Care Home: Ambleside Lodge

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What the care home does well What has improved since the last inspection? The home has implemented both of the requirements and the recommendations of the previous report of 17th July 2007. The service user guide has been revised and all evidence of all recruitment checks required by regulation are being retained. Plans for preventative healthcare are in practice, medication is now administered from blister packs and via pharmacyprinted medication administration records, an independent complaints reviewer has been retained and all staff have received equal opportunities training, complete with a written test. In addition, building works to improve the communal areas of the home have been completed and there is now a through lounge, two conservatories, new chairs in the large conservatory, new chairs in the dining room and lounge and all communal areas have been redecorated. In addition, one bedroom has been redecorated and re-carpeted at the request of the service user. What the care home could do better: CARE HOME ADULTS 18-65 Ambleside Lodge 25 Ambleside Avenue London SW16 1QE Lead Inspector Ms Rehema Russell Unannounced Inspection 16th & 28th July 2008 10:00 Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ambleside Lodge Address 25 Ambleside Avenue London SW16 1QE 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) 020 8677 9175 020 8677 9175 amblesidelodge@fairdasl.co.uk Mr Basdeo Kaydoo Mrs Danon Lutchmee Kaydoo Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 6 17th July 2007 Date of last inspection Brief Description of the Service: Ambleside Lodge is a privately run staffed home for adults with mental health issues. It is located a short walk from Streatham High Road which has full community amenities and good transport links. There is on road parking nearby and off road parking in front of the home. The home provides accommodation and support for six service users. The ground floor has a kitchen, utility room, dining room and through lounge, two conservatories, a large single bedroom and a shower with toilet. There is also a large back garden, accessible from the larger conservatory. The first floor has two single bedrooms, a bathroom with toilet, office and staff toilet. The second floor has three single bedrooms, a bathroom with toilet and the staff sleep-in room. The home could accommodate one person with mobility problems as there is a bedroom on the ground floor where all communal facilities are also sited. Prospective service users are given a service user pack, which contains a copy of the Service User Guide that gives information about the home and the services provided. A copy of the most recent CSCI inspection report is available at the entrance of the home. Fees start from £950.00 per week upwards according to individual care needs. Ambleside Lodge DS0000022780.V368157.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 3 star. This means the people who use this service experience excellent quality outcomes. This inspection took place over two days in July 2008. On the first day the inspector spent only 2 hours in the home and then returned on a day when it would be possible to speak to both of the current service users. Unfortunately, on the second day one service user was called way for an emergency appointment and so the inspector was only able to speak with one of the two service users. The rest of the inspection was spent speaking in depth with the manager and proprietor and one support worker, touring the building and examining documentation and records. The home is under pressure at the moment as it has 4 vacancies. This is due to the current practice of local authorities to prefer to place service users with mental health problems in supported accommodation rather than residential care. Nevertheless, the home was found to be maintaining good standards in all areas. What the service does well: What has improved since the last inspection? Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 6 The home has implemented both of the requirements and the recommendations of the previous report of 17th July 2007. The service user guide has been revised and all evidence of all recruitment checks required by regulation are being retained. Plans for preventative healthcare are in practice, medication is now administered from blister packs and via pharmacyprinted medication administration records, an independent complaints reviewer has been retained and all staff have received equal opportunities training, complete with a written test. In addition, building works to improve the communal areas of the home have been completed and there is now a through lounge, two conservatories, new chairs in the large conservatory, new chairs in the dining room and lounge and all communal areas have been redecorated. In addition, one bedroom has been redecorated and re-carpeted at the request of the service user. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about the home and their individual aspirations and needs are thoroughly assessed. They are given several different opportunities to visit and “test drive” the home. EVIDENCE: The home has a Statement of Purpose and Service User Guide which together provide all of the information needed by prospective service users to make an informed choice about the home. The Service User Guide includes a breakdown of the most recent service user survey, so that prospective service users also get information on how current/previous service users feel about the service at the home. In addition to the Statement of Purpose and Service User Guide, the service user pack also contains a copy contract, a copy complaints policy and complaints form, information on social care and a copy of the visitors policy. The previous inspection report of 16th July 2007 required the Registered Provider to update the Service User Guide in line with recent changes in legislation regarding fees and charges, and this had been done. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 9 Care files evidenced that the home carries out a thorough assessment of prospective service users. This includes visiting the prospective service user wherever they are currently living, meeting with the psychiatric team, obtaining psychiatric reports and any other available information, and completing a detailed assessment of needs form with the prospective service user when they visit the home. Both assessments seen were signed and dated by the registered manager and the prospective service user. On both days of the inspection there was a prospective service user visiting the home. Prospective service users always have introductory visits to the home before making a decision. They are expected to make a minimum of two separate day visits to the home, during which they choose/view their room and meet staff and other service users. They are then expected to spend at least six nights at the home, which must include a weekend. In this way they get a good understanding of what it would be like to live at the home. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users’ assessed and changing needs are reflected in their care plans, and risks are thoroughly assessed. Service users make decisions about their lives and are consulted on and participate in the life of the home. Information about service users is handled appropriately and confidentially. EVIDENCE: Both care files of the current two service users were examined. Both had full contact details of the service user and relevant others, photograph, full assessment, signed and dated contract, and care plan. Care plans have objectives, action and evaluation and cover all relevant areas such as mental health needs, physical health needs, daily living skills, social networks, cultural and spiritual needs educational needs, accommodation and future placement, finance and budgeting, risk areas and service user views. They are signed and dated by the service user and manager, so that the service user is fully aware of the goals and objectives of their care and can ownership of the process. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 11 They are reviewed regularly, following meetings with the general practitioner/community psychiatric nurse or when there is any change to the service user’s condition. For example, the first review of the service user who was admitted in April this year was undertaken at the beginning of July, when he had had time to settle in and see if the home and care plan was appropriate for his needs and wishes. Service users make decisions about all aspects of their daily lives, within any restrictions that are deemed by law (such as by the Ministry of Justice) or medical authorities, and agreed with the service user. Most service users, including the current two, manage their own monies, collecting their personal allowances from the bank and managing their own savings. All have solicitors due to the Sections they are bound by, who attend Care Programme Approach meetings in an advocacy capacity. Currently one service user has an agreement to attend a day centre for a certain amount of time each week, but there are no other restrictions on how he chooses to spend the rest of his time. Service users contribute to the day to day running of the home via the daily morning meetings that are held. During these, which are attended by staff and all service users, they decide on how they will spend their day and decide on what one of them will cook for the evening meal. Service users are free to decide on what they will do each day but are reminded about any appointments or meetings that they are expected to attend. Service users are also encouraged to take an interest in the home environment and one service user recently chose the new coffee table. This meeting can also be used for service users to bring up any concerns or suggestions they may have about any other aspects of the running of the home. Risk assessments are an integral part of the care planning at the home. Each care plan has a risk assessment broken down into risk areas, risk indicators and warning signs. A full risk screen is carried out, covering areas such as suicide, violence and mental state, and if any of these proves positive, then a comprehensive risk assessment with action plan is undertaken. All risk assessments were signed and dated. There is also a daily mood and behaviour monitoring chart for each service user, filled in each day by staff on the morning and the afternoon shift, and daily notes which give an account of service users’ activities, moods, appointments and medication. In this way service users are able to take risks as part of an independent lifestyle whilst the home monitors the level of risk to ensure safety. For the past two years, following advice from the Commission, the home has kept kitchen knives locked away with service users obtaining them from staff when they cook. This was because at that time there were high risk service users in the home. However, the recent and current service users are low risk in regard to handling knives and so it is recommended that the home reviews this policy to determine whether it should still be practiced. If there is little risk of service users mis-using kitchen knives then it would be an unnecessary Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 12 infringement of their independence and dignity to have to ask each time they wish to use one. See Recommendation 1. All written information about service users is kept in lockable cabinets in the office on the first floor, which is kept locked if there is no member of staff in it. In this way, all written information about service users and staff is kept confidentially. Staff spoken with were fully aware of the need for verbal confidentiality and the restrictions on third party information. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have opportunities for personal development and are able to take part in age, peer and culturally appropriate activities as they choose. They are part of the local community and have appropriate personal and family relationships. Service users’ rights and responsibilities are supported and they are encouraged to choose a healthy diet. EVIDENCE: Service users are encouraged and supported to continue their education and training and pursue areas of individual interest. Of the two current service users, one attends a day centre four times per week, studying art, computers, group discussion and ethnic minority issues and the other service user is starting a plumbing course in college next term. He is also consulting with the college’s activity adviser regarding other courses he can undertake. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 14 Service users are able to fully participate in the community. Once they have attended the morning meeting, discussed any appointments they have that day and decided who will cook the evening meal, service users are free to spend their time as they choose. Service users can therefore access the full range of community facilities, including transport, shops, libraries, cafes etc. Both the staff team and the local community are culturally diverse, suitable to the client group. Staff encourage and support service users to maintain appropriate family links and friendships both inside and outside the home. Currently, one service user chooses to spend most of his time visiting his family and friends, and his mother has visited him at the home too. The other service user visits his family at weekends, has friends who visit him at the home and also has a sister who visits. Service users have the choice to see visitors in any of the communal spaces or privately in their rooms if they wish. Staff discuss safe sex issues at keyworker meetings or as appropriate when they arise. There are few routines at the home. There is the morning meeting at 9am, which encourages service users to get up and start the day, and the evening meal at 5.30 – 6pm. These two routines at the beginning and end of the day encourage service users to normalise their days, but meals are cooked and kept for later if necessary. All letters are entered in a book and signed for but are given to the service user unopened, for them to read privately. Service users are encouraged to tidy up after themselves and expected to do their own laundry, make their own beds and clean their own rooms (with assistance if needed). When the home is fully occupied, each service user has a floor allocated to them to keep tidy, with the service users deciding themselves at the Monday morning meeting which chores to allocate to whom. In this way, service users are supported to maintain their independence and daily living skills. Service users get their own breakfast but appear to eat midday meals outside the home as they are usually out during the day. There were no set menus to see as service users decide each day what the evening meal will be, and which of them will cook it. Service users are therefore able to choose foods which suit their cultural backgrounds, if this is what they want. The service user spoken with confirmed that there is a free choice for the evening meal and that food at the home was “OK”. The inspector saw the report from Food Standards, who visited the home in June 2008 and awarded it 4 stars. There was only one recommendation, relating to updating the food hygiene pack. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way that is appropriate for their needs and preserves their independence and dignity. Their physical and emotional health needs are met and they are protected by the home’s policies and procedures for dealing with medication. EVIDENCE: Neither of the current service users need personal physical care but the manager and support worker spoken with gave verbal evidence of the type of social and skills support given via prompting and encouragement. This support is given with sensitivity towards service users’ dignity and self-esteem, for example by discreetly observing a service user cooking or cleaning and offering support if they appear to need it. If a service user’s appearance or behaviour indicates that they are relapsing the manager arranges for a review to take place and appropriate action taken. Service users are completely independent in regard to clothing and appearance and both were observed to be appropriately dressed according to their age and lifestyle. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 16 A service user’s medical appointments sheet is maintained for each individual and these showed that service users access the full range of healthcare specialists as appropriate, for example general practitioner, care co-ordinator, registered medical officer, social worker, psychiatrist, community psychiatric nurse. Soon after admission all service users register with the local GP and are given a full medical examination, and then have a full medical every year from then on. Service users are encouraged to register with a dentist and to access the optician or any other health professionals as appropriate. Medication storage, administration and records were checked and found to be in very good order. Medication is stored in a lockable, wall-mounted steel cabinet in the staff office and as the office is kept locked if there is no member of staff there, medication is kept safely. There is an individual information sheet for each service user with photograph and details of their GP, psychiatrist and medication administration record. There is also a list of all medication entering or leaving the home, each medication on an individual sheet, and there is a weekly tablet count, signed and dated. In this way it is easy to trace every single medication dose and to double-check whether medication is being administered correctly. In addition, patient information leaflets about all of the medicines in use in the home are kept to provide staff with information about possible side effects and there is a sample signature list for each member of staff involved in medication administration. The previous inspection report made two recommendations in regard to medication administration and both of these had been implemented by the home. Neither of the two current service users self-medicate. The manager said that as soon as a service user demonstrates a history of compliance this situation is reviewed. The home has a set of self-medication forms for service users to fill in daily and staff to check at weekends, in order for service users to be assessed for self-medication. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users views are listened to and acted upon. They are protected from abuse, neglect and self-harm. EVIDENCE: The home’s complaints policy and procedure meets all of the requirements of regulation and is given to each service user in their service user pack. In addition a copy of the complaints form is kept on the desk at the entrance of the home so that it is readily available for service users or visitors to use. A record of complaints received is kept and this showed that the home has received no formal complaints during the past year. The service user spoken with said that that “Dana and Brian” (the registered manager and coproprietor) were “easy to approach” so that if he had any concerns or complaints he would tell them. Service users can also raise any concerns or complaints any day at the morning meeting, or at keyworker meetings if they prefer. The previous report recommended that the home ensured that as the registered provider and registered manager are the owners of the home and also work in the home on a day to day basis, they ensure that any complaint about the running of the home or their conduct can be reviewed and/or investigated by someone more independent of the service, and this had been implemented. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 18 The home has a well written abuse policy, with a flow chart that simplifies the process visually. It has a copy of the adult protection procedure of the local borough in which it is located, and all documents are easily accessible to all staff via the office and the resource pack kept in the dining room. The latter makes it also accessible to service users. All staff are trained in adult protection issues. This was confirmed by the support worker interviewed, who was familiar with the procedure and knowledgeable about what to if a service user became verbally or physically aggressive/violent. Records showed that the home has had no adult protection issues. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a homely, comfortable and safe environment, with bedrooms that suit that promote their independence, ample toilet and bathroom facilities, and a range of pleasant shared spaces. No specialist equipment is currently required. The home is clean and hygienic throughout. EVIDENCE: The home’s premises are suitable for its stated purpose, accessible, safe and well maintained. It blends in well with the other houses and looks like an ordinary domestic home. It is a few minutes walk from a busy commercial area that has full community facilities, including rail and bus transport, shops, library, cafes and restaurants, cinema and other leisure and sports facilities. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 20 All bedrooms are single rooms and all are fitted and furnished to a reasonable standard. Service users are given a choice of room and this was confirmed by the service user spoken with. The home could accommodate one service user with mobility problems as there is currently one bedroom on the ground floor, where there is a shower room, toilet and all of the community facilities. There are ample bathroom and toilet facilities at the home, which exceed National Minimum Standards, and there is also a choice of bath or shower. There is a bathroom with bath, shower facility and toilet on the second floor; a bathroom with bath, shower facility and toilet on the first floor, and also another separate toilet; and there is a bathroom with shower cubicle and toilet on the ground floor. These facilities would therefore meet any cultural needs. There is also ample shared space at the home, which again exceeds National Minimum Standards. This includes a large dining room, lounge, 2 conservatories and a large back garden. All shared communities are attractive and fitted and furnished to a good standard with service users observed to be using them as and when they chose. There is also a well equipped kitchen and a separate utility room with laundry facilities. No aids or adaptations are currently needed at the home as no service users have physical disabilities. On the two days of inspection the home was found to be clean and hygienic throughout. It is well lit and ventilated, and homely throughout. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent and qualified staff and an effective staff team. They are protected by the home’s recruitment policy and practices and their needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. EVIDENCE: There are currently 5 support workers employed at the home, all on a parttime basis (20 hours per week). The proprietors would prefer to employ them as full time staff but as there are currently only 2 service users at the home, this is not necessary or feasible. The manager and/or proprietor, who both have the Registered Manager’s Award, work at the home every day and also pop in at night if they are needed. Of the 5 support workers, two have completed NVQ Level 2 (with one now doing Level 3), one is in the process of obtaining Level 2 and the two newest workers will enrol for Level 2 after they have completed their induction. This means that although the home does not meet the recommended target of 50 of support workers with NVQ Level 2 at Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 22 the moment, it soon will. It met the target previously, but lost it through staff turnover. The rota shows that there is at least one manager on duty every day except Sunday, and usually both the manager and proprietor are on duty daily. Currently there is also at least one support worker on duty during the afternoon. At night there is one waking night staff and