Care Home: Amberley Lodge Care Home Limited

What the care home does well Amberley Lodge provides a comfortable and homely environment and the people who live there tell us they they are being well cared for. People have their needs and wishes assessed and recorded in a plan of care and this is kept under regular review. The home works well with other care professionals to provide good health care support and people have the aids and adaptations they need to support their independence and safety. The home provides a range of activities and outings and there is a choice of fresh, home cooked meals. There are robust staff recruitment processes carried out and the staff team are well trained and well supported. People have opportunities to voice their opinions about the way the home is being managed and we are told that the manager and staff team are committed, kind and caring. A returned health care professional survey commented, ` There is a very happy atmosphere in this care home, the staff are well motivated and always very respectful`. What has improved since the last inspection? There is a programme of redecoration and refurbishment underway and this has included the purchase of some new profiling beds, pressure mattresses and two new overhead hoists. Some radiators have been re-covered and redecoration is being carried out. What the care home could do better: Service users are being provided with a good quality of care and support in the home but this could be improved by computerised care plans being adapted to clearly evidence the ways that the emotional well being of Service Users is being addressed. Activities should be restructured to ensure they meet the individual needs of each service user and the way that meals are served should be re-assessed to further assist the needs of people who need a higher level of support. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Amberley Lodge Care Home Limited 11 Chaucer Road Worthing West Sussex BN11 4PB     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: Annie Taggart     Date: 1 5 0 5 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: Amberley Lodge Care Home Limited 11 Chaucer Road Worthing West Sussex BN11 4PB 01903201076 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Amberley Lodge Care Home Ltd Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 17. The registered person may provide the following categories of service only: Care home with Nursing - (N) to service users of the following gender: Either Whose primary care needs on admission tp the home are within the following categories: Old age, not falling into any other other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Amberley Lodge is a care home with nursing that is registered to accommodate 17 service users over the age of 65 years with dementia. The home is situated in a residential area of Worthing and is close to shops and transport links. The building is set out over two floors and has a shaft lift to enable service users access to the first Care Homes for Older People Page 4 of 25 Over 65 0 17 Brief description of the care home floor. Fees at the home range from four hundred and fifty to eight hundred and fifty pounds per week and service users are responsible for paying for their own toiletries, hairdressing, chiropody and items of a personal or luxury nature. The responsible Individual for the home is Mr Asim Chaudhary and the Registered Manager is currently Post Vacant. 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: In order to plan for this inspection and Annual Quality Assurance Assessment (AQAA) was sent to the manager for completion and surveys were sent to service users, families and professional involved with the home. We also looked at the last inspection report and any other information we have received since the last key inspection visit. The AQAA was returned in the given timescales and gave us clear and comprehensive information about the services being provided in the home. Six Service User, five staff and four professionals surveys were also returned , all making positive comments about the care being provided in the home. The unannounced visit was carried out by Annie Taggart at 9.45am on Friday 15th May and the visit lasted for four and a half hours. Gary Needle, Director of Methods for the Care Quality Commission accompanied on the visit. His role was to observe the methodology in practice and he played no part in the judgments reached by the inspector. During the visit we spent time with the people currently living in the home both in communal areas and in their private Care Homes for Older People Page 6 of 25 bedrooms and we spoke to the staff on duty and observed staff practice. We tracked four care plans and all supporting documentation such as daily records and we also tracked the recruitment and training records for four members of staff. We saw lunch, the main meal of the day being prepared and served and looked at evidence of activities and outings for people. Records for the running of the business were seen including complaints and concerns, health and safety and quality assurance processes. We saw Regulation 26 Providers visit reports and observed how the home managed service users monies. Feedback following the visit was given to the manager of the home and the Registered Provider, Mr Chaudhary 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. The home provides clear and accessible information about the services on offer, people have their individual needs and wishes assessed and recorded and contracts of terms and conditions of residency are agreed. Evidence: There is good information available for prospective Service Users and their families to guide them to the services on offer in the home. There is a Statement of Purpose and Service User Guide in place and both documents can be produced in an easy read format, they are also presently being produced in a CD format. There is also a shortened pictorial Service User Guide to aid Service Users to see what the home offers. We looked at the admission process for one recently admitted person and saw that a comprehensive assessment had been carried out and recorded to ensure that the persons needs could be met. Care Homes for Older People Page 10 of 25 Evidence: Contracts of terms and conditions of residency are in place and these have recently been reviewed and updated by the new Registered Provider. The samples that we looked at had been signed by the service users or their representative. Amberley Lodge does not provide intermediate care. 