Care Home: Amberley Hall Care Home

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Inspecting for better lives Key inspection report Care homes for older people Name: Address: Amberley Hall Care Home 55 Baldock Drive King`s Lynn Norfolk PE30 3DQ     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: Brenda Pears     Date: 0 2 0 3 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 27 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Amberley Hall Care Home 55 Baldock Drive King`s Lynn Norfolk PE30 3DQ 01553670600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): phillip.davies@hallmarkhealthcare.co.uk Hallmark Healthcare (Gaywood) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 106 Number of places (if applicable): Under 65 Over 65 60 20 0 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 26 The layout in the home will be: Ground Floor Fulmer Way: Rooms 1 - 20 to accommodate twenty (20) Older People who require nursing care. Curlew Crescent: Rooms 21 - 40 to accommodate twenty (20) services users with a physical disability who are under the age of 65 years who require nursing care. Dunlin Drive: Rooms 41 46 to accommodate six (6) services users with a physical disability who are under the age of 65 years who require nursing care. First Floor Avocet Avenue: Rooms 47 - 66 to accommodate twenty (20) service users with dementia who do not require nursing care. Lapwing Lane: Rooms 67 - 86 to accommodate twenty (20) older people with dementia who do not require nursing care. Sandpiper Street: Rooms 87 - 106 to accommodate twenty (20) older people with dementia who do not require nursing care. Date of last inspection Care Homes for Older People Page 4 of 27 Brief description of the care home Amberley Hall is a care home providing care and accommodation for up to 106 people of varying age and need. These include nursing care, dementia care and people who may be aged under 65 years who have a physical disability. The home is owned by Hallmark Healthcare (Gaywood) Ltd, which has its registered office in Billericay, Essex. The home was first registered on 9 January 2006 and consists of a two-storey building that is purpose built. All the rooms are single with en-suite facilities. Fourteen bedrooms on the ground floor and 12 bedrooms on the first floor have en-suite showers. The home is separated into distinct units, each with their own communal lounge, dining and bathing facilities. Two shaft passenger lifts are installed. There is access to gardens from several points on the ground floor. A hairdressing salon and cinema are located off the main reception. The home is located in the town of King?s Lynn, close to the town centre with all amenities. The full range of fees and additional charges are available on request to the home. Care Homes for Older People Page 5 of 27 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 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced inspection undertaken on the 2nd March 2009, started at 10.00am and was carried out by two inspectors. The focus of this inspection was on the previous requirements, on the core national minimum standards and on the quality of life for people who receive support in the home. The methods used to complete this inspection consisted of looking at the care a resident receives and the records that support this. Information has been provided to us by the home on an assessment form known as an Annual Quality Assurance Care Homes for Older People Page 6 of 27 Assessment (AQAA). During the visit to the home we spoke to the manager, the operations manager, with members of staff and also with five residents. These methods and previous findings all inform the outcomes of this report. 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 Care Homes for Older People Page 8 of 27 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 10 of 27 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. The manager does assess the needs of any new resident to make sure individuals can be fully supported before an agreement is undertaken Evidence: Discussions and a review of records confirm that pre-admission assessments are undertaken. Full information is provided for any person making an enquiry and visits to the home are supported before any decision is made. Pre admission assessments show that areas discussed include information about physical, social and emotional needs. Choices are also noted on care plans regarding any preferences for such areas as types of food and what name a person prefers. Care Homes for Older People Page 11 of 27 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. The care plans contain clear information in some areas but not all sections were fully completed to ensure the well being of residents. Medication is handled and stored correctly for the safety and well being of those living in the home. Evidence: We looked at six care plans and these confirmed the information we have previously received from the home that the care plans and risk assessments are reviewed. However, one care plan seen had not been reviewed since November 2008. We were told that residents always take priority and their needs are met but some things, such as records, have to be left from time to time. The care plan format has sections of information that shows healthcare professionals including doctors and district nurses provide support when necessary. For example, support is provided by such professionals as the chiropodist and also assistance from the mobility centre. Pressure areas needing attention are recorded and these are treated by the the district nurse and monitored regularly. Care Homes for Older People Page 12 of 27 Evidence: While healthcare needs are being met, staff do not always record full information on care plans. For instance, the behaviour of one person at certain times has caused staff to provide some time out in certain circumstances but there was no evidence of guidelines around this action and no risk assessment had been completed. Another example is that risk assessments are in place on care plans but these had not been undertaken for every person who uses a bed rail. Risk assessments were on care plans for the monthly audit of falls. Other information recorded on care plans includes sleeping patters and thorough detail about how a person wishes to have their room when going to bed, for instance if curtains are open or closed. Care plans show that people are regularly weighed and other information includes details for a nursing plan, how a person likes their drinks, life history and night routines and preferences. Daily records do not always contain full information about the mood a person is in or details of how they spent their day. However, the activities are recorded for each person and such comments as enjoyed singing happy birthday to a resident are on file, along with the person showing signs of happiness at holy communion. The format for recording such information could be further developed to encourage more information to be written. The current