Care Home: Amber Lodge

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What the care home does well Care plans enabled staff to support individuals appropriately, as they were detailed and reviewed regularly which ensured any changing needs were identified. Medicines were managed appropriately which meant people were kept safe and received their medication as prescribed. Comments from relatives generally indicated that the care and support provided by the staff team was very good and included, " my mum is very well looked after, the care is very good" and " I can recommend the care of all the staff". Staff observed during the inspection demonstrated a caring and friendly approach. People were being supported in a respectful and dignified way. Comments from people living at the home included, " the staff are always there if you need them" and the staff are friendly and very helpful" What has improved since the last inspection? The two requirements left at the last inspection have been met. Additional information is now obtained about each person. This was called the Residents Profile and provided staff with important information that enabled them to get to know each person better and the support they needed. It looked in more detail at individual`s family and life history, including their working years, their interests, hobbies and beliefs and their preferences regarding meals and beverages and their daily routines. During a guided tour the additional work undertaken to the home since the last inspection, was seen. Some of the changes made ensured the safety of people with Dementia was promoted. Such as the garden, which could be accessed from the dining area. This garden provided an attractive seating area, which had been made secure with a keypad lock, fitted to the gate. Keypads had also been fitted to the lifts to ensure individuals who were unable to use them independently did not access them alone. Fire doors had been painted in the same colour as the walls. This camouflaged the fire doors, which reduced the risk of people with dementia or confusion trying to open them. Since the last key inspection the manager has achieved registration with the commission. What the care home could do better: Assessments were in place for the use of bedrails. However these assessments did not look at all areas of risk in relation to the use of bedrails. The registered manager was provided with the relevant information regarding access to detailed assessments and confirmed these would be undertaken on the bedrails used for all individuals, to ensure their safety was maintained Discussions took place with the registered manager regarding individuals` ability to make decisions about their preferred choice of meal. As many people had some degree of dementia, this meant that they were unable to understand the written menu. It was agreed that pictures/ photographs of meals would aid people with dementia to identify the choices available. As half of the people living at the home had some degree of dementia. It was agreed that the activities coordinator should access courses and information on activities suitable for people with dementia and other health care needs, this would ensure that the service is responsive to each individual`s social and recreational needs and this in turn would enhance their well-being. CARE HOMES FOR OLDER PEOPLE Amber Lodge 686 Osmaston Road Derby DE24 8GT Lead Inspector Angela Kennedy Unannounced Inspection 8th July 2008 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 Lodge DS0000002156.V368302.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 Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amber Lodge Address 686 Osmaston Road Derby DE24 8GT 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) 01332 740740 01332 740923 amberlodge@msn.com None Diginew Limited Muriel Ann Pickersgill Care Home 40 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (40), Physical disability (40) of places Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with nursing - Code N 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 Physical Disability - Code PD Dementia - Code DE The maximum number of service users who can be accommodated is 40 10th July 2007 2. Date of last inspection Brief Description of the Service: Amber Lodge is a forty-bedded care home with nursing for older people. Six of these beds are available for younger people with physical disabilities. The home is situated in the Allenton area of Derby and was purpose built. Resident’s bedrooms are located on both the ground and first floor and are accessed by a passenger shaft lift or stairs. Bedrooms are attractively decorated and personalised. Communal areas are bright. There is a garden area with some outdoor seating. Support services are in place with a choice of GP, optician and dentist. Community psychiatric nurses, occupational therapists, physiotherapists and dietician are accessed as required. Staff training takes place to inform and enable staff to care for residents appropriately. Some entertainment and outings are arranged and residents are assisted to go out if they wish. The scale of fees for 2007 were as follows: Individuals funded by the local authority £355 per week plus nurse banding agreed by the Primary Care Team and weekly top up paid by resident and or their representative of between £20-£50 a week. Individuals privately funded £440- £530 per week plus nurse banding agreed by the Primary Care Team. The following items were not included in the weekly fee: Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 5 All trips out of the home and entertainment provided are not included within the weekly fee, but are funded through the resident’s fund. This fund is sourced through fund raising activities undertaken by the home, and through donations to the home. Hairdressing services- fees variable depending on services given. Chiropody at £8 per visit. Toiletries- these can be purchased from Amber Lodge if required. Taxis for hospital appointments. (This does not include emergency admissions) Further information regarding the home and the current scale of charges can be obtained by contacting the home directly by telephone or by email at amberlodge@msn.com Details of previous inspection reports can be found on the Commission for Social Care Inspection’s website: www.csci.org.uk. Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and took place over approximately seven hours. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s and registered manager’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for providers, which is a legal requirement. This assessment gives the provider and registered manager an opportunity to let us know about their service and how well they think they are performing. The information provided in the AQAA is reflected within this report. At this inspection visit two people were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at care plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. Both people case tracked were able to express their views of the service and the support it provided. Other people living at the home that were not case tracked were also spoken with. Their views of the service and the care and support provided are included within this report. Two members of staff were spoken with at some length and their views and opinions of the care provided, the support and training given to them is included within this report. The comments provided with four surveys received from the people living at the home, four relatives/ representatives’ surveys and five staff surveys are also reflected throughout this report. Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 7 The registered manager and provider were available on the day of this inspection and provided the relevant information requested. Since the last key inspection the home has varied their registration and is now able to admit people with a primary care need of Dementia within their registration category. However this major variation to the homes registration is subject to certain provisions being in place before anyone with a primary need of Dementia is admitted to the home. This is to ensure the service is suitable to meet the needs of people with Dementia. During this inspection visit these provisions were assessed. It was found that not all of these provisions are yet in place. Although there are people with some degree of Dementia living at the home, it is acknowledge by the Commission that Dementia was not their primary care need on admission. The registered manager confirmed that no person has or will be admitted with a primary need of Dementia until all of this work has been undertaken. Information regarding the adjustments to the home that have been undertaken and are still to be undertaken are reflected within this report. For the work that is still to be undertaken requirements have been made. These requirements have not affected the quality rating awarded to the service. As they relate to work that must be undertaken prior to anyone being admitted to the service with a primary care need of Dementia. What the service does well: Care plans enabled staff to support individuals appropriately, as they were detailed and reviewed regularly which ensured any changing needs were identified. Medicines were managed appropriately which meant people were kept safe and received their medication as prescribed. Comments from relatives generally indicated that the care and support provided by the staff team was very good and included, “ my mum is very well looked after, the care is very good” and “ I can recommend the care of all the staff”. Staff observed during the inspection demonstrated a caring and friendly approach. People were being supported in a respectful and dignified way. Comments from people living at the home included, “ the staff are always there if you need them” and the staff are friendly and very helpful” Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Assessments were in place for the use of bedrails. However these assessments did not look at all areas of risk in relation to the use of bedrails. The registered manager was provided with the relevant information regarding access to detailed assessments and confirmed these would be undertaken on the bedrails used for all individuals, to ensure their safety was maintained Discussions took place with the registered manager regarding individuals’ ability to make decisions about their preferred choice of meal. As many people had some degree of dementia, this meant that they were unable to understand the written menu. It was agreed that pictures/ photographs of meals would aid people with dementia to identify the choices available. As half of the people living at the home had some degree of dementia. It was agreed that the activities coordinator should access courses and information on activities suitable for people with dementia and other health care needs, this would ensure that the service is responsive to each individual’s social and recreational needs and this in turn would enhance their well-being. Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 10 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 Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that the home can support then, as accurate assessments are undertaken before admission is agreed. EVIDENCE: The people case tracked had been assessed before admission was agreed. This ensured the home were able to meet their needs. The information within these assessments addressed all areas of health, personal and social needs and preferences. This ensured that each person’s specific needs were identified to enable plans of care to be put in place to ensure they could be met. People that were funded also had assessments in place that had been undertaken by the local authority or primary care team. The records seen also demonstrated that on admission and following admission further information was obtained about each person. This was called the Residents Profile and provided staff with important information that Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 12 enabled them to get to know each person better and the support they needed. It looked in more detail at individual’s family and life history, including their working years, their interests, hobbies and beliefs and their preferences regarding meals and beverages and their daily routines. Records were in place to show that care reviews were undertaken annually. This enabled the individual, their family and others involved in their care to discuss the support given and address any changing needs Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of individuals was met and people were supported to take their medicines in a safe way. EVIDENCE: The records of care and support for the two people case