CARE HOMES FOR OLDER PEOPLE
Ambassador Care Home 670/672 Lytham Road Blackpool Lancashire FY4 1RG Lead Inspector
Mr Kevan Royston Unannounced Inspection 10th April 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ambassador Care Home DS0000061568.V330438.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. Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ambassador Care Home Address 670/672 Lytham Road Blackpool Lancashire FY4 1RG 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) 01253 406371 01253 400990 D M Care Limited Mrs Lesley Anne Evans Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. A suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection must be employed at all times. The home may accommodate up to 31 service users in the Older Person (OP) category. 25/10/05 Date of last inspection Brief Description of the Service: The Ambassador Care Home provides accommodation for older people of both sexes. The home is a large detached property situated in the south area of Blackpool close to the airport and Highfield Road shopping centre. Local bus and tram routes are accessible and close by. The accommodation comprises of two lounges, a large dining area and a recently built conservatory. The front and rear garden areas provide seating for the residents and at the rear of the property there is a lawned garden area. The bedrooms are en-suite with aids and adaptations to the communal bathrooms and toilets situated on the three floors of the premises. There is a passenger lift to all three floors. There is a statement of Purpose/Service user Guide, which is given to all prospective residents. This written information explains the care service that is offered, who the owners and staff are and what the resident can expect if he or she decides to live at the home. The range of fees are £326.50.41-£366.50 per week. Additional charges are for hairdressing £7.50 and chiropody £13.00. Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection site visit that took place on the 09/04/07, over a period of approximately 6.0 hours. The Inspector spoke to the homeowner, manager, four staff, one relative visiting the home, five residents and a group of residents in the lounge. As part of the inspection process the inspector used case tracking as a means of assessing some of the National Minimum Standards. The process allows the inspector to focus on a small number of people living at the home. All records relating to these persons are examined and the rooms they occupy are looked at. Other residents are invited to pass their opinions to the inspector if they wish. The response from surveys sent to residents for there views on how the home is run was good, eleven completed questionnaires received from residents and two from relatives. Comments were positive about the standard of care and support provided by the staff and management of the home. Records of two members of staff were also examined. A tour of the premises was undertaken. Examination of the homes documentation, policies and procedures formed the basis of the inspection process. What the service does well:
The home has a settled staff team with little change in staffing since the previous inspection, which helps relationships to develop between staff and give them a good understanding of residents needs. Observation and talking to staff confirmed support, communication and knowledge of residents needs is good. Comments from staff included, “We all pull together”. Also, “With the same staff we get to know how each other and helps to get to know the residents health needs”. And, “It’s a good atmosphere to work in we all get along fine”. One resident spoken to said, “ It’s nice to have the same people working you get to know them”. The eleven surveys returned from residents for their comments on how the home is run and standard of care provided were positive confirming the support and care of residents is a priority. Comments included, “Staff are very caring”. And, one comment from a resident spoken to said. “I used to live on my own but now wish I could have come here sooner, the place is wonderful”. Examination of training records and discussion with staff confirmed the home provides good training opportunities for all staff to attend courses in relation to their job role. This ensures the development of all staff and provides the skills
Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 6 required to support the residents. One staff member said, “Never a problem attending training the manager always supports you”. The manager spoken to said, “Nearly all the staff are now trained to National Vocational Qualification level 2” (NVQ, a recognised qualification in care). What has improved since the last inspection? 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. Ambassador Care Home DS0000061568.V330438.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 Ambassador Care Home DS0000061568.V330438.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): 3. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The admission and assessment procedures were very clear and precise to ensure the needs of the residents are identified and met. EVIDENCE: The records of three residents were examined and had full assessment information recorded in detail. All three residents are funded by social services and been assessed by social workers with information on file for the care staff at the home to develop a care plan to ensure all health, welfare and social needs are identified and recorded. A staff member spoken to said, “We always invite potential residents to stay and undertake a thorough assessment of our own”. Another member of staff said, “Only the management team see people in hospital or there own homes to do the initial assessment”. Residents spoken to confirmed they were involved in the assessment process and able to give their views of the support they required. One resident survey returned said, “We were able to visit the home and have any questions answered before we made a choice”. A resident spoken to added, “They went through all my health needs before I came”.
Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 9 Standard 6 was not assessed, as The Ambassador Care Home does not provide intermediate care. Ambassador Care Home DS0000061568.V330438.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): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Promotion of health is taken seriously. Resident’s welfare is closely monitored and health needs are identified and met. EVIDENCE: Records of resident’s case tracked were accurate and had good information about their health and social care needs that supported the staff to maintain and promote each individuals daily needs. Care plans were up to date and regular reviews taking place with involvement of the residents and relatives and good information of care provided ensuring the welfare and general wellbeing of residents is continuously monitored. One of the residents spoken to said, “I know they look at my health monthly and I sign the form” Records examined confirmed risk assessments have been completed and are reviewed when required. They are updated reflecting any changes that may have occurred individually and in the environment ensuring the resident’s needs are being monitored. Significant events had been recorded and daily entries by carers demonstrating the care given. Residents spoken to said, “I came here on respite and decided to stay”. Another said, “The staff know us well and seem to know what we
Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 11 need”. A relative of a resident visiting the home and spoken to said, “I am very happy with the care here”. Medication practices observed at breakfast and lunchtime were safe and good records had been kept ensuring residents health is maintained. As an improvement to the medication procedures further identification of each resident is placed on their individual medication to provide and extra safety measure and maintain the protection of the residents. A member of staff observed administering medication said, “Only trained staff is allowed to administer medication”. Another member of staff said, “We are looking to have all carers trained in medication issues”. The three medical records looked at were being accurately maintained to ensure the safety of the residents. At the time of the inspection controlled drugs were being administered and examination of records, storage and handling of medicines confirmed good systems are in place with experienced trained staff to ensure good practice and the health of residents is maintained at all times. The community pharmacist visits on a regular basis to provide advice and training so care staff are well informed of any changes in medication practices. A staff member spoken to, “The chemist is very good and comes out to us when we want”. Resident’s dignity and privacy was observed during the visit ensuring residents are treated with respect. This was confirmed by observing staff members knocking on doors before entering rooms, helping take medication and the way staff talked to the residents. One resident spoken to said, “The staff cannot do enough for you”. Another said, “They show me respect which is nice”. A member of staff spoken to said, “We cover privacy and respecting residents with the manager”. Ambassador Care Home DS0000061568.V330438.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): 12,13,14 and15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: Breakfast and lunchtime meals were seen being prepared, and were wholesome, home baked with fresh produce providing a nutritious meal. Observation at lunchtime showed staff supporting residents with their food with dignity. Menus examined are balanced and interesting. Meal times are set although flexible enough to accommodate preferences. One resident was seen taking meals in the privacy of his own room, which was his preference. Comments were positive in relation to the standard of food and included, “The food is excellent”. And, “good choices”. Discussion with cooks and staff confirmed diabetic diets; liquidised foods and food from different cultures could be provided ensuring residents from any religious faith can be accommodated. Staff spoken to said, “Liquidised foods can be provided if needed” And, “We cater for diabetics at the moment”. Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 13 Activities are centred on each individuals preferences ensuring flexibility and residents can enjoy their own personal interests, which are recorded on their care plan. One resident spoken to said, “ I like a sing song with the entertainers when they come”. A staff member said, “It will be nice to go out the weather is getting better, we are looking at a trip and lunch out at the moment”. Observations of residents rooms showed personal belongings are brought into the home in order to provide a homely atmosphere for each individual. A resident recently moved in said, “Yes I was able to bring my own items I wanted to”. Residents spoken to confirmed visitors are allowed at any time of the day or night. One resident said, “Oh yes any time, my son-in law visits at different times and we go for a pint”. One member of staff spoken to confirmed visitors are allowed any time and said. “Visitors come and go as they please”. Ambassador Care Home DS0000061568.V330438.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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for recording and reporting of complaints are good ensuring people feel listened to. The management team and staff have good knowledge and understanding of adult safeguarding issues, which protect residents from abuse. EVIDENCE: The home has a detailed complaints procedure, which is made available to all residents on admission and contained in the Statement of Purpose and Service User Guide to ensure they know how to raise any issues of concern. Comments from residents in surveys returned confirmed all are aware of the complaints procedure and who to complain to. One resident spoken to said. “Yes I know what to do if I am not happy”. Staff also are aware of the complaints process, one staff member said, “Complaints policies are covered by our training”. There have been no complaints since the previous inspection. The home has a procedure in place for dealing with allegations of abuse. The manager and staff spoken to had a good understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. One staff member spoken to said, “Abuse was covered in NVQ training” Ambassador Care Home DS0000061568.V330438.