Care Home: Ambassador House

What the care home does well Residents expressed a good deal of satisfaction regarding the quality of service they receive at Ambassador House. Their views including those of visiting relatives, professional and staff, have been reflected in the report. The pre-admission assessment and care planning processes are effective. The implementation of health and personal care needs is being monitored internally through a monthly review system. Social services undertake their own annual review for each resident; this ensures that identified needs are being met and unmet needs, closely monitored. Both review systems focus on the individual person, which ensure their involvement in all aspects of their lives. Activities offered to residents provide them with a good level of stimulation. Residents are involved in menus planning and food available is of a high standard. Quality and diversity issues are being promoted and residents` cultural and religious requirements are well met. Residents are treated with dignity and respect. During the inspection the manager and a care staff spoke to residents in a friendly, social and respectful manner. Information gained shows that staff would take swift and appropriate action to protect and promote the welfare of residents. Care and staff management systems are being implemented to good effect. NVQ training for staff is being given a high profile, which means that staff have the skills and knowledge to deliver an improved service to residents. The home is being well managed, which benefits the staff and the people in residence. What has improved since the last inspection? There were 2 requirements and 3 recommendations made in the last key inspection report dated 10 July 2007. These have been implemented to good effect, thus resulting in an overall improved quality of service for residents. The manager ensures that individual risk assessments are carried out for those residents who have diabetes. Written guidance is in place to ensure that personnel are aware of the immediate action that must be taken, should people have a sudden health crisis that is related to uncontrolled diabetes. Whilst maintaining the security of the home, staff now ensure that it does not infringe on the rights of people living in the home to leave the building without restriction; they also ensure that exit from the building in the event of an fire is not delayed. Risk assessments about these issues are being systematically carried out. The home has introduced a refurbishment programme, in order to ensure that the standard of decoration is maintained throughout to a satisfactory standard. There has been a review of the ancillary staffing arrangements to ensure that care staff members are not called upon to carry out ancillary; this has resulted in care staff focusing their attention on the care needs of residents. What the care home could do better: There are 2 recommendations arising from this report, which need addressing. Considering the mental frailty of some of the residents and their lack of mentaI capacity in the decision making process, staff should be proactive in obtaining their representative`s signature. The frequency of fire drills should be be increased as appropriate and fire drills records should include the name of all participants. This would assist the manager to ensure that all staff have the opportunity to participate in at least 1 drill annually. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ambassador House 31 Lansdowne Road Luton LU3 1EE     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Neil Fernando     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Ambassador House 31 Lansdowne Road Luton LU3 1EE 01582486244 F/P01582486244 NoEmail3/7/2007 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) : Mr Cornelius Crowley,Mr Stephen Giles care home 25 Number of places (if applicable): Under 65 Over 65 25 25 25 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 The home can accommodate a maximum of 25 service users of either sex. Date of last inspection Brief description of the care home Ambassador House is located in a quiet residential suburb of Luton. It is a large extended detached house with an observatory feature within the roof. The home is registered to provide care for 25 older people. The bedrooms are located on all three floors of the building and accessed by stairs and/or a shaft lift. Toilet and bathing facilities are on each floor; eight single bedrooms and the one double room have ensuite toilet facilities. A lounge and a lounge/diner are located on the ground floor with a further lounge/diner on the first floor. Arrangements are in place to ensure that people living in the home are able to receive the services of a visiting hairdresser and a podiatrist; those using these services are responsible for the fees. Satisfactory arrangements are also in place to ensure that Care Homes for Older People Page 4 of 29 Brief description of the care home referrals to healthcare professionals are carried out. A well-maintained garden is available at the rear of the property, with flower beds, trees and garden furnitures. It is accessible and well used by residents in the warmer weather, in particular. There is some private car parking facility to the front and some time limited road parking available on the street outside the home. A copy of the service users guide and inspection report is available for residents and visitors to read. The fees for this service vary between £460 and £540 per resident, per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We, the