Inspection on 05/09/06 for Ambleside

This inspection was carried out on 5th September 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ambleside 24/10/07

Ambleside 04/01/07

Ambleside 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 Inspection 09:30 5 & 13th September 2006 th 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.V311801.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.V311801.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.V311801.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. 13th February 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. Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection of Ambleside was undertaken with the registered manager and owners, Elaine Charlesworth and Helen Humphreys . Talking with the residents and relatives at Ambleside, and consultation with staff, provided some of the evidence for this report. Residents’ relatives also responded to the service questionnaire sent by the Commission. The inspector also reviewed care files for residents, and administrative records relating to the implementation of health and safety at the home. The home has friendly atmosphere, with residents familiar with staff who they know well. The manager, staff team and the owner of the home are responsive to requirements and recommendations made through the inspection process. They are pro active in developing relationships with residents and relatives on a one-to-one basis, in order to find out their views as to how the service is being run and whether it meets expectations. The overall priority for the home is the comfort of the resident and their quality of life at the home. Overall the outcomes for the residents at this home are good and the inspector is confident that the residents are well cared for and not at any risk. However, there are areas of service provision, which require improvement in order to meet the standards, and therefore the home has been judged as providing adequate service. The fee level for the home is from £490.50 per week. What the service does well: The inspector managed to speak with several of the residents and their families during the day, and the benefits of Ambleside being a smaller home were discussed. None of the residents or relatives expressed any dissatisfaction with the service they received at the home; they were very complimentary about the staff and their approach to their relatives, staff were described as angels by one family. The food at the home was also praised as residents felt they had a good variety of meals to choose from, and if they are hungry or required a drink, the staff made in it for them. Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 6 There is always an ongoing programme of improvement, and particularly environmental improvements in order to provide a well be decorated and maintained home for the residents. 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 DS0000020268.V311801.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.V311801.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 Quality in this outcome group was adequate. Evidence suggests that prospective residents have a needs assessment carried out before they are admitted to the home. The service has received copies of the summary, and care plans, from those assessments carried out through care management arrangements for most of the residents. EVIDENCE: The inspector was able to see the preadmission assessment for one resident. The home do not keep files for residents and therefore the preadmission assessments and other supporting documentation may not always be easily accessible and found with the current care plan. The preadmission assessment used is comprehensive but it was noted that it wasnt dated or signed. The inspector emphasised the necessity of signing and dating all documentation so that it becomes a valid record. The registered manager must be able to demonstrate that the home can meet the needs identified so that residents and their relatives can be confident of the homes capacity to care for them. The pre-admission assessment also acts as a baseline assessment from which progress or deterioration can be measured. The manager and deputy manager Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 9 are now aware that they need to sign and date all documentation, and to ensure that records are stored effectively so they are easily accessed. Ambleside DS0000020268.V311801.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome group was adequate, however record-keeping for medication was poor. Each resident has care plan, the practice of involving residents or relatives in the development and review the plan is variable. The plan in most cases includes the basic information necessary to plan individuals care and includes a risk assessment element. The home seeks professional advice on health care issues and is able to provide the aids and equipment recommended. Medication records are not up-to-date, there are gaps in recording and information. The current practice and lack of adequate recording puts residents at risk. There is no clear system to monitor compliance with the administration, safekeeping and disposal of controlled drugs. EVIDENCE: The home uses preprepared documentation, Assessment for Good Care Planning, the documentation contains a variety of assessments designed to identify particular care needs of the residents. It also contains risk assessments, and an overall care assessment table which gives a summary of the assessments used and identifies the level of dependency and support Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 11 needed by the resident. The information is comprehensive however not all assessments would be applicable to every resident moving into Ambleside. The inspector reviewed documentation for five residents and found that in general assessments were often incomplete, for example, the nutritional assessment did not contain any information on weight or height and sometimes was not finished, care action plans were not all written up and therefore the care identified by the assessments had not been formulated into a plan. The supporting documentation from care managers/hospitals was not always transferred over accurately, and this meant that where a particular problem was identified on a referral letter i.e. sacral sore, the inspector could not case track all find the care plan relating to this problem, despite it being treated and resolved by the staff at the home. It was also noted that