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): 19,25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is safe and clean maintained to a good standard providing comfortable surroundings for the residents. EVIDENCE: A tour of the building found it to be clean and tidy. The home is maintained to a good standard and maintenance records confirmed there is a rolling programme of general repairs and renewal of the premises ensuring the comfort and safety of the residents is maintained. A relative of a resident spoken to said, “The home is always clean when I come here”. Areas of the home require some painting in particular communal areas such has doors and general paintwork. However discussion with the manager confirmed ongoing work to update the home is ongoing in order to maintain pleasant surroundings. Radiators were noted to be covered throughout the home however one cover was missing over a radiator in the lounge area. A service user was sat very
Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 16 close to the radiator which then presented as a risk. To make sure there is no risk of burning radiators must be of a guaranteed low surface temperature or guarded properly so that the risk to residents is removed ensuring that their safety and protection is maintained. There are policies and guidance for laundry processes and for the control of infection ensuring the home is kept clean, pleasant and hygienic. Ambassador Care Home DS0000061568.V330438.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): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff need to be more robust to ensure that only suitable staff are employed at the home for the safety and protection of the residents. Training for staff is good and enables staff to have the skills and competencies for their roles. EVIDENCE: Observation of duty rotas and discussion with manager and staff confirmed there were sufficient numbers of staff both domestic and carers on duty to ensure the resident’s are supported and their needs are met. Comments from residents included. “The staff are caring people” and, “there are plenty of staff to help if I need them to”. A member of staff spoken to said, “We have enough staff around”. Examination of two staff files confirmed the recording procedures of the home are good. Staff records include, application forms, Criminal Records Bureau (CRB) checks, Protection of Vulnerable Adults (POVA) disclosures and references. However one staff file had only one reference and the POVA disclosure applied for after commencement of employment. A thorough recruitment procedure with proper checks in place prior to employment must be operated to ensure only suitable staff work at the home for the protection and safety of the residents.
Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 18 Examination of training records and staff spoken to confirmed the excellent training opportunities on offer. Staff members spoken to said “I have always been supported for training courses by the management team”. Another said, “Never a problem with access to training”. Discussion with the manager and examination of records confirm the target of 50 of care staff to complete National Vocational Qualification (NVQ) level 2 in care has been achieved with some staff on level 3 and over 90 of care staff completed the recognised qualification. One member of staff said, “Yes the NVQ training was very useful” Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well and systems and policies in place for the protection and safety of staff and residents are good. EVIDENCE: The registered manager has the necessary skills and experience required to support the staff and residents and enable the home to meet its stated purpose and objectives. Staff spoken to say they found the manager supportive and provided a clear sense of leadership. One commented,“ Always approachable and helpful”. Residents spoke positively about the manager, comments included, “Anything you need to ask she is always nice to talk to”. And, “All make a real effort to provide a lovely home”.
Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 20 Examination of records for residents confirmed they are comprehensive, well written and up to date ensuring the correct information is available and health and welfare needs are continuously monitored. Records show the manager has good systems to gather staff, residents and relative’s views to enable ongoing improvements to the home. Regular staff and resident discussions are recorded and suggestions are carried out if agreed by both parties. Relative surveys are sent out has a quality assurance method to gather there views to ensure they feel the home is run smoothly and any suggestions to improve the home are noted and put into practice. Regulations require a visit monthly which has been completed from an appointed person. A report of the findings of the visit with useful information is sent to CSCI to explain any developments and monitor the care provided to ensure the home is managed properly and continues to develop to provide the care and support for the residents and staff. Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 21 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 22 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 OP25 Regulation 23 Requirement Timescale for action 07/05/07 2 OP29 19 The radiator in the lounge must be guarded or have low temperature surfaces to ensure the safety and protection of the residents is maintained. A thorough recruitment 30/04/07 procedure must be operated with proper checks in place prior to employment to ensure only suitable people work at the home for the protection and safety of the residents. 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 Ambassador Care Home DS0000061568.V330438.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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