Care Quality Commission, undertook this unannounced key inspection on 4 June 2009. We spoke with the manager, 6 residents, 3 staff including a team leader, 1 visiting professional and 3 relatives. We had a look round the home and viewed a range of records the home must keep. At the time of the visit, there were 23 residents accommodated with 2 vacancies. We have received a completed AQAA (Annual Quality Assurance Assessment) a document, which gives the manager the opportunity to tell us how the home is Care Homes for Older People Page 6 of 29 meeting the standards and regulations. We have also received surveys from 6 residents and 4 staff. The manager was present throughout the inspection. The last key inspection was carried out on 10 July 2007; an annual service review was undertaken on 13 June 2008. What the care home does well: What has improved since the last inspection? There were 2 requirements and 3 recommendations made in the last key inspection report dated 10 July 2007. These have been implemented to good effect, thus resulting in an overall improved quality of service for residents. The manager ensures that individual risk assessments are carried out for those residents who have diabetes. Written guidance is in place to ensure that personnel are aware of the immediate action that must be taken, should people have a sudden health crisis that is related to uncontrolled diabetes. Whilst maintaining the security of the home, staff now ensure that it does not infringe on the rights of people living in the home to leave the building without restriction; they also ensure that exit from the building in the event of an fire is not delayed. Risk assessments about these issues are being systematically carried out. The home has introduced a refurbishment programme, in order to ensure that the standard of decoration is maintained throughout to a satisfactory standard. There has been a review of the ancillary staffing arrangements to ensure that care staff members are not called upon to carry out ancillary; this has resulted in care staff focusing their attention on the care needs of residents. Care Homes for Older People Page 8 of 29 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admission processes show that the home is careful to only offer a place to the resident whose needs and aspirations it can meet. Evidence: The AQAA tells us A detailed needs assessment is carried out at their home, at our home, hospital or other, by a manager or senior staff member. Where possible, we obtain a copy of a previous/ current care plan. In the Best Interest of the individual a decision is made to determine whether the individual needs may or may not be met and if the home is suitable for them. The statement of purpose and service users guide is available and reflects the service provided. Residents and visiting relatives spoken to confirmed that a copy of this document has been offered to them at the time of admission. Care Homes for Older People Page 11 of 29 Evidence: The case files viewed for 3 residents demonstrate that they have been issued with individual terms and conditions of their placement and the current charges; this has been signed by the resident, their representative where appropriate and the home manager. The manager said that the service agreement is being developed into a user friendly format. Evidence on the 3 files examined also shows that the manager carries out appropriate pre-admission assessments before any residents could be admitted to the home. The manager also takes into account other assessments completed by the social worker from the placing authority. This process therefore makes sure that the home only offers a placement to the prospective resident, whose identified needs could be addressed satisfactorily. The manager visited me at the hospital before I came here, said a resident. The staff spoken to including a team leader said that when a vacancy is available, the prospective resident and their representative would be encouraged to visit and Test drive the service, in order to find out if their needs could be appropriately and fully met. We would always assist and provide any information needed, reported a senior staff and I visited a few homes before choosing this one, said a visiting relative. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The identified needs are carefully woven in the care plan for each resident and staff members have a thorough knowledge of their needs; this ensures that their health and personal care are appropriately and fully met. Evidence: The AQAA states Set up detailed individual care plans, identifying all needs and choices for health, personal and social wellbeing and a plan for how these may be achieved. Where applicable incorporating Advance Plan of Care. Ensuring that they are monitored and reviewed regularly (or monthly as a minimum requirement), with the resident / family where possible and recorded correctly. The care plan is developed with contribution from the resident, their representative and home staff. Information from three care plans, residents and staff members indicates that the needs of residents are being identified and addressed well. The care plan indicates how identified needs are to be met. Staff members maintain a record of the care given, progress made and interactions with other people on each shift. Care Homes for Older People Page 13 of 29 Evidence: Identified health care needs are being addressed and observations are maintained, in order to respond to any changes in the residents health care needs. The resident, their