Inspection on 28/04/08 for Ambleside Residential Home

This inspection was carried out on 28th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ambleside Residential Home 20/10/09

Ambleside Residential Home 23/06/09

Ambleside Residential Home 19/05/09

Ambleside Residential Home 06/04/09

Ambleside Residential Home 07/03/09

Ambleside Residential Home 21/11/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Ambleside Residential Home 69 Hatherley Road Cheltenham Glos GL51 6EG Lead Inspector Mr Adam Parker Unannounced Inspection 09:00 28 , 29th & 30th April 2008 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 Residential Home DS0000069234.V361419.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 Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ambleside Residential Home Address 69 Hatherley Road Cheltenham Glos GL51 6EG 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) 01242 522937 01242 522937 Perpetual Walsh James Christopher Walsh Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 18. 21st November 2007 Date of last inspection Brief Description of the Service: 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. Also, there is a local park within walking distance. The accommodation is located on three floors that are all served by a shaft 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. A number of car parking spaces are available at the front of the house for visitors and staff. The provider supplies information about the home, including the most recent CSCI report to current and prospective residents on request. The fees range from £480 to £598 for local authority funded residents and £610 per week for privately funded residents. Hairdressing, chiropody and any personal items are charged extra. The costs of these services are available as required. Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The registered provider of the home and the manager of the home were present for the three days of the inspection visit, which consisted of a tour of the premises and examination of residents’ care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of residents were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. During the inspection visit four residents were spoken to as well as one visitor, and two members of care staff to gain their views of the service. Survey forms were received from two residents (completed on their behalf by relatives) and two staff working in the home. What the service does well: What has improved since the last inspection? If accidents occur to residents and they suffer any injury the home is now seeking medical advice. Some work has been done around recording the reasons for giving medication prescribed on an ‘as required’ basis and staff have received training in medication administration. Records of alternative diets provided to residents are now being recorded on a regular basis. Two uncovered radiators that may have presented a risk to residents have now been guarded. In general more staff training has been undertaken. Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 6 The home has started using its quality assurance system with actions taken as a result of the findings of surveys. In addition records and documents are now kept in better order. Regular checks are now made on hot water temperatures and cleaning materials are now safely stored. The home has now appointed a manager. 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 Residential Home DS0000069234.V361419.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 Residential Home DS0000069234.V361419.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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for assessing prospective residents suitability for the home have improved so that they can be assured that their needs can be met although some work needs to be done around fees invoices for privately funded residents. EVIDENCE: The Statement of Purpose and Service Users Guide were not checked in detail but it was noted that these documents were not readily available in the home as they were at the previous inspection. After discussion with the registered provider a number of these documents were distributed to residents and plans were made to place copies in the entrance of the home. Information provided around fees charged was brought to the attention of the Commission by a relative of a resident who was privately funded. An example of a fees invoice was looked at and this did not provide detail about what Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 9 services the fee related to. The fees invoice must show the fees payable for accommodation, including the provision of food and personal care. If a single fee is payable then the invoice must demonstrate that the fee relates to the services provided. In addition there had been an increase in fees notified to the relative by letter on the 4th April 2008 relating to a fee increase for the 12th April 2008. The registered provider stated that this increase related to May 2008. However any notification of a fee increase if practicable must be made one month before the increase and must give the reason for the fee increase. The admission documentation and assessments for two residents admitted to the home were looked at. These were privately funded and the home had carried out it’s own assessments. With one resident a hospital discharge summary had been obtained. The home had not admitted any residents who were funded by a local authority since the previous inspection. The home does not provide intermediate care and so standard 6 does not apply. Ambleside Residential Home DS0000069234.V361419.