Care Home: Amelia House

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What the care home does well People are assessed before they are admitted to Amelia House, to make sure their needs can be successfully met when they arrive. People say they are happy with the services they receive. They had no complaints, and staff approached them and spoke with them in a respectful way. Staff are starting to write care plans in a more personal way, which shows they are thinking about people`s individual needs. This will help to uphold their well being. Staff manage people`s oral medication professionally. They keep records up to date, which showed people get the medication as their doctor has prescribed it. People can have their visitors whenever they wish, and can see them in their own room, or in the communal areas. The environment is kept well maintained. This will help to keep it a safe place for people to live. The laundry is well organised, and people`s clothing looked well cared for. Staff are properly recruited, receive an induction, and are offered training opportunities to help develop their skills. This will help to assure people that they are cared for by suitable vetted staff who are reminded about what good care is, and how it should be provided. The home will look after people`s money if they wish. They can be assured that good records will be kept of what has been spent on their behalf, and of how much money they have in their account. What has improved since the last inspection? Improvement was noted in a number of areas at this site visit. However, there is still work to be done to make sure that the care and support people get is of a good, consistent quality, and that the right people are informed quickly when problems arise. Improvements include the following: People`s preferences about their care are being written with more thought. Some care plans are better than others, but it appears that staff are thinking in a more person centred way when describing people`s needs, and the support they require. Concerns about the way staff write their daily records are now addressed by the management. The social activities are improved. Group and individual activities are becoming much more interesting for people. Thought is also being given as to how more could be done to meet people`s individual spiritual needs. Issues noted in the last report about how a person`s capacity is assessed, have been taken seriously, so their liberty is not deprived. Staff are properly vetted before they are allowed to work with the people at Amelia House. This helps to protect people from unsuitable workers. Written instructions have been given to staff about the correct use of wheelchairs, to reduce the risk to people from harm when they are transported. What the care home could do better: The local authority has made the decision not to admit anyone to the service whilst they investigate some recent events, which question whether staff have taken the right action quickly enough when individuals at the home have fallen, or had a problem with their skin. Staff do not monitor risk to people as effectively as they could. This increases the chance that care will be inconsistent and unsafe. Staff could also make sure that important information collected as part of a person`s initial assessment is always followed, so people can be assured that their individual wishes will be followed. People`s fluid intake needs to be more closely monitored where this is of concern, to make sure people get sufficient fluids and remain well hydrated. People`s prescribed creams could be kept locked away when not in use, so people who may come into contact with them accidentally do not come to harm. Notices which help to orientate people, for instance, the day`s menu, and details of the current date, could be kept updated so people do not become unnecessarily confused. Although complaints are recorded now, more detail is needed to show the outcome of the complaint, whether the complainant was satisfied with the outcome of the investigation, and what action has been taken as a result. Despite recent training, some staff are still not clear about the role of the local authority as lead investigators of safeguarding concerns. They could be reminded of this, so they know to whom they can report any concerns they may have about people`s welfare. Thought could be given as to how the areas of the home identified on the day could be kept free from malodour, so that people have a more pleasant smelling environment in which to live. People should not be expected to share communal toiletries. This is not dignified or hygienic. As there were some mixed views about staff availability, this is an area which the home could continue to monitor, taking into account people`s views, and fluctuations in their dependency. Where staff are instructed to keep doors locked to reduce the risk from fire, these instructions must be followed. And risk from harm to people who may come into contact with denture cleansing tablets must be assessed, and appropriate action taken to make sure these are appropriately stored. People`s views are important. They could be given their own surveys to complete, so they have the opportunity to say what the home does well, and where it could do better. Key inspection report Care homes for older people Name: Address: Amelia House Amelia House Coningham Avenue YORK YO30 5NH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 2 5 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Amelia House Amelia House Coningham Avenue YORK YO30 5NH 01325351100 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.southerncrosshealthcare.co.uk Trinity Care Limited Name of registered manager (if applicable) Mrs Patricia Storm Chisholm Type of registration: Number of places registered: care home 81 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Amelia House provides purpose built accommodation for up to 81 older people requiring nursing and personal care. Care for individuals with dementia is provided in two separate units, according to their dementia care needs. The home has three floors. Bedrooms, which all have en suite facilities, are on each level. There are