Inspection on 15/09/09 for Ambleside

This inspection was carried out on 15th September 2009.

CQC found this care home to be providing an Poor service.

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 16/04/09

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Ambleside 60 Hart Hill Drive Luton LU2 0AY Lead Inspector Mrs Louise Trainor Key Unannounced Inspection 15th September 2009 10:30 DS0000072769.V377711.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ambleside DS0000072769.V377711.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ambleside DS0000072769.V377711.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ambleside Address 60 Hart Hill Drive Luton LU2 0AY 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 454402 Alka Patel Gerardine McCrossan Care Home 17 Category(ies) of Dementia (17), Old age, not falling within any registration, with number other category (17), Physical disability (17) of places Ambleside DS0000072769.V377711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical Disability - Code PD The maximum number of service users who can be accommodated is 17 16th April 2009 2. Date of last inspection Brief Description of the Service: Ambleside was located in a pleasant residential suburb of Luton. The amenities of the town, which include links to national bus and rail routes, were a short car ride away. The building had been sympathetically converted from its previous use as a hotel. The accommodation was decorated and furnished to provide a comfortable environment. The home was registered to provide care for seventeen older people who may also have dementia and/or physical disabilities. Single room accommodation was provided. Eight of the rooms had en-suite toilet and washbasin facilities. Washbasins were fitted in the remaining bedrooms. A bathing facility was located on each of the three floors. Six toilets were provided at accessible locations in addition to the en-suite provisions. The fees for this service range from £480.00 - £520.00 per week. Ambleside DS0000072769.V377711.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection was carried out in accordance with the Care Quality Commission (CQC) policy and methodologies, which require review of the key standards for the provision of a care home for older people that takes account of service users’ views and information received about the service since the last inspection. Evidence used and judgements made within the main body of the report include information from this visit. This was the second Key Inspection for this service, since a new Provider took over the business in October 2008. This home was rated as poor in April 2009. This visit was carried out by Regulatory Inspector Mrs Louise Trainor and Mrs Sally Snelson on The 15th of September 2009, between the hours of 10:30 and 15:00 hours. The homes manager was present and assisted throughout the day. During this inspection we looked at the files of two people who live in this home, tracking them in detail. This involved reading their records and comparing what was documented, to the care that was being provided. Documentation and records relating to: staff recruitment, training and supervision, medication administration, complaints, quality assurance and health and safety in the home were also examined. We also spent some time in the communal areas of the home, talking to staff and residents and observing the care practices that were carried out during this four and a half hour inspection by two inspectors, which is equivalent to a nine hour inspection. We would like to thank everyone involved for their support and assistance during this visit to the home. Ambleside DS0000072769.V377711.R01.S.doc Version 5.2 Page 6 What the service does well: The manager was able to tell us how she and the staff team had supported a new admission and their family to make the move into residential care. People who use this service are encouraged to maintain and develop relationships that are important to them. Staff practices promote individual rights and personal choices. People have access to health care professionals within the home and in the local community Staff knocked on resident’s doors and bathrooms doors before entering and appropriately referred to people using their chosen form of address. Interactions that we observed between staff and residents were respectful but also relaxed and familial. We gave three staff a different scenario about possible safeguarding incidents, and all were able to clearly tell us how they would deal with it and what actions they would take. This home provides a clean, comfortable and safe environment for the people who presently live here. People have confidence in the staff that care for them. There are sufficient staff available to meet the needs of the residents in this home who report that staff are confident and skilled in their roles. We looked at supervision records. These indicated that all staff are receiving regular supervision from the manager or the deputy manager. The manager is qualified to run this home and the service focuses on the residents as individuals working in partnerships with residents and their families. What has improved since the last inspection? The home understands the need to comply with the administration, safe keeping and disposal of controlled drugs. We reviewed the regulation 37 reporting processes in this home, and the manager was aware that any events that should be reported to the CQC. There had been no reportable events since the last inspection Pre admission assessments are carried out and well documented on prospective residents before they are admitted to this service. Ambleside DS0000072769.V377711.R01.S.doc Version 5.2 Page 7 Since the last inspection all staff had attended training about safeguarding vulnerable adults (SOVA). There are safeguarding policies and procedure which are easily accessible to staff, who can demonstrate their understanding of the processes. Since the last inspection the manager had sent out quality assurance questionnaires, analysed the results and produced graphs and a report on the outcome. The findings of this exercise are on display in the entrance of the home accessible to anyone visiting. What they could do better: There are information documents in place however these have not been reviewed to reflect all the correct information. There are some gaps in the care plans however staff are able to think in a person centred way and give a verbal update. Meals in the home are well presented and generally nutritious; however