Inspection on 24/10/05 for Ambleside

This inspection was carried out on 24th October 2005.

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

The inspector 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 13/02/06

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 Announced Inspection 24th October 2005 09:30 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.V261742.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.V261742.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.V261742.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. 10th March 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, frail or infirm. The home aims to enable residents to live their lives to the full and to be as independent as possible in 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.V261742.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted during the course of one day. The inspector spent most of the morning talking with residents and observing practice, and spent time in the afternoon with some of the staff on duty. The inspection focused mainly on residents quality of life and the standard of care they receive, and on staffing issues. One visitor had completed and returned a CSCI comment card prior to this inspection, and the inspector met another visitor during the inspection in itself. The inspector spent time with eight of the residents individually, and with four of the staff on duty as well as with the owner and owner-manager. Everyone was really positive about the home, and no one had any complaints or concerns. Residents described it as a relaxed place to live, where routines and services are tailored to their individual wants. Some residents were able to give descriptions of the care and support they receive, and the improvement they feel this has made to their lives and abilities. Relatives felt welcome and involved. One person commented that, if they ask staff to do something, they do it kindly - there is no sense that Im being a nuisance or its too much bother. Another person said that the people who run the home are very honest in their caring of people. Staff were proud to work at this home, and felt valued and respected. The records seen were in good order and in general gave clear guidance, although one recommendation was made regarding manual handling assessments. What the service does well: What has improved since the last inspection? Only one requirement was made at the last inspection, concerning one aspect of medication records, and this is now being met. Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 6 New carpeting in the hallway, landings and stairs looks very nice, and several bedrooms have been refurbished. 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. Ambleside DS0000020268.V261742.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.V261742.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): 2-4 Residents and staff are clear prior to admission that the home will be able to meet residents needs. EVIDENCE: A written record is kept of the preadmission assessments carried out by the manager, and a letter is sent confirming that the home will be able to meet the persons needs. A new, slightly more detailed, residents contract is about to be introduced. Ambleside DS0000020268.V261742.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): 7-11 Residents health care needs are well met. Staff are clear about what is required of them, and there is a framework of recording systems in place to support this, which the home is adjusting to make more effective. EVIDENCE: The home has been gradually improving and expanding its written care plans and associated documentation over the past couple of years. In some peoples case, the decision has been made not to use the manual handling aids listed in their risk assessment, due to reasons such as the fragility of their skin. However, there is no written guidance on how staff should move the person. Communication is good in the home, and the staff met were clear about what they should be doing, but the inspector recommended that a note is 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. The home has a general policy on the use of bed rails, but the manager is in the process of drawing up individual risk assessments. Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 10 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. 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. Although care is evidently very good, the home does not always keep detailed records of the care given, but the manager is setting up a system to keep records such as fluid charts and turn charts. One lady in the lounge became slightly distressed occasionally, and the inspector noticed that different staff frequently stopped by to spend a few minutes with her. People who were able to tell the inspector about the care they receive said that staff are really willing and nice about the way they give help, and go to some lengths to make sure the person gets exactly what they want when they want it. The nurse with delegated responsibility for overseeing medications issues confirmed that staff have been reminded of the importance of completing the medications record as soon as each dose has been administered. All staff responsible for handling medications have recently completed a six-month course. This nurse or the manager carries out a monthly audit of medications. A note is made on the Medication Administration Record of when a new box or bottle of medication is started. This is good practice as it helps to audit stock against medications administered. The home has recently contracted the services of a pharmaceutical waste disposal carrier, and has not yet had a copy of the contractors certificate, although there was a record on file that this was due to be sent to the home. Staff on duty followed this issue up with the contractor during the inspection. Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 11 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): 12-15 Resident’s benefit from flexible routines that can accommodate their individual wants, and a good range of suitable activities. Special care is taken by all the staff involved to make mealtimes a pleasant experience. EVIDENCE: A variety of in-house activities is laid on, including reminiscence sessions, music and movement, and aromatherapy/reflexology. The home pays for the reflexologist to give residents a hand massage, but residents can also choose to pay for a full body massage. Two of the home s staff did a music and movement course, and now provide ad hoc activity sessions for the residents. Staff spend time in the lounges with the residents on Friday mornings, going through the newspapers, and films and chocs afternoons are regular events. Visiting entertainers supplement this regular schedule of activities, and local outings are also arranged, either on an individual or small group basis. A local clothing firm visits periodically with a selection of garments to show residents. The home now keeps a record of which residents participated in which activities. This helps them to monitor that each person is getting reasonable opportunities to enjoy structured leisure time. Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 12 Menus are varied, and are designed to suit the needs and tastes of the residents. There is a choice of two main dishes at each meal time, but various alternatives are offered if people do not want the options listed on the main menus. Residents made very positive comments about the meals, although a couple of people mentioned that they are occasionally served things that are on their list of dislikes. Both people said they had discussed this with the manager, who had advised them to send food back if it happens again. Care staff ask each resident about their teatime choices at lunchtime. Some of the residents am not able to have solid food. Food is served in a variety of states between solid and puréed, depending on the individual persons needs. The cook took great care to present meals nicely, and staff helping residents to eat mashed up small sections of food at a time so that the plate of food still looked appetising. Staff gave considerate support to each person so that nobody felt rushed and was able to relax and enjoy their meal properly. Food cupboards are kept unlocked at all times so that any staff can get snacks for the residents, night or day. Ambleside DS0000020268.V261742.