well-tended gardens, easily accessible to people, and there is car parking at the front of the building. The home is situated in a residential area about three miles north west of the city centre. There are bus links to the city, with its major transport links. The manager told us on 25 March 2010 that the weekly fees range from £371.78 to £774.37. Additional charges are made for hairdressing, chiropody services and individual items like newspapers, and magazines. Care Homes for Older People Page 4 of 35 Over 65 0 26 55 0 1 7 0 9 2 0 0 9 Brief description of the care home The service provides information about the home to people thinking of moving there. The Statement of Purpose and service user guide, which gives information about the home, is displayed in the reception area of the home. The manager should be approached for a copy of the most recent inspection report. Care Homes for Older People Page 5 of 35 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: one star adequate 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 key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last key inspection. A self assessment, called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comment cards sent to ten people living at the home (six returned, all completed by relatives), and ten staff (six returned). A site visit to the service, carried out by two inspectors, which lasted for approximately nine hours. Care Homes for Older People Page 6 of 35 During the visit to the home, several people and a selection of staff were spoken with. We also spent some considerable time observing the general activity, as some people living at Amelia House find it more difficult to express their views. This gave us an idea about what it is like to live there, and what staff support is provided. We looked at seven care plans, some health and safety records, carried out a sample audit to show how staff manage peoples medication and examined some staff files and training records. We looked round the environment, and in peoples bedrooms, where this was appropriate. The registered manager and her mentor, a registered manager for another home belonging to the company, were available throughout the day. We provided both with detailed feedback during the course of our visit, and at the end. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only where it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Improvement was noted in a number of areas at this site visit. However, there is still work to be done to make sure that the care and support people get is of a good, consistent quality, and that the right people are informed quickly when problems arise. Improvements include the following: Peoples preferences about their care are being written with more thought. Some care plans are better than others, but it appears that staff are thinking in a more person centred way when describing peoples needs, and the support they require. Concerns about the way staff write their daily records are now addressed by the management. The social activities are improved. Group and individual activities are becoming much more interesting for people. Thought is also being given as to how more could be done to meet peoples individual spiritual needs. Issues noted in the last report about how a persons capacity is assessed, have been taken seriously, so their liberty is not deprived. Staff are properly vetted before they are allowed to work with the people at Amelia House. This helps to protect people from unsuitable workers. Care Homes for Older People Page 8 of 35 Written instructions have been given to staff about the correct use of wheelchairs, to reduce the risk to people from harm when they are transported. What they could do better: The local authority has made the decision not to admit anyone to the service whilst they investigate some recent events, which question whether staff have taken the right action quickly enough when individuals at the home have fallen, or had a problem with their skin. Staff do not monitor risk to people as effectively as they could. This increases the chance that care will be inconsistent and unsafe. Staff could also make sure that important information collected as part of a persons initial assessment is always followed, so people can be assured that their individual wishes will be followed. Peoples fluid intake needs to be more closely monitored where this is of concern, to make sure people get sufficient fluids and remain well hydrated. Peoples prescribed creams could be kept locked away when not in use, so people who may come into contact with them accidentally do not come to harm. Notices which help to orientate people, for instance, the days menu, and details of the current date, could be kept updated so people do not become unnecessarily confused. Although complaints are recorded now, more detail is needed to show the outcome of the complaint, whether the complainant was satisfied with the outcome of the investigation, and what action has been taken as a result. Despite recent training, some staff are still not clear about the role of the local authority as lead investigators of safeguarding concerns. They could be reminded of this, so they know to whom they can report any concerns they may have about peoples welfare. Thought could be given as to how the areas of the home identified on the day could be kept free from malodour, so that people have a more pleasant smelling environment in which to live. People should not be expected to share communal toiletries. This is not dignified or hygienic. As there were some mixed views about staff availability, this is an area which the home could continue to monitor, taking into account peoples views, and fluctuations in their dependency. Where staff are instructed to keep doors locked to reduce the risk from fire, these instructions must be followed. And risk from harm to people who may come into contact with denture cleansing tablets must be assessed, and appropriate action taken to make sure these are appropriately stored. Peoples views are important. They could be given their own surveys to complete, so they have the opportunity to say what the home does well, and where it could do