Inspection on 03/10/06 for Bay House

This inspection was carried out on 3rd October 2006.

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

The inspector 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

Bay House 28/08/08

Bay House 14/09/07

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 Amber Beach 2-3 Middlesex Road Bexhill-on-Sea East Sussex TN40 1LP Lead Inspector Rebecca Shewan Key Unannounced Inspection 3rd October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Amber Beach DS0000067742.V308506.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. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amber Beach Address 2-3 Middlesex Road Bexhill-on-Sea East Sussex TN40 1LP 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) 01424 210202 Mr N Manji Vacant Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is thirtysix (36). Service users must be older people aged sixty-five (65) years or over on admission. N/A Date of last inspection Brief Description of the Service: Amber Beach is a converted Victorian property that was formerly Guest House. It is situated in a quiet residential area of Bexhill close to the seafront, town centre and mainline railway station. The home comprises of eight single occupancy and fourteen double occupancy bedrooms, located over three floors. Some bedrooms have en suite facilities, with additional toilet and bathroom facilities throughout the premises. There is a small lift shaft servicing all floors. The home has specialist equipment including specialist beds, bath and lifting hoists and walking aids. There is a well maintained garden to the rear of the property that is accessible to service users. Unrestricted parking is available on the road on which the home is situated. Amber Beach Nursing Home is registered to provide general nursing care to older people. Amber Beach has recently been purchased as an on-going concern by Mr N Manji and was registered, by the CSCI, in his name on 7th August 2006. Potential new service users can obtain information relating to the home via the internet, CSCI Inspection Reports, Care Managers, Placing Authorities, by word of mouth and by contacting the home direct. The range of fees charged (at the time of this report) were £417 - £615 per week, with additional charges made for hairdressing, newspapers/magazines, transport and chiropody. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the morning and afternoon of the 3rd and the 12th October 2006. Incident reports and the home’s PreInspection Questionnaire, held by the Commission for Social Care Inspection, were read before the inspection. The inspection of the home took twelve and half hours. A tour of the whole home was undertaken and the Manager, two staff and four service users (known as Residents) were spoken with. Records such as care plans, policies and procedures, maintenance records and medication records were also viewed. Ten Service User Surveys were distributed prior to the inspection, of which three were returned. Comments received included: ‘The new manager seems nice and is always friendly when you talk to her’ ‘I’m pleased my bedroom is going to be decorated and made to look new’ ‘The new owner seems to be very knowledgeable and doesn’t mind going the extra mile to help out’ ‘The food is a ok but I would like to choose my meals on the day rather then three days in advance, as I forget what I have ordered’ ‘The building work doesn’t upset my day, in fact it’s a welcome change to have new faces around’ 22 residents were accommodated at the home at the time of the inspection. The Registered Provider was requested to complete a Pre-Inspection Questionnaire, which was returned in a timely manner. What the service does well: The home ensures that pre- admission assessments are carried out on all new and potential residents. The health needs of residents are well met with evidence of good multi disciplinary working taking place. Staff provide personal support to residents in such a way that promotes and protects resident’s privacy and dignity. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 6 Activities are arranged according to resident choice. Mealtimes are unhurried and all meals are home cooked with an alternative option being available for each mealtime. There is an efficient complaints procedure in place and the homes processes and staff training should protect residents in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to residents. The ongoing refurbishment plan is well underway and residents are pleased with the progress being made to the modernisation of their home. The home has a staff team that have the necessary skills and experience to the meet the needs of current residents. Staff training is on going and is appropriate to the level of needs of current residents. The management and administration of the home is good, with evidence of consideration being given to resident’s and/or relatives opinion. Suitable financial and insurance processes and procedures are in place for the effective day to day operation of the home. What has improved since the last inspection? What they could do better: The home were required to ensure that urgent action was taken to ensure that all missed entries on Medication Administration Record (MAR) sheets must cease, that all handwritten entries onto MAR sheets must be signed by two staff and an explanation for the handwritten entry entered onto the back of the MAR sheet, that all ‘F’ omission codes must be detailed onto the back of the MAR sheet, that liquid soap dispensers must be deemed static and tamper proof and that all exposed hot water pipes must be covered and safeguarded. In order to prevent the risk of hazard to both residents and staff these Immediate Statutory Requirements were addressed by the home between the two inspection dates. The home must ensure that the Statement of Purpose and Service User Guide reflects the change of ownership and management of the home, an updated copy must be made available to all new and existing residents, in order to provide all parties with the correct and most recent information relating to the home. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 7 In order to ensure that pre admission assessment are comprehensive and give a complete overview into the potential residents needs and limitations, pre admission assessment forms must be updated. Care plans must be updated to be user friendly and to provide staff with comprehensive information relating to all aspects of residents needs. The home must also ensure that these plans must be devised in consultation with the resident (where able) and/or their representative. Records must be maintained of medication fridge temperatures on a daily basis in order to prevent the risk of medications requiring refrigeration are stored in the appropriate manner. MAR sheets must be maintained appropriately to ensure that all medications administered, which are creams/lotions/ointments, are signed for as either administered or omitted. Staff recruitment files must be updated to include all recruitment checks, health checks, registered body checks and other documentation required by the regulations in order to ensure that only suitable staff are recruited by the home. In accordance with the conditions of registration an application must be made to the CSCI to register the Manager of the home. The home are advised to ensure: that amendments are made to residents contracts in order to reflect the recent change of ownership of the home, that staff who make entries onto residents daily care records, record the date, time and their job designation on each entry made (in accordance with the Nursing and Midwifery Council (NMC) documentation and record keeping guidance), that any advice and guidance given by the Tissue Viability Practitioner, is followed by the home, following the review of all ‘at risk’ residents, that consideration is given to when residents place their order for mealtime options and that advice is sought from the EHO regarding the testing of water systems for the Legionella bacterium. 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. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 & 6 Quality in this area is good. This judgement has been made using the available evidence including a visit to this service. The home has processes in place for assessing potential new resident’s with services being offered to only those resident’s whose needs can be met. However, some improvement is required to ensure that the information conveyed to new and potential new residents is current and reflects the new ownership and management of the home. EVIDENCE: It was evidenced that a copy of the former Registered Providers Statement of Purpose and Service users’ Guide is displayed within the home. Copies of both documents were noted in the main reception area of the home and in each of the resident’s bedrooms that were viewed. The new Registered Provider informed the Inspector that these documents were currently under review and would be amended accordingly, to reflect the change of ownership and to make the documents more user friendly. However, until these documents are amended potential new residents would be in receipt of out of date information relating to the home. Therefore a requirement has been made. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 10 Resident’s contracts were viewed and these were found to be comprehensive and detailed in content. Of those documents viewed it was evidenced that the resident’s and/or their representative or placing officer had signed their contract. However, contracts should be reviewed with a view to contracts reflecting the change of ownership of the home and the responsibilities of the new Registered Provider. Therefore a recommendation has been made. The home’s Manager carries out pre- admission assessments. Prior to her designation to the home, the Registered Provider and a senior nurse conducted pre admission assessments. The home obtains a copy of a care management assessment from a placing authority where this exists. Any issues, which are highlighted within this assessment, are addressed by the home and documented records are maintained of all correspondence with the placing authority. Records inspected showed that pre- admission assessments are carried out on all new and potential residents. Documentation relating to preadmissions were viewed and it was noted that the document is very basic in content and does not give the assessor space to provide all the relevant data relating to the potential new service user. The Manager reported that the pre admission assessment form would be reviewed and amended in order to gain a comprehensive assessment of the potential new resident. Staff were observed to have the appropriate skills and experience to deliver the services and care, which the home offers. Discussions with the Manager highlighted that although many of the current residents fall into a specific age group and have similar religious beliefs, the home would welcome any potential new resident who has special cultural/religious/spiritual beliefs and would make provision to accommodate their needs. Residents spoken with confirmed that staff are always ‘willing to help with anything you need’. Trial visits are arranged as such that potential new residents would be encouraged to attend the home for a morning or afternoon and have a meal with current residents. The current trial period offered is four weeks. The Manager reported that after the four week period a review would take place, which involves the residents and/or their representative, in order to determine whether the resident will remain at the home or whether the trial period should be extended so that the resident can make a decision to stay. Emergency admissions are not currently accepted by the home. Intermediate care is not offered by this home. