Inspection on 04/01/07 for Ambleside

This inspection was carried out on 4th January 2007.

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 05/09/06

Ambleside 13/02/06

Ambleside 24/10/05

Ambleside 10/03/05

Ambleside 13/09/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Ambleside 6 Southside Weston Super Mare North Somerset BS23 2QT Lead Inspector Nicola Hill Unannounced Key Inspection 4th January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 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.V325606.R01.S.doc Version 5.2 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.V325606.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 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. Staffing notice dated 24/05/2001 applies May accommodate up to 3 persons between 18 - 64 years of age, with Physical disabilities. 5th September 2006 Date of last inspection Brief Description of the Service: Ambleside provides personal care and nursing for up to 20 people aged 50 years and over who are elderly and in need of general nursing care. The home aims to provide a warm, friendly and homely environment. Visitors are welcome at any time and are encouraged to be actively involved in many aspects of the homes life. The home is set close to the town centre and is not far from the seafront. Local shops and other amenities are nearby. The home is on four floors and has a passenger lift accessing all areas. The current fee for the home is £495.54 per week. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection of Ambleside took place with the inspector and the home owners, Mrs Helen Humphreys and Mrs Elaine Charlesworth. The inspector reviewed written documentation relating to the provision of nursing care services, and met with three members of staff to discuss their experience of working at the home. The inspector also met five visitors to the home, who expressed positive comments about the care and support received by their relatives. The inspector also walked around part of the home observing the interaction between staff and residents, and talking to some residents who were in their rooms. The comments from residents, visitors and staff were very complimentary about the day-to-day running of the home and the friendliness of the home. Some of the outcome groups have been assessed as being excellent, however the overall service assessment for the home is good. What the service does well: What has improved since the last inspection? The management team have been very responsive to suggestions and recommendations made from the last inspection and have worked extremely hard to implement new systems of working. The care plan documentation has been reviewed; supervision and appraisal for all staff has been implemented; medication procedures have been reinforced Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 6 and a monitoring system implemented. Quality audits have been started so that the home can demonstrate the systems in place ensure the standard of service is maintained. 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. The summary of this inspection report can be made available in other formats on request. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 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.V325606.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home only take place if the service is confident the staff have the skills, ability and qualifications to meet the assessed needs of the prospective service user. EVIDENCE: Helen Humphreys stated that the intention is to review and update the information provided to potential residents, and this includes the statement of purpose/service user guide that has been produced for Ambleside. The individual care files for residents indicated that a pre-admission assessment had been undertaken which ensured that the home was able to meet identified need. The contract for the home is straightforward and written in an easy to understand format. It does include all the information listed in the standard, however it may be advisable for the management to review how the Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 9 information is presented so that all the services provided are listed together, terms and conditions etc. and to include any additional points found in the guidance issued by the Office of Fair Trading. It would also be advisable to include the name and address of the person who is responsible for paying the fees to the home on the contract. At the time of the inspection there were 17 people in residence, and two vacancies in single rooms. The average age for residents at the time of the inspection was 86 years old, there were 15 female and two male residents. Religious beliefs were recorded on individual care documentation and the home support residents to follow their chosen religion. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ care and well being is the priority for all the people working at the home. EVIDENCE: The manager and deputy manager have reviewed the documentation used for care planning, recording and review and customised this to meet the home’s requirements. The inspector looked at five residents pre admission assessments and care plans. The daily records could be easily linked to the care needs identified through the assessment process and the action listed within individual care plans. The residents have additional files for any other paperwork which may be received at the home such as doctors letters, outpatient reports; within this documentation there was evidence that additional health care support and expertise was sought where necessary. Reading through the documentation it was clear that care plans were changed Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 11 as necessary and in response to changing needs as well as being reviewed in order to meet the national minimum standard. The information contained in the daily records was indicative of very personalised support being given to residents, and recorded choices that residents were making about their day-today life at the home. The care staff work closely with the trained nurses, and also act as key workers to residents in order to develop good relationships and improve the quality of life for residents. The care staff told the inspector they were very proud of the high standard of care at the home, and the support given to residents and their relatives. The home was described by staff as being very friendly and welcoming with time allowed within the day-to-day routine to have conversations and develop friendships, one member of staff stated that they tried to make the time they (the residents) have left, as pleasant as possible. Staff also confirmed that residents are consulted and can decide which staff members they want to help them with personal care. The residents have a wide range of health care needs which the home support by using their own professional skills and accessing professional expertise whenever necessary. The GP visits on regular basis and residents are asked if they wish to see the doctor when he visits, as well as staff nominating residents who may need a consultation. The home has a range of equipment available to support the care of the residents i.e. hoists, pressure relieving mattresses, syringe drivers. The medication system was checked on the last visit to the home and found to be up-to-date. Inspector checked the controlled drugs register and noted that all medication is correctly recorded with accurate stock levels. The home is able to offer support for those with terminal conditions and the staff have developed considerable expertise in end of life care. The manager was able to show the inspector the feedback from relatives who had had someone at Ambleside, and it was evident that relatives appreciated the love and care given to their relation whilst at the home. The inspector discussed with the management the arrangements in place to support people, it was acknowledged by both the management and the staff that wherever possible additional staff are on duty when someone is terminally ill to ensure that they receive one-to-one care and that there is someone available to sit with the resident and family if required. Sadly, during the inspection one resident died, however the inspector was able to observe at first hand the support given to the family, and to the staff and residents at this difficult time. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home encourages residents to be actively involved in the day-to-day running of the home. The home takes resident feedback seriously and makes changes were possible. The home operates a key worker system which enables closer resident staff relationships. EVIDENCE: The preferred day-to-day routines of the residents at the home are accommodated as far as possible. Visitors are always welcome at the home and those who were at Ambleside during the inspection confirmed this. There are planned activities which residents can opt to attend, for example, the manager and staff team had organised pantomime tickets. Activities also take place on an ad hoc basis but this is dependent on staff having time, and residents being willing to join in. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 13 The normal routine for the home is that they have visiting musicians, hairdresser etc but because of the variability of health of the residents there are no structured daily activities. This was identified by the staff as an area which could be developed further as the staff stated that when organised activities did take place there were usually half a dozen residents who were willing or could be encouraged to join in. Favoured activities identified by the staff were singalongs and activities involving gentle exercise. The key worker system, which has been introduced from the beginning of the year, is designed to support residents to develop relationships with their key worker and identify what people would like to do. For example, some key workers are planning to take residents out shopping, whilst others may go out for a meal. Although there are no volunteers currently working at the home, relatives and friends of service users are always made welcome by the staff and are invited to attend any planned event i.e. the Christmas carol service. The manager currently holds a minimal amount of money on behalf of three residents, however responsibility for anything other than personal needs is passed to the local authority. The management of the home is of the opinion that residents should have a diet they enjoy. To ensure this happens the cook regularly talks to the residents and discusses what they would like to eat. Residents, relatives and staff all commented on the quality of the meals, and the quality of the ingredients used. The kitchen is accessible 24 hours a day so that if anybody requires a snack or additional drinks then they can be made. The lunchtime meal on the day the site visit was roast lamb and the feedback from one member of staff was that the residents had all cleaned their plates”. Special or religious dietary needs are catered for and the four-week menu is planned to provide a balanced and nutritious diet. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is widely distributed, and residents and others associated with the home demonstrate a good understanding of how to make a complaint. In respect of adult protection, the service is clear when incidents need to be referred to external organisations. EVIDENCE: The organisation has a complaints procedure; no formal complaints have been received since the last inspection. The registered manager stated that complaints are brought to her notice directly by relatives or residents and they are resolved at that time. All staff at home have undertaken training to enable them to recognise abusive practice, and the action taken to report any concerns. There have been no adult protection issues at the home. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a well maintained environment, which provides aids and equipment to meet the care needs of the residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. EVIDENCE: The home is well maintained with nicely furnished communal areas. Some areas of the home are limited for space but this is because the building is not purpose built. It is a very cosy, comfortable environment and staff do ensure that personal areas are to residents’ personal taste. The home is clean and odour free. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 16 Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have confidence in the staff to care for them. EVIDENCE: The inspector spoke to three members of staff, and both home owners during the site visit. The staff were enthusiastic about the new key worker system that had been introduced at the beginning of January, as it gave them a greater responsibility in working with the residents. The key workers are in charge of maintaining key worker files, which are kept in residents’ rooms. The residents all have a named key worker and are able to jointly plan the care and support needed. There is a continuing care record sheet for key workers to complete. This is in addition to the care documentation held in the office. The comments from the staff were that love and care were given to the residents at Ambleside; the home is very friendly and welcoming to residents and their families. The ethos of the home was identified as being open and the focus remained on providing a high standard of care to the residents. One of the staff was a bank worker and they confirmed that they had received induction when starting work at home, and were included in the supervision and training sessions, and was invited to attend team meetings. The staff praised the working practices in that they had time to have conversations with Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 18 residents and were encouraged to spend any quiet times talking with residents or involving them in ad hoc activities. The staff recognise that activities are enjoyed by some residents, but that there should be more structure to activities so that they happened more frequently. All the staff stated that they would recommend Ambleside as a good place to work, as it provided job satisfaction. The staff training at the home is very good with the majority of staff either already having NVQ2 or above. All staff are encouraged to attend statutory training as well as specific training to meet identified needs i.e. dementia care. The staff rota indicated there was sufficient staff on duty for the number of residents at the home; the inspector discussed with the management of the home the Residential Care Forum calculation for staff levels and agreed to provide the calculation with the proviso that the management understood it was dependent on residents need which may change on a daily basis. The management has introduced regular supervision and team meetings for staff to attend, and have undertaken an appraisal for staff in order to identify training needs. This has included ancillary staff, which concentrated on infection control around the home. The management also included a spot check on the night staff in December 2006. The evidence from staff, residents and families was reinforced through documentary evidence and presents a picture of a very close staff team who have shared goals and work together to achieve them. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home work continuously to improve services and provide a good quality of life for the residents. EVIDENCE: The management of the home have worked together to ensure that the requirements and recommendations made at the last key inspection have been implemented and any areas of concern have been resolved. The ethos at the home is one of openness and the owners of the home make themselves available to residents and their relatives as well as the staff team, and are approachable. The quality assurance systems identified for the home include service satisfaction questionnaires as well as internal audits of service provision. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 20 The health and safety policies and procedures at the home are good with a minimal number of accidents. The home also participates in the North Somerset PCT falls audit. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 21 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 X 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 3 3 X X X X X X 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 X 3 X 3 X X 3 Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 22 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. 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 OP12 Good Practice Recommendations A more structured approach to activities could be introduced. Ambleside DS0000020268.V325606.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V325606.R01.S.doc Version 5.2 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. 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