better. Care Homes for Older People Page 9 of 35 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 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 10 of 35 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 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their needs will be properly assessed before they are admitted, to make sure these needs can be met. Evidence: The care plans showed that people are assessed by staff, to check their current needs can be met, before they are offered a place at Amelia House. During this assessment period, people are given written information about the service. Six surveys completed by relatives on behalf of people living at Amelia House, agreed the person had been given enough information to help them decide whether the home was the right place for them. Staff said they saw a copy of the assessment so they had some information about what care the person would need, ready for when they arrived. This helps to keep care right from the outset. Often staff have access to a draft care plan, which gives basic information about the persons care needs, and which can be built upon as staff Care Homes for Older People Page 12 of 35 Evidence: get to know the person better. There were instances where this draft care plan could have been completed in more detail, to give more information about the individuals needs, choices and preferences. The plans were not always dated, which meant it was difficult to tell when they were completed, and how relevant the information was. Intermediate care is not provided. Therefore standard six is not applicable. Care Homes for Older People Page 13 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people look well cared for, risk to them is not consistently monitored and reviewed, to make sure they receive this care in a safe and consistent way. Evidence: Staff normally consider the pre admission information when completing care plans and associated risk assessments for each individual. They use this information to decide how the persons needs can best be met. However, the information was not always used. For example, assessment information which told staff that a person was frightened of showers had been overlooked, which meant that this person had still been encouraged by staff to shower rather than bath. Not everyone had a completed social profile. This helps to provide staff with important information about peoples social preferences and choices, and should be completed. Staff now ask which gender of staff the person would prefer to receive care from, and this too is documented. One care plan looked at said the person would prefer to receive care from a male. However, they still received care from a female on the day we visited, even though there was a male on duty. Care Homes for Older People Page 14 of 35 Evidence: Returned staff surveys gave mixed views about whether the way they share information works well. However, those we spoke with told us they have sufficient time to look at peoples care plans, and that they get a report before each shift, so they know where peoples needs have changed since they were last on duty. One member of staff thought that more work was needed to make sure that care plans fully reflected the care people get, or need. Another thought that people living at Amelia House get 100 care. The care plans had generally improved, were normally reviewed regularly, and they demonstrated that staff were thinking in a more person centred way. Some were written very well, so staff could get a much better understanding of the persons needs. Comments written in the daily records were generally more personal and individual, and showed more respect for people, although we saw examples where this was still not the case. Though at this site visit, the manager was already aware of the issue, and had addressed it with the staff member concerned. This shows that she is now monitoring staff practice better, and acting upon things that need to be put right. Shortfalls however persist in the way staff monitor and record risk to people, and they need more training to help them get this part of peoples care right. We discussed some of these shortfalls, which could make a considerable difference to the outcomes people experience, with the manager. Examples where shortfalls were identified included the following: Increased episodes of agitation experienced by individuals had not been well monitored, and the risk assessment had not been reviewed frequently enough where problems persisted, to make sure that staff approach was consistent. The use of equipment, such as bed safety rails, had not been reviewed and risk assessed, after issues relating to a persons safety had arisen. Reactive changes made to this persons care, to make them safer, had not been recorded. Short term care plans were not always kept up to date, and lacked information. One related to the current condition of an individuals skin, what dressings were to be used, and when staff next needed to check the wound. We observed people who spent longer than their risk assessment said they should, off their pressure relieving cushion. And someone with nutritional problems did not have a completed risk assessment to monitor the risk to them from pressure sores, which could become more of a problem if good nutrition is not maintained. Care Homes for Older People Page 15 of 35 Evidence: Everyone had drinks and a cup in their room. Communal areas also had a supply of drinks, which were used throughout the course of the day. However, not everyone was getting fluids in the amounts the care plan said they should. This is of concern. Fluid charts were not tallied, so it was difficult to see how staff were monitoring risk to the person. Weight loss is not always well managed. One person had lost a significant amount of weight over a short period of time. However, there was nothing to show they had been referred to the dietitian for advice. Someone who was supposed to be weighed weekly because of problems in maintaining their weight, had not been weighed since the end of January. And one persons care plan made no mention of the fact they were prescribed fortified drinks, so staff would know they