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. The people living in the home have their individual needs and wishes recorded in a detailed plan of care, they have access to good health care support, including input from health care professionals and medication is being well managed Evidence: For each person living in the home there is a detailed plan of care in place that guides the staff team to peoples individual needs and wishes. The care planning system is computerised with all staff members having access to the information they need on a daily basis. Care plans detailed areas such as personal care preferences, pressure area care, nutritional assessments and weight monitoring plans and we saw that where there were bed rails in use, agreements have been signed and are kept on file in the home. We saw that people have the equipment they need to assist with their care and this included specialist beds, pressure mattresses, hoists and assisted showers. We saw that the care plans clearly detailed the use of pressure relieving equipment, for example the size of slings to be used and the weight that pressure beds are to be set at and they also detailed the number of carers needed to safely carry out the tasks. We discussed with the manager how the system could be further improved by Care Homes for Older People Page 12 of 25 Evidence: highlighting on the beds the pressure they should be set at, in case it was knocked, for example when cleaning was being carried out in bedrooms. From observation, looking at records and from returned health care professionals surveys, we saw that the home is providing people with good health care support and there is evidence that the home works well with other health care professionals. Comments from returned surveys included, from a Doctor, the home seeks advice promptly and keeps a record of the conversations with GPs and the actions taken, and from a Chiropodist, the care given in this home is very supportive and is documented well in the care plans. We saw that end of life wishes are also recorded and there was evidence that this was also discussed with families. In a returned survey, an Associate Specialist Nurse told us, I have a number of palliative care patients in this home and the staff have contacted me as appropriate when symptoms or conditions change. Risk assessment both environmental and personal are completed and an automatic system alerts the manager when care plans are to be reviewed and updated. We looked at the system of administering and recording medication and saw that this was well managed. There is a clear record of medications coming into and out of the home, Medication Recording Sheets (MAR) were current with no gaps in signing and there was a current list of the nurses who administer medication in the file. The computerised care plans were very detailed but there was a lot of information to go through to follow an audit trail of, for example when people last saw their doctor or other health care professionals and the system also does not address the emotional well being of service users. We spoke to the manager about how this could be improved as for people with Dementia it was important to evidence that the home was addressing peoples emotional needs. The manager said that she would speak with the people who provided the computer plans and see if there were ways the system could be used to more easily record and evidence these areas. The manager also said that work with familes and Service users on producing life histories for people had been started. 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. There is a programme of activities and outings in place that provides people with interest and stimulation, people can see their families and friends at any time and they have a choice of fresh home cooked meals on offer. Evidence: From looking at activity plans and talking to staff and service users we saw that the home provides activities and outings for people and this includes games and exercises, music sessions and outside entertainers such as a theatre group and music for health sessions. We also saw that some outings are arranged and in the staff meetings notes we saw that staff were offering to come in early on shifts or staying late in order to take people out in their wheelchairs to the local park. One of the activities being provided was hand massage and we saw that the female Service Users living in the home had their nails manicured and painted. Although there are a range of activities being provided they do not always meet peoples identified needs for example one person who was being cared for in bed said they sometimes got a bit lonely and would like the staff to sit and talk with them more often. We discussed this with the manager who told us that she was in the process of re-evaluating the activities being provided to ensure that they were more Service User specific. A monthly church service is held in the home and people told us that their families and friends were made welcome at Care Homes for Older People Page 14 of 25 Evidence: any time. Menus and food records showed us that people are offered a variety of fresh home cooked meals each day and each person has a nutritional assessment and monitoring tool completed in their care plans. We saw lunch, the main meal of the day being prepared and served and the meal looked nutritious and was attractively served. The menus do not have an alternative meal recorded but we saw that people are offered a choice and two people had a different meal. Once a month people have a fish supper from the local fish and chip shop and we were told that this is very popular. For people being cared for in bed there were fluid and nutritional charts in place and these we current and in good order. Over the lunch time period we carried out a short observation and saw that although the staff on duty were very kind and patient in their dealings with service users, explaining to them what they were eating and giving them time to finish, as there were so many people who needed assistance, some people were kept waiting and lost interest, became agitated or their meal was not hot when they were assisted to eat. We discussed with the manager how meal times could be improved, for example by providing pictorial menus and staggering the times of the meal so that people who needed assistance were given their meals first. Observation during the visit showed us that the people living in the home were treated with dignity and respect and in a survey from a health care professional, we are told, in this home all individuals race, cultural and religious beliefs are addressed and personal privacy and dignity is respected. 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. The people living in the home have their complaints and concerns recorded and acted upon, the staff team are aware of Safeguarding procedures and the homes policies, procedures and working practices are designed to protect people from risk of abuse or harm Evidence: There is a complaints procedure in place and we saw that this was displayed in the home and forms part of the Service User Guide. From looking at the complaints book we saw that complaints and concerns are recorded and acted upon and outcomes are fed back to complainants in the homes given timescales. Service Users told us that they would feel comfortable in making a complaint and said that they felt it would be taken seriously and acted upon. The manager was aware of the recent Deprivation of Liberties legislation and told us that independent advice had been gained by the home is respect of one Service User. From looking at training records we saw that the staff team receive training on protecting people from risk of abuse or harm and the five staff members that we spoke to were aware of Safeguarding procedures and said they would report any suspected abuse straight away. One Safeguarding referral made by the home has been investigated under West Sussex Safeguarding procedures and is now closed. The outcome was that no further action was needed. 