CARE HOMES FOR OLDER PEOPLE
AMBLESIDE BANK CARE HOME Older Peoples Resource Centre High Street, Lower Ince Wigan WN3 4RL Lead Inspector
Judith Stanley Unannounced 26 July 2005 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 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 BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ambleside Bank Care Home Address Older Peoples Resource Centre High Street Lower Ince Wigan WN3 4RL 01942 321112 01942 234331 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Century Healthcare Limited Mrs Susan Jackson CRH Care Home only 30 Category(ies) of DE(E) Dementia over 65 - 1 registration, with number OP Old Age - 30 of places AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 30 service users to include:up to 30 service users in the category of OP (Older People) 2. One named service user (RC) in the category of DE(E) (Dementia over 65 years of age) may be accommodated within the overall registered numbers. 3. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 1 March 2005 Brief Description of the Service: Ambleside Bank is a purpose built Older Peoples Resource Centre that provides personal care and support and rehabilitation care sevices for up to 30 individuals over the age of 65 years. The Centre is approximately 10 minutes drive away from Wigan town centre; however some local amenities are close by. The Centre offers five categories of placement; these include: 12 long term residential places, 8 intermediate beds, 6 respite beds, 4 emergency beds and up to 10 day care places. Admissions and discharges can occur on a daily basis. The Centre provides 26 single rooms, and 2 shared rooms, all rooms have en suite facilities. There is a large patio area at the rear of the Centre with appropriate seating for serivce users; car parking is available at the front of the Centre. The external areas of the premises and grounds are well maintained. AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over a period of 4 hours on one day. The first part of the morning was spent talking with the deputy manager and looking at care plans. The remainder of the day was spent speaking at length to 5 service users, 2 had lived at the Centre for some time, 2 were regular visitors to the day care unit and 1 who was admitted for intermediate care and was hoping to return home soon. Members of staff and other service users and 2 relatives were spoken to over the course of the visit as well as a tour of the premises. What the service does well: What has improved since the last inspection?
Since the last inspection the company have brought in new information to ensure that staff are fully aware of how do their jobs properly and how they expect the Centre to be run. New company care plans have been put in to place for the long-term service users. These are more detailed and give a clear picture of what care and support each person needs. A social history explaining about what jobs people used to do, their interests and hobbies and about their life has been introduced in more detail. The deputy manager confirmed this is a great help when chatting one to one with service users.
AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 6 The company have looked at staff files to see if these could be improved and these now contain more detailed information about the individual. New menus have recently been introduced with a wider selection of fresh fruit and vegetables and more home cooking. 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 BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 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 standard(s) 6 The Centre has excellent systems in place to ensure that service users are helped to maximise their independence and return home. EVIDENCE: Ambleside Bank offers intermediate care for up to 8 service users. An area of single, en suite rooms has been allocated for intermediate care. Service users can remain at the Centre for up to 6 weeks; an extension can be arranged if all parties deem this necessary and if it is thought that the service user will benefit from an extended stay. One service users spoken with had been at the Centre for rehabilitation and was due to leave and was planning his return home, he said that the staff had been very good, and they had help him to get his confidence back, he said he had enjoyed being at the Centre but was looking forward to returning home. The staff work closely with a team of Physiotherapists, Occupational Therapists and Support Workers in order to facilitate any assessments and possible treatment required. If a service user does not already have a social worker, one is allocated from the Intermediate Team. The Centre was seen to be well equipped and has dedicated space for treatment and therapies.
AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 9 All the staff working at the Centre have received appropriate training. Therapists are trained to use techniques for rehabilitation, including treatment and recovery programmes, promotion of mobility, continence and self-care and outreach programmes to establish community living. The Centre has sufficient space for dedicated areas, however the majority of the service users join in activities together and dine together. One long term service users was asked her opinion about the numbers of different people coming in to the Centre, she said that she didn’t mind, it was nice to see different faces and that she had used the service prior to being admitted for long term care. AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 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 standard(s) 7 & 9 The standard of care planning and review was good, providing all staff with the information they needed to meet the service users needs. The systems for the administration of medication are good, with clear guidelines being in place to ensure service users medication needs are met. EVIDENCE: A new care plan format for long term service users had recently been introduced. Information from the old plans had been transferred over. The deputy manager confirmed that the new system is working well and the files now contain more information, including more background history of the service user, which she feels has been beneficial when staff are doing one–toone chats with service users and for reminiscing. One care plan was inspected from each of the services provided, some contain more detailed information than others, and this is due to the care package provided. Long - term service users have a detailed plan of care that sets of the arrangements for their dayto-day care to ensure that all aspects of health, personal social care needs are met. The plan examined had been update and amended as required. Service users receiving respite care tend to use the Centre on a regular basis; their care plan is kept and updated by staff on each visit. Intermediate care plans
AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 11 contain all the necessary information, assessment and therapy programmes as required. Risk assessments applied to all service users with regard to falls, pressure areas and nutrition. Environmental risk assessments were maintained and updated. The morning medication round was observed, the member of staff administering medicines confirmed that she had undertaken appropriate training. The mediation was seen to be suitably stored, and recorded on the individual’s drug sheet. Long-term service users living at the Centre have their medication re ordered as required. Service users on short stay have their medication requirements discussed prior to admission and suitable arrangements are made for service users to bring a supply of medication in to the Home with them on admission. AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15 Social activities and meals were both well managed, providing daily variation and interest for people using the Centre. EVIDENCE: The Centre has a day care supervisor who, with the help of the service users plans and wide range of activities. They were appropriate to the service user group and catered for individual tastes and capacities. The activities are offered to all service users. One service user from day care said she attended the Centre a couple of days a week, she said she enjoyed the activities available especially the craftwork, mainly she enjoyed the companionship and the hot meal served at lunchtime. Other activities are clearly displayed, these include: board games, wool craft, manicures, art work, current affairs chats, bingo, memory lane games, phrase games, water colours, aromatherapy and sing-a-longs. The dietary needs of the service users were well catered for with a balanced and varied selection of foods available. The Centre has recently introduced new menus to include more fresh vegetables and fruit and more home cooked food. Service users spoken with were satisfied with the food served. One service user from day care said, “the food is excellent, you get a hot meal, tea and biscuits during the day for £1.35”. On the day of the inspection the main
AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 13 meal was chicken casserole, creamed potatoes, broccoli and mixed vegetables, followed by blackcurrant cheesecake. Alternatives to the main meal offered were jacket potatoes with various fillings or a selection of sandwiches. The cook was spoken with and confirmed that new menus had been introduced and service users appeared to be enjoying them. The cook is aware of service users likes and dislikes and caters for any special dietary needs. AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: None of the key standards were inspected on this occasion. inspected on the next inspection. They will be AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The standard of the environment within Ambleside Bank is good, providing service users with a comfortable and homely place to live Infection control procedures environment for service users. EVIDENCE: are good, making this a clean, hygienic From a tour of the building, it was seen that the premises were being maintained to a good standard, both inside and out. The premises were clean and free from offensive odour throughout, and service users and relatives spoken with complemented the domestic staff on the level of cleanliness maintained. One service user spoken with said she liked her bedroom and that it was comfortable and that she had everything she needed. It was evident that, mainly the long-term service users had personalised their rooms with small items of furniture, photographs and mementos brought in with them from home. Other rooms for short stay were clean and well equipped. There are several lounge areas for service users to sit; these were seen to be
AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 16 comfortable with furniture and fittings that were maintained to a good standard. Systems were in place to control the spread on infection. Staff spoken with were knowledgeable about infection control procedures and were seen using different aprons and gloves for different tasks. The laundry was not inspected on this occasion but staff advised that all equipment was in good working order. AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Staff morale is good, with low levels of staff turnover. This ensures that service users are provided with care by people they know and are familiar with. Staff are properly trained to deliver the care that service users need. EVIDENCE: The staff team have worked at the Centre for some considerable time. This helps provide continuity and a high standard of care for the service users. It was observed that a friendly and respectful rapport had been built up between the service users and staff. The manager ensures that enough staff is on duty at all times to meet the assessed needs of the service users. Staff were observed carrying out daily tasks but had time to sit and chat with service users. To ensure that staff are trained and competent to do their jobs a comprehensive training programme is available. Staff spoken with felt the training provided was good and relevant to their job. They confirmed that they had the support of the manager who encouraged them and assists them with any training and formal qualifications, for example NVQs AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Procedures and practices operating within the Home promote and safeguard the health, safety and welfare of the people living and working in the Home. EVIDENCE: In the main, the health and safety issues were good with regular maintenance checks of equipment being undertaken, these were suitably recorded and available for inspection. All accidents and incidents were being correctly recorded and reported. Discussion with the deputy manager and staff confirmed that staff have completed mandatory health and safety training, this includes a full induction programme, moving and handling, fire safety and first aid. AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 3 AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 20 No 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 Regulation None 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 None Good Practice Recommendations AMBLESIDE BANK CARE HOME F56 F06 S5720 Ambleside Bank V240700 260705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Turton Suite, Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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