one sleep-in staff. This was discussed with the manager and it was decided that as there are currently only two service users at the home, neither of whom wake at night, then it is sufficient to have one waking night staff only. The manager or proprietor often pop in at night and it takes them only 20 minutes to get to the home, and there is also a support worker who has been at the home for over a year and who lives only 5 minutes away. Therefore, should a second member of staff be needed at night, this can be arranged reasonably quickly. Recruitment files are kept in a locked cabinet in the office. Four files where examined and all were in good order, containing all of the information required by regulation. All staff had had enhanced Criminal Records Bureau checks, and also POVA first checks when this was necessary. All staff are given 3 months induction using the Skills for Care Induction course, evidence of which was seen on staff files. Staff do not work alone with service users until they have completed the course. From then on the home provides a range of relevant training for staff, including medication, protection of vulnerable adults, health and safety, food, fire safety, infection control. All courses are certificated and certificates were seen on staff files. In house training is also given on areas such as care planning, keyworking and needs assessment. In the first 6 months of their employment at the home the manager coaches and advises staff on mental health issues, then after the first six months they receive mental health training from a privately employed tutor. This takes the form of 6-8 two-hours sessions covering mental illness, treatments and signs and symptoms of relapse, and is certificated. All staff are also supported to attain NVQ Level 2 if they do not already have it. Evidence of regular two monthly supervision was seen on staff files, with supervision notes signed and dated by both the manager and the member of staff, which is good practice. Minutes of monthly staff meetings were also seen. Staff are therefore fully supported in their roles. The support worker spoken with said that they felt part of a team, with good support from the manager and other support workers, and that they found supervision sessions very useful. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home and the ethos and management approach of the home. Service users’ views are regularly sought and used to improve the service at the home. Service users rights and best interests are safeguarded by the home’s record keeping and the health, safety and welfare of service users is promoted and protected. EVIDENCE: Both the registered manager and the proprietor are Registered Mental Nurses and have the Registered Managers Award. In addition, the registered manager also has NVQ Level 4. They have many years previous experience working in mental health hospitals and several years managing the home. The manager Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 24 keeps her RMN pin updated by undertaking the necessary training days each year. Both staff and service users spoken with said that both the manager and proprietor were “very approachable” and “very supportive”. This encourages a positive and inclusive atmosphere at the home. There is a commitment to equal opportunities, and all staff have had training in diversity issues. For quality assurance purposes the home employs an independent home manager to carry out an annual quality assurance inspection of their home. He conducts the inspection in two parts, the physical environment and records, but doesn’t speak with service users. The inspector was told that he does however look at service user surveys and notes of service user meetings. Apart from this, the home also carries out anonymous service user quality assurance surveys every three months. Each batch is summarised, with a copy of the summary put in the service user guide, as is recommended by National Minimum Standards. A practical indication of the quality of service at the home is that many previous service users have moved on from this home to establishments providing less support or back into the community. Also, some ex-service users still come back to visit the home. A range of documentation was examined at the home and all was found to be well ordered, thoroughly and clearly written and well kept, with all necessary documentation signed and dated. Health and safety documentation is well organised and evidenced the following: • • • • • • • • • Regular fire drills Weekly call point testing Annual fire extinguisher checks Health & Safety poster displayed Weekly fridge and freezer temperature checks Environmental risk assessments, reviewed monthly Fire risk assessment Visit from London Fire Executive Planning Authority visit on 27.11.07 with no requirements Gas and electrical appliance services. In addition, COSHH (substances hazardous to health) materials are stored safely in a locked cupboard. Legionella checks are not carried out as the home uses a Megaflow system directly from the mains, which does not required any form of water storage. Valves have been fitted on all hot water taps however to ensure thermostatic control. It is recommended that the actual time that fire drills take place is noted in the fire records. See Recommendation 2. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 4 28 4 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 3 4 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 3 3 X 3 3 X Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard YA9 YA42 Good Practice Recommendations The home should revise the policy of keeping kitchen knives locked away to determine whether it is still necessary in regard to the current service users. It is recommended that a record of the actual time that fire drills are carried out is added to the recording of the drill. Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ambleside Lodge DS0000022780.V368157.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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