Inspection on 29/11/05 for Ambleside

This inspection was carried out on 29th November 2005.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ambleside 04/06/07

Ambleside 18/08/06

Ambleside 12/04/06

Ambleside 07/04/05

Ambleside 04/11/04

Ambleside 05/05/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

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Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Ambleside Wengeo Lane Ware Hertfordshire SG12 OEQ Lead Inspector Mrs Jan Sheppard Unannounced Inspection 29th November 2005 9.30 Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 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 DS0000019267.V267202.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 Adults 18-65. 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 DS0000019267.V267202.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ambleside Address Wengeo Lane Ware Hertfordshire SG12 OEQ 01920 460415 01920 466089 hilary.porter@turning-point.co.uk 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) Turning Point Southern Area Office Ms Hilary Porter Care Home 6 Category(ies) of Learning disability (6), Physical disability (1) registration, with number of places Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate up to one person with a physical disability when associated with a learning disability. 7th April 2005 Date of last inspection Brief Description of the Service: Ambleside is a residential care home for adults with a learning and physical disability. The secluded house is large, detached and is located at the end of a private road approximately one mile from the town centre of Ware. It is owned by Hertfordshire County Council but the home is run by Turning Point Ltd, which is a voluntary organisation. The building was renovated and first registered as a Care Home in 1998. It comprises six single bedrooms, offices and a staff sleeping- in room, and has communal spaces consisting of a large hall, lounge, dining room, kitchen and activities room. The home has a well designed and accessible rear garden with a large patio accessible from the lounge. Adequate parking space is provided to the front of the building. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection of this inspection year and took place over one day when all the residents, the staff on duty, a finance officer and an admin assistant from the Turning Point regional office and two visiting relatives were spoken with. The comments in this report reflect the findings made by the inspector during that time. Not all of the standards were examined during this inspection as they were all covered during the last inspection on 7th April 2005 to which reference may be made. All the staff reported to the inspector that the home is continuing to experience considerable difficulties due to the effects of the various reorganisations that have been carried out by the Turning Point Organisation over the past years. Not all of the requirements made during the last inspection have been met. Seven requirements are made following this inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not inspected on this occasion, as there have been no new residents admitted to the home since the last inspection. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 10 The service users all have care plans. Information about the service users is held securely. EVIDENCE: Since the last inspection there appeared to be no changes to the manner in which the residents care plans are kept. Detail as to how the individuals care needs could best be met was seen to be adequately recorded. Several of the plans had been subject to a review and other reviews were planned, one was held on the afternoon of this inspection. Staff spoke with the inspector about the new format of more person centred care planning that was being introduced by the company but admitted that progress with this at Ambleside was slow because of the staffing shortages over the past months. During this inspection staff were observed to be consulting with the residents in a manner which give due consideration to their privacy and dignity. One carer was heard to say to a resident, “ Shall we go into your room where we can discuss this more privately?” Staff who spoke with the inspector about particular residents did so in private and did not unnecessarily reveal any confidences. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 and 17. The service users day centre activity programmes offer them the opportunity for personal development alongside peers of a similar age and ability. The homes participate in activities and events, appropriate for the residents abilities, in their local community. A nutritious and varied menu, chosen by the residents and supervised by a dietician, is offered with fresh ingredients and home cooking being provided on a daily basis. EVIDENCE: At the beginning of the day of this inspection all the residents were seen preparing to depart in the homes bus for their day centre activities. They were all appropriately dressed relaxed and happy and appeared to be prepared for what is, for them, a familiar routine. When they returned later in the afternoon it was noticeable how quickly and happily they settled back into the home and their teatime routines. Some who bought back work that they had completed during the day were seen to share this with the staff who helped one resident to display his work in his room. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 10 All the residents have activity programmes arranged to meet their interests and abilities for three and a half days each week. Several staff and relatives complained to the inspector that staffing shortages in the home during the previous week, when there were no staff available qualified to drive the bus, had resulted in the residents had not been able to attend their usual day centre activities for several days. Other family members attending the home for their relatives annual review told the inspector that their brothers holiday during the summer had had to be cancelled because of the infectious illness of his key worker. Whilst they explained that the manager had done her best to compensate by arranging days out for him later in the season they commented that the ongoing staffing difficulties of this home were” worrying” and although overall they remained satisfied with his care they did comment that they felt that with better staffing the home could develop services for its residents further and at a faster pace. Holidays for all the other residents were taken during the summer with visits for two residents to the New Forest said to be particularly enjoyed, The manager explained that because of the high care needs of all the residents and because of their need for familiar staff to care for them holidays where the residents went either singularly or in pairs with their key worker staff were found to be most successful. She mentioned that a particularly noticeable social skills improvement that had occurred for one resident during a holiday to a particularly beautiful cottage where she had been very happy, and that this improvement had been maintained since she had returned from the holiday. The homes records evidenced that all except one of the residents has regular contact with family and friends and that staff are very proactive in ensuring that links with relatives who live abroad or where relatives because of their age and infirmities are unable to visit, are maintained. The home continues to provide a nutritious diet with home cooking of fresh ingredients given a high priority. The records evidenced that all food actually consumed is recorded daily and that the dieticians advisory notes concerning the needs of one resident who requires two build-up drinks each day were being followed. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 and 20. Personal care and health care offered to the residents continues to be of a good standard thus meeting their individual needs. The home has a robust medication administration system but one requirement concerning the storage of medication is made. EVIDENCE: Individual personal care practice observed during this inspection was good, most of the carers have worked with these service users for many years and have an in depth understanding of their care needs and of their varying moods and can interpret their wishes as to how these needs should best be met on any particular day. The residents appeared to have a good rapport with their carers and were observed to be making their wishes known to them and it was observed that their carers had a good understanding of their various methods of non verbal communication. The home continues to use the monitored dosage medication system that is supplied from a local Boots the chemists. This medication system was found to be well organised with individual residents non blistered medication stored separately with the opening/ commencement dates recorded on all loose packets and bottles of liquid medication. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 12 One liquid medication was however found not to be being stored at the correct temperature and a requirement is made about this. The medication administration record sheets were seen to be properly recorded and that the accuracy of these was routinely checked by the homes manager. The home has a controlled drugs cupboard and register. No controlled drugs were currently being administered in the home. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The home has a complaints policy and procedures and also has policies and procedures concerning Adult Protection and Whistle Blowing, which follow the guidelines given in the Hertfordshire Adult Protection Joint Agency procedures. EVIDENCE: There have been neither complaints nor any incidents concerning adult protection since the last inspection. Staff were aware of their obligations concerning these areas and of the importance of them remaining diligent in keeping awareness for any non verbal signs of distress or concern that may be exhibited by the residents. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The environmental standards of this home have improved since the last inspection. Further works agreed following previous inspections must be completed On the day of this inspection the home was found to be clean and hygienic and to have a pleasant and homely appearance. EVIDENCE: Since the last inspection a number of works of refurbishment have been carried out at this home. All of the ground floor communal areas have been redecorated and many of the residents bedrooms also have been repainted and have had new furnishings curtains and other soft furnishings. Several of the residents were obviously proud to show off their rooms to the inspector. The manager discussed with the inspector how a recent flood on the first floor landing had delayed the fitting of the new carpet on the stairs and hallway. A date for this fitting has been planned for January 2006. The front entrance of the home has a much improved appearance since the works to repave and level the driveway have been completed. This linked to the provision of winter flowers in tubs at the entrance door gives the home an altogether more cared for appearance. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 36. The home is run by a caring, very dedicated and well established staff team of experienced carers many of whom have worked with the residents of Ambleside for several years. All the staff have job descriptions and clearly identified roles and responsibilities with in the home. However the home has carried a number of staff vacancies for several years and this is putting an increasing strain on the permanent workforce many of whom expressed their frustrations to the inspector. The standards concerning staff NVQ training and the standards required for staff supervision are not met. EVIDENCE: The staff on duty during this inspection were seen to be working very well together as a team. They appeared to be clear about their individual roles and responsibilities but told the inspector that because of the vacant posts they were often required to cover for absent staff or for agency staff who were not so familiar with how to adequately meet the residents needs. The manager despondently reported that no new staff appointments had been possible since the last inspection and that four carers posts remain vacant this putting a great deal of stain on all the existing staff. One advert placed earlier in the summer had not given any suitable applicants who could be called for interview. She said that a second recruitment fair to be held in conjunction with another Turning Point home was being planned for early in the New Year. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 16 Two agency staff confirmed to the inspector that they were very well treated by the home, (just like any of the other staff), and that they had worked consistently at Ambleside for many months this giving continuity of care to the residents. Staff continue to have opportunities to attend individual training sessions and courses concerning Adult Protection, Food Hygiene and Skip training could be evidenced from the records. However no carer has yet achieved the required NVQ level 2 qualification and currently there are no staff studying for this qualification. One carer told the inspector that he had been waiting for over two years to commence the course and that he had lost count of the number of times that the promises of a start date had been broken by the company Turning Point. The National Minimum Standards require that at least 50 of the homes carers have achieved this qualification by 2005. Refer also to standard 38 concerning NVQ level 4 training for the homes manager. Requirements concerning this training made previously have not been met. A further requirement is made. All the staff spoken with told the inspector that they were well supported by the homes manager and that they felt very supportive of her and appreciated her continued efforts to keep the home running with good care standards despite the lack of support that, they felt, she received from the company. One said,” the manager is always here trying to keep everybody’s spirits up”. The records evidenced that the standard for staff supervision, at least six times a year, had not been met. This was a requirement from the previous inspection that has not been met. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,40 and 43. The manager and staff team continue to endeavour to run this home well and with the best interests of the residents constantly in mind but it would appear that their employing organisation is not assisting them as fully as they should be with these endeavours which is resulting in the home not being well run and continuing to fall short of meeting the minimum requirements of the Care Standards Act. EVIDENCE: The homes registered manager has a nursing qualification and has several years experience of running a care home for this client group. She does not however have an NVQ level 4 management qualification which is a requirement of the National Minimum Standards to have been achieved during 2005. She is very disappointed that the numerous promises made to her by the company concerning a start date for this course have never materialised. She reported with some anxiety to the inspector that at present with the lack of staff this necessitating her to undertake extra work shifts working as a carer rather than a manager she was concerned that she would not have time to undertake these studies even if a place were now available for her. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 18 A requirement is made that the manager commences this NVQ level4 training as soon as possible and that she is given sufficient time to undertake periodic training and development so as to maintain her level of competency in managing this home. Refer also to standard 35. The records evidenced that since the last inspection, April 2005,no visits by the registered provider required under Section 26 of the Care Standards Act have been made to the home. These unannounced visits intended to provide support and surveillance of the performance of the home by the registered provider should be made monthly with a report sent to the CSCI. The records evidenced that during the past year only four visits were made, on 4th January 2004, the 29th April 2004 the 1st September 2004 and during January 2005. This lack of regular visits and consequent lack of proper support for the manager suggests a lack of concern and proper attention by the registered provider. During this inspection the inspector witnessed a carer taking a phone call from a contractor who was threatening legal action if the bill for recently carried out repair works that had not been paid. Several carers confirmed that his was one of several calls that had recently and increasingly been made to the home. The manager explained that since the last inspection and following another reorganisation by the company all bills relating to the home, which she had previously paid and been accountable for, were now paid centrally by the head office. Unfortunately this new system was not working well as the head office was being overwhelmed by requests for payments from their many homes that they had no knowledge of and the subsequent delays were resulting in a diminished service for the residents. The reordering of supplies essential for the maintenance of good care for the residents had been delayed. The managers flexibility in ensuring the smooth running of the service had been very much diminished as the company credit card which she had been issued with to deal with urgent situations had not been accepted by several suppliers. The inspector spoke about this deficiency with a newly appointed finance officer who was making an introductory visit to the home. A requirement is made that the registered provider provides financial systems to support the care homes finances so as to ensure its viability in achieving the aims and objectives of the home as set out in its statement of purpose. Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 Score x 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x x x 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score 3 x 3 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ambleside Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x x 2 DS0000019267.V267202.R01.S.doc Version 5.0 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA41YA43 Regulation 25(1) Requirement It is a requirement that sound financial management systems are put in place by Turning Point to enable the home to run smoothly. The registered person must ensure that the requirement that new carpeting is provided on the stairs and landing is fulfilled. This requirement from the previous inspection has been partially met but the new carpeting will not be fitted until the works of redecoration are completed. This requirement from the previous two inspections has still not been fully met due to the flood damage caused by a recent leak. The manager was able to demonstrate the homes plans to have this new carpet fitted when the affected areas have dried out. The registered person must ensure that NVQ training is provided for the manager and carers so that the national minimum standards can be met. It is a requirement that sufficient DS0000019267.V267202.R01.S.doc Timescale for action 31/12/05 2. YA24 23(2)(b) 31/12/05 3 YA35 18(1)&(2) 28/02/06 Ambleside Version 5.0 Page 21 4. YA36 18(2) 5. YA12 18(1)(a) 6. YA20 13(2) 7 YA43 26 staff commence this training by 28/2/06, This requirement from a previous inspection has still not been met. The registered person must ensure that all staff receive formal recorded supervision at least six times a year and an annual appraisal. This requirement from the previous inspection has still not been met. The registered person must ensure that the lack of staff who can drive does not adversely affect the residents attendance at their day care centres. The registered person must ensure that a fridge is provided so that all medication kept in the home is stored at the correct temperature this to ensure the safety of the residents at all times It is a requirement that unannounced monthly visits are made to the home by the registered provider and that a report of these visits is sent to the CSCI 31/12/05 31/12/05 31/12/05 31/12/05 Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ambleside DS0000019267.V267202.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 DS0000019267.V267202.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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