out care plans and assessments were not always signed and dated. This issue was discussed in depth with the registered manager and deputy manager who understand that they must be able to demonstrate professional practice which is based on research and which is evaluated for effectiveness. The lack of documentation negates the work and high-level of professional care and support the inspector observed at the home and that the relatives and residents gave testament to. The inspector stated her opinion that the residents appeared well cared for and the outcomes for their daily life are good however the care and support given to achieve this must be recorded. The care records contained evidence of health need being reviewed, and visits to hospitals, and from the allocated GP are recorded with outcomes. The daily records at the home are completed in a non-judgmental, factual manner. They supply a good source of information and insight into the daily lives of the resident. The inspector reviewed the medication with one of the trained staff. The following issues were found, and it is required that the registered manager ensures that all staff comply with the NMC codes of practice relating to medication. • There should be a light in the medicines cupboard so that staff can read directions and labels effectively. • Medication prescribed for one resident must not be given to another resident. • Medication that has been administered should be recorded on the MAR sheet. • If medication has been refused or not administered, due to illness, then this should be recorded on the MAR sheet. • Where additional when required medication is administered the type of medication, time given and dosage should be clearly recorded. • All controlled drugs entering the home should be clearly labelled and entered into the controlled drug register. • Large pots of cream/ointments should be destroyed 28 days after being opened. Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 12 All of the trained nurses completed a distance learning course in medication administration last year therefore the registered manager must develop a system whereby she monitors compliance and capability of the trained staff in respect of safe administration of medication. Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 13 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, 13, 14, 15 Quality in this outcome group was good. The routines of the home are planned around the resident’s needs and wishes. The home has developed a system for displaying information and bringing attention to community events and activities. Family and friends are welcome and know they can visit the home at any time. Staff always make time to talk to visitors and share information with the agreement of the resident. EVIDENCE: As part of the care planning process the recreational and social preferences for the residents at the home are identified. The inspector spoke with several residents and families who confirmed that various activities were available, the most successful are the one-to-one sessions with staff taking residents out of the home to local amenities. The inspector and management team discussed the increasing frailty of residents referred to the home, and their capability to enjoy and take part in organised activities. The plan for the home is that a key worker system will be introduced which enables closer residents/staff relationships and enable key Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 14 workers to use information to plan activities that residents enjoy. It was suggested that staff be allowed key worker time on a regular basis to give oneto-one attention to residents for activities. The families who spoke with the inspector were very happy with the support and relationships staff have with the residents. The home encourages good communication and relatives stated they felt able to raise any issues. There is audiovisual equipment available at the home, but it was nice to observe staff sat down talking with residents, and encouraging them to join in the general conversation. The residents also praised the quality and quantity of the food at home and said that the cook always made a point of talking to them so there was opportunity to ask for alternatives should they not like what was on the menu that day. The lunchtime meal was attractively presented and options for other choices are available to the residents. The home uses nutritional screening and places emphasis on provision of adequate fluid intake and a balanced diet to promote optimum health and wellbeing. Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 15 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, 18 Quality in this outcome group was good. 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 rigorous 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. In order to facilitate good communication with the team, concerns that have been raised are recorded in the individuals daily record and in the communication book. The inspector made the registered manager and deputy manager aware that the lack of documentation at the home would make it very difficult to establish good care practice if a complaint was made to the home. 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.V311801.R01.S.doc Version 5.2 Page 16 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, 20, 23, 26 Quality in this outcome group was good. 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 inspector toured the building with the registered owner, who was able to inform inspectors that she took on responsibility for planning the ongoing maintenance and repair of the home. The development of the environment of the home is limited by its layout and size. The home has an ongoing programme for refurbishment of bedrooms, and replacement of furniture and equipment. The owner also takes on responsibility for implementing health and safety at the home and risk assessing the environment. Currently two issues raised at the last inspection are in the process of being resolved, the hot water supply in the hand basins of some residents rooms have temperature Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 17 control valves fitted but priority has been given to those residents who are less dependent or able to use the basins themselves. The issue of fire safety and fitting sonic closures to fire doors is also ongoing, however the areas of greatest risk (laundry/kitchen) have been addressed and have closures in place. The general appearance