Inspection on 13/02/06 for Ambleside

This inspection was carried out on 13th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ambleside 24/10/07

Ambleside 04/01/07

Ambleside 05/09/06

Ambleside 24/10/05

Ambleside 10/03/05

Ambleside 13/09/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Ambleside 6 Southside Weston Super Mare North Somerset BS23 2QT Lead Inspector Catherine Hill Unannounced Inspection 13th February 2006 09:50 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 Ambleside DS0000020268.V272983.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. Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ambleside Address 6 Southside Weston Super Mare North Somerset BS23 2QT 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) 01934 642172 01934 642172 Mrs Helen Humphreys Mrs Elaine Charlesworth Mrs Elaine Charlesworth Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (3) of places Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Staffing notice dated 24/05/2001 applies May accommodate 20 residents aged 65 years and over who require nursing care. May accommodate up to 3 persons aged 65 years and over in need of personal care only. Manager must be a RN on Parts 1 or 12 of the NMC register. May accommodate up to 3 persons between 18 - 64 years of age, with Physical disabilities. 24th November 2005 Date of last inspection Brief Description of the Service: Ambleside provides personal care and nursing for up to 20 people aged 50 years and over who are elderly and in need of general nursing care. The home aims to provide a warm, friendly and homely environment. Visitors are welcome at any time and are encouraged to be actively involved in many aspects of the homes life. The home is set close to the town centre and is not far from the seafront. Local shops and other amenities are nearby. The home is on four floors and has a passenger lift accessing all areas. Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over the course of one morning and focused on how the home is meeting residents needs. The inspector spoke in depth with five of the residents and spent most of the inspection sitting in bedrooms or the communal rooms with residents, talking and observing interactions. The last half-hour of the inspection was spent giving feedback to the owner and owner-manager. The examples of residents’ physical care observed were of the home’s usual excellent standard but the team needs to develop its awareness of the needs of people with dementia. While the environment is generally very comfortable, attention needs to be paid to some aspects to ensure that residents’ privacy, dignity and safety are protected. What the service does well: What has improved since the last inspection? What they could do better: While there are some exceptionally caring and committed people on the team, some of the approaches to significantly confused residents did not conform to current ideas of good practice, and may not have been interpreted in the way they were intended. Intentions are good but specialist training is needed in how to interact successfully with people with significant degrees of confusion to ensure that Amblesides aims continue to be met. Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 6 Manual handling practice did not conform to current accepted good practice. Poor techniques were seen that put residents and staff at risk of injury. Infection control practice is generally good but communal combs should be avoided. Fire doors must be able to close freely in the event of the alarm sounding. The Fire officer will be able to advise on safe hold-open devices that can be easily installed. Toilets must be fitted with working safety locks. Hot water temperatures must be regulated to ensure residents’ safety. 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. Ambleside DS0000020268.V272983.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 Ambleside DS0000020268.V272983.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): These standards were not assessed at this inspection. EVIDENCE: Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 9 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): Residents receive a high standard of personal care. EVIDENCE: The home has several very frail residents, and staff evidently give each of these people regular care and attention. Each person was well groomed and clean, bedding was fresh and pillows were kept plumped. Drinks were within the person’s reach or staff called in to their room regularly to help them take fluids. Radios or TVs provided some background sound in some peoples rooms, depending on what staff know of each persons preferences. Call bell extensions had been placed in the hands of those people who would be able to use them, but staff made a regular check on each person throughout the day. Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 10 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): These standards were not assessed at this inspection. EVIDENCE: Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 11 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): These standards were not assessed at this inspection. EVIDENCE: Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 12 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, 21 & 26 The environment is generally very comfortable but not all aspects currently promote privacy, dignity and safety. While infection-control practices are generally very good, care needs to be taken to ensure back to good practice is followed consistently. EVIDENCE: Many of the fire doors around the home were wedged open throughout this inspection. Approximately half of the bedroom doors were wedged open. Some bedrooms were occupied but others were empty. Fire doors must be able to close safely in the event of the fire alarm sounding. It is possible to fit reasonably priced safe hold-open devices that will allow the fire door to shut when the alarm sounds, and the inspector advised that the home must consult the Fire Officer about this. Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 13 There are notices on the bedroom hand basins warning of hot water. The water tested by the inspector in a couple of bedrooms was too hot to hold the hand under. Given that there are now so many people living at the home with a significant degree of confusion, these notices are unlikely to be sufficient, and proper temperature regulators are required. The stock cupboard next to the medications cupboard contains some medical supplies that could be hazardous if they were misused. To avoid the risk of these causing harm to particularly vulnerable people, they need to be kept locked away, in accordance with COSHH (Control Of Substances Hazardous to Health) requirements. Four of the toilets around the home were fitted with locks that were either obviously broken or simply did not work. Toilet doors must be fitted with working safety locks to promote residents privacy and dignity. While the inspector was sitting in one of the lounges, she noted that one member of staff produced a comb from her top pocket and used this on a residents hair, returning the comb to her pocket when she had finished. This was done in an affectionate way, but combs should only be used for the individual person to whom they belong, and should not be used communally, in order to reduce the risk of cross-infection. The manager said that the staff team is about to do an infection control distance learning course. As usual, all areas of the home were clean, well maintained and smelt fresh. Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 14 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): 30 Residents benefit from a committed and caring staff team, but staff need specialist training in caring for people with dementia to ensure that their approaches promote dignity and well-being. EVIDENCE: One member of staff hopes to do an NVQ 4 qualification in the near future, three others hope to start NVQ 3, and one person wants to do NVQ 2. At the time of the last inspection, both cleaners held NVQ 1, six of the care staff held NVQ 2, and three held NVQ 3. The staff team has recently completed distance learning courses in nutrition for elderly people and in safe medications practice. Over the past year, all staff have had training in the principles of moving and handling, in fire prevention, in managing challenging behaviour, and in dementia care. However, despite this level of training, several instances of poor manual handling practice were observed, and several inappropriate interactions with confused residents were seen. One resident told the inspector that staff sometimes use the hoist to help her out of bed but often do not. This person reported that staff say it is easier to lift her manually than to use the hoist, and described a lifting style that puts both the person and the staff doing it at risk of injury. The inspector observed several instances of poor manual handling practice. Staff should not lift the Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 15 rear wheels of wheelchairs to get them around tight corners as this may put the occupant at risk as well as making an injury more likely to staff. The inspector also saw drag lifts and staff assisting residents to stand by holding their hands and pulling them under the arms. This may be quicker than encouraging a person to shuffle forward in their chair or to wait while a handling belt is fetched, but it greatly increases the risk of injury to both parties. It is vital that senior staff set a good example of manual handling practice to other staff. Staff must be reminded of good manual handling practice, and the manager must ensure that actual practice complies with this. Staff are evidently very caring and try their best to treat residents with kindness and respect. Staff took time to listen to the residents, even when they appeared to be rambling, and answered directly and with good humour. However, staff need to be very aware of how their body language might be interpreted by a confused person. Current accepted good practice would be to avoid looming over a seated person with hands on hips, as this can appear threatening, especially when staff need to raise their voices to be heard. A significantly confused person may not get the sense of what is being said as readily as they interpret body language. While staff are evidently very fond of residents, it may not make people feel that they are seen as dignified equals if they hear staff telling each other Aah, look at Flossie and other staff responding Aah as if to say they find Flossie somehow sweet. Similarly, staff should avoid comments like Good girl when a resident co-operates. These comments may not be intended to be patronising, but they underscore the inequality between the vulnerable person and their helper. Staff are trying to encourage one person to observe common good manners, and remind this person of the need to make requests of them in a polite manner. This is an entirely reasonable goal, but staff need to be very careful to address this issue in an adult-to-adult manner, and to avoid adopting a parent-to-child approach as this is only likely to push the person further into childish responses and to emphasise their inequality. The way staff interacted with some of the mentally alert residents revealed a fondness and liking of the person, and both parties evidently thoroughly enjoyed some of the humorous exchanges. However, any banter that only makes the staff laugh is likely to be felt by residents to be derogatory. Some residents commented privately to the inspector that they felt not all staff are as polite as they should be, and it may be that the staff team needs to reassess its approach to ensure that good intentions are properly translated into effective interactions. The physical care of residents at Ambleside is exemplary, but more and more residents have significant degrees of confusion that now require more specialist skills from the staff team. The inspector therefore made the requirement that staff undertake dementia training from a specialist in this field. This should help the team to develop their skills in this area and to Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 16 continue giving the excellent standard of all-round care that the home is accustomed to offering. The owner and owner-manager are attending a conference on dementia next week, and this may well help to identify areas of practice where awareness can be raised and improvements can be made. Ambleside DS0000020268.V272983.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): These standards were not assessed at this inspection. EVIDENCE: Ambleside DS0000020268.V272983.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 x X X X X x HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 X 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 X 17 X 18 x 2 X 2 X X X X 3 STAFFING Standard No Score 27 X 28 X 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 19 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 OP19 Regulation 23 Requirement Fire doors must be able to close safely in the event of the fire alarm sounding. The Fire Officer must be consulted about safe methods of holding doors open. Hot water temperatures in outlets accessible to residents must be regulated in line with the Environmental Health Officer’s guidance. All hazardous chemicals must be kept safely in accordance with COSHH (Control Of Substances Hazardous to Health) requirements. Toilet doors must be fitted with working safety locks. Staff must have refresher training in correct manual handling techniques and the manager must ensure that practice complies. All staff must have suitable training in meeting the needs of people with dementia stop Timescale for action 20/02/06 2. OP19 23 13/05/06 3. OP19 23 13/02/06 4. 5. OP21 OP30 23 18 27/02/06 13/03/06 6. OP30 18 13/05/06 Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 20 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 OP7 Good Practice Recommendations A note should be added to the manual handling assessment to ensure that everyone is using consistent and safe methods, and is clear about the reasons behind the decision. This requirement was first made at the inspection of 24th November 2005 but was not followed up at todays inspection. Combs should not be used communally, in order to reduce the risk of cross-infection. 2. OP26 Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Ambleside DS0000020268.V272983.R01.S.doc Version 5.0 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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