sometimes produce ordered lacks quality and quantity. The complaints procedure was included in each resident’s Service Users Guide, but was not on display in the home therefore we did not know if visitors would know how to complain. The inspection report displayed in the home was from an inspection carried out in 2007. This could be considered misleading for visitors, and potential residents who do not have internet access, as it was not reflective of the findings from the most recent inspection carried out earlier this year when the service was rated as poor. We did note that some carpets were worn and there were some frayed edges which if not attended to in the near future could become potential health and safety issues. There is a complaints policy, however this in not easily accessible to visitors, and a number of complaints received relating to the same issues indicates emerging themes which require further address. The provider takes responsibility for the homes accounts and finances. Complaints received reflect ‘corner cutting’ which may indicate problems with this providers’ financial viability. Ambleside DS0000072769.V377711.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 9 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 DS0000072769.V377711.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6, People using the service experience adequate quality outcomes in this area. Pre admission assessments are carried out on prospective residents before they are admitted to this service. There are information documents in place however these have not been reviewed to reflect all the correct information. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at the Statement of Purpose and the Service Users Guide. Both documents had the required information, but not all the information was up to date. For example we (CQC) were referred to as National Care Standards Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 11 Commission, which ceased to exist in 2004. This shortfall had been identified at the last inspection. Each resident had a copy of the Service Users Guide and a contract. The inspection report displayed in the home was from an inspection carried out in 2007. This could be considered misleading for visitors, and potential residents who do not have internet access, as it was not reflective of the findings from the most recent inspection carried out earlier this year when the service was rated as poor. The manager told us that there had been two admissions since the last inspection, although only one of these individuals remains at the home currently. We looked at the pre-admission assessment of the other recent admission. This was detailed and had been carried out prior to admission. A trial period of admission had been offered in the first instance. In the care file, along with the information from the pre-admission assessment, there was Care Management referral. Both documents had been appropriately used to formulate the initial plans of care. The manager was able to tell us how she and the staff team had supported a new admission and their family to make the move into residential care. Ambleside does not offer intermediate care. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 People using the service experience adequate quality outcomes in this area. People have access to health care professionals within the home and in the local community. The home understands the need to comply with the administration, safe keeping and disposal of controlled drugs. There are some gaps in the care plans however staff are able to think in a person centred way and give a verbal update. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at the care plans for two people who live in this home. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 13 Both were presented in different styles as the residents had different needs, and the staff were exploring different care planning documentation. One plan of care had been written in a very person centred way and clearly identified the likes and dislikes of the individual. Since the last inspection care plans had been kept under review and altered to reflect care needs as they changed. However staff must remember that the care plans need to set out in detail instructions that care staff need to follow to ensure all aspects of the residents health, personal and social care are met with continuity. For example a person with diabetes must have the details of how and when blood sugars are tested even when the district nurse is involved and it is not the responsibility of the staff at Ambleside. Because the staff team worked well together and were a consistent team, it was apparent from talking to staff, that some information was held in their heads and not documented. The plans we looked at included some detailed risk assessments but again these could be expanded. For example one plan for a resident who often woke and wandered at night had a risk assessment for him going out in the day when accompanied, but nothing relating to his night time risks. The files that we looked at indicated that people were reregistered with a GP and were supported to keep appointments with health professionals. The home had recently had the need to change the community nurses who visited. We saw evidence that with the support of the district nurses, pressure areas had been healed. We saw people being moved correctly and we saw equipment such as hoists and pressure relieving mattresses being used correctly. We were aware that the manager had identified the need for a shower chair for one resident and this piece of equipment had not been delivered in a timely fashion. The owner had agreed to make the order, but when it became apparent that the resident could wait no longer for this equipment, the manager was unable to track the original order. The manager contacted the equipment provider and the chair is now on order. During this inspection we looked at the Medication Administration Record (MAR) sheets for ten of the residents living in this home. All had been accurately completed with signatures and omission codes where appropriate. The reverse of the sheets were also being used to reflect where ‘as required’ medication was being offered. All MAR sheets corresponded correctly with stocks remaining. A new Controlled Drugs (CD) cabinet had been installed since the previous inspection, and new CD records had been introduced. Two residents presently receive CD medication, and the records and the stocks reconciled correctly. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 14 All of the residents were dressed in their own clothes and looked tidy. A resident who had a visitor had the opportunity to use the conservatory in private and residents could spend time in their bedrooms or other areas of the home if they did not wish to join in communal activities, for example Holy Communion, which was being ministered on the day of the inspection. Staff knocked on resident’s doors and bathrooms doors before entering and appropriately referred to people using their chosen form of address. Interactions that we observed between staff and residents were respectful but also relaxed and familial. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience adequate quality outcomes in this area. People who use this service are encouraged to maintain and develop relationships that are important to them. Staff practices promote individual rights and personal choices. Meals in the home are well presented and generally nutritious; however sometimes produce ordered lacks quality and quantity. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: As reported at the last inspection, ‘Throughout this visit residents were busy doing activities of their own choice. Some were reading, some doing puzzles and some just having a good gossip and a giggle as they waited for their turn with the hairdresser.’ Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 16 Good interaction was seen between the residents and the staff and visitors. We were welcomed into the home by the residents, who were keen to talk to us. There was appropriate background music playing, which residents were singing along to. We were told the TV was rarely on during the day. There was a plan of activity for each week which included quizzes, music and exercise groups, visiting entertainers, 1 to 1 trips out to the town and pampering sessions. All of the residents we spoke to told us that the amount and type of activities provided suited them. We were however concerned to hear that trips out had not been happening so frequently over recent months. We noted that visitors were welcomed into the home throughout the day, and could meet in private with their loved ones if they wished. One visitor told us, “I am very happy with the care my ----- receives. There would be trouble if I wasn’t.” During the inspection a local church representative visited to provide Holy Communion to those who were interested. We heard the celebrant say, “People in this home are always smiling and happy”. The inspection spanned lunch time. We spent time talking to the chef about the food he prepares and his understanding of the correct diet for an older person; we found him to be well informed. We were disappointed that although he wanted and knew older people should have full fat milk to enhance their calorie intake, the milk ordered and used in the home was semi-skimmed. The midday meal on the day of this inspection was lamb hotpot and fresh potatoes, carrots and broccoli, followed by treacle sponge pudding and custard. Because of concerns that had been brought to our attention about the quality and quantity of the food served in this home, we tasted the meat. It was extremely flavoursome and tender. People were served appropriate sized portions, and residents told us that they usually enjoyed the food, and that the cook would prepare them an alternative if they did not like what was on the menu. The cook told us that a group of the residents liked more spicy food so he would divide dishes such as casseroles and hotpots and make half more spicy for them. We did see evidence of special foods such as diabetic foods, especially treats/ biscuits, which had not been available in the past. We noted that all but one resident had maintained or put on weight over the last few months. Weights had not been linked to height (BMI) so did not clearly indicate expected ranges. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 17 The fridges and freezers were well stocked. The chef told us that the owner generally orders general stocks and sometimes there was a surplus of foods that would not be regularly used such as frozen chips and casserole vegetables. The manager purchases fresh fruit and vegetables on a weekly basis from a local green grocer. These are far more preferable to frozen. We had been made aware prior to this visit, from a source outside of the home, that there had been some problems with meat provision. For example that some had had to be returned or thrown away due to poor quality, and that at times certain items ran out. We also noted that the meat was delivered in small portions. Therefore the staff in the home were making the decision to use two portions to provide a meal for one day. The mealtime was a social affair with all but one resident (who was on bed rest) using the dining room. Specialist equipment such as plate guards were available and where a meal had to be pureed it was done so that each individual component of the meal remained identifiable and therefore more pleasing the eye. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience adequate quality outcomes in this area. There are safeguarding policies and procedure which are easily accessible to staff, who can demonstrate their understanding of the processes. There is a complaints policy, however this in not easily accessible to visitors, and a number of complaints received relating to the same issues indicates emerging themes which require further address. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the last inspection the home had introduced a complaints file in which any complaints that had been received were filed along with the information about how the complaint had been investigated and the complainant responded to. However there was no information relating to any form of investigation which may have taken place to reach the conclusion. There had been three complaints logged in this file since the last inspection. None of these were relating to the standard of care being provided in the home. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 19 One was regarding concerns about the provision of hot water in the home being limited by the provider to certain hours of the day. The other two were both relating to financial issues, namely a random increase of one residents fees, and pocket money not being correctly recorded by the provider when deposited by a family. There were letters of response to both of these complaints by the manager. However one of the complaints had resulted in a resident being moved out of the home by their family. The complaints procedure was included in each resident’s Service Users Guide, but was not on display in the home therefore we did not know if visitors would know how to complain. Since the last inspection all staff had attended training about safeguarding vulnerable adults (SOVA). We gave three staff a different scenario about possible safeguarding incidents, and all were able to clearly tell us how they would deal with it and what actions they would take. This was a vast improvement on their knowledge of SOVA at the last inspection. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 People using the service experience good quality outcomes in this area. This home provides a clean, comfortable and safe environment for the people who presently live here. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There had been no major changes to the environment since the last inspection. The home was clean and tidy and there was no unacceptable odours noted. The home was kept clean by the night staff and a cleaner who was employed four hour a day three times a week. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 21 We did note that some carpets were worn and there were some frayed edges which if not attended to in the near future could become potential health and safety issues. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29, 30 People using the service experience adequate quality outcomes in this area. All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Duty rota’s confirmed that there are generally three staff on duty during the day, and two staff at night. At the last inspection we had left an immediate requirement that two waking staff were needed to cover the night shift as there were residents who required turning and assistance, and the home has four floors. This had been appropriately acted upon. We looked at the personal file of two staff members. Both files contained appropriately completed application forms, Criminal Record Bureau (CRB) and POVA first checks, two references from appropriate sources, which had been Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 23 verified by the manager, interview notes, health questionnaires and various forms of identification, including a photograph. Home Office documentation was present where staff were from overseas. All staff had contracts that were clearly signed and dated. We spoke to most of the staff on duty during this inspection. This is a very well established staff team who are obviously committed to each other as a team and to the residents that they care for. They all spoke very highly of the ‘support, training and expertise’ they received from the manager. One newer member of staff told us that she felt ‘at home’, in the home when she went for her interview, and had been extremely pleased to be offered the job. The staff told us that more recently they had been offered a variety of training including that which is considered mandatory, such as moving and handling, infection control, SOVA, food hygiene and that which is considered more specialist, such as dementia awareness, deprivation of liberty (DOLS) and medication. Throughout our discussions with staff, we were given a lot of information, however staff did not wish to be identified as they felt that action would be taken against them by the provider as a result. We were told by staff that although some had completed training, some more recent certificates had not been issued because the training company are waiting for payment for courses completed. The Provider informed us that invoices to the training company are always paid within the 28 day period given. We were also told by staff, that staff who had been more recently appointed to the home, four in particular were identified to us, when they are not on duty on the day that training takes place, do not get paid to attend. Standard 30.4 states all staff receive a minimum of three paid days training a year. The Provider states in her response to this report that this is not the case and “Staff are paid for all training they attend”. On the day of this inspection, one member of staff requested to speak with us. She told us that she had not been paid for the first three months and had to take the provider to the bank to prove the money had not been transferred. She described this as humiliating. However with the response to this inspection report, we were sent a statement from this staff member stating this was not the case. We are therefore not able to establish the actual events. We had also been copied into another letter from a member of staff to the provider relating to non payment of wages. Since we carried out this inspection, we have been informed both by relatives of residents in the home, and by current staff, that at least two of the established staff team in this home have left their positions. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 24 Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38 People using the service experience poor quality outcomes in this area. The provider takes responsibility for the homes accounts and finances. Complaints and letters received reflect ‘corner cutting’ which could affect the people in this home and may indicate problems with this providers’ financial viability. The registered manager has resigned from her post since this inspection. We have made this judgement using a range of evidence, including a visit to this service. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 26 EVIDENCE: The manager at this home has worked in this home for seven years, however only took on the role as manager when the home changed hands in October 2008. She has continued to work hard to maintain a level of stability for both staff and residents, and improve standards. She has completed her NVQ level 4, and is working on her Leadership Management Award to ensure her management skills and knowledge are in line with present best practices. Her management style involves being visible and accessible to both staff, residents and visitors. However we received a call from the manager of this home on the 23/09/09 to advise us that she has resigned from her post at this home. We believe that this manager has taken appropriate actions to protect the people who live here over the past year, in particular when there were allegations made relating to food quality and quantity, limited hot water availability, heating and lighting. We reviewed the regulation 37 reporting processes in this home, and the manager was aware that any events