Care Home: Amber Lodge

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What the care home does well The home has an open door policy and encourages people to tell them what they think about the service. Quality assurance survey questionnaires are sent out yearly. Comments from people living at the home and/or their relatives included the following "the home is kept clean and tidy and staff very helpful and kind" and "since the refurbishment I would recommend this home to anyone" "food provide here is very good". There is a warm and welcoming atmosphere and people said they were very happy living at the home. Visitors were seen to be made welcome throughout the day. What has improved since the last inspection? Staffing levels have been increased to meet the care needs of people with dementia. The home has undergone a major refurbishment to ensure that people benefit from safe, warm and comfortable surroundings in a pleasant environment. What the care home could do better: The home should seek additional information from other professionals involved with the person during the pre admission assessment. To ensure that a comprehensive care plan can be produced to provide person centred care. The home should ensure all the people in the home have regular yearly dental checkups. Care plans would benefit from additional information about individuals dementia. For example what type of dementia and how it affected them and how staff could help them. People`s wishes of what they want at the time of their death should always be recorded. This would ensure people`s wishes are not over looked. The manager should ensure medications are dealt with safely and staff record when medication is given so that medication is not given more than once. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Amber Lodge 21 Thornhill Road Armley Leeds West Yorkshire LS12 4LL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Frederick Rawlins     Date: 0 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Amber Lodge 21 Thornhill Road Armley Leeds West Yorkshire LS12 4LL 01132633231 01132038556 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Meridian Healthcare Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of users who can be acomodated is 40 The registered person may provide the following cateogry of service only Care home only - Code PC To service users of the following gender - Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP, maximum number of places 40 Dementia - Code DE, maximum number of places, 40 Mental Disorder, excluding learning disability or dementia - Code MD maximum number of places 6 Date of last inspection 40 6 0 Over 65 0 0 40 Care Homes for Older People Page 4 of 25 Brief description of the care home Amber Lodge is owned and managed by Meridian Healthcare Ltd. The home is a care home without nursing, registered to provide personal care for up to 40 older people. The building is a two-storey purpose built home situated in Wortley, near Armley. It has a garden to the rear of the building. A large car parking area is located at the front of the building therefore access is easy for those with mobility problems. Local shops and bus routes are also within easy access. For the people who use the service, their accommodation is provided on both floors. There are 40 single bedrooms. All bedrooms have en-suite facilities. Lounge and dining areas are located on the two levels. There are three bathrooms, two of which have hoisting facilities, and two shower rooms. All laundering is undertaken on the premises. The people who use the service can access the garden through the dining room patio doors. Copies of previous inspection reports are available in the home. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars (2). This means that people that use the service experience good quality outcomes. The inspection process included looking at information we have received about the service since the last key inspection, as well as this unannounced visit to the home, which was carried out between 09:00 and 16:30 hrs. The methods we used included looking at records, observing staff at work, talking to the manager and looking around the home. Before the visit we provided some people using the service, their relatives, staff and other healthcare professionals with survey questionnaires so that they could share their views of the service with us. The questionnaires returned have been used as evidence in the body of the report. Care Homes for Older People Page 6 of 25 The home had also completed and returned their Annual Quality Assurance Assessment form and the information provided has also been used as evidence in the body of the report. The purpose of the visit was to assess what progress the home had made in meeting the requirements made in the last inspection report and the impact of any changes in the quality of life experienced by people using the service. We have recently improved our practice when making requirements to improve national consistency. Some requirements from previous inspections may have been deleted or carried forward as recommendations, but only when it is considered that people that use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Feedback was given to the acting manager at the end of the visit. The fees for the service currently range from 435 pounds to 505 pounds per week. Details of the exact charges can be obtained by contacting the manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can make an informed choice about the home through visits and the information they are given. Evidence: The information about the service is good and gives people the opportunity to decide whether or not the home can meet their needs. Records show that peoples needs are assessed before they move in to Amber Lodge. We looked at the pre-admission assessment information for three people and found that in some instances it only provided basic