Care Home: Ambleside

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What the care home does well This small home provides a very individualized caring service for its residents in a homely and safe environment. There is a stable, experienced and very well motivated staff team who interact well with the people who use the service. The staff are able to provide continuity of care to the people who use the service. The standard of care provided for thepeople who use the service is good, the staff team interact well with the residents and staff are supported with a good standard of training and management. All the staff are enthusiastic about their work and committed to the welfare of the people who live in the home. The manager is passionate about communicating effectively with each individual and she leads by example in making sure that each person is able to express their own needs and wishes. What has improved since the last inspection? Since the last inspection the home has concentrated on improving the care plans into a personal portfolio format so that the care provided meets the specific needs of each individual in a person centered way. The service has worked hard to listen to the people who use the service and to give them opportunities to make choices in all aspects of their lives. The home has benefited from various works of refurbishment and new equipment and the people who use the service along with their friends and relatives are involved with planning and choosing the next phase of these improvements. What the care home could do better: Where it has been possible to discuss this with the friends and relatives of the people who use the service any plans or information concerning their end of life wishes should be included in the care plans. All staff must complete POVA refresher training regularly. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ambleside Wengeo Lane Ware Hertfordshire SG12 0EQ two star good service The quality rating for this care home is: 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: Jan Sheppard Date: 2 7 0 4 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) 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. 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Ambleside Wengeo Lane Ware Hertfordshire SG12 0EQ 01920460415 01920466089 hilary.porter@turning-point.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Turning Point Southern Area Office care home 6 Number of places (if applicable): Under 65 Over 65 6 1 0 0 learning disability physical disability Additional conditions: This home may accommodate up to one person with a physical disability when associated with a learning disability. Date of last inspection 0 4 0 7 2 0 0 7 A bit about the care home Ambleside is a residential care home for adults with a learning and physical disability. The secluded house is spacious, detached and is located at the end of a private road approximately one mile from the town centre of Ware. The building is owned by Hertfordshire County Council but the home is run by Turning Point Ltd, which is a voluntary organisation. The building was renovated and first registered as a Care Home in 1998. It comprises six single bedrooms, offices and a staff sleeping- in room, and has communal spaces consisting of a large hall, lounge, dining room, kitchen, activities room and two assisted bathrooms. The home has a welldesigned and accessible rear garden with a large patio accessible from the lounge. Adequate parking space is provided to the front of the building. All the residents are sponsored by Hertfordshire County Council. Information concerning the current fees can be obtained from the manager. Information concerning the services offered by this home along with previous inspection reports is held in the office and is available to visitors and relatives. 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The last inspection of this service was completed on 4th June 2007. This inspection which was unannounced took place over eight hours on a weekday. This was a key inspection that focused on the key standards of the Care Standards Act 2000 relating to Adults. The report is written using accumulated evidence gathered prior to the inspection including information contained in the AQAA (Annual Quality Assurance Assessment) completed by the manager, information given in any pre-inspection questionnaires and also takes account of statutory notifications sent periodically to the CQC by the home. We made a tour of the building had in depth discussions with the homes manager and were able to speak with all the staff who were on duty. We also met and spoke with or communicated with all the service users (none has full speech). Spot checks were made on a number of the homes records and care plans What the care home does well This small home provides a very individualized caring service for its residents in a homely and safe environment. There is a stable, experienced and very well motivated staff team who interact well with the people who use the service. The staff are able to provide continuity of care to the people who use the service. The standard of care provided for the people who use the service is good, the staff team interact well with the residents and staff are supported with a good standard of training and management. All the staff are enthusiastic about their work and committed to the welfare of the people who live in the home. The manager is passionate about communicating effectively with each individual and she leads by example in making sure that each person is able to express their own needs and wishes. What has got better from the last inspection Since the last inspection the home has concentrated on improving the care plans into a personal portfolio format so that the care provided meets the specific needs of each individual in a person centered way. The service has worked hard to listen to the people who use the service and to give them opportunities to make choices in all aspects of their lives. The home has benefited from various works of refurbishment and new equipment and the people who use the service along with their friends and relatives are involved with planning and choosing the next phase of these improvements. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jan Sheppard CQC CPC1 Capital Park Fulbourn Cambridge CB21 5XE Tel 01223 771300 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 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 . Before their move into Ambleside the service user’s needs were fully assessed. The home has a Service Users Guide and an up to date Statement of Purpose. Evidence: Ambleside Home opened ten years ago when all its six residents transferred from a long stay hospital setting. At that time their needs were assessed and they and their families were able to visit the home and meet with the staff. Their compatibility as a group of residents was carefully considered. Since that time there have been no new admissions to the home so it is not possible to examine any recent admission records or procedures. However discussions with the homes Manager evidenced that she has a good understanding of the necessary procedures according to the policies, which will be followed when this situation does arise. Comments received from relatives have always been very positive about the home with its great contrast in style and quality of living from the previous old institutional life pattern of the old hospital setting. The home has all the required information about the service, Statement of Purpose and Service Users Guide, and these along with a tenancy contract are present on each residents file. Since the last inspection the home has made progress with adding easy read picture illustrations to much of the homes documentation this to enable better understanding for the service users. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 . Person centred care plans provide an up to date record of the service users needs and how these should be met. Risk assessments are regularly reviewed to accommodate changing ability need and risk. Evidence: Since the last inspection further progress has been made with compiling the service users care plans, now to be known as personal portfolios, in a person centred format. Four plans were examined and these were all found to be maintained with very good detail with records being up to date and to show how changes could be made to meet the changing needs of the service users. The portfolios were seen to be compiled with pictures and that service users had been involved with their compiling although in many cases this involvement because of their lack of speech could only be very limited. The manager states in the AQAA that staff who have known the services users for a long time are skilled at documenting events through observations, trial and error and using respectful guesses. Staff always support the service user to make their own choices. This could be choosing an item of clothing when getting dressed or just as important deciding not to wear a certain item. At meal times making a choice of what to eat or drink. The Manager states Often refusal of something is seen as positive as it demonstrated the service user feels comfortable in their home to make a choice and decision and feels supported in doing so and their decision will be respected. Evidence of this was seen during the inspection when a service user who usually on their return from the day centre went straight to their room on this occasion choose to take their tea first. Having very clearly made his wishes known staff respected these and quickly assisted him with his tea. Evidence: Information in the personal portfolios about the service user is written from their perspective for example Who am I? my history, My health, the support plan I need, My health action plan. Details of their social and family history were given, Communication charts recording behaviour patterns and changes kept, risk assessments, details of their GPs annual health and medication check, notes of any visits from the community nursing team and of their contact with dentist’s opticians chiropodists and hospital consultants. The records also contained an Assessment of their Capacity undertaken by a Community Psychiatric Nurse. Protocols for medication were seen on some plans for example a protocol for the administration of Sudocream. All the profiles contained examples of particular likes and dislikes of the service user; for example I like being in a warm bath with staff pouring warm water over me. Another said I like lying on sofas and on the grass. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 people who use this service participate in a range of activities based on their individual needs and choices and they are supported appropriately by staff to use local community facilities. A healthy varied diet of freshly prepared food is provided in a manner which meets their individual needs. Evidence: All the service users have an individually planned day activities programme encompassing either three or four weekdays. Two local day centres are accessed where various small group activities and classes are attended. Since the last inspection the manager explained that various changes to these day activity arrangements had been made to accommodate the changing needs interests and abilities of the service users. At the time of this inspection all the assessed needs or wishes of the service users concerning day activities were being met. One of the older service users now has a less active programme whilst more engaging classes have been found for others who are still able to be more active. The individual care plans evidenced that the home and the day centre carry out regular reviews and risk assessments of these services and the staff confirmed that communication between the home and the centres has improved and is regular and consistent. A telephone call from one centre about a problem experienced with one attendee which occurred during this inspection confirmed this good liaison. The manager and inspector discussed an additional risk assessment for one service user which should be compiled to fully ensure their safety Evidence: when travelling. Five of the six service users arrived home from their various activities during the afternoon of this inspection and met with the inspector. They all looked happy and settled quickly into their individual routines in a relaxed manner. Some went, with staff, to their rooms to change whilst others had tea and a snack. It was clear that the staff knew and understood their individual routines and it was noted that assistance was being given to their feeding in a professional manner. Throughout this tea time the atmosphere was happy calm and relaxed and it was clear that the service users were confident