paperwork restricts staff and does not provide a great deal of space for fuller information. When the accident book was checked, we found these details on the daily record and on the medical sheet when a health check had been necessary, showing that staff had clearly recorded all areas of this information. Records for the administration of medication were clearly completed, up to date and medication was in date and stored in an orderly way. The manager said that regular audits are carried out to make sure medication is stored and handled correctly. A spot check is also carried out regularly to make sure medication is in date and that the date of opening ins clearly written on the box. We saw that the temperatures of the medication fridges are taken and recorded regularly. Two records on the audit sheet for medication had some entires that had been scribbled out and the numbers on the sheet did not correspond against the total amount. This was discussed at this time as the audit process is to support good practice and the safety of residents. Care Homes for Older People Page 13 of 27 Care Homes for Older People Page 14 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While activities are organised and enjoyed in some areas of the home, those residents who have any degree of dementia need more appropriate stimulation. Food is good and meals chosen daily, however, the dining routines are not providing a pleasant experience for everyone. Evidence: The daily meals are displayed on a notice board in the home and residents choose what their meals are on a daily basis. Staff were seen to be gently encouraging residents to come into the dining room. Due consideration was shown for the dignity of the individual and people were not rushed at any time. Those people living on the unit known as Curlew were happy with the way they are being supported and with the routines in the home. They have cookery club, regular meetings and people said the staff were very helpful and really support them in the way they choose. An activities programme was on display and this included planting cress, craft, Karaoke, a visit from the mobile library and films. Comments about the food were that they had plenty and that meals are enjoyed. Care Homes for Older People Page 15 of 27 Evidence: People said they always had enough to eat and they choose their own menu. There is one main kitchen that supplies food to all areas of the home and a varied and nutritional menu was seen. In the Lapwing unit, where people with dementia are supported, staff were also taking their time when assisting people to eat. However, staffing levels in this area did not allow for a member of staff to be in the lounge with residents while other people were being fed in the dining room. Although the routines regarding assisting people with meals has been adjusted, staff were still unable to meet all needs appropriately during meal times. Observations during the mealtime period showed that staff were not able to provide support, answer the phone, serve meals and monitor those people who did not need assistance. At one time, two residents were becoming aggitated and walking from room to room and staff had to leave their place at the tables and assist with this matter. The person eating had their meal interrupted and had to wait for this situation to end before having any more food. It is noted that the staff maintained a calm and supporting atmosphere at all times and did not rush anyone at any time. Five people required support with their meal and one person had to wait when requesting their meal as all staff were dealing with other people. Residents were left in the lounge with music playing quietly while another member of staff completed care plans. However, individual people were sitting and looking around with no direct interaction. One person sitting in a chair was watching staff and looking when they walked through the lounge but staff did not speak or interact with anyone who was sitting quietly. One person continually called out and staff did speak to this person from time to time and another resident constantly went up to the serving hatch and was given something to eat each time and then went and sat down. There were no activities undertaken at this time, but staff explained that residents may choose to join people in another area of the home with their activities. Care Homes for Older People Page 16 of 27 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. A clear complaints procedure is in place and is followed appropriately by the home with residents feeling they are listened to. Evidence: The Commission has received two complaints about the home and the newly appointed manager has dealt with these quickly and efficiently. Both were taken to the regional manager and any required action was undertaken. People in the home that we spoke to at this time, members of staff and residents, said they feel supported in the home. They would not have any problem with speaking about their concerns and the manager is approachable and does what she says she will do. The regular residents meetings also help with any matters of concern and allow these to be discussed and dealt with quickly and how people choose. Discussions with staff and a review of records confirm that staff have training regarding safeguarding people and also on recognising abuse. The appropriate recruitment procedures also support the protection of residents in the home. Care Homes for Older People Page 17 of 27 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 does provide a comfortable, safe, clean environment that residents are encouraged to personalise. Evidence: The home is divided into distinct areas that are named Lapwing, Avocet, Sandpiper (that has recently opened) Fulmer and Curlew. Curlew is designated for younger adults, Fulmer provides nursing care and the remainder are for people with dementia. The home is spacious and has a large reception area with comfortable seating areas. On the tour of the building we did encounter some odour in one particular area, staff explained the reasons for this and what action is being taken at this time. All other areas seen on a tour of the building were clean, bright and comfortable. There are hand rails around the corridors and names and pictures on doors. Some doors have transparent boxes that contain specific items or pictures to remind the person of special events and important people in their lives. The home is to move the position of the smoking area to a more convenient place and we saw rooms that are to have new carpeting. Care Homes for Older People Page 18 of 27 Evidence: People living in Curlew area said that they like the wide corridors and are able to move around independently in their wheelchairs and visit other residents as they choose. People were seen chatting and laughing with staff and moving around the home freely. Care Homes for Older People Page 19 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their needs met by a staff team who are trained and regularly