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 is providing a comfortable, homely and safe environment for the people who live there, Service Users have the equipment they need to assist with their mobility and independence and infection control issues are addressed. Evidence: Amberley Lodge provides a homely and comfortable environment and the people we spoke with told us that they were happy living there. There is a large, attractively decorated lounge and conservatory area overlooking the rear garden and there is also a small dining room and an enclosed courtyard garden with seats and a water feature. There are wheelchair accessible bathrooms with walk in showers and an overhead hoist and there have recently been two new overhead hoists fitted in the home. Service Users bedrooms have been personalised to suit their individual choice but some rooms and furniture are looking a bit tired and in need of updating. We discussed this with the new Registered Provider, Mr Chaudhary, who told us that there is a programme of redecoration and refurbishment underway and this has included the purchase of six new pressure mattresses, two profiling beds and several radiators being covered. Mr Chaudhary said that he felt that having the correct equipment to cater for peoples safe health care needs was a priority and they would then begin to redecorate and replace furniture. There is some signage around the home to assist with orientation for people with Dementia and the manager told us that she was in the process of improving this. There is evidence in records that the home works with Care Homes for Older People Page 17 of 25 Evidence: Dementia specialists such as the Alzheimers Society in order to improve the facilities for the people they are supporting. We looked at maintenance records and saw that checks were up to date and that hot water temperatures were regularly tested and recorded. Infection control issues are addressed, for example we saw the staff on duty use antiseptic hand gels and they changed aprons at meal times. The home was clean and hygienic throughout. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff numbers to meet the assessed needs of the people currently living in the home, Service Users are being protected by the homes robust recruitment practices and by the staff team being well trained and supported. Evidence: From looking at staffing rotas and observation on the day of the visit, we saw that there are sufficient numbers of staff on duty to meet the assessed needs of the seventeen people currently living in the home. On the early shift there was a Registered Nurse, three carers, a cook and two cleaners and the managers hours were in addition to the rota. The people living in the home were very complimentary about the staff team describing them as very kind and lovely to us all and in returned surveys we are told, this is a small but very caring nursing home, the staff are well trained and people are well looked after, the staff are good at listening to service users and their families and they inform health care professionals of any concerns. Observation during the visit showed us that the staff team had a good knowledge of the people they are supporting and they were very kind, patient and friendly in their dealing with Service Users. We tracked the recruitment records for four members of staff and saw that all of the files contained the required documentation including a current Criminal Bureau Check (CRB) and two references, there was evidence of a structured interview process and Care Homes for Older People Page 19 of 25 Evidence: new staff receive an induction in line with Skills for Care guidelines. Training records showed us that the staff team receive all mandatory training such as manual handling and health and safety and we saw that a staff member who had only been employed for two weeks had been given a named nurse as a mentor, had attended a number of days training and had shadowed more experienced staff for a week. There is a varied programme of training available for staff including areas such as dementia awareness and palliative care and in the AQAA we are told that over 70 of the care staff hold NVQ at level 2 or above and others are working towards the award. The staff on duty told us that they felt very well supported and one person said, we get a lot of guidance and training in the home, communication is very good and the trained nurses always take time out to explain things, which makes us very enthusiastic and willing to learn. 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. There is a competent and caring manager in place and the home seeks the views of service users and their families. Service Users monies are safely managed, records are in good order and health and safety issues are being addressed. Evidence: The manager of the home is a Registered Nurse and has previous experience managing homes for people with mental health care needs. The manager has been in post for four weeks, three of which were an induction and handover period and we were told that she would be completing the Registered Managers Award and had begun the process of registration with the Commission. The staff on duty were complimentary about the way the home is being managed and said that the new manager was accessible and open to suggestions from the staff team. We saw that a quality assurance process is in use by sending surveys to families and other professionals involved with the home, there was a good return of surveys and Mr Chaudhary told us that the outcomes are used to inform the future development of the home. Care Homes for Older People Page 21 of 25 Evidence: Monthly Regulation 26, providers visit are carried out by Mr Chaudhary and we saw that very detailed reports are produced as a result. During each visit all areas of care being provided are addressed and we were shown records of two unannounced night visits recently carried out. Accidents and incidents are recorded and there is a monthly audit in place to look for trends in order to minimise risks to Service Users and the staff team. Where the home hold monies on behalf of Service Users, there are clear and detailed records in place and receipts and copies of records are kept and passed on to families. We checked the records for two people and found them to be correct. From looking at staff records we saw that the staff team receive regular supervision and support sessions, the home holds regular staff meetings and also residents meetings. Fire records and staff fire training records were current and in good order and the homes policies, procedures and working practices are reviewed and updated and are designed to protect both Service Users and the staff team 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 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. 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