representative and the key worker are involved in the care planning process and their signatures are being obtained in the care plan where appropriate. Residents spoken with were able to identify their key worker by name and they provided many examples of how their key worker helps them on an ongoing basis. Care plans are being reviewed monthly to reflect the changing needs and objectives for health and personal care. Review minutes are maintained and evidence shows that the resident and their key worker have signed them, but there is some inconsistency in obtaining the signature of their representative. Considering the mental frailty of some of the residents and their lack of mentaI capacity in the decision making process, staff should be proactive in obtaining their representatives signature. Once this issue is addressed, this standard would be fully met. Risk assessments are completed for each resident and these are reviewed as required. All residents are registered with a GP from three local practices. Other professionals, residents have access to include district nurse, dentist, optician, podiatrist, dietitian and occupational and physio therapist. Residents spoken with expressed a high level of satisfaction in the manner their health care needs are being addressed, a view echoed by both visiting relatives. My granddad has been ill a couple of times and staff called on both occasions to inform me about his health, excellent communication from staff, said a relative; When service users develop any pressure sores, staff always follow our advice, said a visiting professional. The procedure on medication is comprehensive and this ensures that staff members administer medication in a safe and satisfactory manner. Only senior care staff are authorised to administer medication; they have all received training in the administration of medicines. None of the current residents, bar one person, administer their own medicines; appropriate risk assessment has been completed for the resident. Medication administration records for 8 residents were checked and these were in order. The storage and handling of medicines including controlled drugs is safe and satisfactory. I am given my medicines always, said one resident. Residents stated that their care is provided in a dignified and respectful manner, and their privacy is upheld. Examples include: They are always courteous and respectful to us, Helpful and alright, always you know and Staff always knock before entering. The bottom line is that staff are caring and have very good relationship with the residents, said a visiting relative. Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the opportunity to participate in a range of activities that develop and enrich their social and personal lives. They can also be assured that they will be offered a varied diet that meets their requirements. Evidence: The AQAA tells us We gather as much background information on each individual to identify their previous lifestyle, in order to establish their expectations, preferences and accommodate their social, cultural, religious and recreational interests and needs. The care records viewed and residents, and staff spoken with confirm that activities and facilities accessed reflect the needs of each individual in relation to their interests and abilities. The care plans seen evidence that individuals prefer to occupy themselves with different things. Residents are encouraged to be proactive in their views about the services offered and make suggestions about improvements or new initiatives. Residents and their representatives are encouraged to complete an annual customer satisfaction questionnaire. Activities are arranged either individually or in small groups; they are both planned Care Homes for Older People Page 16 of 29 Evidence: and ad hoc, to suit the residents taste and preference. Outside entertainment is brought in at least once every month and residents are informed well in advance. Social events and trips out are offered to service users throughout the course of the year. The hairdresser visits regularly and residents appear to value this service very much. Example of comments from residents include: There are always activities taking place and enjoyable too, I prefer to read and watch television and I like most activities board games and gardening, in particular. However, responding to our survey as to What could the home do better?, one resident wrote More activities Outdoor events. This issue has been shared with the manager to deal with. The owners have recently purchased a minibus, which is being shared by all four homes within the organisation. The staff told us that this is very helpful for residents to access outside activities. The care plans for three residents were examined; they show that residents are being assisted to follow the lifestyle of their choice as discussed and agreed at the time of their assessment. Four residents spoken with said they are satisfied with their lifestyle at this home. Evidence shows that family and friends visit regularly and they are always made welcome. Staff are helpful, caring and maintain good communication and Its like a family home, commented two visiting relatives. Resident are able to entertain their visitors in the communal areas or the privacy of their own bedroom. Equality and diversity issues are given a high profile. Of the current 23 residents, 7 people are from a minority ethnic group. Good evidence is available to show that residents are actively encouraged and they are able to practice their religion and their culture, as