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this area is adequate. This judgement has been made using the available evidence including a visit to this service. Residents are offered a good provision of health care and personal support by the home. However improvements are required to ensure that medication records are maintained appropriately in order to prevent the risk of errors being made by staff when administering medication to residents and that care plans are up to date and contain information that is consistent with the residents current needs and limitations. EVIDENCE: Three residents individual care plans were viewed and it was evidenced that they are currently maintained in such a way, that plans of care were generically devised and not user friendly. It was also noted that care plans and risk assessments were being filed in many different areas of the care plan file and often contained conflicting information in relation to reduced mobility, level of need and capabilities, sensory impairment and memory loss. The Manager reported that care plans would be reviewed and a new recording system implemented in order to ensure that care plans are streamlined, user friendly and contain information that is relevant to residents current needs and capabilities. The Manager also reported that residents would be involved in Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 12 this process and consulted on the recording of their needs. However, there is a need for the home to maintain care plans which are current to ensure that they are administered the care that is consistent with their level of need. Daily care records were also viewed and it was noted that many entries were signed but not dated, timed or the person’s designation recorded. Therefore a recommendation had been made. From the records sampled and from discussions with staff it was evidenced that the health needs of residents are met by a multi disciplinary approach, on a required basis. The Manager said that residents have a choice of GP from one of the local surgeries. Resident’s are encouraged to attend the GP surgery were able and home visits are conducted when necessary. Referrals to the Occupational Therapist, Physiotherapist and Audiologist are made via the GP or the hospital. The home has access to pressure relieving equipment and the Registered Provider and Manager have recently reviewed pressure area management procedures, to ensure that residents are nursed utilising the most appropriate equipment. Following a recent Adult Protection alert, the home are liaising with the Tissue Viability Practitioner and a review of all ‘at risk’ residents, to determine whether the pressure relieving equipment utilised is the most effective, will be conducted within the coming weeks. The Manager will also be attending the Providers Forum, which is being held by the Hastings and Rother PCT (Primary Care Trust) Tissue Viability Specialist. The home has good procedures in place for the monitoring and recording of all drugs entering and leaving the home. The controlled drug register and controlled medication were audited and were found to be correct. However, the medication administration record (MAR) sheets were viewed and it was evidenced that some improvements are required, to address the manner in which staff record medications either administered or non- administered. It was evidenced that where medication had been omitted, the recording for the reason of this omission was not clearly recorded, with the code ‘F’ being recorded without an explanation being recorded onto the back of the MAR sheet. Some handwritten entries were also noted and it was evidenced that these were unsigned or signed by one staff member only, undated and that no explanation had been given on the back of the MAR sheet. Some missed entries were also noted. It was also evidenced that where medications such as creams/lotion/ointments have been prescribed, entries onto MAR sheets were either not completed or had been ‘ticked’. The medication fridge records were also viewed and it was evidenced that fridge temperatures had not been maintained since 26th September 2006. Therefore immediate requirements were made, which were addressed between the two inspection dates and a satisfactory action plan had been received by the CSCI from the Registered Provider. Staff were observed providing personal support to service users in such a way that promoted and protected residents privacy and dignity. Of the three service user surveys received two stated that they always received the care and Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 13 support that they needed, whilst one responded that they usually received the care and support that they needed. Resident’s death and dying recorded in care plans are brief in content and detail whether resident’s wish to be buried or cremated. This was discussed with the Manager who said that when the new care planning records are implemented this issue would be reviewed with a view of obtaining more details on residents choice in this matter. There is a Death and Dying Policy in place. The Manager said that resident’s would be supported to stay at the home in the even of critical illness/dying, until the home could no longer meet their needs. Residents family, friends and representatives would be able to stay with the resident for as long as is required and in accordance with the resident’s wishes. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this area is good. This judgement has been made using the available evidence including a visit to this service. The home provides social, cultural and recreational facilities, including a balanced diet to residents, with some consideration being recommended to how residents order their meals. EVIDENCE: The home has a carer who ensures that a range of social activities are conducted twice weekly, with residents choosing what they would like to attend. Resident activities are arranged and can be altered according to resident’s requests. Residents are free to participate in activities, held by the home or within the local community, or not as they wish. Residents also benefit from one to one activities. Records are maintained of all activities attended by residents. Of the three service user surveys received one responded always, one responded never and one did not respond to the question that asks ‘are there activities arranged by the home that you can take part in?’ Comments made in the surveys stated that ‘ I do not attend the activities out of choice’ and that ‘I do not attend the activities because I am in a wheelchair’. Resident’s religious wishes are observed and arrangements are in place for residents to receive non-denominational Holy Communion if they wish. Contact with family and friends is positively encouraged with visitors being able to Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 15 attend the home at any time and in accordance with the resident’s wishes. This was observed on the day of the inspection and confirmed by relatives/representative spoken with. Many of the current residents attend the local community to attend the local shops, hairdressers and to enjoy a walk along the seafront and afternoon tea and local cafés. Residents and staff confirmed this. The Registered Provider reported that activities will be reviewed with a view to providing more activities for the residents and the carer who undertakes them has highlighted that they would like to attend courses, which relate to meaningful activities for older people. Residents are treated with respect and there is a good rapport between staff of the home and residents. This was observed at the time of the inspection. Residents reported that the home assists them to maintain their independence with their daily living and daily routines. The home’s menus are devised on a four week rolling programme. The menus viewed showed that there is a variety of food and that the menus are varied. All meals are home cooked with an alternative option available for each mealtime. One mealtime viewed highlighted that four different alternative meal options had been catered for in one sitting. Mealtimes can be varied upon request and resident’s guests are also welcome to have meals at the home. Medical, therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. The meal served during the inspection was ample in quantity and attractively presented. Mealtimes were observed to be unhurried and taken as a ‘family’. Of the three service user surveys received two responded always and one responded usually to the question that asks ‘Do you like the meals at the home?’ Resident’s spoken to said that they did not like choosing their meals three days in advance as they ‘often forget what I’ve ordered by the time that day gets here’ Therefore a recommendation has been made. One resident commented that their low fat diet is often quite bland and tasteless and ‘nothing like what I have ordered off the menu’, this was conveyed to the Manager at the time of the inspection who reported that ‘low fat’ diet information would be discussed with this residents, in order to ensure that their dietary needs and tastes could be improved. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this area is good. This judgement has been made using the available evidence including a visit to this service. Resident’s benefit from an efficient complaints procedure, whilst the homes procedures, processes and staff training should protect resident’s in the event of an allegation of abuse. EVIDENCE: The home has an established complaints procedure in place. However this is due to be reviewed and revised, with a view to implementing a two tier structure for responses to complaints. The Registered Provider reported that the current complaints procedure, although satisfactory, requires improving to be more user friendly and that this will be achieved within the next few months. From the section in the service user surveys received relating to complaints, this showed that the three resident’s always felt listened to and two felt that they always knew who to speak to in the event of a complaint/concern, whilst one responded that they usually know who to speak with. Neither the home nor the CSCI have received any complaints since the home was registered to the new Provider in August 2006. Current residents have relatives and/or representatives who protect their legal affairs. The Manager said that residents are free to vote in accordance with their wishes and would be encouraged to attend the polling station, where able, or to vote by proxy. Verification of nursing staff’s registration to practice is obtained from the Nursing and Midwifery Council (NMC) prior to nursing staff commencing employment, however evidence of this is not maintained on all nursing staff Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 17 files. Criminal Record Bureau (CRB) checks have been carried out on all existing staff. Both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. Staff have attended training in the Protection of Vulnerable adults within the last two months. This was evident from the staff files that were viewed and from staff spoken with during the inspection process. Staff said that they were confident that in the event of an allegation of abuse, they would know the correct procedure to follow. The home has a copy of the East Sussex County Council Multi-agency Procedures for the Protection of Vulnerable Adults. There is currently one Adult Protection alert being investigated at the present time, which relates to prior to and during the time of registration of the new Provider, whilst the home were observed as being cooperative and open to all issues being addressed as a result of this investigation. