Care Home: Ambleside

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What the care home does well The home understands the importance of having enough information when choosing a care home. Admissions and re admissions are not made until a full assessment of needs has been carried out so that prospective residents and their representatives can be sure that their needs will be fully metAmblesideDS0000072769.V378751.R01.S.docVersion 5.2The complaints procedure is supplied to everyone living in the home. Staff working in the home understand the procedures for safeguarding, and know when incidents need to be reported externally. We looked at the records for personal financial expenditure of four residents. These were being completed correctly and the funds remaining in each account balanced with the records. We cross referenced receipts for two recent transactions and these were correct. Rotas show that the home is staffed efficiently, with particular attention given to busy times of day, and changing needs of residents. This homes sees induction and probation as vital in the employment process and positions are only confirmed when satisfactory competencies are achieved. Risk assessments had been completed relating to a wide range of activities/ individual needs, including nutrition, moving and handling, skin viability, Mental Capacity and Deprivation of Liberty where appropriate. These were being kept under review. What has improved since the last inspection? Following the last inspection in September 2009 the home owner was required to submit to the Care Quality Commission: • The annual accounts of the care home certified by an accountant. • A reference from a bank expressing an opinion as to the registered providers’ financial standing. • A business plan and current cash flow forecast in respect of the care home. • Information as to the financing and financial resources of the care home. This information was submitted and was all in order. At present the new manager is working closely with the home owner Ms Alka Patel to implement new structures to improve the service. In the previous report we raised concerns that the manager at the time had limited involvement in the ordering of food stores. This was being done by the home owner whose time spent in the home was minimal. The new manager confirmed to us that she and the home owner now do this together, and incorporate resident’s preferences and their suggestions regarding the menus.AmblesideDS0000072769.V378751.R01.S.docVersion 5.2 What the care home could do better: The manager told us that she was in the process of implementing the supervision plan for staff, however this is work in progress, and the staff that we spoke to had not yet received any supervision from the new manager. The environment is generally clean and comfortable and meets the specific needs of the people who live here, however not all bathing facilities are suitable or accessible to all residents at present. Since coming into post the manager has introduced new care plan documentation, and is in the process of rewriting existing care plans. We could see the extent of work that had gone into formatting and implementing these plans, however more work is needed to ensure there is detailed information for staff to follow to ensure that continuity of care is maintained for these residents. People in this home are generally happy with the care they receive, however details on how care should be delivered are not consistently recorded. The home understands the need to comply with the administration, safekeeping and disposal of medication, however good practices are not always being followed. The manager has the appropriate skills and experience to run this home. She is improving and developing systems that monitor practice and compliance with the plans, policies and procedures, however more work is needed. Key inspection report CARE HOMES FOR OLDER PEOPLE Ambleside 60 Hart Hill Drive Luton LU2 0AY Lead Inspector Mrs Louise Trainor Key Unannounced Inspection 11:15 21st December 2009 DS0000072769.V378751.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ambleside DS0000072769.V378751.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Ambleside DS0000072769.V378751.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ambleside Address 60 Hart Hill Drive Luton LU2 0AY 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) 01582 454402 Alka Patel Vacant Care Home 17 Category(ies) of Dementia (17), Old age, not falling within any registration, with number other category (17), Physical disability (17) of places Ambleside DS0000072769.V378751.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical Disability - Code PD The maximum number of service users who can be accommodated is 17 15th September 2009 2. Date of last inspection Brief Description of the Service: Ambleside was located in a pleasant residential suburb of Luton. The amenities of the town, which include links to national bus and rail routes, were a short car ride away. The building had been sympathetically converted from its previous use as a hotel. The accommodation was decorated and furnished to provide a comfortable environment. The home was registered to provide care for seventeen older people who may also have dementia and/or physical disabilities. Single room accommodation was provided. Eight of the rooms had en-suite toilet and washbasin facilities. Washbasins were fitted in the remaining bedrooms. A bathing facility was located on each of the three floors. Six toilets were provided at accessible locations in addition to the en-suite provisions. The fees for this service presently range from £500.00 - £520.00 per week. Hairdressing and chiropody are available at an additional cost. Ambleside DS0000072769.V378751.