the recent changes in POVA corrisponding with the local authority protocols. The registerded manager informs the commission once she has completed the Registered Mnagers Award. 2. 3. OP18 OP31 Ampersand House H56-H06 S55868 Ampersand House V239775 220705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection The Oast Hermitage Court Hermitate Lane Maidstone Kent, ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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