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 Residents and visitors feel comfortable expressing their views. Staff take prompt action in response to these. EVIDENCE: The home revised its complaints procedure earlier this month. This is very welcoming, and invites comments and suggestions. No complaints had been received by either the home or the CSCI. Ambleside DS0000020268.V261742.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): 19-26 Residents benefit from a comfortable, homely and well maintained environment. A regular programme of improvements and adaptations helps to ensure that this meets peoples needs. EVIDENCE: All areas of the home were clean, well maintained and smelt fresh. Residents and visitors confirmed that this is always the case. There is a passenger lift to all levels. The home has a floor hoist to lift from the floor. There is a cancel-at-source call bell system with long extension leads available for less mobile residents’ use. There is a large lounge near the front door. The quiet lounge the other end of this corridor has been turned into a bedroom. This is awaiting its ensuite to be fitted before it can be registered for use by a resident. The dining room is on the lowest level and has some comfy seating. New dining room furniture is on Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 15 order. The home plans to make some changes to the conservatory to create an additional bedroom. It is also intended to provide all single bedrooms, and to increase the number of en-suites. (At present, only four of the bedrooms have en-suite facilities.) A new ramp has been built outside the front door to improve wheelchair access to the home. All landings and stairs have been recarpeted since the last inspection, as have several of the bedrooms. Ambleside DS0000020268.V261742.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): 27-30 Residents are well protected by the homes staffing practices. EVIDENCE: At least one trained nurse is on duty at all times. Three care staff are on duty each morning, and two care staff cover the afternoon. An extra care assistant is now on the late afternoon to early evening shift to provide additional support to the people who need assistance eating, and to ensure that bedtime routines can be done when each person prefers. A nurse and one care assistant are on waking duty at night. The home also has a Cook on duty each day, a laundry assistant, and one or two cleaners. Most of the staff have worked at the home for a number of years, and there is a comparatively low staff turnover. The staff files sampled included an application form, two written references, a signed copy of the homes disciplinary procedure, an induction training checklist, and a record of a PoVA First check (the check that must be carried out on an applicants criminal background before the full Criminal Records Bureau check is received back). One of the trained staff has delegated responsibility for carrying out the induction training programme with any new staff. This is particularly thorough, and includes at least two training sessions for key issues. Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 17 The two cleaners both hold NVQ 1, six of the care staff hold NVQ 2, and three of them hold NVQ 3. Five more of the care staff are just about to start NVQ3, and another three people plan to start this course late next year. One of the staff is considering doing NVQ 4. In addition to the manager, five first level nurses and two second level nurses are employed. 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. Four of the trained staff have recently completed a course on the safe handling of medications. Several staff are going to have training in food and nutrition in the near future, and further training is planned in the dementia care, health and safety, Appointed Persons first aid, and basic food hygiene. Trained staff recently made the decision to stop wearing nurse uniforms, to see if this would make them seem more approachable to residents and visitors. Each staff has a hard name badge, but staff told the inspector that they always remove these before giving close contact personal care. Each of the people the inspector spoke with said how nice staff are, and it is evident that some strong relationships have been able to grow. Two of the senior staff came in for particular praise, and one person commented the matron here is a charming girl. Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 18 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): 31-38 Ambleside is a well-managed home. It has an open culture in which residents needs and wishes are paramount. EVIDENCE: Helen Humphries, one of the owners, holds the Advanced Management City and Guilds certificate. Elaine Charlesworth, the other owner and the manager of the home, is a Registered General Nurse. Both owners have extensive experience of working in care services. The manager is part of the basic rota for 30 hours a week, and usually spends one additional day in management tasks. When this happens, an additional Registered General Nurse will be on duty, along with one extra care assistant. The owner is also present in the home on most days. Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 19 The manager supervises some staff, but two of the other trained staff have been delegated responsibility for some staff supervision, and Helen Humphries supervises the catering and auxiliary staff. A formal program of staff supervision began in June of this year. The first session with each staff member went into some detail so that each person was clear about its underlying purpose and received an in-depth appraisal. Each person is receiving supervision once every two months. Ways of giving meaningful oneto-one supervision and support to the nursing staff were discussed. All staff hold the basic first aid certificate, and one person has the Appointed Persons first aid certificate. The home owners have been providing refresher fire training to staff for the past year or so. The inspector suggested that a suitably qualified external trainer could be asked to train staff occasionally, and could give the owners professional support in reviewing the homes Fire Risk Assessment, particularly regarding the fire doors between the kitchen and dining room. The home does not normally handle residents money, but will administer their Personal Allowance if the resident themselves or their representative is not able to do it. The home tried to find bank accounts for residents without success, and now hands any excess cash back to the persons nominated next of kin. Relatives sign for receipt of this. Clear records and receipts are kept of any residents money that the home handles. Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 20 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 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 21 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. Standard Regulation Requirement Timescale for action 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. Ambleside DS0000020268.V261742.R01.S.doc Version 5.0 Page 22 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.V261742.R01.S.doc Version 5.0 Page 23 - 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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