tracked were informative and addressed all areas of assessed need including any health conditions and prescribed medications. The information within these plans of care had been reviewed each month or sooner if needs had changed. Comments from relatives generally indicated that the care and support provided by the staff team was very good and included, “ my mum is very well looked after, the care is very good” and “ I can recommend the care of all the staff”. One person did raise concerns regarding the care of their relative. However the manager was aware of these concerns and both the manager and this person Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 14 confirmed that these concerns had been addressed. From discussions with the manager it was agreed that staff must ensure that all care records are completed when care is provided. This not only provides clear communication amongst the staff team but also provides reassurance to relatives that the required care has been given. There was evidence to demonstrate that individuals or their representatives had signed in agreement regarding access to their care plans, however there was no evidence to demonstrate that individuals or their representatives had been involved in the formulation of their care plans. People were supported in a safe way. Assessments were in place for the two people case tracked. These assessments addressed any areas of risk that had been identified through the support plans. For example areas such as moving and handling, including risk of falls, pressure area care, social inclusion and activities. Other assessments were also in place to ensure people’s safety was maintained such as nutritional assessments and mental well being. Disclaimers were in place that had been signed by relatives regarding the use of bedrails to confirm their consent. Although a safe use of bedrails assessment was in place, this did not provide sufficient information to ensure all areas of risk were identified. This is further addressed within standard 38 of this report. Health care needs were clearly addressed and this was demonstrated in the records seen of the people case tracked. Everyone had access to healthcare such as G.P services, chiropodist, dentist and optician. Records seen also demonstrated that specialist healthcare was provided as required such as Speech and Language assessments. People living at the home confirmed that their healthcare needs were met, “ you can always see the doctor if you need to”. People were supported to take their medication safely. The medication records of the two people case tracked were looked at and no errors were noted. Records had been completed accurately. Medications were stored correctly and all records seen were clear and accurate. Staff observed during the inspection demonstrated a caring and friendly approach. People were being supported in a respectful and dignified way. Comments from people living at the home included, “ the staff are always there if you need them” and the staff are friendly and very helpful” Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were supported to be part of their local community, however lack of one to one or group activities within the home could compromise individual’s social well being. The meals provided were generally enjoyed but the systems in place did not enable choices to be made by everyone. EVIDENCE: People were supported to be part of the community by accessing the community on a regular basis. This was provided through trips out. Information was provided regarding a variety of community activities and external entertainers that were booked/ planned over the next few months. On the week of this inspection two trips had been organised to garden centres and a trip was planned to the theatre at the weekend. People that were spoken with confirmed that there was trips out which they said they enjoyed. One person spoke about a trip they had been on to the theatre saying, “ the show was very good, I enjoyed it”. Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 16 External entertainers visited the home every three weeks to provide a variety of entertainment. People spoken with indicated that they enjoyed this entertainment. It was however indicated that there was not many in-house activities provided within the home. One person said, “ There’s not much to do in here”. Discussions with the activities coordinator indicated that due to the health of many of the people living at Amber Lodge it was difficult to provide many of the in house activities that used to take place. As half of the people living at the home had some degree of dementia. It was agreed that the activities coordinator should access courses and information on activities suitable for people with dementia and other health care needs, this would ensure that the service is responsive to each individual’s social and recreational needs and this in turn would enhance their well-being. Contact with family and friends was encouraged and promoted. People spoken with confirmed that the staff always made them feel welcome. A suggestion in one survey was that there should be a drinks machine for visitors. This could indicate that drinks are not offered to visitors, although no comments were made on the day of the inspection that suggested this was the case. People that were able were encouraged to exercise some choice and control over their lives. Individuals preferred daily routines were recorded in their care files, such as the time they liked to rise and retire. One person spoken with was able to confirm that they were able to get up and retire to bed, as they preferred. Information regarding independent advocacy services was displayed at Amber Lodge. This ensured that people were aware of this service and the contact details were available if required In general the comments received about the meals provided was good. One person did say that the meals were ‘o.k.’ they then expanded on this comment by saying that they had always been a fussy eater and didn’t like a lot of meals. They did however confirm that alternative dishes were provided for them when they didn’t like the choices available. Comments within a survey stated that one person would like “ more of the foods that I enjoy and better choices”. This person also stated “sometimes I’m still hungry”. However those spoken with and other surveys received indicated that the meal portions were generous. Discussions took place with the registered manager regarding individuals’ ability to make decisions about their preferred choice of meal. As already stated many people had some degree of dementia and this meant that they were unable to understand the written menu. It was agreed that pictures/ photographs of meals would aid people with dementia to identify the choices available. Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 17 Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Concerns are looked into and actions are taken to put things right. The home safeguards people from abuse and neglect. EVIDENCE: Amber Lodge had received four complaints within the last twelve months. Records were in place regarding these complaints and their outcomes. All of the complaints seen had been responded to within the twenty-eight day timescale. We have received one complaint regarding Amber Lodge in the last twelve months. We asked the service to investigate this complaint. The home provided us with the relevant information regarding the outcome of their investigation. We were satisfied that this complaint was dealt with appropriately. The comments received from the people living at the home and their representatives indicated that they were aware of the homes complaints procedure and knew who to speak with if they had any concerns. One relative spoken with had raised a concern with the home and the registered manager had addressed this. The manager confirmed that courses had been booked with Derby College regarding dementia awareness and stated that this training would then Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 19 incorporate a review of the homes key policies and procedures on managing aggression in people with dementia. It was agreed that this would be undertaken prior to any new admissions of people who have dementia as their primary need. This would ensure all staff were aware of and followed the correct procedures to ensure people were supported in a safe way The practices in place ensured the people living at the home were safeguarded from abuse. One member of the nursing team was trained to provide training to staff in Safeguarding Adults, this training had been provided by the local authority, who are the lead investigators in any safeguarding investigations and referrals. This ensured that the training provided was in line with the local authority procedures and practices. Staff training records demonstrated that staff had undertaken this training and were provided with refresher courses as required. The staff spoken with demonstrated a good understanding of the procedures that should be followed in the event of any safeguarding concerns or allegations. This means that people can be confident that the staff team will ensure the correct procedures are followed to keep them safe. Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is suitable for the people currently living at the home and is well maintained, clean, pleasant and hygienic. EVIDENCE: During a guided tour the additional work undertaken to the home since the last inspection, was seen. Some of the changes made ensured the safety of people with Dementia was promoted. Such as the garden, which could be accessed from the dining area. This garden provided an attractive seating area, which had been made secure with a keypad lock, fitted to the gate. Keypads had also been fitted to the lifts to ensure individuals who were unable to use them independently did not access them alone. Fire doors had been painted in the same colour as the walls. This camouflaged the fire doors, which reduced the risk of people with dementia or confusion trying to open them. Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 21 Further work was planned to provide a more suitable environment for people with dementia. This included a door, which was to be fitted at the bottom of the stairs, which would have a keypad lock. Securing the door to the laundry with a keypad lock and assessing the accessibility of the allocated wheelchair storage area. The registered manager also discussed plans to colour code toilets to enable them to be recognised more easily by people with dementia. From observation it was noted that the general maintenance of the home continued to be updated as required, providing a pleasant environment for the people living there. This included the dining room on the first floor, which was in the process of redecoration and new carpets, which had been fitted in the lounge and dining area since the last inspection visit. The laundry room was seen and housed the appropriate equipment to enable disinfection standards to be maintained. The rotas demonstrated that the laundry was staffed seven days a week to ensure the laundering of peoples clothing was maintained on an ongoing basis. In general the comments regarding the laundry service were positive. However one visitor spoken with felt that the maintenance of clothing could be better. This was in relation to repairs such as sewing and clothes shrinking. This was discussed with the registered manager who confirmed this would be further investigated. The general standards of hygiene within the home were good and ensured that people lived in a clean environment. Comments from residents included, “ the home is always clean” and “ I can recommend the care of all the staff and the cleanliness of the home.” Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty at all times. EVIDENCE: The rotas seen demonstrated that sufficient staff were rostered on duty to meet the needs of the people living at the home. It was confirmed that staffing levels would be reassessed prior to any individuals being admitted to the home with a primary need of dementia. Staff spoken with confirmed that the staffing levels in place were generally good. It was indicated that staff absences had impacted on staffing levels. However it was confirmed that agency support was used when required and this was confirmed in the information provided by the home prior to this inspection visit. Residents and visitors spoken with were in general satisfied with the levels of staff on duty. Comments included, “ the staff are always there to answer any concerns or questions we have”. One visitor spoken with did raise their concerns about staffing levels, however this related to the use of agency staff and their knowledge and understanding of their relative. Comments included Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 23 “generally they’re a good staff team, but I do feel that agency staff don’t know my wife well enough”. Comments within staff surveys received indicated that the communication between the staff team could be improved upon. The comments included “better communication at staff handover is needed to ensure all the relevant information is passed on” and “ I feel the service could be better if the staff worked more as a team, such as information passed on better and more support from all staff across the board”. From the information provided by the home prior to this visit and through discussions held and records seen it was confirmed that all but one member of the care staff team had achieved a National Vocational Qualification (NVQ) at level 2 or above in care. This demonstrates that a competent staff team supports the people living at Amber Lodge. The recruitment records of two members of staff were looked at and all of the documents required by law were in place. This demonstrates that the safety of the people living at Amber Lodge is enhanced because the required checks have been done to make sure the staff employed are suitable to care for them. The training records seen demonstrated that the staff had received the relevant training. This enabled them to meet the needs of the people living at the home and support them appropriately. This included all mandatory training, which covered health and safety, fire training, food hygiene, safeguarding adults and moving and handling. In addition to this records demonstrated that training in Dementia awareness had been undertaken and further training planned with Derby College. The majority of the nursing team had undertaken training regarding the Mental Capacity Act. The manager confirmed that it was planned for all members of the nursing and care staff team to attend this training. Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed appropriately and the views of the people living at the home are sought to ensure the home is managed in their best interests. EVIDENCE: The registered manager has the required qualifications to run the home. From discussions with people living at the home, their representatives and the staff team it was concluded that she manages the home appropriately and ensures she is available to answer any concerns or questions that people may have. Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 25 Satisfaction questionnaires were sent out to individuals and their representatives and the findings of these questionnaires and any actions taken were fed back by means of a newsletter that was handed out and made available within the home. The registered manager confirmed that these questionnaires were due to be sent out again within the near future. The service and maintenance documentation indicated that the people living at the home, visitors and the staff team are protected by robust procedures, with all evidence of gas, electrical, hoists and lift services having been suitably checked/maintained. Assessments were in place for the use of bedrails. However these assessments did not look at all areas of risk in relation to the use of bedrails. The registered manager was provided with the relevant information regarding access to detailed assessments and confirmed these would be undertaken on the bedrails used for all individuals, to ensure their safety was maintained. The registered manager confirmed that homes written risk assessment of the environment and fire safety precautions have not yet been updated to take account of the risks associated with people who have dementia. It was stated that this would be incorporated into the risk assessment for 2008 and prior to any individuals being admitted with a primary need of dementia. Amber Lodge DS0000002156.V368302.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP12 Regulation 16 (2) (n) Requirement Timescale for action 08/12/08 2 OP15 12 (2) 3 OP18 13 (7) (8) 4 OP22 23 (2) (a) Training and information on activities for people with dementia and other health care needs must be undertaken. This is to ensure the activities within the home are responsive to individual’s social and recreational needs. The choice of meals available 08/12/08 should be offered in a format that suits the capacity of all individuals. Such as photographs or pictures of meals. Key policies and procedures 08/12/08 relating to the management of aggression and use of control and restraint must be reviewed in line with current practice. This must be undertaken before any individuals with a primary care need of dementia are admitted to the home. Further signs and aids must be 08/12/08 provided throughout key areas of the home to assist people with Dementia to recognise their surroundings. This must be undertaken before any individuals with a primary care DS0000002156.V368302.R01.S.doc Version 5.2 Amber Lodge Page 28 5 OP27 18 (1) (a) 6 OP38 13 5 OP38 23 need of dementia are admitted to the home. The staffing levels and skill mix 08/12/08 must meet the needs of people with Dementia. This must be undertaken before any individuals with a primary care need of dementia are admitted to the home. A detailed risk assessment on 08/09/08 the use of bedrails must be undertaken for all people who use bedrails to ensure their safety is maintained. The homes written risk 08/12/08 assessment of the environment and fire safety precautions must be updated to take account of the risk associated with people who have Dementia. This must be done before any people with a primary need of Dementia are admitted to the service. 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 OP7 Good Practice Recommendations Care records and charts must be updated when care is provided to ensure clear communication is provided within the staff team and to reassure relatives that care practices are carried out as agreed within the care plan. Evidence should be in place to demonstrate that individuals or their representatives have been involved in the formulation of their care plans. The communication between all staff should be maintained to a high level to promote teamwork and ensure the needs of individuals are met. 2 3 OP7 OP27 Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Amber Lodge DS0000002156.V368302.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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