of the home is of a domestic house, with many individual features, which make it less institutionalised. The communal areas are comfortable and well furnished; in particular the dining room is spacious and well lit providing a pleasant room, which is used for mealtimes and activities. The small courtyard garden is a bonus as it is accessible, but enclosed and not overlooked. The resident’s bedrooms are all individual, and the home encourages residents to bring in personal items to make themselves comfortable as possible. Some rooms are larger than others, and some have ensuite facilities. The home appears clean and well cared for. The infection control measures include alcohol hand rub in corridors for staff and visitors to the home to use. One of the trained staff has recently undertaken a course in infection control, and has provides training to all the staff in hand washing techniques. The inspector suggested that an audit of the success of the hand washing training be undertaken at the home as part of the monitoring of clinical practice. Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome group was good. Residents have confidence in the staff that cares for them. The service ensures that all staff within its organisation receives relevant training that is targeted and focused on improving outcomes for residents. EVIDENCE: There has been no new staff appointed to the home since the last inspection. Staff turnover at the home is low. It is planned that all of the residents have an allocated key worker. The manager provided the inspector with a staff rota. It is noted that there are a minimum of four staff on for the morning shift, and three staff in the evening. The residents were very complimentary about staff, and the number of staff available to meet their needs. The staff team at Ambleside are well trained, and are accessing NVQ 2 or 3in care currently 66 of the care staff have an NVQ. They have also accessed specific training through the North Somerset PCT programme e.g. catheter care. All of the statutory training for the staff is up-to-date and evidence of the training could be seen on the staff files. Some staff are also following distance learning courses such as infection control. The staff training records are on file Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 19 with copies of training certificates available to verify attendance and competence. The records available presented a picture of a well-trained staff team, who were able to meet the needs of the residents at the home. Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 20 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): 31,33,35, 36, 37, 38 Quality in this outcome group was adequate. The registered manager is qualified and has the necessary experience to run the home. The service is planned to be user focused, and generally works in partnership with family of residents and professionals. The registered manager must develop systems that monitor practice and compliance with the homes plans, policies and procedures. EVIDENCE: The registered manager has continued to implement good practice at home. The staff training is good, and the continuity of support from staff provides a safe and stimulating environment for the residents. Currently the registered manager has no formalised management training. Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 21 Staff stated they felt the management was approachable and listened to them. The staff feedback about the home was positive, especially about the level of care and support given to the residents. The staff are involved in daily handover of information directly relating to the care of the residents. The home is part of the North Somerset PCT fall monitoring audit and work closely with them to reduce the number of falls in the home. There were six accident reports available to read by the inspector, this clearly showed any follow-up action that needed to be taken. Supervision of care staff is undertaken on a regular basis. This takes the form of supervised practice; the registered manager and deputy manager also provide witness statements for NVQ candidates. Supervision was discussed and will be a mixture of supervised practice and formal recorded sessions in order to promote the key worker role and to identify the training needs of the workforce. Supervision must also include trained nurses. The implementation of health and safety at the home is the responsibility of the owner who has recently commissioned a health and safety audit, and is in the process of updating risk assessments and prioritising work that needs to be done. The fire safety procedures at the home are implemented as the recommendations. There was evidence of regular maintenance of the electrical system, alarm system, and portable electrical appliance testing. Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X 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 3 X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 N/A 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 2 3 Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 23 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 OP7 OP3 Regulation 14,15 Requirement The registered manager must ensure that an assessment of need is undertaken and documentation is validated by being signed and dated. The registered manager must prepare written plan as to how service users needs are to be met, and keep the plan under review. The registered manager must develop a system for monitoring the implementation of policies and procedures by staff in relation to the safe administration of medication. The registered manager must ensure all staff working at the home receive appropriate supervision in order to monitor the skills and quality of care provided. The registered manager must ensure that records are kept up to date and kept available for inspection. Timescale for action 14/09/06 2. OP7 15 14/09/06 3. OP9 13,18,24 14/09/06 4. OP36 18,24 14/09/06 5. OP37 17 14/09/06 Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 24 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 OP26 Good Practice Recommendations A clinical audit of handwashing is carried out to ensure infection control procedures are implemented effectively. Ambleside DS0000020268.V311801.R01.S.doc Version 5.2 Page 25 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.V311801.R01.S.doc Version 5.2 Page 26 - 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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