Inspection on 10/05/05 for Ambassador House

This inspection was carried out on 10th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ambassador House 10/07/07

Ambassador House 16/08/06

Ambassador House 15/11/05

Ambassador House 27/01/05

Ambassador House 10/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ambassador House 31 Lansdowne Road Luton Beds LU3 1EE Lead Inspector Sally Snelson Unannounced 10th May 2005 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 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 House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ambassador House Address 31 Lansdowne Road Luton LU3 1EE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01582 486244 01582 726265 Mr Cornelius Crowley Patricia Archer Care Home 21 Category(ies) of OP Old Age - 21 registration, with number PD(E) Physical disability over 65 - 21 of places DE(E) Dementia over 65 - 21 Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27.01.05 Brief Description of the Service: Ambassador House is located in a quiet residential suburb of Luton. The home is a large extended detached house with an observatory feature within the roof. The home is registered to provide care for 21 older people. The bedrooms are located on all three floors of the building accessed by stairs or a shaft lift. Toilet and bathing facilities are located on each floor; four single rooms and the one double room have en-suite toilet facilities. A lounge and separate dining room are located on the ground floor with a further lounge/diner on the first floor. The accommodation is well maintained. Arrangements are in place to ensure that service users are able to receive the services of a visiting hairdresser and a chiropodist; service users are responsible for the charges for these services. Satisfactory arrangements are also in place to ensure that referrals to healthcare professionals are carried out. There is adequate parking for staff and visitors with additional road parking available if necessary. There are plans for an extension to be added to the rear of the house for four additional bedrooms.. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Ambassador took place over a five and a half hour period on 10th May 2005. The inspection started at 08.20 am. The registered manager Donna Archer was present throughout the majority of the inspection. The inspection methodology was to case track two service users, speak to staff, service users and visitors and to observe practice. What the service does well: A manager who was hard working and committed to raising standards and making improvements led the home. Service users were regularly asked about their views as to how the home was run, and changes were made accordingly. A group of service users had requested more salmon on the menu and the cook had seen that this happened. A number of activities were on offer throughout the day and staff spent individual time with all of the service users. Service users were keen to talk about the singing, line dancing and bingo sessions that were held, and to explain the procedures for winning prizes. During the inspection the husband of one of the service users, who had a birthday, was taking her and two other service users for a car ride; much of the morning was spent imagining where the ride would be to. Food was varied and well presented and mealtimes were social occasions, with staff and carers discussing the previous nights television. One of the service users had her whole day mapped out to coincide with her favourite T.V. programmes, and would even ask for her meal to be delayed if there was a clash. All of the staff were keen to attend training, with one stating “there is always something new to learn, and there is a lot of opportunity to learn here”. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 6 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. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,4 and 5 The Statement of Purpose and the Service Users Guide provided prospective service users and their families with sufficient information about the home for them to be able to make an informed decision about admission. EVIDENCE: The manager had ensured that the Statement of Purpose had been kept updated and that it reflected the current situation within then home. The inspector discussed with the manager the changes that would need to be made following the proposed extension to the home. A sample of the ‘terms of residence’ was included in the documentation provided to service users at the point of admission. There was evidence that the manager assessed service users for their suitability prior to admission and completed the appropriate documentation. The manager confirmed that, as well as making a care assessment to ensure that the staff could meet the needs of the service user, she also considered those service users already accommodated, and how a new service user would ‘fit in’. At the time of the inspection the majority of the service users living at Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 9 Ambassador had low to medium care needs; some had a diagnosis of dementia. The terms of residence and the Service Users Guide confirmed that service users were initially admitted for a six-week trial period. Staff had completed training as it became available, and a number of carers had completed dementia care training. The inspector did not see anything that had been specifically put into place because a number of service users had dementia. The home had two lounges and on the whole those service users with dementia used the lounge and dining room on the ground floor. However the inspector was confident that this was not segregation. The home did not provide intermediate care at the time of the inspection. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,and 11 Care plans for all the activities of daily living were in place but they needed to be expanded to ensure that staff had precise details of how to provide the required care for service users. EVIDENCE: The manager and the staff had put a lot of work into improving the care planning process. There was still a need for the plans to be expanded to include all the care needs of service users, so that anyone could provide the necessary care. This was a difficult concept for the staff team to comprehend, as they all made it their duty to understand the needs of all the service users in the home, and did not have to rely on agency staff to cover for sickness and holidays. At the time of the inspection the manager, or the key-worker, were completing 22 care plans for each service user covering all the activities of daily living and more. The expanded care plans would need more specific detail. For example a file sampled had a care plan for sleep/rest that stated ‘sleeps well during the night’. This needed to be expanded to include the time the service user preferred to go to bed and get up and any ritual associated with sleep for example---- B enjoys hot milk before settling. There also needed to be care plans for issues that did not routinely fit into the activities of daily living. For example a service user who had an ulcerated leg did not have Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 11 a care plan for this as the community nurse did the dressing. There should have been a plan indicating when the nurse was expected and other relevant details such as staff’s actions in the event of any changes being noted to the ulcer. Once written the plans must be reviewed monthly, or whenever a change has been identified. Discussion with the staff suggested that care needs were being met even if the plans did not indicate this. Since the last inspection risk assessments were being regularly reviewed and updated. There was evidence that the home had discussed individual wishes with regard to terminal care and death arrangements with some of the service users and/or their relatives, but not all. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 Activities and the welcome that any visitors were given to the home enriched the social interaction service users had. The food was home-cooked and nutritious providing service users with a wholesome diet. EVIDENCE: A number of the service users spoke about the entertainment that the home provided and how much all enjoyed this. The owner of Ambassador also owned two other homes in the same area. This meant that the service users could get together and enjoy entertainment more frequently as they could attend an activity put on by one of the other homes or share an entertainer. The inspector noted that visitors were welcomed into the home at anytime and were made to feel comfortable. One of the visitors spoken to on the day of the inspection had lost her mother at the home more than a year ago but continued to visit regularly. On the day of the inspection one of the service users was supported to attend a day centre. Staff organised a taxi for him and ensured that he was ready at the appropriate time. Social services had arranged for the home to pay the Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 13 taxi directly from the service users’ allowances. This gave the inspector the opportunity to ensure that service users monies were held appropriately by the home on their behalf and that receipts for purchases were appropriately kept and documented. The inspector witnessed breakfast and lunch during the course of the inspection. Service users were offered breakfast in one of the two dining rooms or in their bedroom as they requested it. On the day of the inspection lunch was boiled bacon, potatoes, cabbage and carrots followed by cheesecake. The inspector noted during a visit to the kitchen that vegetables were freshly prepared and steamed in an attempt to retain maximum nutrients. Alternatives were not offered at each meal but the inspector noted that service users had been asked about preferences by the cook who kept a list of likes and dislikes. There was also documentation to support service users being routinely consulted at residents meetings about the food. The inspector saw minutes of a meeting where the service users had requested more brown bread and salmon, and was able to confirm that these were now regularly included as part of the menu. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed in detail at this inspection and will form part of the next inspection visit later in the year. EVIDENCE: Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,24,and 26 The standard of the environment within the home is good, providing service users with an attractive and homely place to live. EVIDENCE: Nineteen of the service users had a single bedroom with five of the rooms having en-suite facilities. There was a lounge/diner on the first floor with a small kitchenette off it. The inspector discussed with the manager the possibility of some of the service users being risk assessed to use this facility if they wished to make themselves or their visitors a cup of tea. The lounge and the dining room on the ground floor were separate, a provision that encouraged some service users to mobilise with a purpose. Service users had free access throughout the property and could take the lift or the stairs to the first or second floor. There were a sufficient number of toilets and a variety of bathing facilities to meet the needs of the range of service users accommodated at Ambassador Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 16 House. The manager stated that at the time of the inspection the toilet shower was a firm favourite. All of the bedroom doors had a lock fitted although few of the service users choose to use this facility. The laundry area was appropriately equipped with a sluicing washing machine and a tumble drier. All the staff took responsibility for the laundry; washing was dried in the open whenever it was possible There were plans to extend the property to the rear of the building to provide four additional bedrooms. Work had been due to start in the spring but had been delayed, as work in one of the other homes had taken longer than expected. The manager was aware of the need to provide the CSCI with an action plan prior to the work commencing and to ensure that all the service users and their relatives were aware of the plan. Following the building of the extension it was planned that the garden would be landscaped as at present some of the space was not suitable for use as it was laid to tarmac. The area of the garden that was in use was large enough for service users to sit in and a gazebo had been erected in preparation for the better weather. The local Fire Authority had carried out an inspection of the home on 19th April 2005. The report from this visit stated that all safety measures were being satisfactorily maintained. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28 There was an enthusiastic staff group with a high morale which resulted in all the staff working cohesively to provide a high quality of care. EVIDENCE: It was noted that the staff worked as a team and, although carers had specific service users to care for, they engaged with all of the service users appropriately. Staff spoken to were confident about caring for the service users and all had recently attended some type of training. It was hoped that all staff could access a Protection of Vulnerable Adult training in the near future, as this was an area where the manager had identified a need. A number of staff had completed NVQ level 2 training and one carer on duty had level 3; all spoke highly of the benefit from the courses, despite the hard work. As at previous inspections concerns were raised about the practise of having only one waking member of staff on duty throughout the night. There was evidence that this practise was regularly risk assessed and that the sleeping member of staff was called infrequently. The manager and the owner were aware that this could not continue when the planned extension was operational. An induction programme was in place that new carers were expected to follow. On the day of the inspection no new carers were spoken to who could confirm that this process was in operation. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 18 Visitors spoken to confirmed that all the staff provided ‘kindly care’ and they were happy to have their relatives in the home. During the inspection staff spent time talking to service users about last nights television and the headlines in that days newspaper. Staff files were not sampled as part of this inspection. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,35 and 38 The manager had been in post a number of years and demonstrated a commitment to the service users and the staff. EVIDENCE: The manager, Donna Archer demonstrated that she understood her responsibilities as the registered manager. Staff confirmed that Mrs Archer supported them and consulted them before making changes in the home. The manager had been working towards her NVQ 4 for sometime and was aware that she must make an effort to complete this study. The manager reported that she was supporting one of the service users to make a trip to Australia to visit her daughters; this had necessitated her organising a passport and making calls to Australia to speak to the family. As mentioned earlier in the report, the home only held small amounts of money on behalf of the service users, and did not handle their financial affairs. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 20 The manager reported that she would speak to families if service users needed anything and in cases where the money was late, petty cash was used as a loan. The owner provided monthly regulation 26 reports to the CSCI. These had improved but did not provide the required detail. Regular health and safety checks were carried out by the handyman and documentation was kept appropriately. Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x 3 x 3 STAFFING Standard No Score 27 2 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 x x 3 x x 3 Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Timescale for action Care plans must include detailed previously information as to how care is to 1.4.05 be provided. extended to 30.6.05 Waking staff on duty must reflect 01.08.05 the numbers and needs of the service users and the layout of the home. Staffs qualification and training 01.08.05 must reflect the needs of the service users. Requirement 2. 27 18 3. 28 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 31 Good Practice Recommendations The manager should continue with and achieve NVQ level 4 in management Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Ambassador House I51 S14876 Ambassador V226566 100505 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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