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments must be further developed for all residents to guide staff in meeting their personal and health care needs, In addition medication administration practices need improvement to ensure that residents receive their medication when needed and that an accurate record of administration is made. EVIDENCE: Care files for a number of residents were looked at. There were three types of folder in use for care notes and care plans. One resident had two care plans for one problem and although it appeared that the one plan was intended to replace the other, the earlier plan had continued to be reviewed for several months after the start of the replacement. This situation must be confusing for any care staff that intend to follow written care plans and should be reviewed in the interests of providing clear and accurate information for care staff to follow. Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 11 In addition some care plans did not give clear actions to follow to meet residents’ needs. General statements were made such as “needs encouragement to walk more so she doesn’t lose her independence” which would not give carers clear instructions to follow. One member of care staff spoken to described the care plans as “vague”. A relative of a resident stated on a survey form “New staff or temporary staff do not read care plans.” Care plans as they existed had been kept under monthly review. One resident had a care plan for communication which did in this case gave clear instructions regarding wearing her hearing aid. However on checking with the resident this identified action had not been carried out and the hearing aid had remained in its box. It was reported that nail care was carried out for residents every two weeks. However following up on comments from a relative on a survey form the condition of the finger nails of some of the residents were clearly in need of more frequent attention. A number of risk assessments had been completed individually for residents around such areas as nutrition, mental health and pressure areas. One resident had been identified as having a risk of developing a pressure sore and although a pressure relieving mattress was in place on their bed this had not been identified on the risk assessment document or care plan. In addition two risk assessments had been completed for pressure sores for this resident by different staff giving different scoring and so giving different outcomes. The registered provider must ensure that staff completing such assessments are competent to do so. It was noted that some residents had pressure relieving cushions on chairs in their room and in addition a second cushion was provided for use when they sat in the lounge. One resident was having input from community nurses and others were having visits from chiropodists. The arrangements for medication storage and administration were looked at. Medication is stored securely and storage temperatures have been monitored and recorded. Apart from the refrigerator these were within correct levels. The refrigerator had been showing lower temperatures than those required for the correct storage of the medication. The controlled drug register was examined although in some cases the exact times of administration had been recorded, on many entries only ‘AM’ had been entered. It is important that the exact time of administration is recorded for controlled medication given for pain relief as an indication for the next administration in order to achieve effective pain control. The controlled drug register would also benefit from completion of the index as an aid to identifying separate prescriptions for different residents. The medication administration sheets showed that on the whole two signatures had been recorded where directions were handwritten, checking this practice had formed part of an annual medication audit. The practice of using two Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 12 signatures to check hand written entries should also be extended to courses of medication that are finished or stopped by a GP. Examination of the medication administration records on the days of the inspection visit showed that there had been a number of occasions when administration had not been signed for and one where a staff member admitted to not having signed for several doses of medication and then another staff member had filled the empty spaces in with an omission code. This shows a rather casual and ill-informed approach by some care staff to the administration of residents’ medication. One of the instances of failing to record medication administration had been identified by the new manager who was taking up the issue with the staff member concerned. Staff must ensure that they are signing for medication given or recording an appropriate code if the medication is omitted. Care staff have received training in medication administration and it was confirmed by the registered provider that only staff that have been trained are responsible for administering medication. Given the issues raised in this report around medication a more frequent and thorough medication audit should be introduced. Following a requirement at the previous inspection some work had been done around recording the reasons for giving medication prescribed on an as required basis. This information should now be used to develop individual protocols or plans to guide staff in when to administer medication and for what reasons. Staff were observed treating residents with respect and up-holding their privacy. Residents confirmed that staff knocked on doors before entering and were polite to them. Ambleside Residential Home DS0000069234.V361419.