Care Home: Ampersand House

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What the care home does well There is a full range of activities available for those who like to join in. There are also outings and entertainers that come into the home on a fairly regular basis. The manager has ensured that there is a full programme of activities over the festive period including Boxing Day. There is a very warm and inclusive atmosphere in the home and service users spoke freely with staff. Staff were seen enabling service users to do what they preferred to do. What has improved since the last inspection? The staff at the home have worked hard to improve the standards at the home since the last inspection. Improvements in documentation were seen and adherence to the medication procedures ensured all service users received their prescribed medication. The environment has also greatly improved. A programme of redecoration has been undertaken and lots of new furnishings have been purchased. The whole home is now starting to look more homely and cared for. The staff have also undertaken much of the required training to enable them to better meet service users` needs. The home now has over 50% of its staff with an NVQ Level 2 or above. All staff now have a POVA first and then the CRB`s are sent for to ensure the safety of their service users. What the care home could do better: Although a lot of documentation has improved, more detail is needed to individualise the care plans and the outcomes of these need to be recorded in the daily log and reviews. The fire log was not completely up to date, with two tests not having been undertaken in the last two months. The home needs to review its practice in this area CARE HOMES FOR OLDER PEOPLE Ampersand House 164/166 Frindsbury Road Frindsbury Rochester Kent ME2 4HP Lead Inspector Sally Hall Key Unannounced Inspection 10:30 18th December 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ampersand House Address 164/166 Frindsbury Road Frindsbury Rochester Kent ME2 4HP 01634 724113 01634 724113 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Thuraisamy Ravichandran Mr Nallanathan Suganthakumaran, Mrs Radha Ravichandran, Mrs Suganthini Suganthakumaran Antoinette Lawrence Care Home 27 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (27) of places Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th July 2007 Brief Description of the Service: Ampersand House is a care home registered to provide residential care and accommodation for a maximum of twenty seven older people of which twelve may suffer from dementia. The home is a large detached property set in pleasant grounds. It is situated in the residential area of Frindsbury and is approximately one mile from Strood town centre. Motorway links are close by. The home is near a bus route and Strood mainline railway station is approximately one mile away. The accommodation is set out over three floors and has a passenger lift serving the upper floors. There are two lounges and a conservatory leading off the dining room for use by residents. The home is now none smoking throughout. The fee range for this home currently £416-450.00 per week; this does not include the costs of hairdressing, chiropody or newspapers. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection at Ampersand House took place on the 18th December 2007 starting at 10.30am. The lead inspector was Sally Hall On the day of the inspection the inspector agreed and explained the inspection process with the registered manager. Time was spent reading a sample of care plans, written policies and procedures and records kept within the home. Staff were spoken with and a tour of premises was undertaken. The focus of the inspection was to assess Ampersand House in accordance with the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. The home was asked to complete an AQAA (Annual Quality Assurance Assessment) and evidence from this document was included in a previous report. Surveys of service users, their families and other health professionals were also used during a previous inspection. However the views of the relative spoken to during this inspection process have been included. What the service does well: What has improved since the last inspection? The staff at the home have worked hard to improve the standards at the home since the last inspection. Improvements in documentation were seen and adherence to the medication procedures ensured all service users received their prescribed medication. The environment has also greatly improved. A programme of redecoration has been undertaken and lots of new furnishings have been purchased. The whole home is now starting to look more homely and cared for. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 6 The staff have also undertaken much of the required training to enable them to better meet service users’ needs. The home now has over 50 of its staff with an NVQ Level 2 or above. All staff now have a POVA first and then the CRB’s are sent for to ensure the safety of their service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users can be confident that if offered a place at the home their care needs will be met. EVIDENCE: Pre assessment documentation is completed prior to a place being offered at the home for a trial period. The assessment covered all the information required within the relevant National Minimum Standard . The assessment is comprehensive, and further assessments are undertaken during the trial period which is normally four weeks in duration. From the information gained by the assessment process a service user’s first care plan is devised. The staff training matrix indicated that staff are trained to enable them to meet the identified individual needs of the service user. It is the home’s policy to ensure that in the future all staff have dementia awareness training and the manager hopes that all care staff will undertake more in-depth training regarding dementia. Seven staff including the manager had completed, and NVQ equivalent in caring for people with dementia. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 9 Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users can feel confident that their health and care needs will be met, and they will receive their prescribed medication. EVIDENCE: A number of service user files were sampled which included two service users who had been admitted to the home within the last three months prior to the site visit. Each file contained in the various assessments undertaken, which identified each service user’s individual needs. Whilst these were seen to be translated into care plans it was recommended that these would benefit from more detail. Care plans had been reviewed on a monthly basis. However, details of outcomes were not recorded. The daily record in which care staff recorded the day-to-day events and care provision of individual service users did not contain sufficient detail to reflect service users’ care` plans. Staff had in all cases recorded in detail what service users had eaten or drank during the day, sometimes commenting on how much was eaten but other areas of the care plan that needed to be cross-referenced were not. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 11 It was evident that health needs are followed up and outside professionals such as GPs chiropodist and opticians are requested as needed. Several service users require regular blood tests for sugar levels and evidence was seen that these are taken and documented. Service users are weighed on a regular basis and the home has purchased a set of scales on which the service users can sit. This makes it possible to weigh service users who find it difficult to stand. During the day staff were observed, treating service users with the utmost respect. Staff were mindful when talking about sensitive information and a lot of encouragement was seen to ensure service users remained independent. Service users spoken to confirmed that their dignity and privacy is respected as much as possible. The medication audit was undertaken and was found to be correct. M. A. R. sheets were checked. They contained the required information and had been completed correctly. Medication coming into the home had been recorded and signed for and medication given to service users had also been signed for. Medication storage is appropriate and secure. The improvement from the last inspection has been maintained due to the stringent monitoring of the procedures and systems. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users can be confident that they will be offered a full programme of activities if they wish to join in and that their independence will be promoted. Service users can also be confident that they will receive a menu, which offers a choice and will receive nutritious meals. EVIDENCE: A full range of activities had been arranged for the Christmas holiday. The manager had been able to secure an entertainer to visit on Boxing Day - a lady who was popular with service users. A party had been organised as well as a country and western concert and a carol service in the home orchestrated by the local church. On a day-to-day basis during the year there is a programme of daily activities. The home has an activities coordinator who works three days per week. The other days are covered in the afternoons by the care staff. All activities are recorded in an activities file as well as in each service user’s individual file. The home also arranges outings and outside entertainers to visit the home fairly regularly throughout the year. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 13 Visitors are made to feel welcome and a visitor has spoken to during the inspection confirmed that there was never a problem when visiting the home. The visitor informed the inspector that when she arrives, she is made to feel welcome, and she can be with her mother either in her own room or in the lounge where her mother usually sits. Some service users confirmed that their relatives and friends visited them on a regular basis. Staff confirmed that there were no set visiting times. The Christmas menu was seen and the manager said that service users had been consulted and they had chosen traditional Christmas fare. Many of the service users said that they were looking forward to their Christmas dinner at the home. The choice was available for those who do not like the traditional turkey roast. The normal menus were also seen and they all showed the choices available on a daily basis. The manager confirmed that most meals are home-cooked and fresh ingredients are used whenever possible. Service users spoken to said they enjoyed the meals at the home and found them to be more than sufficient. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users can be confident that any complaint will be taken seriously and they will be protected by the home’s robust safeguarding adults policy. EVIDENCE: The complaints file was seen and no formal complaints had been made since the last inspection. The manager confirmed this. Service users have a copy of the complaints procedure in their rooms. Service users spoken to said they were happy to speak to their manager or the staff if they had any problems. There are no outstanding safeguarding adults issues and all staff at the home have now been trained appropriately. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users can feel confident that the home they live in is safe, clean and homely. EVIDENCE: A lot of work has been undertaken since the last inspection. The redecoration of areas on the ground floor have improved the feeling of homeliness and created a nice atmosphere. New lighting had been installed and the manager indicated further changes that had taken place in the lighting around the home. It was also noted that armchairs in the lounges and conservatory had been replaced. The home looked cleaner and, apart from one room, there were no unpleasantly odours. The room with an odour problem identified in the last report has had its flooring replaced. The new room identified with the problem is also having its flooring replaced plus its vanity unit, which has become damaged, is also being replaced.. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 16 Bathrooms seen were all clean and did not have the items such as cleaning chemicals left unattended. However, the rooms looked very clinical and not homely. This was discussed with the manager. Service users’ rooms were found to be clean and to contain the furniture required for each service user. It was pointed out to the manager that it is not appropriate to store items on top of wardrobes given that this might be regarded as a health and safety issue. There is a rolling programme of maintenance for bedrooms as and when rooms become vacant. The flooring in the entrance hall, dining area and conservatory had been replaced with nonslip flooring that can be washed. New pictures and wall hangings have been purchased which has added to the overall improvement of the environment of the home. The laundry was inspected and it was noted that new flooring has been put down. Although the laundry was quite congested it was a much cleaner than it was during the last inspection. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users can feel confident that there will be sufficient trained staff on duty to meet their care needs. EVIDENCE: Staff files were sampled for those staff that had been most recently recruited. The files contained the information required and included ID, references, application form contract and POVA first check. CRBs had been received, but were kept securely elsewhere. Interview notes were not found in three files. A recent photograph is also a requirement though some files only contained a copy of a passport photograph. The staff rota was seen and note was taken of the staff on duty on the day of inspection. The number of staff on duty was considered to be adequate, as was the skill mix. All the new staff employed had undertaken the required formal induction and evidence was seen that they had also completed an in-house induction. A great deal of training has taken place since the last inspection and most staff had completed most of the required training. The home now has over half its care staff with an NVQ Level 2 or above. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the home is well-managed and is run in their best interests. EVIDENCE: The manager has the required qualifications to manage the home. It was apparent from the rapport seen between the manager, staff and service users that the home has a very inclusive atmosphere. Service users spoken to said that they were happy to talk to the manager who they see most days of the week. The home looks after a small amount of personal money for service users. This money was documented and an audit showed that it was correct. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 19 Certificates were seen for gas, electrical appliances, hoists, the lift and recent legionella testing, all these were in date. However the periodic electrical certificate was not in date and the manager was going to check to see when the electrician last undertook an inspection since it was possible that an inspection had been undertaken and that the home had not yet received the certificate. As has been described previously, there is a rolling programme of redecoration in the home and the handyman is available most days for day-to-day items that may need his attention. The fire check log was seen. It was not completely up-to-date since the previous week’s tests had not been carried out, and one test was missed during the month of November. This was discussed with the manager. There is a fire risk assessment for the building and fire risk assessments were also seen for each individual service user in their files. A recent fire drill had not been documented correctly although the manager does remember seeing the details the inspector was looking for. Policies and procedures are in date and the manager is currently reviewing them. The health and safety problems identified in the last report have now been action, and staff have been trained. Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 X X X 2 Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Schedule 3.1(b) Requirement A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. Confirm that the electrical period certificate held at the home is up to date and ensure fire system testing and recording is undertaken as is good practice Timescale for action 31/01/08 2 OP38 Schedule 4 (12)(d)(e) (14)(15) 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 22 Ampersand House DS0000055868.V348102.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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