supervised, however, staffing is not sufficient in all areas to meet needs. Evidence: Several members of staff were spoken to at this inspection plus the manager attended for a short time as she was on annual leave at this time. The operations manager was also in the home during this time and discussed findings at the end of the inspection process. On the day of this inspection there were a total of 82 people living in the home. People living on Curlew unit stated they feel staff meet their needs and are always available and happy to assist where needed. A copy of the rotas was provided at this time and staff explained that they have regular training that is updated and a list of training was provided. Training includes specific needs such as dementia and the home is currently highlighting door frames and addressing other environmental needs. While recruiting staff is taking place, the manager explained that she recognises staff must be in place to support any new residents that are admitted. The home acknowledges each person has individual needs and these are fully assessed before any new admission to the home and staffing levels are also considered at this time. Care Homes for Older People Page 20 of 27 Evidence: Staff said they feel they work well together to support each other if there are any absences and that their training does cover the needs of the residents. Discussions and the review of records show that recruitment practices are appropriate and regular supervision and staff meetings are carried out. It was also confirmed that staff undergo an induction period and one new member of staff explained they had an induction and training covering moving and handling, hygiene and health and safety before starting work on the allocated unit. One member of staff did say that supporting activities and taking time to spend with residents would be good but staffing numbers do not allow this. Staffing is often short on the night shift and the manager is currently recruiting in this area. The home does not use agency staff as any cover is provided by their own team of bank staff. Observations during the afternoon period also showed that staff had other duties, such as dealing with putting clean laundry into each room, that take them away from the main areas. The current times on the rota for care shifts mean that a third member of staff is starting on one unit at 9am. One member of the staff team said this is not a problem, another felt this was a problem. This can make things difficult when there is a particular occurance that needs to be dealt with or if there is a high demand for support at any one time. The manager explained that she is currently looking into this practice. As explained in section three covering Daily Life and Social Activities, staff levels do not currently support residents at all times. The observatons undertaken during the meal time in Lapwing unit confirmed this. The five people needing assistance with their meal could not be supported as well as allowing staff to observe and support other residents who have to wait for their meal. Staff did say that they often find it difficult to attend to everyone and they do not always have time to give individual attention when needed. Care Homes for Older People Page 21 of 27 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. Residents live in a home that is managed by a suitable person and is run in their best interests. Evidence: Staff discussed the difficulties in the past with the constant change of manager in the home. However, the appointment of the current manager has helped to stabilise the home and staff said they do feel supported by the manager who has an open and inclusive management style. Areas of maintenance that support he safety and well being of residents were found to be up to date and regularly maintained. These areas included the testing of electrical equipment, regular checks on building temperatures, hot water temperatures and other health and safety monitoring checks are recorded weekly and monthly. Care Homes for Older People Page 22 of 27 Evidence: The risk assessments for the event of a fire include assessments on individual residents and personal information in the event of a fire. Weekly alarm tests are undertaken and previous requirements made by the fire safety officer have been completed. Other maintenance records show where flats have been detected in equipment and this has been dealt with immediately. Since being appointed, the new manager has started to undertake meetings with professional groups, such as the local Alzheimer association, to learn more about this and also to forge stronger links with the local community. The manager has kept us fully informed of any incidents in the home and works closely with other professional organisations. The organisation has also appointed a new dementia specialist who covers the whole organisation and a new procedure is now in place to assess those residents who have dementia. Care Homes for Older People Page 23 of 27 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 24 of 27 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 1 7 13 The service user plan meets 30/04/2009 relevant clinical guidelines produced by the relevant professional bodies concerned with the care of older people, including a risk assessment, with particular attention to prevention of falls. Risk assessments must be in place for any action the staff take that may affect the health and well being of the resident. In this particular case regarding bed rails and time out sessions. 2 7 12 The service user plan sets 25/05/2009 out in detail the action which needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Daily records need to contain fuller information about the person. Care plans Care Homes for Older People Page 25 of 27 are informed by thorough records regarding daily life and how a person spends this time. 3 12 16 People are given 26/06/2009 opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities, particular consideration is given to people with dementia and other cognitive impairments. That regular stimulation and interaction be provided for those people with dementia and that staffing levels support this. 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 7 That a more supportive format be developed for use on care plans and other documents. To provide staff with paperwork that allows them to fully record details of the person in all areas of their life to inform the development of care plans and reviews. That all residents, particularly those with dementia, are enabled to eat their meals uninterrupted. Providing an individual experience that is not altered by the actions of other residents, so far as is practicable. 2 15 Care Homes for Older People Page 26 of 27 Helpline: 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 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. Care Homes for Older People Page 27 of 27 - 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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