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ are able to maintain contact with family, friends and parts of the local community. This provides a good degree of social contact although further development of activities and of the recording of residents’ preferred social activities and interests would be of benefit. EVIDENCE: During the inspection visit different musical entertainers visited on different days. In the document’ Needs Assessment and Care plan’ it was noted against the heading ‘Social Activities’ “ Music man calls every week to play games and sing and dance”. While this may show what happens on a weekly basis it is not a record of the individuals preferences in terms of social activities. One resident was being taken out for walks several times a week by staff and also taken to visit her husband in another local care home. During the inspection visit there were some visitors to the home and one resident was taken out for the day by their relative. Holy Communion is Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 14 provided in the home fortnightly and a mobile library visits. Concerts had also taken place where relatives of residents had been invited. A trip to the seaside was being planned for June. The home has information about advocacy services available if this should be needed by residents. Individual rooms showed various degrees of personalisation where residents had brought in their own personal possessions. In the homes care documentation there was an area for recording issues around mental capacity. This area was not seen to have been completed for any resident and there was little awareness in the home about the implications of the Mental Capacity Act 2005. The home has a menu that runs on a four weekly basis. A cooked lunch is provided and in the evening supper consists of sandwiches. One resident was eating a vegetarian diet and a separate record was being kept. However on examination the diet was largely lacking in protein and on most occasions consisted of the vegetables without the meat but with no protein substitute added apart from some meals where cauliflower cheese or an omelette had been served. The home must look into providing a balanced nutritious vegetarian diet in the health interests of this resident. Comments from residents about the meals provided were “pretty good” and “ good food”. On a survey form one resident commented “ Excellent food. Well prepared and presented.” Ambleside Residential Home DS0000069234.V361419.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. 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 home’s policies on complaints and preventing abuse should protect residents from harm although training in this area for all staff would be of benefit to people who use the service. EVIDENCE: The home’s complaints procedure was clearly displayed in the entrance hall. In addition it is contained within the Resident’s Handbook (service user’s guide). Three complaints had been received since the previous inspection and these and the written responses were looked at. On the two survey forms completed by relatives of residents both indicated that they knew how to make a complaint. The policy and procedure for protecting residents from abuse was looked at. This was displayed near the entrance of the home and made reference to contacting other agencies if the need should arise. The alerters guide was also on display from the local authority adult protection unit. As well as training in abuse staff have also completed training in managing challenging behaviour. Some staff though have not received training in dealing with abuse and this needs to be followed up. Ambleside Residential Home DS0000069234.V361419.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of living in a well-maintained and generally clean, environment with personalised individual rooms. EVIDENCE: A tour of the premises revealed that the home was generally clean, well decorated and well maintained. Communal areas consist of a lounge at the front of the home, a dining room adjacent to the kitchen and a rear lounge that was particularly light and overlooked the extensive rear garden. Outside there were two patio areas accessible to residents. CCTV equipment was noted to be installed in a number of communal areas of the home although the cameras were no longer functioning and the monitoring equipment was disconnected. Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 17 Individual rooms showed various degrees of personalisation and were clean although one room on the top floor lacked adequate ventilation in that only one of the roof windows could be opened to any extent and this only with difficulty. In some bedrooms small tables were in use and these were showing some wear to the tops and the base and should be replaced. Rooms had locks fitted on the doors suitable for resident’s use and lockable drawers were available. The registered provider gave examples of where residents were able to choose decoration such as the colour of the walls in their rooms. A risk assessment exercise had been carried out on each room in the home to check on the condition of the room and if any issues arose from this. One resident spoken to confirmed that their room was kept clean. Radiators in residents’ bedrooms were covered and since the previous inspection two radiators in communal area had also been covered to protect residents from accidental burns. The laundry was tidy, well organised and had been painted prior to the previous inspection although the paint was starting to peel away in one corner. Hand washing facilities were available in the laundry and in a number of other locations in the home. Ambleside Residential Home DS0000069234.V361419.