and knew their home and the staff well and felt comfortable there. The manager said that the home continues to arrange a number of outings into the local community and that these had been facilitated by the provision of a new more spacious bus. A programme of in- house events was seen this involving outside entertainers and is especially arranged over the winter and Christmas periods. Last summer the home hosted a very successful BBQ garden party to celebrate the homes 10 year anniversary and the monies raised at this had been used to purchase new and varied garden equipment. Ambleside joins with another local Turning Point home for social events and a number of photographs around the home evidenced these. As usual it is planned that all the residents will have a staying away holiday in the summer. The manager explained that because of the planned refurbishment works which will affect every area of the home it had been decided to take all the residents away together so that the builders have full access to all areas and can thereby complete the works in less time. Suitable accommodation in a small holiday cottage complex has been found. The homes continues to maintain very good relations and regular communication with the resident’s relatives and friends despite some living overseas and others at a distance in the UK. Telephone calls are made and service users are assisted to send cards and photographs. Relatives regularly take two residents out to visit them in their own homes and one parent makes monthly trips from the Continent to see his son. For the service users with no relatives a befriending service and for one resident an IMCA has had involvement since the last inspection. The home plans a relatives and friends meeting in May so that the choices of furnishings colours and fabric needed for the renovations of the home can be discussed with them. The menus are chosen weekly with the service user’s involvement. A varied menu using fresh ingredients and following a healthy diet is planned. Evidence of fresh fruit, meat, vegetables and yogurts were seen in the fridges. Menus were seen to be varied with particular dishes made to meet the individual choices of some residents Homemade soup was prepared on the day of this inspection for one service user who had remained in the home having not been well while waiting to be seen by the doctor. The manager said that unfortunately the use of visual menu cards and illustrations of specific dishes had not proved to be useful as none of the service users could understand these. She said that the best way to ascertain their likes was to offer them a new choice prepared meal and see if they ate it. It was noted at tea time that all the service users appeared to have a good appetite with one indicating that she wanted a yogurt from the fridge which she was helped to choose. The records indicated what food is chosen and the amounts actually consumed for each service user for every meal is recorded along with the regular recording of their weight. Now that the County Evidence: Council no longer offers a visiting dietitian service the manager said that the homes GP had been helpful in getting them dietary assistance and advice when special thicken drinks and other nutritional aids are needed. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 health and personal care that people receive is based on their individual needs and they are treated with respect and dignity. Evidence: During this inspection visit it was seen that service users were being supported by staff in a respectful way. It was reported that the staff are very kind and very attentive to detail. Also that the home is very caring and staff very dedicated. Staff reported that the care is different for each service user but that we focus on everyone as an individual’. The service users care plans show how they are to be supported around personal hygiene and it was seen that this was done with respect for their dignity and with support being given in private. Ambleside puts great emphasis on ensuring that the services users are respected and their dignity maintained at all times. The homes protocol for entering a residents bedroom evidenced this, it states,’ as the service users are all non verbal staff cannot knock and wait for an invite to come in; instead staff should knock wait for a few moments then say I am so and so and I am going to come in then enter slowly giving the service user plenty of time and affording them their respect and dignity. During this inspection it was seen how a member of staff supported a service user who was feeling unwell, encouraging them to eat a specially made soup and then suggesting that they rest quietly. The staff consulted with the doctor and later with a community nurse and made sure that staff coming on duty were fully aware of the situation. It was noted that records are kept of any contact service users have with health professionals along with any changes to their care afterwards. Ambleside uses an MDS (monitored dosage system) for medication storage and administration this being supplied from a local pharmacy. The medication storage area has been relocated into one of the new offices where good space and working surfaces Evidence: are available. The storage cabinets are of adequate size and there is also a Controlled Drugs cabinet although this has never been used. There is a small fridge with temperature controls and another storage cabinet for the non bubble medication. Medication is stored securely. Only trained staff, the shift leaders, administer medication. An inspection visit from the pharmacist in October last year 2008 was recorded and signed by him. The MAR sheets seen on the day of this inspection were found to be accurately recorded with no omissions. A record of the amounts of medication received into and disposed out of the home for each service user were seen to be maintained. The manager makes monthly checks as to the accuracy of all medication records. None of the service users are able to handle their own medication but it was seen that staff were assisting them in a kindly manner and allowing them to go at their pace. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 . People who use the service are able to express their concerns, have access to an effective complaints procedure and they are protected from abuse. Evidence: The home has a clear Complaints policy and procedures which is also available in easy read picture format. This policy is available in the homes entrance hallway and a copy of the visual complaints policy was seen on the service user’s files. The manager explained that the staff had gone through this with the residents but that she did not judge that any of them would be able to understand this. The manager said that she is satisfied that the relatives all have a copy of and understand this policy and have in the past used it. There have however been no complaints since the last inspection. During this inspection the inspector saw recent compliments that had been sent by relatives to the home following a social event and in response to the regular quality questionnaires sent out by the home. These comments included “we have great satisfaction that our relative is being so well looked after. “Wonderful accommodation exceptionally good staff who maintain superb communication with us even though we live so far away. Since the last inspection refresher training on the protection of adults has been attended by some staff and the homes training records evidenced that further training on this subject has been planned for all staff during May. Staff spoken with showed a good awareness of their roles and responsibilities in protecting these very vulnerable service users and the diligence needed when working with such vulnerable persons who cannot speak for themselves. Staff spoken with also demonstrated their good understanding of whistle blowing procedures. There have been no incidents concerning adult protection since the last inspection. The manager and the senior staff have attended training concerning the Mental Evidence: Capacity Act and the Deprivation of Liberties and the manager said that further training concerning this for all staff is being planned by Turning Point for later in the year. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: Since the last inspection routine works of maintenance and improvement to the home have been carried out and on the day of this unannounced inspection Ambleside was found to be clean and tidy with a well kept appearance and homely feel to it. Improvement works have included the reconfiguration of previously unused first floor space to provide two offices and staff toilet and shower facilities, the improvement of the ramp into the patio door of the lounge and new fencing around the garden. New roof insulation and exterior painting works have also been carried out and a new central heating boiler fitted. The private road way, Wengeo Lane, leading to the home has been resurfaced with Ambleside making their share of the cost along with other residents who live in the lane. Staff reported that this new smooth surface gives the service users a much more comfortable ride in the bus and also makes it possible for staff to safely take residents out for a walk in their wheelchairs. Since the last inspection the home has had a new bus. This is bigger than the previous vehicle and enables all the service users to go out together. Staff reported that it has more safety features is more comfortable and has tinted windows which helps service users with visual impairments. In the kitchen a new gas hob has been installed and new washing machine and tumble dryer provided for the laundry. Profiling beds have been purchased for two service users and it is hoped that more will be obtained when funds permit. The manager explained that it is planned that works to redecorate some bedrooms and all the communal areas, lounges, dining room and hallways, to refurbish the bathrooms with the provision of a wet room shower area and a new assisted bath, to provide new flooring and furnishings in some bedrooms and in the communal walkways and lounges is planned to take place in the summer. The home is consulting Evidence: with the service users and with their relatives concerning the choices of colours and fabrics. During this inspection the services users bedrooms were seen to be appropriately decorated and furnished to meet their needs and to reflect their tastes and styles. Personal items evidenced their interests, cars, soft toys and art works. The kitchen was inspected this is a small domestic kitchen where many varied staff prepare meals and snacks for the service users. It is well equipped and at the time of this inspection was found to be clean and tidy. The temperatures of fridge and freezer are regularly recorded. The staff follow the Safer Food Better Business protocols and records relating to the planned menus, alternative dishes offered and what is actually consumed by all the service users were seen to be well maintained. The kitchen was subject to an Environmental Health inspection in March 2009 following which no requirements were made. Staff reported that they found the recent refurbishment works made in the home to be a great improvement as it enabled the smoother running of the home and they spoke very positively about the planned further improvements especially to the bathroom facilities. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 . People who use the service are supported by well trained and supported staff. Evidence: Following a recent recruitment drive the home is now virtually fully staffed. Two staff who had recently commenced duties both spoke very positively about their recruitment and interview process and the induction training that they were undertaking. One said “I had wanted to work at this home for some time I am happy to be here there is a good atmosphere amongst the staff and we have time to properly care for the residents which was not the case at my last home. The manager explained that vacancies had arisen because of internal staff promotion and because one long standing staff member moved away. She said that she was encouraged that the home had been able to recruit new staff with experience and one with existing NVQ qualifications. She also said that new Bank staff who had previously worked at the home and who therefore knew the residents well had also been appointed and that she hoped this would mean that agency staff would not now have to be called upon. The recruitment records of three recently appointed staff were examined and were found to contain all the required checks and references which should give the proper protection to the service users. The home compiles an annual training needs plan and it could be seen that the individual training