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out in accordance with the Care Quality Commissions (CQC) policy and methodologies, which requires review of the key standards for the provision of a care home for older people that takes account of residents views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgments made within the main body of the report include information from this visit. This was a Key Inspection carried out by Regulatory Inspector Mrs Louise Trainor on the 21st of December 2009 between the hours of 11:15 and 15:45 hours. During this inspection the care of two residents was case tracked. This involved reading their records and comparing what was documented to the care that was being provided. Documentation relating to: staff recruitment, supervision and training, medication administration, complaints, quality assurance and health and safety in the home were also examined. We also had a tour of the premises and spent some time in the communal areas of the home, talking to the residents and observing the care practices and interventions that were carried out during this four and a half hour inspection. We would like to thank everyone involved for their assistance and support during this inspection. What the service does well: The home understands the importance of having enough information when choosing a care home. Admissions and re admissions are not made until a full assessment of needs has been carried out so that prospective residents and their representatives can be sure that their needs will be fully met Ambleside DS0000072769.V378751.R01.S.doc Version 5.2 Page 6 The complaints procedure is supplied to everyone living in the home. Staff working in the home understand the procedures for safeguarding, and know when incidents need to be reported externally. We looked at the records for personal financial expenditure of four residents. These were being completed correctly and the funds remaining in each account balanced with the records. We cross referenced receipts for two recent transactions and these were correct. Rotas show that the home is staffed efficiently, with particular attention given to busy times of day, and changing needs of residents. This homes sees induction and probation as vital in the employment process and positions are only confirmed when satisfactory competencies are achieved. Risk assessments had been completed relating to a wide range of activities/ individual needs, including nutrition, moving and handling, skin viability, Mental Capacity and Deprivation of Liberty where appropriate. These were being kept under review. What has improved since the last inspection? Following the last inspection in September 2009 the home owner was required to submit to the Care Quality Commission: • The annual accounts of the care home certified by an accountant. • A reference from a bank expressing an opinion as to the registered providers’ financial standing. • A business plan and current cash flow forecast in respect of the care home. • Information as to the financing and financial resources of the care home. This information was submitted and was all in order. At present the new manager is working closely with the home owner Ms Alka Patel to implement new structures to improve the service. In the previous report we raised concerns that the manager at the time had limited involvement in the ordering of food stores. This was being done by the home owner whose time spent in the home was minimal. The new manager confirmed to us that she and the home owner now do this together, and incorporate resident’s preferences and their suggestions regarding the menus. Ambleside DS0000072769.V378751.R01.S.doc Version 5.2 Page 7 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 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. Ambleside DS0000072769.V378751.R01.S.doc Version 5.2 Page 8 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 DS0000072769.V378751.R01.S.doc Version 5.3 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 People using the service experience good quality outcomes in this area. The home understands the importance of having enough information when choosing a care home. Admissions and re admissions are not made until a full assessment of needs has been carried out so that prospective residents and their representatives can be sure that their needs will be fully met We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: This service has a Statement of Purpose and Service User Guide in place. It is reviewed regularly to ensure that the information is current, and each person who lives in the home has a copy of these documents in their bedroom. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 10 We looked at these documents during this inspection; they appropriately reflected the current management structure of the home and facilities available. We looked in detail at the files of two people who live in this home, one had been admitted since our last inspection, and since the new manager had been appointed. There was a pre admission assessment in place, which clearly identified all the needs of this individual, and the level of care they would require in the home. This information had been used to formulate basic care plans. Contracts are in place for all people who live in this home. This home does not presently provide an intermediate care service. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 People using the service experience adequate quality outcomes in this area. People in this home are generally happy with the care they receive, however details on how care should be delivered are not consistently recorded. The home understands the need to comply with the administration, safekeeping and disposal of medication, however good practices are not always being followed. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During this inspection we looked at files and documentation for three residents, two in detail. Resident’s profiles were clear and informative, and included individual’s personal preferences, likes and dislikes. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 12 Risk assessments had been completed relating to a wide range of activities and individual needs, including nutrition, moving and handling, skin viability, Mental Capacity and Deprivation of Liberty where appropriate. These were being kept under review. Since coming into post the manager has introduced new care plan documentation, and is in the process of rewriting existing care plans. We could see the extent of work that had gone into formatting and implementing these plans, however more work is needed to ensure there is detailed information for staff to follow to ensure continuity of care is maintained for these residents. One care plan that we looked at, read. “Staff to assist ------ with personal care, oral hygiene, shaving / showering”. This did not give staff any indication of the level of support required to carry out these tasks. Another file that we looked at identified that this person had a catheter in situ, but there was no clear care plan for staff to follow relating to basic catheter care. The manager showed us an information sheet on catheter care and told us that staff were being given this to read, and then asked to sign confirming their understanding. However the staff that we spoke to had not yet seen this document. We appreciate that the District Nurse attends the home regularly to manage catheter issues, but it is important that staff are aware of the basic daily care procedures. This was similar for someone with diabetes. Although the district nurse manages the administration of insulin and monitoring of blood sugar levels. We would expect to see a care plan that advised care staff in the home, how to recognise when blood sugar levels were unstable, and what actions they should take if this were to occur. Interactions that we observed between staff and residents were respectful but also relaxed and familial. Staff knocked on resident’s doors and bathrooms doors before entering and appropriately referred to people using their chosen form of address. During this inspection we looked at the Medication Administration Record (MAR) sheets for eight of the people who live in this home. The first three MAR sheets that we looked at, we were unable to reconcile correctly with stocks, due to missed signatures, however as the inspection progressed and we looked at more MAR sheets, it became evident that the missing signatures were all on the same date, at the same time indicating that one member of staff was responsible. This matter was taken up by the manager who was able to identify the person responsible and was going to address the matter immediately. With the exception of the above mentioned, the regular medication that was dispensed in blister packs were correct, but ‘as required’ medication such as Paracetamol and Movicol could not be accurately reconciled as stocks were not Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 13 being recorded when carried forward from one month to the next. The reverse of the MAR sheets was rarely being completed when doses of medication were omitted or varied from the prescription. We also noted when checking the Controlled Drugs (CDs) in the home, that although stocks and records reconciled, the completion of the CD records was not very clear and they were not all completed in a formal CD record. Despite bound records being put in place by the previous manager, there were still single sheets of paper in place for some residents, this is not acceptable. However the new manager has just purchased a new CD register that meets with regulations and is in the process of transferring records. She also explained that she is introducing a new audit system so that she can monitor the medication administration more closely herself. We appreciate that the manager is very new in post and the implementation of new systems takes time. We expect to see these working effectively by the time we visit the home for a compliance check. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. People who use this service are encouraged to maintain and develop relationships that are important to them. Staff practices promote individual rights and personal choices. Meals in the home are well presented and generally nutritious; however nutritional choices could be improved. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: As reported at previous inspections, residents in this home are generally busy doing activities of their own choice. During this inspection some were reading, some doing puzzles and some just having a good gossip and a giggle. There is a plan of activities displayed each week, which included quizzes, music and exercise groups, visiting entertainers, 1 to 1 trips out to the town and pampering sessions including hairdresser visits. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 15 All of the residents we spoke to told us that the amount and type of activities provided suited them. Good interaction was seen between the residents and the staff; however we did not have the opportunity to meet any visitors during this visit. We were welcomed into the home by the residents, many of whom who were more than happy to talk to us. There was appropriate background music playing, which residents were singing along to, and later in the day a war time movie was on. On the day of this inspection, a group of the residents had been due to go out to a local restaurant for Christmas lunch, however due to heavy snow and icy conditions this outing had had to be postponed, therefore all the residents were present for dinner. We looked at the menus. These were varied, however did not offer a choice of two nutritious main meals each day. For example on the day of this inspection, the main midday meal served was corned beef hash with vegetables. There was no alternative on the menu, although three residents were given ‘beef grills’ at their request. We were however concerned that where clients may not have the