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The general improvement in staff training should ensure that residents’ needs are met although recruitment practices are still in need of more development in order to protect residents. EVIDENCE: On the first day of the inspection visit the home was short staffed with one of the cooks being off sick. However the newly appointed manager was starting on his first day of working in the home and the registered provider was also present. Generally though examination of duty rotas show that the home has been able to maintain sufficient staffing levels. One resident spoken to stated that there was “just enough staff” A survey form completed by a relative of a resident stated “Sometimes shortage of staff. Therefore you may have to wait for attention. Especially if more than one staff is required.” Two survey forms were received from staff one stating, “The home is always well covered with staff.” normal staffing in the home is 3 care staff on all day and two at night. In addition to the management, care staff are supported by a cook and two cleaners. Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 19 The home has less than 50 of its care staff trained to NVQ level two or three with five out of twelve care staff with an NVQ. there are two staff currently undertaking NVQ with one doing a level two and one a level three. A number of staff had been recruited since the previous inspection. Recruitment files were examined in general all the required information and documentation had been obtained for the recruitment of staff although one staff member had not provided a full employment history and so a reference that related to care work had not been taken up. In order to protect residents, the home must check that applicants are providing a full employment history. In addition dates of employment on application forms need to be more accurate. It is not sufficient just to accept years as dates. Induction has been provided to new staff although the home must consider how its current induction meets with the nationally recognised Common Induction Standards. Ambleside Residential Home DS0000069234.V361419.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recent appointment of an experienced manager together with the use of a quality assurance system should help to ensure that the home is being run in the interests of the residents. However some current practices may not be in the interests of residents’ safety and need review. EVIDENCE: On the first day of the inspection visit a new manager had started working. The manager has previous experience in working in care settings and has the Registered Managers Award and NVQ 4 in care. The home has been making use of the quality assurance system through compiling the results of surveys sent to people with an interest in the home. Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 21 This includes residents, their relatives and visitors, staff and health care professionals. There was some evidence of action taken as a result of the findings to improve the care for individual residents. Reports had also been compiled following visits to the home by the registered provider. The arrangements for looking after residents’ money in secure storage was looked at and were satisfactory with records kept. A check on the money held for three residents showed this to be accurate in relation to their records. At the previous inspection it was noted that records kept in the home were not in a good state of order. At this inspection there was an improvement with information stored in an orderly fashion and more easily obtainable. Staff had received training in fire safety, first aid, manual handling, food hygiene and infection control. Two staff had not attended the manual handling training and the registered provider said that this would be followed up. However one resident had some moving and handling needs identified relating to them getting up out of bed. When asked how this was managed (in the prescence of the registered provider and the manager) a member of care staff described the use of an under-arm lifting technique wich is unsafe for both the resident and members of staff. There was clearly a need for moving and handling aids to be brought into use which other staff identified as being available in the home and being part of training provided. An accident record from December 2007 showed that a member of staff had injured themselves moving a resident. Examination of the care notes for a resident who had recently been moved on to a care home with nursing care showed that they had been identified as requiring a hoist as early as February 2008 although there was no record of the hoist being used until April 2008.The registered provider stated that the resident had refused the use of the hoist which must have caused some problems with safe moving and handling. One resident had fallen out of bed, the accident had been recorded and suitable bed rails were being sought in the mean time grab rails had been placed on the bed to prevent the resident falling out. These were not designed to prevent residents falling out of bed but as an aid to independence. The home must check with the manufacturer regarding the use of these rails for a purpose that they may not be designed for. In addition a risk assessment exercise must be carried out regarding the use of bed rails or grab rails taking into account information published by the Health and Safety Executive and the Medicines and Healthcare products Regulatory Agency. The accident records were examined; these are subject to a monthly audit and the registered provider has demonstrated how there has been a reduction in the number of falls in the home through auditing accidents and taking any necessary action to meet residents’ needs in this area, which is a commendable piece of work. Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 22 The central heating system had been previously serviced and was due another service in the week of the inspection visit. Portable electrical appliances had been checked in August and hoists in November 2007. Work had been carried out in respect of any potential risk to residents from Legionella. The home has kept a regular check on hot water temperatures both in individual rooms and communal bathrooms. The home had started work on a fire risk assessment although the copy seen at the inspection was incomplete. However the home had an inspection from the fire safety officer in December 2007 with a satisfactory follow up visit in April 2008. It was noted that individual fire risk assessments had been completed for residents. The home had received a visit from the environmental health department of the local authority in August 2007 and the report was looked at during the inspection. Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 23 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 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 2 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 2 Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5A (2) (a) Requirement 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. Any increase in fees must include a statement for the reasons for such an increase. Any notification of an increase in fees must be made one month in advance of the increase if it is practicable to do so. 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. Where care plans do give clear instructions in meeting resident’s needs then these must be followed by care staff. Care staff that complete risk assessments for residents especially those which relate to pressure area care must be competent to do so in the DS0000069234.V361419.R01.S.doc Timescale for action 31/07/08 2 3 OP2 OP2 5A (3) 5A (3A) 31/07/08 31/07/08 4 OP7 15 (1) 31/07/08 5 OP7 12 (1) (a) & (b) 12 (1) (a) & (b) 30/06/08 6 OP8 31/07/08 Ambleside Residential Home Version 5.2 Page 25 7 OP9 13 (2) 8 OP9 13 (2) 9 OP15 16 (2) (i) 10 OP25 23 (2) (p) 11 OP29 19 (1) (b) Schedule 2 12 OP31 13 OP38 14 OP38 Care Standards Act Section 11 (1) 13 (5) In the interests of residents’ safety the registered provider must ensure that all care staff are using safe and recognised moving and handling techniques with appropriate aids identified through assessment. 13 (4) (c) Any equipment used to prevent residents from falling out of bed must be used in line with the DS0000069234.V361419.R01.S.doc interests of the resident’s health and wellbeing. Medication administration or omission must be signed for as an accurate record that residents are receiving the medication that they require to meet their health needs. Controlled drugs for pain relief must be administered as close as possible to the directed time and administration times must be accurately recorded. Ensure that any special diets such as vegetarian meals provided for a resident are balanced and nutritious to ensure their well-being. Ensure that there is adequate ventilation in room 19 for the comfort of the person using the room. Before a person starts work 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. An application to register a manager at the home must be made. 30/06/08 30/06/08 30/06/08 30/06/08 30/06/08 31/07/08 31/07/08 30/06/08 Ambleside Residential Home Version 5.2 Page 26 manufacturers instructions and subject to risk assessment. 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 2 3 4 5 6 7 Refer to Standard OP7 OP7 OP8 OP9 OP9 OP9 OP9 Good Practice Recommendations The care of resident’s finger nails should be carried out more frequently. Review the use of different care plan files for residents to provide clearer and more accurate information for care staff to follow in meeting resident’s needs. Where residents are identified as needing pressure relieving equipment such as a mattress this must be identified in the appropriate risk assessment or care plan. The temperature in the medication storage cupboards should be monitored and recorded to check that residents’ medication is being kept at the correct temperature. The index in the controlled drug register should be completed as an aid to identification of different prescriptions for different residents. A more frequent and thorough medication audit should be introduced. Information gathered about the reasons for giving medication prescribed on an as required basis should be used to develop individual protocols or plans to guide staff in administration. The practice of using two staff to check and sign for handwritten medication directions should also be used where medication is stopped or finished. Further develop the provision of activities in the home through consultation with residents and use of resources. Make a record of residents, hobbies, interests and preferred social activities not just those they take part in that are provided by the home. Tables in individual rooms that are showing signs of wear should be replaced. Attend to the peeling paint in the corner of the laundry. The home should improve the number of care staff with an NVQ level 2. DS0000069234.V361419.R01.S.doc Version 5.2 Page 27 8 9 10 11 12 13 OP9 OP12 OP12 OP24 OP26 OP28 Ambleside Residential Home 14 OP30 The home should check how its current induction fits with nationally recognised standards. Ambleside Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Residential Home DS0000069234.V361419.R01.S.doc Version 5.2 Page 29 - 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!