information and did not always give a clear indication about the level of care or support required. However, the acting manager is aware of this and said pre admission assessment documentation is to be reviewed to ensure that it meets with each persons individual needs. Information from surveys and talking to people said that: - People are always invited to visit the home before admission. - They had been given enough information about the services Care Homes for Older People Page 10 of 25 Evidence: provided by the home. - One person said they and their relative had been well supported when they moved into the home. - They were satisfied with the services received. The acting manager said people are always invited to visit the home before admission. She also said people considering moving in to the home are always supported through the admission process and once admitted care is taken to make sure they are happy and content in their new environment. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are set out in care plans. Evidence: Since the last inspection in April 2008, the organisation has introduced a new system of care planning. Some training and guidance about how to use it has been given to some staff. The aim is to make sure that all people living in the home have detailed, individual, person centred care plans that provide staff with all the information needed to meet their needs. The new care plans are more person centred, designed to meet peoples health, personal and social care needs. Care plans seen were reviewed on a monthly basis or updated following a change in the persons needs. The home has started to ensure that a full review of people is done 6 monthly involving the person, their relatives and staff. All care plans had included in them a risk assessment in regarding to nutrition, moving and handling and pressure sore prevention. Care Homes for Older People Page 12 of 25 Evidence: Some of the plans would benefit from additional information about individuals dementia. For example what type of dementia and how it affected them and how staff could help them. The acting manager said every effort is made to ensure that people are able to maintain their own G.P upon admission to the home. Where this is not achievable people will be registered with the local G.P. She said the home is able to access other services such as Optician, Dietitian, Podiatrist as and when required. However on checking the files of some peoples personal hygiene there was no evidence of people receiving annual dental checks. One persons file said full set of her own teeth, staff to give support in cleaning. The acting manager said people visit the dentist when required. However this would mean peoples teeth and gums are not looked at until they are in pain which could then create other problems for them. The acting manager said she will ensure a system is put in place for people to have annual dental checkups. There was no record in peoples file to show that at the time of their death, staff will treat their family with care, sensitivity and respect. Although the acting manager did assure me that would be the case. Medication records and stocks were looked at. The medication administration record (MAR) showed a few gaps where staff have not recorded that people had received their medication. This could lead to people being given medication twice which could effect their health. The acting manager was advised that records must show that people receive their medication as prescribed by their GPs. The acting manager said she would ensure staff record medication as they should. Information from people living in the home and returned surveys said that: - Peoples privacy and dignity was respected. - People usually got the care and support they needed. - People were treated with respect. - Relatives were kept up to date about changes in the persons condition such as illnesses or accidents. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples choice are respected and contact with family and friends is encouraged. Evidence: Relatives and visitors said that they could come at any time and they were always made to feel welcome. Two relatives said with the change in management the atmosphere in the home was warm and friendly. It was clear that there were good relationships between people living in the home, their visitors and staff. People said that they could choose how to spend their time, when to get up and when to go to bed. They said that the staff were kind and attentive and did what they could to meet their needs. An activities organiser has been in place for the last six months. The acting manager and relatives said they have tried hard especially around activities for people with dementia. There is a regular programme of activities through the week. It includes armchair exercises, reminiscence sessions, sing-a-longs, quizzes and bingo. Everybody is encouraged to join in but people can choose whether or not they want to. The activity organiser will visit people who stay in their own rooms and do things with them such as talking and reading. Care Homes for Older People Page 14 of 25 Evidence: Once a month there is a communion service for people who want to take it and local clergy visit the home regularly. Menu plans are in place and these are changed at regular intervals. People can choose what they want to eat and alternatives are always available if they do not want what is on the menu for that day. The chef speaks to people and is aware of individuals likes and dislikes and will accommodate these and any special diets or preferences. Meals were seen at the time of the inspection to be served nicely and people said that they enjoyed their food. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable systems in place to make sure that complaints are dealt with appropriately and people are protected from abuse. Evidence: There is a complaints procedure in place. It is made available to everybody in the Statement of Purpose. A copy is also given to people to keep in their bedroom. People living at the home said that they were aware of the complaints procedure and would have no problem at all in approaching the acting manager if they had any concerns about the standard of care being provided. The Care Quality Commission had received one concern from a staff member. There were evidence that this was addressed in their staff meeting. Feedback from staff indicates that they are aware of the homes policy on whistle blowing and knew what to do if they suspected that people were being abused or working practices at the home were not in the best interest of the people living there. Adult protection policies and procedures are in place and training records provided by the acting manager show that staff have received training in recognition and reporting of allegations of abuse. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides people with a pleasant, safe and comfortable environment in which to live. Evidence: There is a large garden to the rear of the property with a pleasant patio area, which is accessible by a ramp leading from the lounge. The well maintained lawned garden is now created into a safe garden with laid paths and seating areas. Since the last inspection the providers have made a substantial financial investment in improving the standard of accommodation. This has included decorating and refurbishing the bedrooms. The communal areas have also been decorated and new furniture purchased, providing comfortable places to sit. People were happy with their rooms and said that they were kept clean and free from smells. The rooms seen were nicely decorated and furnished. It was clear that people can bring their own belongings and furniture where possible, to personalise their rooms. It is apparent when talking to the acting manager and staff that they take pride in providing people with a good standard of accommodation. Disposable gloves and aprons are available and there is adequate provision of liquid soap and disposable towels for staff use. This helps to make sure staff follow good Care Homes for Older People Page 17 of 25 Evidence: infection control practice. The kitchen was clean and tidy throughout and the cook said all equipment was in good working order. People said they were satisfied with the laundry service. Clothes and linens seen were clean, well laundered and ironed. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by robust recruitment procedures. The Staff are trained and competent to do their jobs. Evidence: Recruitment is properly managed; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. Information provided by the acting manager said 80 percent of staff have their National Vocational Qualification (NVQ) at level two or above in care. Staff spoken with said they felt they had a good team and the acting manager is very supportive. They have had supervision in the form of one to one meetings. Records showed that this is done regularly. Survey from staff said training courses are always available. A survey returned by a person living in the home said senior staff are always on duty and staff are very helpful and understanding. Five people spoken with said they felt safe and well looked after. A relative commented over the past six months I have seen a real change in the home the staff Care Homes for Older People Page 19 of 25 Evidence: appear to be more helpful now the work has been done on the building. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in a manner that promotes good service delivery in the best interests of people using the service. Evidence: Survey from staff said the acting manager always ensures there are enough staff on duty. One of the comments from a relative said all the staff are brilliant, the acting manager is great we are always kept informed about our mothers care. I would recommend the home to others. The manager and all the staff are always happy and friendly. The acting manager has turned the home around. The acting manager holds a Registered Managers Award and has 41 years experience in care. The home been adequately managed by the acting manager whilst they seek a new manager. However since the inspection a new manager has been appointed and her style of management is unknown to the Care Quality Commission. Information from the Annual Quality Assurance Assessment (AQAA) said that all Care Homes for Older People Page 21 of 25 Evidence: maintenance and safety checks were carried out and kept up to date. People are encouraged to manage their own finances were this is possible with assistance from their next of kin if required. The company has a comprehensive accounting, financial and safeguarding procedures in place to protect the interests of people using the service. All the peoples financial records looked at were maintained and reviewed as required. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The home should seek additional information from other professionals involved with the person during the pre admission assessment. To ensure that a comprehensive care plan can be produced to provide person centred care. Care plans would benefit from additional information about individuals dementia. For example what type of dementia and how it affected them and how staff could help them. The home should ensure all the people in the home have annual dental checkups. To ensure peoples health needs are fully met. The medication administration record (MAR) should show that people receive their medication as prescribed by their GPs so that their health and general wellbeing is maintained. There should be a record to show what peoples wishes are at the time of their death. This would ensure peoples wishes are not over looked. 2 7 3 8 4 9 5 11 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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