Random inspection report
Care homes for older people
Name: Address: Ambleside Residential Home 69 Hatherley Road Cheltenham Glos GL51 6EG one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Adam Parker Date: 2 3 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Ambleside Residential Home 69 Hatherley Road Cheltenham Glos GL51 6EG 01242522937 01242522937 pepwalsh@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : James Christopher Walsh,Perpetual Walsh care home 18 Number of places (if applicable): Under 65 Over 65 18 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 18. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Ambleside is a large, detached, Victorian house that has been extended and adapted to provide accommodation for older people. It is situated in a residential area of Cheltenham close to a few shops and the bus route into town, which is approximately a mile away. The railway station is within easy reach, together with a number of churches. The accommodation is located on three floors that are all served by a shaft
Care Homes for Older People Page 2 of 13 0 7 0 3 2 0 0 9 Brief description of the care home lift and stairs. All the bedrooms have en-suite facilities, approximately five have a bath or shower. There are three bathrooms two of which have hoists. Ground floor communal facilities include a dining room and two lounges one of which has a piano. The lounge at the rear of the property is an extension of the main building and gives an all round view of the large landscaped garden. A patio area provides a pleasant place for service users to sit in warmer weather. The provider supplies information about the home, including the most recent CQC report to current and prospective residents on request. The fees range from 480 to 598 pounds per week for local authority funded residents and 610 pounds per week for privately funded residents. Hairdressing, chiropody and any personal items are charged extra. The costs of these services are available as required. Care Homes for Older People Page 3 of 13 What we found:
We visited the home again to inspect arrangements and practices for dealing with medication to make sure that the Statutory Requirement Notice that was served on 21 April 2009 was met. We were therefore checking that there were safe systems in place to make sure of safe administration, safe recording and safe handling of medicines. We looked at some stocks and storage arrangements for medicines and various records about medication. We saw how staff administered some medicines to people living in the home. We spoke to the new manager (designate) and a member of care staff who was trained to administer medicines. We gave full feedback during the inspection to the new manager (designate) about the medication issues we found. We judged that the particular issues about the handling of medicines included in the Statutory Requirement Notice dated 21 April 2009 had been sufficiently attended to. We explained to the manager (designate) that there were some other matters to address in order to provide further improvement in the arrangements for medication in the home. The manager (designate) has carried out some staff medication competency checks and made changes to the staff who are now authorised to administer and handle medicines. Additional medication training has already been provided with more planned. Since the last inspection the home has changed to a different pharmacy to supply all the medication for the home. There have been changes to the medicine administration record charts that were used. We found these were clear and properly completed so that there was a full record of medicines that each person in the home had taken. There had been a few teething problems with the change and a few occasions when medicines had been missed as there were none in the home. These were situations which were not entirely the fault of the home. The manager (designate) had taken action to resolve this as soon as possible. In conjunction with a pharmacist for the PCT and the GPs medicines for everyone have been reviewed so that the medicine records were up to date and reflected each persons current needs. A particular issue at previous inspections has been understanding about the use of medicines with directions to use when required. Systems in place to manage these medicines have been revised, were much clearer and staff have been provided with more information to help them in understanding when to use such medicines. We discussed with the manager (designate) about using written protocols to supplement the information already in place. One person was prescribed a particular medicine where a dose of one or two sachets could be administered daily. Although staff had signed each time they had given a dose they did not record how many sachets. This is important to monitor the effect of the medicine and help decide if any further actions were necessary. The records for the application of prescribed skin treatments that staff had applied did not always appear to be made consistently. We found that at least three people living in the home were looking after one of their medicines to administer themselves when they needed them. The medicine records did
Care Homes for Older People Page 4 of 13 not indicate this and there was no risk assessment in place to make sure this process was safely managed. There was no record of when people were given a supply of the medicine to look after. This is important to help monitor that the right amounts of medicines are being used. We were very concerned that on the Sunday teatime just two days before the inspection, because of staff illness, there was no staff member who was trained to administer medication so nobody in the home had received any of their doses due this time. The staff on duty had not thought to alert the manager (designate) to this situation. This incident was a series of medication errors that need formally reporting to us on a statutory notification form. We discussed with the manager (designate) about what he had already done about this and how he was proposing to make sure this does not happen again. He told us that he had checked everyone on the Monday morning when he was told. The manager (designate) has now made arrangements to order and see all the monthly repeat prescriptions in the home before they are sent to the pharmacy for dispensing. This will help to improve stock control and help make sure the medicine records are kept up to date. Medicine storage areas had been sorted out further and were clean and well organised with no excessive stocks. Since the last inspection a new medince storage fridge was installed so that medicines needing storing in a fridge were now stored at the right temperature. Daily records of the fridge temperature were in place to show this. We advised that the temperature of the room where medicines were stored should also be recorded each day as we saw that the thermometer in the medicine trolley was reading 25 degrees C, which is the maximum safe temperature to store most medication. We discussed a couple of ways to reduce heat gain in the room used to store medicines. The manager (designate) told us that opened containers of prescribed creams or ointments applied to the skin were kept in each persons bedroom. We saw that the manager (designate) had a stock checking system in place and was recording results of stock checks he had made. We still also consider that it is good practice to write the date of opening on medicine packs as this helps with proper stock rotation in accordance with guidance that the pharmacy can provide or the manufacturer specifies. It is also useful when auditing medicines. We checked the stocks of controlled medicines with the manager (designate) and these agreed with the quantities in the controlled medicines record book. We found the records in here about the times these medicines were administered were clearer and showed doses given at the right intervals. The discrepancy in the records on a couple of pages in the book identified at the last inspection had been clarified to us in a letter from the previous acting manager and we were able to check that this information was correct. A note is still needed to explain about the recorded stock balance showing on page 72. The manager (designate) has updated some of the medicine policy and brought this together in one place with the medication records file so that it is easily available for staff to refer to. We advised that this could still usefully be further reviewed. What the care home does well:
As reported at the last random inspection of medication in May 2009 medicines were now stored safely and there were regular checks of controlled medicines in place. Care Homes for Older People Page 5 of 13 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 2 5A (2) (a) The Fees Invoice must show information about what services the fee relates to in terms of accommodation, including the provision of food and personal care. The Fees Invoice must show information about what services the fee relates to in terms of accommodation, including the provision of food and personal care. This is so that any resident or their representative paying fees are clear about the services being charged for. 31/07/2008 2 2 5A 30/06/2009 3 3 14 Where a prospective resident 30/06/2009 is funded by a local authority, the home must receive a copy of the care plan before the resident is admitted to the home. This is so that the home has enough information to determine if it can meet the needs of any prospective resident. 4 7 15 (1) The registered person must ensure that all care plans contain clear instructions as 31/07/2008 Care Homes for Older People Page 7 of 13 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action to how the care needs of each resident are to be met. This is to ensure that care staff have the correct information to follow. 5 7 15 The registered person must ensure that all care plans contain clear instructions as to how the care needs of each resident are to be met. This is to ensure that care staff have the correct information to follow. 30/06/2009 6 8 12 Care staff that complete risk 30/06/2009 assessments for residents especially those which relate to pressure area care must be competent to do so in the interests of the residents health and wellbeing. This is so that an accurate assessment can be made. 7 12 16 The home must ensure that 30/06/2009 management and staff have the knowledge and access to information on how residents religious and spiritual needs can be met. This is to ensure that residents religious and spiritual needs can be met. 8 29 19 The registered person must 17/04/2009 complete a risk assessment relating to any information disclosed by Criminal Records Bureau checks in the
Page 8 of 13 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action interests of protecting residents. This is to protect people from possible harm. 9 29 19 The registered person must ensure that before a person starts work in the home, all the information and documents specified in Schedule 2 of the Care Homes Regulations are obtained. This is to safeguard people from possible harm. 10 29 19 The registered person must 17/04/2009 complete a risk assessment relating to any information disclosed by Criminal Records Bureau checks in the interests of protecting residents. This is to protect people from possible harm. 11 29 19 (1) (b) Schedule 2 Before a person starts work 30/06/2008 in the home, all the information and documents specified in Schedule 2 of the Care Homes Regulations must be obtained to ensure that residents are protected through robust recruitment procedures. This requirement has been repeated from the previous inspection. The registered person must ensure that before a person 17/04/2009 17/04/2009 12 29 19 Care Homes for Older People Page 9 of 13 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action starts work in the home, all the information and documents specified in Schedule 2 of the Care Homes Regulations are obtained. This is to safeguard people from possible harm. 13 33 26 The registered person must 17/04/2009 complete unannounced visits to the home and produce reports in accordance with regulation 26 keeping copies in the home. This is so that the registered provider can demonstrate that they are checking that the home is being managed in the interests of the residents. 14 33 26 The registered person must 17/04/2009 complete unannounced visits to the home and produce reports in accordance with regulation 26 keeping copies in the home. This is so that the registered provider can demonstrate that they are checking that the home is being managed in the interests of the residents. Care Homes for Older People Page 10 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 Make sure that when people 17/07/2009 look after and administer any of their medicines themselves there is a proper written risk assessment process in place with actions taken to reflect best practice guidance and to make sure this is safe for everyone in the home. Make records when medicines are given to people to look after, as well as regular checks that they are using their medication correctly. This to help make sure that people are taking the correct amounts of medication and that the arrangements are safe for everyone in the home. Introduce additional written 31/07/2009 guidance for staff about each persons use of any medicine with a direction to use when required, taking into account where necessary the provisions of the Mental Capacity Act 2005.
Page 11 of 13 2 9 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action This is to help make sure staff understand each persons needs for this type of medication and that people receive the correct amounts of medication in a consistent way. 3 9 13 Make sure that there are 17/07/2009 always arrangements in place to have a staff member on duty who is trained and authorised to administer medicines. This is to make sure that people living in the home always receive their medicines at the right times and are not put at risk from missed doses because there are no staff on duty to administer their medicines are the right time. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 Keep a daily record of the temperature in the room where medication is stored to help make sure that medicines are stored below 25 degrees C. Review the arrangements to further improve the recording of prescribed medicines that are applied to skin areas to make sure there is consistent practice and complete records of treatment provided. 2 9 Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