capacity to request an alternative, this would not be an option. The manager advised us that there is always a choice of baked potatoes, salads and other light alternatives as listed on the supper menu, and the main menus had been reviewed in consultation with the residents. Although we appreciate some residents may only have small appetites, it is important that everyone is offered a choice of nutritious hot meals each day, particularly through the winter months. The inspection spanned lunch time, and generally comments around the dining room from residents were positive, and there was very little waste. The mealtime was a social affair with all but two residents, who were being nursed in bed, using the dining room. Specialist equipment such as plate guards were available and where a meal had to be pureed it was done so that each individual component of the meal remained identifiable and therefore more pleasing the eye. We spent time talking to the chef about the food she prepares and her understanding of the correct diet for an older person and we found her to be well informed. She had only been in post a few weeks and this was her first experience as chef in a care home. She told us that in time she hopes to be able to take responsibility for the ordering of stock and the preparation of menus. The manager agreed with this concept and said that this would be the plan following completion of the chefs three month probationary period in the home. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 16 In the previous report we raised concerns that the manager at the time had limited involvement in the ordering of food stores. This was being done by the home owner whose time spent in the home was minimal. The new manager confirmed to us that she and the home owner now do this together, and incorporate resident’s preferences and suggestions regarding the menus. We looked in the fridges and freezers. All were well stocked, and generally jars and packets were being labelled with a date when they were opened. Food temperatures were being checked and recorded daily. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience good quality outcomes in this area. The complaints procedure is supplied to everyone living in the home. Staff working in the home understand the procedures for safeguarding, and know when incidents need to be reported externally. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: This home has a complaints policy, which is easily accessible to residents and visitors to the home. It details expected timescales for responses, and guidance for any complainant that remains dissatisfied with investigatory outcomes. During this inspection we looked at the complaints file. There had been no formal complaints received since the last inspection. Safeguarding policies and procedures are in place in this home, and had been reviewed since the last inspection. Staff have attended safeguarding training, and those that we spoke to were able to demonstrate a sound knowledge of the subject. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 18 The manager has introduced a quiz on safeguarding for staff to complete, so that she can be sure that their knowledge is up to date, and identify if further training is required. Safeguarding issues within the home are being appropriately reported and addressed by the management in this home appropriately. However the manager discussed with us two recent incidents where individual’s discharge conditions from hospital were not acceptable. These had not been reported to the safeguarding team. We suggested that the manager contact the safeguarding team to discuss these matters further. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 People using the service experience adequate quality outcomes in this area. The environment is generally clean and comfortable and meets the specific needs of the people who live here, however not all bathing facilities are suitable or accessible to all residents. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: This home was clean and tidy throughout and there was no evidence of offensive odours anywhere in the building. The home was decorated for the Christmas season and in the main day area there was a homely atmosphere, however one or two residents were complaining of feeling the cold. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 20 This was an extremely cold day and despite the heating being on, some residents were still feeling the chill. When we visited one resident who was being nursed in bed, we found her room was particularly cold. Her bedroom door had been left open and a chill from the stairwell leading to the top floor of the home had generated a drop in temperature in the bedroom. However this resident had plenty of blankets on her bed, and did not feel cold to touch. Although there was a room temperature thermometer in place in this bedroom, and the manager immediately increased the heating level when we brought this to her attention, we were concerned that it had not been identified sooner by staff. We also found the bathroom on the top floor of the building cold and not suitable for bathing at present. When weather temperatures are so low, we would expect staff should be closely monitoring indoor temperatures, remembering that older more frail people may feel the cold more severely. Individual rooms that we saw were decorated and furnished with personal belongings and photographs that were precious to them and in some cases reflected life histories. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. Rotas show that the home is staffed efficiently, with particular attention given to busy times of day, and changing needs of residents. This homes sees induction and probation as vital in the employment process and positions are only confirmed when satisfactory competencies are achieved. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the new manager has come into post in this home staffing levels have been increased in some areas. For example there are now two waking night staff on duty. During the day shifts there is generally three care staff on duty, however the manager informed us that she increases the staffing as and when the needs of the residents change. The manager works various shifts in the home, including night drop in visits, and she is permanently on call. The ‘consultant’ Sally Williams, who has worked closely with the home over the past few months, helping to implement new strategies and improvements in Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 22 the home, remains involved, however the time she spends at the home is now minimal. The manager told us that she had focused on the mandatory training for all staff, and was currently waiting for confirmation dates for Moving and Handling to complete this particular area of improvement. She also told us that she is hoping to introduce other specialist training, such as diabetes and catheter care. However to date only a few staff have received instruction on these topics from the visiting district nurses, but this is work in progress. During this inspection we looked at the files of two members of staff that had been appointed since the last inspection. Each file contained fully completed application forms, appropriate references, Criminal Record Bureau (CRB) and/ or checks against the new barring criteria, a variety of identification documents such as birth certificates and passports, interview notes, job descriptions and terms and conditions of employment. All documents were signed and dated appropriately. The manager has reviewed all the job descriptions for staff and these are ready to be distributed. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38 People using the service experience adequate quality outcomes in this area. The manager has the appropriate skills and experience to run this home. She is improving and developing systems that monitor practice and compliance with the plans, policies and procedures, however more work is needed. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the last inspection, a new manager, Yvonne Russon, has been appointed. She is a qualified nurse with home management experience and is in the process of doing her NVQ 4 – Leadership and Management certificate. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 24 At present she is working closely with the home owner Ms Alka Patel to implement new structures to improve the service. She is enthusiastic in her role and told us she is planning to submit her application to the Care Quality Commission as a Registered Manager in the near future. Her management style is focused on working with the clients and their families and care staff, being visible and accessible throughout the varied shifts. The manager told us that she was in the process of implementing the supervision plan for staff, however, this is work in progress, and the staff that we spoke to had not yet received any supervision from the new manager. Staff that we spoke to were very positive about changes in the home. One told us that she had worked in the home for five years. She said. “I feel I can go to the manager with anything and I am listened to and supported”. Following the last inspection in September 2009 the home owner was required to submit to the Care Quality Commission: • The annual accounts of the care home certified by an accountant. • A reference from a bank expressing an opinion as to the registered providers’ financial standing. • A business plan and current cash flow forecast in respect of the care home. • Information as to the financing and financial resources of the care home. This information was submitted and was all in order. We looked at the records for personal financial expenditure of four residents. These were being completed correctly and the funds remaining in each account balanced with the records. We cross referenced receipts for two recent transactions and these were correct. The manager understands the importance of being transparent with us, and submits notifications appropriately. She is aware that there are some gaps in record keeping at the moment but is working hard to ensure that this is addressed efficiently and effectively. We appreciate this is only her second full month in post and many areas are work in progress and will take time to make an impact on the service. Health and safety checks such as fire alarm tests, water and rooms temperatures are being monitored and recorded. Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 25 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 3 3 1 2 3 Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement People who live in this home must have care plans that clearly describe the care they require, and are kept under review to reflect changing conditions. People who live in this home must be cared for by staff that understand and follow safe medication administration procedures. People who live in this home must all have access to appropriate bathing facilities. All areas of the home must be kept at an appropriate temperature, in all weather conditions. People who live in this home must be cared for by staff have been appropriately trained to carry out their care, and recognise any problems arising from their respective medical conditions. People who live in this home must be appropriately supervised. Timescale for action 31/01/10 2. OP9 13(2) 08/01/10 3. 4. OP21 OP25 23(j) 23(p) 20/01/10 08/01/10 5. OP30 18(1)( c) 28/02/10 6. OP36 18(2) 31/03/10 Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP14 Good Practice Recommendations The registered person should consider different ways of assisting everyone in the home to make personal choices Ambleside DS0000072769.V378751.R01.S.doc Version 5.3 Page 28 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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