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this area is good. This judgement has been made using the available evidence including a visit to this service. The home provides accommodation for residents that is safe, hygienic and odour free. There are satisfactory numbers of bathroom, toilet, laundry and sluicing facilities. Individual bedrooms and communal areas are in the process of being redecorated and modernised, including all furniture and fittings providing residents with an up to date modern environment. EVIDENCE: The home is maintained and many areas of the home, including the garden, are accessible to residents. The areas, which are inaccessible, are at the present time being refurbished. Of the three service user surveys received two responded always and one responded usually to the question that asks ‘Is the home fresh and clean?’ Residents, representatives and staff spoken with confirmed that the current building works had ‘not impacted on the daily routine of the home’ and had ‘not caused too many disturbances’. Staff spoken with said that they were pleased that the home was being modernised in order to further benefit the residents. The Registered Provider reported that all Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 19 bedrooms and communal areas should be redecorated and refurbished within the next eighteen months, in accordance with his maintenance programme. The communal areas of the home are in need of redecoration and this will be undertaken as part of the Registered Providers ongoing maintenance plan. The homes lounge and dining area have recently been rotated in order that there is more seating available in both these areas. The Manager and staff reported that since this change has taken place more residents now sit in the dining room to eat their breakfast and lunchtime meals. The garden area is well maintained and is accessible to all residents. The furniture and fittings in the homes communal areas will also be replaced as part of the refurbishment of the home. Lighting is domestic in character and is sufficient for the purposes of residents needs. There are fifteen bedrooms in the home, which have en-suite facilities consisting of a hand washbasin and/or a toilet. Additionally there are three bathroom and shower rooms throughout the home, with six toilets available. Sluice areas were noted as being situated separately from residents bath, except in one area, where this room has been decommissioned for redecoration. There were a number of aids and adaptations noted throughout the premises. Wheelchairs, zimmer frames, hoists, specialist beds, ramps, a shaft lift and grab rails were evidenced. As part of the homes refurbishment plan a bed audit is soon to be conducted in order to review the residents beds, with a view to obtaining up to date and specific beds, required in accordance to the residents needs. Other aids and adaptations will also be reviewed as art of the Tissue Viability review of residents. There is a call bell system that encompasses all areas of the home. Previous storage facility issues will be addressed as part of the ongoing refurbishment of the home. The home currently has fourteen double occupancy bedrooms, which are all currently utilised as single occupancy. Bedrooms were noted to be in need of redecoration. One bedroom in the process of redecoration is near completion, this was noted to have been decorated in a tasteful and calming manner. The Registered Provider said that current residents would move into newly redecorated bedrooms. Residents bedrooms that were viewed provided evidence of personalisation. The furniture and fittings are adequate, however are in need of replacement in some areas. The Registered Provider reported that this issue would be addressed during the redecoration process. Residents said that ‘they were looking forward to having a new room, which has been updated.’ There are lockable facilities available in each residents bedroom. Screening in double occupancy bedrooms is available. Bedroom furniture would be provided to any new residents who requires it, this would be provided in the form of a bed (including bed linen), bedside table, two chairs, wardrobe and table lamp. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 20 Residents are encouraged to bring in items of personal possessions, which meet the necessary fire requirement standard. The heating and lighting throughout the home was sufficient for the purposes of the home and residents needs. Emergency lighting is in place throughout the home. Radiators were noted to be covered and are thermostatically controlled. Water temperature check records confirmed that water is stored within the home, in line with current guidance. However, due to some areas of the home being decommissioned for redecoration, there is a need for the home to seek advise from the Environmental Health Officer regarding Legionella water testing for nay dead pipes within the home. Therefore a recommendation has been made. The home has an infection control policy in place and staff are trained in infection control procedures, this was confirmed by staff training records, by staff spoken with and by observation of staff adhering to procedures. The home was odour free throughout. It was evidenced that a clinical waste contract is in place. Of the three service user surveys received two responded always and one responded usually to the question that asks ‘Is the home fresh and clean?’ Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this area is good. This judgement has been made using the available evidence including a visit to this service. The home has a staff team that have the necessary skills and experience to the meet the needs of current residents, with some improvements required to ensure that staff records are maintained so that the necessary checks and records required, are obtained for all staff in order to reduce the risk to residents, associated with poor recruitment record procedures being utilised by the home. EVIDENCE: A competent staff team meets the resident’s needs. There is a staff rota in place, which details staff designations and hours of working. Of the three service user surveys received responded always and one responded usually to the question that asks ‘Are the staff available when you need them?’ The Manager reported that in the near future, some changes would be made to staff numbers, in order to increase the staff to resident ratio, thereby providing a more sufficient service to residents. The home has a permanent care staff team of ten care assistants, five of which are trained to a National Vocational Qualification (NVQ) level 2 in care. With a further three staff due to commence the NVQ training in the early part of next year. Staff recruitment files were viewed and it was evidenced that these files do not contain all items required under the Care Homes Regulations 2001.Therefore a requirement has been made. The home has an Equal Opportunities policy in Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 22 place and is an equal opportunities. A number of the current staff team are from abroad. All necessary visa and Home Office related documents were found to have been obtained and kept on file for these employees. Staff training records showed that over the last twelve months, staff have been provided with a range of training, including Induction Training, Medication Training, Fire Training, Health and Safety, Moving & Handling, Infection Control, Protection of Vulnerable Adults and First Aid. Other training related to the needs of the resident’s such as Tissue Viability and Caring for People With Dementia have also been undertaken. Training provided by the newly Registered Provider has been implemented since the date of registration and a staff training and development plan was noted to be in place. The home has also obtained a copy of the Skills for Care - Common Induction Standards training programme, which will be implemented within the next month for a new carer who is due to commence work with the service. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 32, 33, 34, 35, 36, 37 & 38 Quality in this area is adequate. This judgement has been made using the available evidence including a visit to this service. The management and administration of the home is good, with evidence of consideration being given to residents choice and opinion. Whilst improvements are required to ensure that the health, safety and welfare of residents and staff being protected at all times. EVIDENCE: The Manager has many years relevant experience in caring for older people and is a qualified Registered General Nurse. The Manager confirmed that she would be commencing the Registered Managers Award in January 2007. The Managers job description is currently being devised in accordance with her developing role within the home. Residents, relatives and staff spoken with said that the Manager is friendly, knowledgeable, and approachable and any issues raised are actioned quickly and efficiently. However, there is a need for Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 24 the home to make application for the Manager to become registered with the CSCI in accordance with the homes conditions of registration. The Manager reported that an ‘open door policy’ is operated within the home, with access to the Manager, by residents, staff and relatives, being available at anytime during her rostered time of working. Staff spoken with said that both the Registered Provider and the Manager were open, approachable and knowledgeable when they needed to discuss issues with them. Staff also reported that since the new management has taken over the home they have ‘ felt inspired to be more proactive and encouraged to be more innovative.’ At the present time there is no formal means of Quality Assurance within the home. The Registered Provider and Manager consult with residents, staff and visiting relatives, on a daily basis to inform them of the progress made with the current building work and other matters relating to the home. The Registered Provider reported that a formal Quality Assurance process would be devised and implemented in the near future. The plans for Quality Assurance auditing were discussed and the Registered Provider confirmed that Quality Assurance audit questionnaires would be distributed on a six monthly basis, that staff meetings would be implemented and conducted on a six to eight weekly basis, that monthly monitoring visits (Regulation 26 Visits) would be introduced once the Registered Provider is in less day to day contact with the home and that resident/relative meetings would also be introduced. Therefore a requirement has not been made relating to this. Suitable insurance cover for the effective running of the business were noted to be in place. The homes financial procedures, accounts and business plan were viewed at the time of registration and were found to be satisfactory; therefore these items were not reassessed during the inspection. The Registered Provider reported that the home does not take any responsibility for resident’s finances and that most residents have family/representatives/friends who protect their financial affairs on their behalf. It was evidenced that formal staff supervision is yet to be implemented, however all staff have been met, on a one to one basis, with by the Registered Provider and records have been maintained of these sessions. The Manager reported that plans are in place to introduce a six weekly supervision programme of all staff, with ancillary staff being supervised by the Registered Provider and care staff being supervised by the Manager. Therefore a requirement has not been made relating to this. On the first day of the inspection records relating to residents, in particular care plans, were noted to be kept in an in unlocked cabinet in the main entrance hall. These were found to have been moved to a locked facility on the second day of inspection. All other records relating to residents and staff were Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 25 found to be maintained in locked office within the home. The Manager reported that residents could have access to their records upon request. The home’s maintenance files were viewed and it was evident that fire drills, fire alarm testing and fire equipment checks, water checks and Portable Appliance Testing (PAT) had been carried out. Accidents are well documented in the home’s accident book. Fridge, freezer and food temperature probe readings are recorded on a daily basis. Detailed risk assessments are maintained for all risk areas such as fire, external premises and building contractor/works risk assessments. However it was noted during the tour of the premises that hot water pipes were exposed in all en-suite bedrooms and in some of the homes bathroom and shower rooms. It was also evidenced that portable liquid soap dispensers and items such as ‘Hibiscrub’ were in use throughout the home. Therefore immediate requirements were made, which were addressed between the two inspection dates and a satisfactory action plan had been received by the CSCI from the Registered Provider. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 2 N/A 3 3 2 Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 OP1 Regulation 6 Requirement That the Statement of Purpose and Service User Guide must be updated to reflect the change of ownership and management of the home, an updated copy must be made available to all new and existing residents. That pre admission assessment forms must be updated to provide comprehensive details about the potential new residents health, physical, psychological, social and mental health. That care plans are updated to be user friendly and to provide comprehensive information relating to all aspects of residents needs and limitations and that these plans must be devised following the consultation of the resident and/or their representative. That all missed entries on MAR sheets must cease. This is an immediate Requirement. That all handwritten entries onto MAR sheets must be signed by two staff and an explanation for DS0000067742.V308506.R01.S.doc Timescale for action 13/01/07 2. OP3 14 13/11/06 3. OP7 15 13/12/06 4. 5. OP9 13 (2) 13 (2) 03/10/06 05/10/06 OP9 Amber Beach Version 5.2 Page 28 6. OP9 13 (2) 7. 8. OP9 13 (2) 13 (2) OP9 9. OP29 19 (schedule 2) 8 10. OP31 11. OP38 13 (4) (a) (b) (c) 13 (4) (a) (b) (c) 12. OP38 the handwritten entry entered onto the back of the MAR sheet. This is an immediate Requirement. That all ‘F’ omission codes must be detailed onto the back of the MAR sheet. This is an immediate Requirement. That medication fridge temperature records are recorded on a daily basis. That all medications administered, which are creams/lotions/ointments, must be signed for by the person who has administered the treatment. That all new and existing staff files are updated to include all items listed under this regulation and associated schedule. That application is made to the CSCI to register the Manager, in accordance with the conditions of registration. That liquid soap dispensers must be deemed static and tamper proof. This is an immediate Requirement. That all exposed hot water pipes must be covered and safeguarded. This is an immediate Requirement. 05/10/06 13/10/06 13/11/06 13/01/07 01/12/06 05/10/06 05/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP2 OP7 Good Practice Recommendations That amendments are made to residents contracts in order to reflect the recent change of ownership of the home. That staff that make entries onto residents daily care DS0000067742.V308506.R01.S.doc Version 5.2 Page 29 Amber Beach 3. 4. 5. OP8 OP15 OP25 records, record the date, time and their job designation on each entry made. That the home follows the advice and guidance given by the Tissue Viability Practitioner following the review of all ‘at risk’ residents. That consideration is given to when residents place their order for mealtime options. That advice is sought from the EHO regarding testing for Legionella. Amber Beach DS0000067742.V308506.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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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