CARE HOMES FOR OLDER PEOPLE
Ambassador House 31 Lansdowne Road Luton LU3 1EE Lead Inspector
Sally Snelson Unannounced Inspection 15th November 2005 01:00 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 House DS0000014876.V266858.R01.S.doc Version 5.0 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 House DS0000014876.V266858.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ambassador House Address 31 Lansdowne Road Luton LU3 1EE 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) 01582 486244 01582 726265 Mr Cornelius Crowley Mr Stephen Giles Ms Patricia Donna Archer Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21), of places Physical disability over 65 years of age (21) Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th May 2005 Brief Description of the Service: Ambassador House is located in a quiet residential suburb of Luton. It 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 and accessed by stairs and/or a shaft lift. Toilet and bathing facilities are on each floor; four single bedrooms 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. The home has recently had an extension built that provides four extra en-suite bedrooms and an extension to the dining room. The extra bedrooms will come into operation after this inspection when the registration for the home has been increased to admit 25 service users. 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. Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection of Ambassador House was unannounced and took place on 15th November 2005 from 13.00hrs. The inspection, the second of the year, was brought forward and combined with a site visit to register the newly completed extension. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the services provided. The process considers the home’s capacity to meet regulatory requirements and minimum standards of practice. During the inspection three service users were ‘case tracked’, which means their care and the supporting documentation was looked at. Service users were spoken to and the new areas of the home were looked at in detail. The inspector would like to thank staff and service users for their time and help with the inspection. What the service does well:
Because of its size the home has a small ‘homely’ feel to it. The owner and the manager said that they are keen that this feeling will not lost with the provision of the extra bedrooms and do not expect to expand any more in the foreseeable future. The new bedrooms and the extended dining room are decorated and furnished to a high standard. This emphasised that some other areas of the home were in need of redecoration and consequently new carpets were being fitted throughout and new furniture provided for the lounge. Service users have a good relationship with the staff, it was noted that staff would often sit with service users and chat. The staff encouraged service users to maintain their links with the community and welcomed visitors into the home and supported service users to attend day centres and groups. One service user said, “If I can’t live at home this is where I want to stay, because everyone is happy and we are looked after.” Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 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 DS0000014876.V266858.R01.S.doc Version 5.0 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 House DS0000014876.V266858.R01.S.doc Version 5.0 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 the following standard(s): 1,3 The manager assessed all of the service users prior to admission to ensure that the home could meet their needs. EVIDENCE: The manager and the owner had made a draft copy of a revised Statement of Purpose that would become operational when the new bedrooms were registered. To meet the standard the Statement of Purpose must include all the information detailed in schedule 1 of the National Minimum Standards for older people, including the arrangements for dealing with a complaint and how to contact the CSCI if a complaint was not dealt with appropriately by the home. The Statement of Purpose should also include details of the rooms that could be suitable for those service users requiring a wheelchair for mobility. Following the inspection the manager stated that the complaints procedure was included in the Service Users Guide. However the Statement of Purpose is a standalone document and must include all the information listed in schedule 1. The care plans indicated that service users were assessed prior to admission to ensure that the home could meet their needs. The manager stated that
Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 9 occasionally the assessment would be carried out at the home, if, for example, a social worker or a relative had taken a service user to the home for a preadmission visit. The manager confirmed that the assessment considered the needs of the service user in relation to the qualification and experience of staff as well as the location of the bedroom that was available to ensure its suitability for the physical needs of the service user. In order to confirm how the decision was made that Ambassador House could meet the assessed needs of a particular service user the pre-admission assessment should be expanded to include more areas. These are listed in standard 3 of the national Minimum Standards. The information gathered about a service users family history was particular useful to staff when engaging service users, particularly those with dementia, in conversation. Ambassador House did not admit service users for intermediate care. Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 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 the following standard(s): 7,9,10 Medication systems were in place and adhered to appropriately. Staff and management value service users by treating them with a high level of respect. EVIDENCE: Care plans for service users who had lived at the home covered all the aspects of daily living but were sometimes lacking in the precise detail of the care that staff were expected to provide. The manager was in discussion with the managers from the ‘sister’ homes about how these documents could be more focused. The plan was to leave the care plans that were in place and introduce the new style plans for new admissions. The medication charts sampled for the service users who were being case tracked confirmed that medication was correctly signed into the home. The list of staff that were assessed to administer the medication had had appropriate training and a sample of their signatures was on file. The medication was stored in a medication trolley that was locked to the wall in the inner hall of the home. Care must be taken to ensure that the temperature around the trolley does not exceed 25 degrees Celsius and consequently ruin the efficacy
Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 11 of the medication. The manager had a larger trolley on order to meet the needs of the expanded number of service users. Two staff members were observed appropriately helping a service user with mobility problems to transfer from a wheelchair to a chair. Staff dealt with service users with dementia and used a respectful and appropriate technique that was effective for the particular person they were dealing with. The care plans included a suggested care agreement where service users or someone on their behalf outlined their care preferences, for example what time they liked to get up or go to bed. Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: None of these standards were assessed during the inspection. Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 16,18 There had been no complaints since the last inspection. The complaints procedure was displayed making it available to all people involved in the home’s life. There were still a number of staff who had not been trained in the principles of the Protection of Vulnerable Adults (POVA), which could have a negative effect on service users. EVIDENCE: The home displayed a “complaints procedure” that clearly described the process of making a complaint and also showed the appropriate sources where potential complaints could be directed. There was a need to include this information in the Statement of Purpose. Two staff had attended a training provided by the Local Authority on recognising and preventing the abuse of vulnerable adults (POVA). There was no evidence that all staff had some degree of training on this subject, which could have serious consequences if procedures were not carried out correctly if an incident occurred. The home’s recruitment practise ensured that staff who were unsuitable to work with vulnerable adults were not employed. Risk assessments were in place and families were contacted when service users were taken out of the home for car rides etc.
Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19,23,24 Ambassador House provided service users with a comfortable, safe environment in which to live. EVIDENCE: These standards had been looked at in detail at the past inspection therefore only the new part of the building was looked at in detail although the inspector did visit other areas of the home. The recent extension had added four extra bedrooms to the home. These rooms were single en-suite bedrooms of at least 12 square metres. The rooms had been well decorated and appropriately furnished. Each of the en-suites had a toilet and a wet room type shower. The position of the bedrooms on the ground floor and the fact that they were accessed from a wide straight corridor made them suitable for service users who needed to use a wheelchair. As part of the extension the dining room had been considerably extended and reAmbassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 15 decorated and the garden landscaped. The garden could be accessed from the dining room via a ramp. The dining room had been extended making it possible to accommodate all the service users together if they wished. It was also planned that staff would use the dining room, outside of meal times, for writing up their records as the manager’s office was small and often in use. On the day of the inspection carpet fitters were laying new carpet throughout the home including the staircases. The fitting of the carpets was staggered in order to cause minimal upheaval to the service users. The new build and the new carpets showed up some of the original areas of the home and the need for re-decorating, particularly the first floor lounge became apparent. New furniture had been provided in the ground floor lounge which the service users were very pleased with. Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29,30 The homes recruitment policy ensured that service users were cared for by staff who had been checked against the appropriate lists to confirm they were considered suitable to work with vulnerable adults. EVIDENCE: The manager had identified additional members of staff, to ensure that one extra staff member would be on duty at each shift, including the night shift, once the new bedrooms were operational. The number of staff on duty at night must be continually monitored in relation to the needs of the service users. The staff files sampled confirmed that the home’s recruitment practices had been adhered to and that staff were asked to provide the necessary documentation and undergo the appropriate checks before being offered a position. Staff files demonstrated that new staff completed an induction plan. Certificates of attendance suggested that staff attended training as places became available, however it was not apparent how the manager was sure that all staff had annually updated the mandatory training, such as fire and moving and handling. Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, The home was managed in an open, creative and inclusive way and service users benefited from appropriate leadership. The home had a quality assurance system that ensured the views of service users and stakeholders were sought. EVIDENCE: The manager had completed the Registered Manager’s Award and now had the necessary qualifications to meet this standard. Service users and stakeholders were regularly asked for their views about the home and their comments and questionnaires were retained. Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 18 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 X X X 3 3 X X STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X X Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 19 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 OP1 Regulation 4 Requirement The Statement of Purpose must include all the information included in schedule 1 of the National Minimum Standards. It must be remembered this is a standalone document and information must be repeated in the Service Users Guide if necessary. The home’s Protection of Vulnerable Adults (POVA) policy and the policy of the Local Authority must be relayed to all staff (for example, via a staff member who had already been trained), while waiting for places on accredited courses to become available. Timescale for action 01/01/06 2. OP18 18 01/01/06 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 House DS0000014876.V266858.R01.S.doc Version 5.0 Page 20 1. OP3 2 OP30 The documentation in the pre-admission assessment should make it clear how the decision that the home could meet the assessed needs of the service user had been made. The manager should have a plan that confirms that all staff have had the opportunity to update mandatory training at the required interval and to attend at least 3 days training a year. Ambassador House DS0000014876.V266858.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office 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
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