requirements of all staff had been incorporated into this. Staff spoken with confirmed that training is given a high priority in the home and the records evidenced that since the last inspection training on POVA, Equality and Diversity, Moving and Handling, Infection Control, Food Hygiene, Mental Capacity Act, Fire Awareness, Risk Assessments and Health and Safety had been attended. New staff all attend induction training and complete at least four weeks shadowing more experienced staff according to their individual experience and needs. Evidence: Since the last inspection the manager has completed the NVQ level 4 Managers Award and the percentage of staff holding NVQ qualifications at either levels 2 or 3 and of staff currently studying for these has slightly increased this despite the loss of two qualified staff who relocated. Overall the staffing position remains quite consistent and benefits from having several very experienced staff who have worked at the home and with these service users for many years. The homes records evidenced that all staff have regular supervision and an annual appraisal. Staff reported that they were well supported by the managers and that being a small home there was always someone to consult if they were every in any doubt. The manager explained that three staff on duty during day times are required to ensure the smooth running of the service and that a two staff to one service user ratio is followed for trips and outings outside of the home. At night one waking and one sleeping in staff member are employed with always a qualified person leading the shift. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 . People using this service receive a well managed service. Evidence: The manager has the required qualifications, (NVQ level 4 Registered managers Award), and experience and is competent to run the home. She has a clear understanding of the key principles and focus of the service and an open door approach to management. Her aim is to continually improve the quality of life for the service users and to enable them to maintain their independence and this aim has become part of the homes ethos and is embraced by all the staff. She has a calm and open management style and supports and encourages her staff very well. One said “She would never expect us to do anything that she would not herself do. The home follows Turning Points quality assurance procedures with quality surveys being sent annually to service users, relatives and other professional stakeholders in the home. The results are collated into a company report which has until now only been produced for the company nation wide but from this year, 2009, specific mention will also be made of individual establishments so that they can compare their results and performance against the national response. The manager showed the inspector copies of the most recent replies received at Ambleside from relatives and other professionals and these were entirely positive. The home has appropriate systems in place to enable good communication between the various staff something which the manager recognised as being very important to ensure the smooth running of even a small home like Ambleside. Regular staff meetings are planned ahead and were seen to be well recorded and to have good staff involvement. A daily communications book and log which is completed at the hand Evidence: over of each shift were also seen to be being appropriately used. The home gives good priority to promoting the health safety and welfare of the service users and staff through the regular maintenance of safety checks, training and record keeping. One member of staff is responsible for undertaking regular health and safety checks. The records relating to fire testing the monitoring of water temperatures, servicing and safety checks of the home equipment were found to be well maintained. Risk assessments for the environment were seen to be compiled and periodically updated. The home has a policy and procedures to ensure the protection of the service user’s finances and three spot checks made on these found that the amounts and the records and receipts kept did all tally. The home is subject to an annual external audit carried out by Turning Point and a finance administrator visits weekly to check the finances and other administrative records kept in the home. All financial records kept in the home for example staff taking over monetary responsibility from shift to shift are all done with double signatures. The records of the fire alarm testing evidenced that this is carried out regularly and that the service users, where they are able, respond positively to it. Since the last inspection a Fire officer has visited the Home to give advice concerning one resident who may not be willing to be taken down stairs at night. A full evacuation of the home is carried out every three months and a written plan as to how service users might be kept both safe and warm (by sitting in the bus) has been prepared. The manager said that full contingency plans as to where the service users may go if ever Ambleside became uninhabitable have also been made this following her consultation with a local hotel. The manager reported that since the last inspection the company Turning Point has provided additional management and administrative support which she has found very helpful. She mentioned particularly the input from the new Risk Team and the Procurement team who she said will really listen when she voices problems and will visit and carry through with the improvements that are required. However such consistent support to her and the home from her immediate line management could not be similarly evidenced. The records did not show that any Regulation 26 management visits had been made to the home between June 2008 and March 2009. The manager confirmed that this had been the case although she said that a new manager recently appointed had planned future visits to the home and that she was looking forward to working with her. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 Description 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 Description 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 Helpline: Telephone: 03000 616161 or Text phone: 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). 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. 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