were to offer these, and how often. There have been some concerns raised recently, which are being looked into by the local authority, about whether staff have taken the right action quickly enough, when people have fallen. We saw evidence of incomplete moving and handling risk assessments, some of which had been neither signed or dated. Surveys sent to people living at the home, but which were completed and returned by their relatives, gave a mixed responses when asked whether people get the care and medical support they need, and whether staff listen and act on what they say. When we asked what the home does well, we were told Care, and Basic needs are done well. When asked what the home could do better, one person said Shave residents daily. Change pads before bed becomes wet - change pad if resident is asleep to avoid discomfort later. We did however speak to some relatives on the day, who were very pleased with the care. One said that this had improved a great deal, and that there had been big changes since the current manager took over. They were pleased that the group of staff caring for their relative knew their needs. They were involved in a regular review of their relatives care plan, and said staff always called them with any concerns. We spent a lot of time watching the general activity at the home, and speaking to some people living there. People looked well cared for. Gentlemen looked clean shaven. People cared for in bed looked comfortable, and staff had kept a record of when these peoples care had been provided, and by whom. Staff used appropriate equipment, with confidence, when assisting people who could not walk, or move safely on their own. They reassured people, and never rushed them. They spoke to them with due respect and kindness. Everyone made positive comments. One said No complaints whatsoever - we are well looked after. The staff are very nice. By, we do Care Homes for Older People Page 16 of 35 Evidence: get looked after here. We visited someone else who was in bed, and they told us they were lovely and comfy. We looked at peoples medication, and how it is managed by staff. We were told that nobody at the home looks after their own. The systems were generally very good. Staff took their responsibilities in recording and auditing the systems seriously. We noted on one floor that the medication round was completed when the mealtime was finished. This means there were more staff available to assist people, and helped to make the meal much more of a social occasion. We did however find some prescribed cream in peoples rooms which was not locked away. In one case, the cream did not belong to the person occupying the room. We told the manager to keep all medication locked away, and to make sure only creams prescribed for each individual are used. Care Homes for Older People Page 17 of 35 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. Activities for people are becoming more individual, which will help to make their lives more interesting and fulfilled. But the mealtime experience for people could be improved upon. Evidence: Relatives who returned surveys on behalf of people living at the home, gave mixed views about the activities provided. One said they were improving. Another, when asked what the home could do better, said More activities, getting out and about from the home - fresh air!. Staff also made comments that there could be more weekend activities. However, there appears to be good improvements being made, and more activity staff hours are being provided, to help make sure everyone gets a good range of activities to help make their lives more interesting. We spoke to the activities organiser, who plans activities for people in groups, and also for those people who choose to stay in their room. He said there are daily events organised, and regular evening entertainers. Advertised events included Circle Dancing, and a day out at the garden centre. One the day of our visit, he helped someone plant bedding plants into a wheelbarrow for an outside display. This person said they had really enjoyed it. Another activities person was helping people make Care Homes for Older People Page 18 of 35 Evidence: eggs for Easter. There is a regular communion service, and people from every floor, who wish to attend, are assisted to the service. Thought is also being given for those with more diverse spiritual needs, and how these can be best met. And a support group is being organised for people with dementia. The manager is currently advertising for more activity hours. This is to be commended. She will consider whether activities staff can be present at the home at weekends, as well as during the week, when the new staff are appointed. Staff explained ways in which they try to give people choices in their daily lives, such as when they get up and go to bed, and what they would like to wear. As stated in the previous section, important information should not be overlooked when developing peoples care plans, so choices, such as how people like to bathe, are always considered. People can have their visitors whenever they wish. This helps to maintain important contact with family and friends. Surveys completed by relatives, on behalf of people living at the home, gave mixed views about the food. And a staff member thought breakfast could be organised better, so people who chose to get up earlier could be served their breakfast sooner. We were told by the manager that there are plans to introduce a meals hostess, who will provide this service for people. The manager has also completed a survey since the last inspection, to check people are satisfied with the food offered. She said the feedback was positive. The menus are displayed on each unit. They provided a choice at each mealtime. On the dementia unit, the displayed menu was from six days previous. This can cause unnecessary confusion for people with dementia, and does not help them to be reminded of, and look forward to, their forthcoming meal. We observed a mealtime. We saw staff offering people choice, although some people could have been offered more assistance. For instance, there was no assisted cutlery provided, even though one care plan told us