they wish. The local church representative offers services and a priest visits the residents regularly. Without exception, all residents spoken with said that they are fully satisfied in the manner their cultural and religious needs are being addressed. Despite visiting the kitchen during lunchtime preparations, it was clean and orderly. The menus viewed and residents confirmed that fresh vegetables are provided daily. Lunch was served in a pleasantly furnished and decorated dining area and appeared nutritious and appetising, with residents confirming how much they enjoyed the food. Staff were available in good numbers and residents who needed support to eat their food, received help in a very sensitive and dignified manner. Evidence also shows that they are offered choices of what to eat and drink. Smashing, always plenty and good variety too, Very good, if you ask and Its as good as you would expect, are example of comments from residents spoken with. Care Homes for Older People Page 17 of 29 Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints and safeguarding procedures are well publicised; thus, ensuring residents are listened to if dissatisfied with any aspects of the service and they are protected from harm. Evidence: The AQAA tells us Ensure that all residents and/or their families/representatives have a copy of our complaints procedure and understand it. The document is comprehensive with clear objectives and timescales indicated. Robust recruitment policy assure the safeguarding of vulnerable adults. The previous inspection has established that the home has satisfactory written complaints and safeguarding procedures in place. These have been updated in May 2009. We have been informed that information on how to raise a concern is provided to everyone living at the home. Evidence from completed surveys from 6 residents show that they feel able to make a complaint. I would speak to my key worker or community nurse and The home does the majority of most things well and I have no complaints and quite happy, are examples of comments reflected by 2 residents in their survey. All 5 residents spoken to expressed confidence in that staff would respond appropriately if they had any concerns. The service is simply good, if you ask Care Homes for Older People Page 19 of 29 Evidence: me, said a resident and We are happy with the care given to our granddad, reported a visiting relative. Staff spoken with demonstrated a knowledge of the complaints procedure. There is one complaint recorded since the last annual service review of the home in June 2008. The matter was investigated and concluded in writing by the manager. The Commission has not received any complaints about this service. 16 staff have received training on safeguarding of vulnerable adults. Documentary evidence is available to show that this specific training is being provided by Luton Borough Council to the remaining 7 members on 12 June 2009. With this in mind, a requirement is not being made. This standard will be fully met once these staff have completed their training. Record indicates that there has been no safeguarding matter arising in the previous 12 months. The systems in operation should adequately protect a resident from harm. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation offers a homely and pleasant environment, and is suitable for the needs of the people in residence. A high standard of cleanliness was evident. Evidence: We undertook a brief tour of the premises to include 9 bedrooms, 2 lounge/diners and 3 bathroom/toilet facilities. The standard of decoration and furniture and fittings in all those areas viewed is good. There is adequate space for residents to sit quietly and or meet with their friends. The bathroom and toilet facilities have been adapted to meet the needs of people with a physical disability. Suitable specialist equipment is available and serviced regularly. The staff spoken with told us that residents are encouraged to personalise their bedrooms and choose the decoration to suit their taste and preference. The residents spoken with confirmed that they are able to personalise their bedroom with additional furniture, photographs and other personal effects. Evidence of this was seen in the bedrooms viewed. Residents, where appropriate, keep the key to their bedroom and are able to lock their own bedroom door. This upholds their privacy and security. Staff were seen to knock and wait before entering bedrooms and residents were being offered an explanation prior to staff assisting them; these are good examples of how Care Homes for Older People Page 21 of 29 Evidence: staff members ensure the privacy and dignity of residents. Residents spoken with expressed a good deal of satisfaction with their physical environment - Very satisfied with my accommodation, reflected a resident in their survey and Always smelling fresh and very hygienic place, commented a visiting relative. There is a good size garden to the rear of the property, which is well maintained. It offers a patio area with garden furnitures. On the day of the visit an occupational therapist together with a couple of residents were potting flowers. Residents spoken with said that they enjoy the garden during the warmer weather, in particular. A high standard of cleanliness was evident throughout those areas viewed. There were no health and safety hazards noted. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment processes are robust, which means that residents are protected from harm. Training ensures that staff have the knowledge and skills to adopt a more holistic approach to meeting the needs of residents. Evidence: The AQAA states As declared in our statement of purpose, we have experienced, competent, well trained staff. We avoid using agency staff, in the event of absences, fellow staff will cover shifts or our core group of staff from our sistering homes on the same road will assist. This offers continuity of staff, with residents always having the opportunity to recognise their carer. Information from staff and duty rota for a period of 4 weeks shows that there are adequate numbers of staff available during the day and night shifts. In terms of skill mix, the staffing arrangements are appropriate to ensure that the needs of the people in residence could be met. All new members receive induction tailored to their needs. I feel that it really helped me become more orientated with the practice at the home, stated a new staff member. Evidence demonstrates that staff receive relevant training on a range of subjects including Health and Wellbeing, Good Nutrition, Bereavement, Aggression and Care Homes for Older People Page 23 of 29 Evidence: Violence, Diabetes, Dementia, Medication, Continence Management, and Mental Capacity Act. Management team members have completed Skills and Supervision. Of the current 20 care staff including seniors, 12 hold an NVQ level 2 and 6 members are currently working (completing in June 2009) towards it. This demonstrates that a high ratio (90 ) of care staff hold an NVQ Level 2. The training and future development of staff is being given a high profile, thus providing them with the skills to deliver good quality service to residents. The recruitment policy and procedure was discussed with the manager. Examination of personnel files for three staff members including the latest recruit evidence that the required checks are in place, including references and Criminal Records Bureau checks. Staff interviewed said that the above checks had been carried out before they started work at the home. Residents expressed a good level of satisfaction regarding the service they receive and complimented staff for their hard work. They are always courteous and very helpful, said a resident; I enjoy coming here and staff are pleasant, Staff are helpful and they maintain good communication are examples of positive comments from 2 visiting relatives. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed and the staff team, well supported. This ensures a good and safe standard of service delivery for residents. Evidence: The AQAA tells us The registered manager is registered, responsible, fit, qualified, competent, skilled and accountable, who ensures the service users and staff benefit from the ethos, leadership and management approach of the home. The manager has worked at Ambassador House for 11 years, the latter 7 years as the registered manager. She holds an NVQ level 4 and 5 in management. The manager has the skills and experience to manage the home very well. Staff are complimentary about the management support they receive. Examples of comments include Very good, Very accommodating, She is always there to talk to, You feel happy to come to work and I have been here for 7 years and she ensures that staff are happy and residents needs are met. Care Homes for Older People Page 25 of 29 Evidence: There is good evidence to demonstrate that quality assurance systems are in place to seek the views of residents and their representatives. The last annual survey was completed on 18 January 2009. The outcomes of the survey are publicised and finally displayed in the main entrance area for the benefit of residents, visiting relatives and other stakeholders. The owner has undertaken monthly visits to the home, in order to ensure that appropriate standards are being maintained. A random sample of reports on these visits were viewed and noted to be satisfactory. Evidence of recorded supervision sessions is available. All staff members spoken with confirmed that they receive formal 1 to 1 supervision regularly. We viewed a sample of records the home is required to keep, including administrative records for 3 residents day today expenses; these were in good order. Health and safety are being attended to. Mandatory training has been completed by staff. Fire drills are carried out once every six months. Considering the size of the staff team and frequency of fire drills, it is unlikely that all members will have the opportunity to participate in at least one fire drill annually. The frequency of fire drills should therefore be increased as appropriate. Also, fire drills records should include the name of all participants; this would assist the manager to ensure that all members participate in at least 1 drill annually. The manager said that action would be taken to address the above issues. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 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, Care Homes 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 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 7 Considering the mental frailty of some of the residents and their lack of mentaI capacity in the decision making process, staff should be proactive in obtaining their representatives signature. The frequency of fire drills should be be increased as appropriate and fire drills records should include the name of all participants. This would assist the manager to ensure that all staff have the opportunity to participate in at least 1 drill annually. 2 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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