that should be reported to the CQC. There had been no reportable events since the last inspection. We looked at supervision records. These indicated that all staff are receiving regular supervision from the manager or the deputy manager. There is a safe in the manager’s office where residents can keep small amounts of spending money. We looked at the records for six of the resident’s accounts. Since the last inspection, new documentation had been introduced. All the records balanced correctly with the funds remaining, regular audit checks of accounts were recorded. Records that we looked at indicated that fire call points are being tested weekly, water temperatures and emergency lighting are being tested monthly, and fire evacuation addressed in training. Since the last inspection the manager had sent out quality assurance questionnaires, analysed the results and produced graphs and a report on the outcome. The findings of this exercise are on display in the entrance of the home accessible to anyone visiting, At the last inspection in April 2009, we identified that some of the core processes involved in the running of this home, particularly those involving budgets, had been taken out of her control by the new provider, and had Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 27 resulted in a drop in standards. This was clearly explained to the provider in feedback from the inspection. On the 3rd of June 2009, following receipt of an ‘inadequate improvement plan’ we met with the Provider Ms Alka Patel. She stated that she had not been involved in formulating this plan, and had not seen a copy of it, prior to being sent one by the inspector following our receipt of the document. At this meeting concerns relating to food and training budgets in particular were discussed and we were assured that she would address them to resolve the problems immediately. Another improvement plan was submitted dated the 1st of June 2009. This addressed each requirement individually, although did not specify which budgets the manager would take responsibility for. It also included additional information such as “At least monthly Reg 26 to be carried out by owner to ensure all above mentioned and all other regulations and standards are being met /held”. It is a legal requirement under regulation 26 of the Care Homes Regulations 2001 that the providers who are not in day to day control of the home, must visit on a monthly basis and undertake certain duties as prescribed by the regulation. There was no evidence at this inspection to indicate that any regulation 26 visits have been recorded or carried out. It is the Providers responsibility to ensure that the home is being conducted in accordance with the regulations including all aspects of the running of the home and recording systems. The manager told us that she still does not have any control over any budgets, and is regularly purchases food produce such as bread and milk out of her own pocket. The Provider refutes this and has told us that there is always a substantial petty cash float available. Since October 2008 when this home reregistered under the new provider, we received complaints relating to poor quality and insufficient food in January 2009 and heating provision being limited in January 2009. In addition we have been made aware via the Local Authority Safeguarding Team, of complaints they have received relating to poor quality and insufficient food and hot water provision being limited, both in September 2009. Only due to actions being taken by individual members of staff have these restrictions not affected the residents. We were told that the staff are not all paid for their training and not always paid their wages accurately or on time. For two members of staff there have been concerns relating to delay and/or non payment of wages. This matter has been addressed with the Provider. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 28 During this inspection we saw letters relating to financial concerns of two resident’s families, one which was relating to a random increase in fees, a week after admission to the home, which resulted in the resident being moved by her family. The other relating to incorrect monies being recorded by the provider as deposited in a residents account by the family. All of the above factors indicate that there maybe issues relating to the financial viability of this provider, and we will be requiring the provider to submit to us evidence that this is not the case. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 29 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 1 2 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 1 2 3 2 2 Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 30 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 5 Requirement The registered person must ensure that the service user’s guide is kept under review so that it reflects accurate information. This must include the most recent CQC report. This document must be accessible at all times to everyone who lives in the home. The registered person shall provide in adequate quantities, suitable, wholesome and nutritious food. The registered person must ensure that the complaints procedure kept under review and is accessible for anyone who may wish to make a complaint. The registered must ensure staff receive support, including time off to attend training appropriate to their roles. The registered person must provide the commission with the following documents. • The annual accounts of the care home certified by an accountant. DS0000072769.V377711.R01.S.doc Timescale for action 15/10/09 2. OP15 16(2)(i) 15/09/09 4 OP16 22 15/10/09 6 OP30 18(1)(c) (ii) 25 15/10/09 7. OP34 15/10/09 Ambleside Version 5.3 Page 31 8. OP35 17(2) Schedule 4(9) A reference from a bank expressing an opinion as to the registered providers’ financial standing. • A business plan and current cash flow forecast in respect of the care home. • Information as to the financing and financial resources of the care home. The registered person must 15/10/09 ensure that an accurate record is kept of all monies or valuables deposited in the home for safe keeping. • 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 OP27 Good Practice Recommendations The registered person should consider how continuity of care will be achieved where regular staff are leaving the service with immediate effect. Ambleside DS0000072769.V377711.R01.S.doc Version 5.3 Page 32 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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