this was needed. There were no plate guards to help stop food sliding off peoples plates, and no napkins to help people maintain their hygiene and dignity. Some people ate with their hands, and one person was offered no support when they tried to eat with inappropriate cutlery, despite this persons care plan stating that they needed help. However, we also saw some good practice, where people in their room were given appropriate support. People seemed to enjoy the food. Care Homes for Older People Page 19 of 35 Evidence: We visited the kitchen. The cook told us that the kitchen is open at all times, day and night, so when kitchen staff are not available, staff can make snacks and drinks for people who may become hungry. Sandwich ingredients are provided on each floor for suppertime, although we was not sure how often these were used. The cook prepares meals for people with special dietary requirements. He also fortifies meals, to help keep people well nourished. We were told that fresh meat is delivered regularly, and there was a supply of fresh fruit and vegetables in stock. We asked the manager whether there were any restrictions placed on the food budget, and she gave assurance that there was not. This should be discussed with the staff who order the food, so they are clear that this is the case. Care Homes for Older People Page 20 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvement is needed to make sure the complaint procedure is robust, and that safeguarding incidents are recognised as such, and acted upon without delay. Evidence: Family who completed surveys on behalf of people living at the home, all agreed that there was someone they could speak to informally if they were not happy, and that they knew how to make a formal complaint. Although one person continued But nothing changes. The manager told us that there have been twenty four complaints made to the service in the last twelve months. We looked at the complaints record. This showed that although some improvements have been made since our last inspection in how complaints are managed, more work is still needed to make sure that issues are properly and fully addressed and responded to. Some of the responses we looked at did not explain what the results of the investigation were, and whether the complainant was satisfied with the response. One relative said the home was good at reacting to complaints. A staff member said they had confidence that the manager would sort things out if a complaint was brought to her attention. Although another thought if they took a problem to the manager, they would leave with themselves being the problem. There have been a number of incidents which have been reported to the local authority, and which they are investigating under their safeguarding responsibilities. Care Homes for Older People Page 21 of 35 Evidence: This includes how staff respond when someone falls, and also to the incidence of pressure sores. They have made a decision that they will admit no one else to the home, until such time they are satisfied that it is appropriate and safe to begin admitting people once more. The home has also voluntarily stopped admissions there. The management are keen to make sure that they get the care right. They have devised a step by step guide for staff to follow should an incident occur, so they take the right action more quickly. We spoke to one member of staff who said they have learnt from the recent events, and said that staff now are more aware of their responsibilities in reporting incidents quickly, so they can be investigated by the right professionals. Five staff members who returned their surveys said they knew what to do if someone had concerns about the home. One said they did not. Staff have been reminded about their safeguarding responsibilities, and they have a chart to show what action they must take if they believe someone at the home may be being abused. Some staff were still not clear about the role of the local authority, despite this being included on the chart. The manager said she would remind staff of their role during supervision. Care Homes for Older People Page 22 of 35 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 environment meets peoples needs, but small pockets of malodour need further attention to make all areas of the home more pleasant for people. Evidence: Returned surveys completed by relatives on behalf of people living at the home, gave mixed views about whether the home was always clean and fresh. One person commented that there were no cleaners. We received some comments from relatives that some bedrooms could be cleaned to a higher standard, although on the day we visited, all rooms looked clean and well cared for. The majority of the home was free from offensive smells. Although when we first arrived, the hallway smelt unpleasant. This smell disappeared later. A small number of bedrooms also had a malodour, which prevailed over the course of the day. These rooms must be regularly deep cleaned, so they remain pleasant for the people who occupy them. A relative confirmed the home was generally clean and tidy, although said sometimes the standard dropped at a weekend. Staff told us that there are always cleaners on duty on the floor where they work, unless cover cannot be provided at short notice following unexpected sickness. We were told that a weekend cleaner has just been employed. This will help to keep the home clean and fresh at all times. Where appropriate, we looked in a number of bedrooms. On the dementia units, people have memory boxes on their bedroom doors, which contain family pictures or Care Homes for Older People Page 23 of 35 Evidence: personal items. This orientates people with memory problems, helps them to find their room without having to ask for help, and keeps people more independent. Some rooms contain personal belongings and furniture. All bedroom doors have door knockers, which helps remind staff and visitors to knock and wait to be invited in. Menu boards displayed the meal choice on offer, but as stated previously, on the dementia unit, the wrong menu was displayed. Neither was the notice board telling people about forthcoming events display the correct date. This is not helpful for people who have dementia. Other signeage has also been provided. This directs people more easily to rooms such as the toilet, bathroom and bedroom areas. We looked in the laundry, and there were good systems in place to manage infection control. We received a comment from a relative about the good service the laundry staff provide. We looked in the bathroom areas people have access to, and saw communal toiletries. This is not hygienic nor dignified, and must not continue. We have received concerns that staff were not provided with sufficient personal protective clothing, such as gloves and aprons. We asked the home to look into these concerns when they were received. The staff we spoke with when we visited confirmed that these are now always available, and that if they run short, they are given more supplies. One staff member said that they never run out. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the way staff are recruited and trained will help to make the care people receive more safe and consistent. Evidence: Relatives, who returned surveys on behalf of people living at Amelia House, had mixed views about whether there were enough staff available when they were needed. One commented that more staff with more training and motivation were needed. However, a relative we spoke with said that staffing had improved. They said they used to hear staff moaning, but that this is no longer the case. The majority of staff who returned their surveys said there were usually enough of them, although one commented that there were staff shortages, and that morale was low. They continued, because of what is being asked of them, there is really no time to do for the residents. However, we spoke to a number of staff on the day, and we received comments like There are almost always enough staff unless there is sickness, which the manager always tries to cover, and We cant complain about the staffing levels. One staff member said I like working here. They said that previous staff shortages had been addressed, and that now generally there are enough of them. Where sickness causes shortages, they said the manager will come out and help. A member of the ancillary staff said that the staffing was much better. Another non-care staff said though that they felt the care staffing levels had been diabolical Care Homes for Older People Page 25 of 35 Evidence: from their observations. We spoke to staff about the morale at the home. Those spoken with made comments like Carers and staff members enjoy being here. There are good relations between days and nights. We were also told that there is a good working relationship between the different floors, and that staff morale was good. Staff thought, both in their surveys, and on the day, that they were being provided with a range of training to assist them in their role. Although they had mixed views about whether they were given enough support by the manager to discuss how they were working. We asked the manager what training has been put into place to make sure staff have enough basic skills to be able to manage peoples needs, such as use of equipment like syringe drivers and the suction machines. We were told that named nurses are now being given particular areas of interest to monitor. One staff member has been given the responsibility of assessing skills, and keeping staff up to date with current good practice regarding the use of equipment. Links are also being developed with professionals in the health service, so people can be more assured that the treatment they are offered will be in line with current good practice in areas such as palliative care, tissue viability and continence. We looked at some files of recently recruited staff. This showed that the recruitment process is better, and the home had completed all the necessary checks before staff were allowed to provide care for people. Staff get an induction, and care staff are encouraged to work towards National Vocational Qualifications in Care. This helps everyone to have a common understanding about what good care is, and how it should be provided. Care Homes for Older People Page 26 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is improving. Encouraging people further to express their views would help to make sure the home is running in their best interests. Evidence: Since the last key inspection in September 2009, Storm Chisholm has, after applying to the Care Quality Commission, become registered manager of Amelia House. She has a range of experience in health care, and is a qualified nurse in both general and mental health. She took up post at the home in March 2009, and is being mentored by a registered manager from another service belonging to the company. We received a negative comment within the staff surveys returned, that the management is not good, and that staff have to endure many adversities. However, we spoke to several staff on the day. Their views were mainly positive. One said Shes good - friendly with everyone, and open with everyone. We can talk to her and she gives her full attention. She also makes sure things are done. This person confirmed that regular staff meetings take place, and that they get individual supervision about Care Homes for Older People Page 27 of 35 Evidence: the work they do. Someone else said, now the manager has settled into her role, that she listens, and provides good support. They said Storm is sitting down and taking on board what the home has to do, and continued that she is working as more of a manager now. Another staff member said that the manager has done a really good job. They continued that the home is a lot better with Storm here. They said she has improved the place. To monitor the ongoing improvement at the home, annual surveys are sent out by the company, to obtain views about how the home is operating, and where individuals would like to see improvements made. In addition, following a recommendation made at the last key inspection, random surveys have also been sent out by the home about the quality of the food, and the activities provided. It was not clear whether surveys are given to people themselves, or whether they are circulated only to their relatives. For example, returned surveys, sent to the home by the commission for people to complete, had been given to, and completed by, their relatives instead. It is important that people themselves are given the opportunity to comment about their home. However, improvements are being made to the way the home measures its own success. For instance, a relative was pleased that regular meetings are now held. They confirmed they are often given a survey by the home, so they can offer their views. Visiting professionals can also provide good evidence when judging areas of excellence, or where improvements can be made. They should also be surveyed. The home will look after peoples personal allowance if this is requested. There were good records to show how this was managed on their behalf. People also have lockable facilities in their room, in which they can store belongings which are valuable to them. The information provided before our visit provided evidence that the home is kept well maintained. The home has also actioned the requirements and recommendations made at the last fire officers visit. The most recent visit from the Environmental Health resulted in an award of four stars. A maintenance man carries out in house checks regularly, to make sure that equipment, such as bed safety rails and the fire alarm, are in good working order, and that water temperatures are maintained at a safe temperature for people. Staff receive a range of compulsory training, which is updated as required, to make sure they all working a safe way. This includes training in fire safety, moving and handling, food hygiene and infection control. We made some observations which we told the registered manager about, which need Care Homes for Older People Page 28 of 35 Evidence: further attention and assessment. She assured us she would assess these, and make sure the current arrangements are safe for people living there: Denture cleansing tablets were stored in some of the bedrooms. These were not locked away. A risk assessment had not been completed to check this arrangement was safe for the person occupying the room, or anyone else who may enter it. Not all of the rooms marked keep locked had been secured by staff. These instructions should be followed, to reduce the risk from the spread of fire. The fire door in the kitchen was wedged open, so it would not close automatically in the case of fire. The manager agreed to remove this straight away, when we brought the matter to her attention. Care Homes for Older People Page 29 of 35 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 30 of 35 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 Risk to people in relation to their health, safety and welfare must be calculated, monitored and reviewed regularly. Staff must be suitably equipped and informed to measure this risk, and must take the right action necessary to keep this risk to a minimum. This is so that care and support remains correct, consistent, safe and adequate. 31/05/2010 2 8 14 Fluid intake, nutrition and 30/04/2010 unexplained weight loss must be better monitored, and advice sought where there are concerns that an individual is not drinking and eating enough. Care Homes for Older People Page 31 of 35 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 This is so the person remains well hydrated and nourished. 3 9 12 All medication, including creams, must be kept safely locked away. This is to reduce the risk from harm to people who may come into contact with them. 4 16 17 Clear records must be kept to show what action has taken place in response to complaints made to the service. This record should include whether the complainant is satisfied with the outcome of the investigation. This is so clear evidence is available that the complaint has been dealt with effectively and promptly. 5 18 13 Staff must be reminded about the role of the local authority, who they can refer to at any time, if they should need to report concerns about the welfare of people living at the service. 30/04/2010 30/04/2010 30/04/2010 Care Homes for Older People Page 32 of 35 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 This will make sure that any safeguarding event is reported promptly to the right people. 6 26 16 Steps must be taken so that 31/05/2010 all areas of the home remain free from malodour. This is so people enjoy a home which smells pleasant throughout. 7 38 13 Areas of the home which staff are instructed to keep locked, should remain so when not in use. This is so people are not exposed to unnecessary risk from the spread of fire. 8 38 12 The risk to people who may have access to denture cleansing tablets must be assessed, and appropriate action taken where the current arrangements are deemed to be unsafe. This is so risk to people is kept to a minimum. 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 30/04/2010 30/04/2010 1 7 Staff should always consider the information in peoples pre Page 33 of 35 Care Homes for Older People 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 admission assessment about their health and social care needs, so they can be certain that they are providing care in the way the individual has said they prefer. 2 15 Details about the menu should be kept up to date so people can see what choice they will be offered. This is so they can be reminded of, and look forward, to their meal. Staff should take more care at mealtimes to make sure people get the support and equipment they need. This will help to maintain their dignity and independence. 3 26 People should have access to their own toiletries, and not communal ones. This keeps their care more personalised, and helps maintain good infection control. The home should continue to measure staff availability for people by reviewing the staffing levels regularly, according to any fluctuating dependency levels, and by asking people whether they get the care they need, when they want it. Surveys should always be offered to people living at the home, so they can give their own views about the care and support they receive. 4 27 5 33 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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