Care Home: Ambleside Residential Care Home

What the care home does well Information given to prospective residents is good and provides them with the opportunity to make an informed choice about residing in Ambleside Residential Care Home. Prior to a resident moving into the home, a thorough pre-admission assessment is carried out by the the registered manager and her deputy, and this may involve more than one visit to the prospective resident. Information is also gained from other health care professionals and care manager, who have knowledge of the prospective resident. All care plans are based on the thorough pre-admission assessment and other information gained. Risk assessment are based on day to day living activities, and health care needs. Both care plans and risk assessments are reviewed on a monthly basis and any changes are recorded. As far as possible the manager ensure residents and relatives or representatives are involved in the care planning process. Health care needs are considered a priority and there is good evidence that residents have access to a variety of health care professionals as and when required. The receipt, recording, storage, handling, administration and disposal of medication is well managed promoting the residents good health. Residents are able where possible to make choices in regard to their daily living routines and are encouraged and supported to do this by the staff team. A variety of appropriate activities are available to residents. The majority of activities are carried out in small groups and residents are able to make choices on a daily basis as to what activities they would like to participate in. The home does make arrangements with external entertainers and specialist groups who come into the home to work with residents or just for entertainment. Menus in the home are varied, giving residents a varied, nutritious and wholesome diet with specialised diets being catered for as and when required. Relatives spoken to during the course of this inspection said that the standard of care, attention to health care needs, social care and food was excellent. They spoke highly of the manager and her staff team. One relative said `nothing is too much trouble here, I cannot speak too highly of the care that my mother receives.` The complaints system in the home is good ensuring that any complaint is appropriately investigated and a timely reply is made to the complainant. Residents are protected from abuse by stringent recruitment policies and procedures, and ensuring that staff receive the appropriate training to reduce the risk of abuse. Ambleside Residential Care Home provides the residents with a comfortable and homely place to live. Residents are protected by good infection control procedures being adherred to by the staff team. Staffing levels in the home are good providing satisfactory staff input at busy times and enabling staff to spend one to one social time with the residents during the course of the day. There is good evidence that staff have the appropriate qualifications and training to meet residents needs. Recruitment processes are diligently followed so that each member of staff is appropriately vetted prior to taking up employment in the home, so that residents are not placed at risk of abuse. The registered manager, Mrs Gillian Gierus, works well with her staff team often covering care shifts and working alongside the care staff. Her main priority is the health, well being and social care of the residents. She has developing a good quality assurance system in the home that promotes a high standard of care to the residents. Where the manager has accepted responsibility for residents personal allowances this is well managed and all documentation and monies are kept safely. Satisfactory health, safety and fire risk assessments are carried out regularly, and appropriate weekly checks are recorded to ensure that the fire system, call bells and emergency lighting is working effectively. Hot water outlets throughout the home are also checked on a weekly basis, to make sure that residents are not placed at risk of scalding. All accidents are recorded and where necessary appropriate steps are taken in referring residents for further health care assessment. What has improved since the last inspection? This is a first Key Inspection as the home is under new ownership. What the care home could do better: There is an area in the garden that residents have free access to, where paving slaps have been laid on top of shingle, this area could place residents at risk from tripping. The registered provider must provide formal supervision and support to the registered manager so that she is aware of where further knowledge, skills are needed so that she can continue to provide the best standard of care for the residents in the home. Key inspection report Care homes for older people Name: Address: Ambleside Residential Care Home 122 De La Warr Road Bexhill-On-Sea E Sussex TN402JL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: June Davies     Date: 0 4 0 6 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 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. 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 Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Ambleside Residential Care Home 122 De La Warr Road Bexhill-On-Sea E Sussex TN402JL 01414219821 01424734259 mail@amblesiderch.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Grace Care Homes Ltd Name of registered manager (if applicable) Mrs Gillian Mary Gierus Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - DE Date of last inspection Brief description of the care home Ambleside Residential Care Home is situated on the main road to Bexhill on Sea, and close to regular public transport services. The home has been converted from a residential property and has been extended over the years to provide living accommodation for 21 residents. It is registered to provide care for residents who have a dementia type illness. The home is well maintained and provides comfortable living accommodation for its residents. There are three double bedrooms and fifteen single bedrooms, some have en-suite facilities. The bedrooms are situated on both ground floor and first floor levels. A stairlift provides residents with access to the first floor. Care Homes for Older People Page 4 of 26 Over 65 0 21 Brief description of the care home Throughout the building there is provision of aids to assist residents with mobility. There is a large lounge dining room with a smaller quieter lounge situated to one side of this main communal area. Both communal rooms have access to a well tended secure back garden to which residents have unrestricted access. At the front of the home there is a large parking area for visitors. Information in regard to the fees charged can be obtained from the Registered Manager. Extra charges are made for therapeutic services, hairdressing, chiropody, toiletries, dry cleaning, clothing, and luxury items. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on Thursday 4th June 2009 over a period of seven hours. During this inspection the inspector spoke with the Registered Manager, Mrs Gillian Gierus, the Deputy Manager, staff and four visitors to the home. An audit of medication and tour of the home took place, all documentation relating to the key standards inspected were also inspected. Some information contained in the Annual Quality Assurance Assessment sent to the Commission by the manager has also been used in this report. The quality rating for this service is GOOD. Care Homes for Older People Page 6 of 26 What the care home does well: Information given to prospective residents is good and provides them with the opportunity to make an informed choice about residing in Ambleside Residential Care Home. Prior to a resident moving into the home, a thorough pre-admission assessment is carried out by the the registered manager and her deputy, and this may involve more than one visit to the prospective resident. Information is also gained from other health care professionals and care manager, who have knowledge of the prospective resident. All care plans are based on the thorough pre-admission assessment and other information gained. Risk assessment are based on day to day living activities, and health care needs. Both care plans and risk assessments are reviewed on a monthly basis and any changes are recorded. As far as possible the manager ensure residents and relatives or representatives are involved in the care planning process. Health care needs are considered a priority and there is good evidence that residents have access to a variety of health care professionals as and when required. The receipt, recording, storage, handling, administration and disposal of medication is well managed promoting the residents good health. Residents are able where possible to make choices in regard to their daily living routines and are encouraged and supported to do this by the staff team. A variety of appropriate activities are available to residents. The majority of activities are carried out in small groups and residents are able to make choices on a daily basis as to what activities they would like to participate in. The home does make arrangements with external entertainers and specialist groups who come into the home to work with residents or just for entertainment. Menus in the home are varied, giving residents a varied, nutritious and wholesome diet with specialised diets being catered for as and when required. Relatives spoken to during the course of this inspection said that the standard of care, attention to health care needs, social care and food was excellent. They spoke highly of the manager and her staff team. One relative said nothing is too much trouble here, I cannot speak too highly of the care that my mother receives. The complaints system in the home is good ensuring that any complaint is appropriately investigated and a timely reply is made to the complainant. Residents are protected from abuse by stringent recruitment policies and procedures, and ensuring that staff receive the appropriate training to reduce the risk of abuse. Ambleside Residential Care Home provides the residents with a comfortable and homely place to live. Residents are protected by good infection control procedures being adherred to by the staff team. Staffing levels in the home are good providing satisfactory staff input at busy times and enabling staff to spend one to one social time with the residents during the course of the day. There is good evidence that staff have the appropriate qualifications and training to meet residents needs. Recruitment processes are diligently followed so that Care Homes for Older People Page 7 of 26 each member of staff is appropriately vetted prior to taking up employment in the home, so that residents are not placed at risk of abuse. The registered manager, Mrs Gillian Gierus, works well with her staff team often covering care shifts and working alongside the care staff. Her main priority is the health, well being and social care of the residents. She has developing a good quality assurance system in the home that promotes a high standard of care to the residents. Where the manager has accepted responsibility for residents personal allowances this is well managed and all documentation and monies are kept safely. Satisfactory health, safety and fire risk assessments are carried out regularly, and appropriate weekly checks are recorded to ensure that the fire system, call bells and emergency lighting is working effectively. Hot water outlets throughout the home are also checked on a weekly basis, to make sure that residents are not placed at risk of scalding. All accidents are recorded and where necessary appropriate steps are taken in referring residents for further health care assessment. What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide provide residents and prospective residents with the information they need to make a decision about moving into the home. Residents move into the home knowing their needs can be met and their independence will be maximised and promoted. Evidence: The Statement of Purpose and Service User Guide has been reviewed and provides good informatin in relation to what Ambleside Residential Care Home can offer its residents, and the quality of care they can expect. Each new resident is supplied with a copy of terms and conditions and a contract that states the number of the room they will occupy and the amount of the fees being Care Homes for Older People Page 10 of 26 Evidence: charged. All three contracts viewed have been signed by the residents representatives. The registered manager ensures that a thorough unrushed pre-admission assessment is carried out prior to a new resident moving into the home, this may involve the manager and her deputy visiting the prospective resident on several occassions prior to the resident moving into the home. The registered manager also ensures that she obtains reports and assessments from other professionals who have had contact with the prospective resident. The prospective resident and their relatives are invited to visit the home to meet with existing residents and staff prior to making a final decision. Two relatives spoken to during this inspection said that they appreciated the visit to the home, and stated how kind staff were during this visit. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system in the home adequately provides staff with the information they need to satisfactorily meet the resident needs. The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication at this home is well managed promoting good health. Personal support is offered in such a way as to promote and protect residents privacy, dignity and independence. Evidence: The residents care plans are intitially written up from information obtained from preadmission assessments as well as using information gained from other health care professionals. The care plans are informative and clearly show staff what the residents assessed needs are. A variety of risk assessments are in place that relate to the Care Homes for Older People Page 12 of 26 Evidence: individual resident and take into account what their capabilities are. Three care plans were viewed by the inspector, each care plan and risk assessment had been reviewed regularly and updated where necessary. There was evidence in care plans and daily reports that residents health care needs are well met, and that they have access to a variety of health care professionals as and when needed. Where there are particular health care problems like diabetes, skin integrity, continence etc., the manager arranges with community nurses to carry out training with staff, so they have a better understanding of managing the residents health care needs. Medication in the home is well managed, with policies and procedures having been recently reviewed, Medication Administration Records fully completed and staff observed by the inspector as administering medication to residents in an appropriate manner. Evidence was seen on Medication Administration Records to show that the manager is working closely with Community Psychiatric Nurses and Consultants in trying to reduce the amount of antipsychotic medication prescribed for residents in the home. Staff were observed interacting with residents in a caring and professional manner, using communication methods suitable to each individual residents needs and respecting the privacy and dignity of residents when carrying out personal tasks for residents. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are helped to make choices in regard to their daily living routines and the activities they participate in. The meals in this home are good offering both choice and variety and catering for special diets. Evidence: Residents are helped by staff to make choice in regards to their daily living routines. While there is no set weekly programme of activities, staff explained that residents are able to choose their own activities on a daily basis and that sometimes staff sit with just one or two residents to play a board game, look through photographs, or look at a magazine. The manager and staff said how much residents enjoyed music with some residents choosing to sing along and some getting up to dance. External entertainers are brought into the home on a regular basis. On the afternoon of this inspection there was an entertainer who brought in hand held musical instruments and residents where shaking these instruments in time to the music, while other residents who had chosen not to have an instrument, were tapping their feet or swaying their bodies in time to the music. Care Homes for Older People Page 14 of 26 Evidence: Staff take residents out from time to time either to the local retail park, to the park or for a walk along the sea front. The local Baptist Church supports the home by carrying out small church services in the home, and visiting and sitting talking to the residents. Two residents are Roman Catholic and the local priest or lay preacher visit these residents. The manager said that she was disappointed that support from the local Church of England is not available to the residents since the last vicar moved on. Relatives and friends are welcome in the home at any time and staff make them welcome. Four relatives were spoken to on the day of this inspection, all had praise for the home and the work that the manager, her deputy and staff do with the residents. The all said that their residents were treated as individuals, and staff took a pride in each residents appearance. That the care residents received was excellent. None of the residents have the capacity to manage their own financial affairs, and relatives or solicitors have power of attorney. One resident has an advocate, who speaks on her behalf. Meals in the home are good, and are based on a four week rotating menu. The cook said that she varies the some meals so she can use vegetables that are in season. The menus show that the home offers a balanced, varied and nutritious diet to the residents. At the present time the menus are only in written format but the manager is considering producing a picture format so that residents can relate better to the food that is being offered. The home caters for specialised diets as and when they are required, and presently caters for diabetic and vegetarian diets. Mealtimes are unrushed, and staff ensure that assistance with eating food is carried out discreetly and sensitively. Liquidised diets are present in an attractive and appealing manner. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that residents concerns are listened to. Staff have a good knowledge and understanding of Safeguarding Vulnerable Adult protection issues which protects the residents from abuse. Evidence: The complaints policy and procedure is up to date and contains all the correct contact addresses, it is placed next to the visitors signing in book in the main entrance of the home. While it is not easy to assess if residents have any understanding of the complaints procedure, it was evident that relatives are aware, and know that their complaints will be acted on. Only one complaint has been received by the home in the last six months, this was dealt with appropriately with all documentation being kept within the complaints file. The home has up to date policies and procedures in place for the Safeguarding of Vulnerable Adults. There have been no safeguarding referrals to Social Services in the last six months.. The recruitment process is robust ensuring that all new staff have the appropriate checks carried out prior to taking up employment in the home. Staff with exception of the newest staff have receive training in the Safeguarding of Vulnerable Adults. New staff also cover Safeguarding in their Skills for Care related induction. Care Homes for Older People Page 16 of 26 Evidence: Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within the home is good providing residents with an attractive and homely place to live. Evidence: Ambleside Residential Care Home offers its residents a comfortable homely place to live. The communal lounges and dining area is bright and cheerful, with good decoration and furniture. Bedrooms are appropriately furnished and well maintained. Some bedrooms on the first floor have recently been decorated, but residents have not been able to choose their colour schemes. Some of the new bed linen in these bedrooms is rather contemporary and the design could lead to confusion for residents with a dementia type illness. Communal toilets and bathrooms are generally in good decorative order and fitted with mobility aids. One bathroom on the ground floor requires some attention to the decoration. The home is kept in good clean condition with no offensive odours. The back garden of the home is secure and well maintained and provides residents with a pleasant outside space. Residents have free access to the garden and are able to use this garden at will. The inspector did however note that an area to one side of the garden that is laid to shingle with paving slabs set on top is not safe and could be a tripping hazard to the residents. The inspector observed a resident walking rather unsteadily over this area. Care Homes for Older People Page 18 of 26 Evidence: Infection control procedures throughout the home are good, with staff being supplied with disposable aprons and gloves to minimise the risk of cross infection to the residents. Liquid soap and paper handtowels are available in all communal toilets. The laundry room is clean and tidy, and fitted with an industrial washing machine with sluicing facility and industrial tumble drier. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Recruitment policies have been consistently followed resulting in residents receiving care from staff that have been appropriately vetted. Staff are multi skilled ensuring good quality care and support. Evidence: From observation of staff rotas, talking to staff and relatives there are sufficient care staff on duty to meet residents assessed needs at the present time. The registered manager said that she keeps staffing levels under review to ensure that residents assessed needs are met and that staff have time to spend one to one with residents. There is no domestic employed at the present time but plans are underway to ensure that a cleaner is employed in the near future. At the present time sixty percent of staff have a NVQ qualification at level 2 or above with one member of staff about to start the NVQ qualification. Recruitment procedures are strictly adhered to and ensure that staff are appropriately checked prior to taking up employment in the home. All new staff are required to do a Care Homes for Older People Page 20 of 26 Evidence: trial supervised shift in the home, prior to doing an initial induction, followed by skills for care related induction. Many of the staff have undertaken their mandatory training, and newer members of staff will be doing this training within the next three months. There is evidence that staff also receive further training in continence care, avoiding and caring for pressure areas, falls and osteoprosis and communication. The manager has also booked an Equality and Diversity course for care staff. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has the knowledge and skills to manage this care home and is well supported by her deputy manager. The quality assurance system while still being developed is good and helps towards providing residents with a high standard of care. Emphasis is placed on health and safety in the home so that residents live and staff work in a safe environment. Evidence: Jill Gierus, the registered manager has both the qualification and experience to manage Ambleside Residential Care Home. She has obtained her NVQ level 4 in Social Care and the registered managers award, has obtained her Certificate in Education levels 1 and 2, has D32 and D33 assessors award and has completed Level 3 in food management. Jill Gierus works hard to ensure that all residents living in the home have a good quality of care and support. Although the registered provider has visited Care Homes for Older People Page 22 of 26 Evidence: the home on a regular basis, Jill Gierus has not received formal supervision that will enable her to identify where her weaknesses in management are and where she needs to update or gain further knowledge. The quality assurance system in the home is still being developed, to encompass stakeholder and staff surveys. The manager monitors some systems used in the home and is in the process of developing further quality monitoring checks to ensure the residents receive a good overall quality of care. The registered provider carries out monthly regulation 26 visits to the home, while reports are lengthy more detail needs to be given as to what areas of care were observed and where further maintenance or refurbishment work is required in the home. The inspector viewed building Health and Safety and Fire Risk Assessments that are carried out regularly. Only one resident has requested that the home looks after her personal allowance. Appropriate records are kept of all incoming and outgoing monies. Both the record and money are kept securely. As mentioned previously under staffing, most of the staff have completed their Health and Safety related training, and further training has been arranged for newly employed staff. Weekly checks are carried out and recorded on the fire system and hot water delivery and regular fire drills take place to help prevent residents being placed at risk. Appliances used in the home all have an up to date maintenance certificate. All accidents are recorded and monoitored, where a resident is falling regularly their falls risk assessment will be reviewed and referral made to the residents general practitioner. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 The area in back garden where paving slabs are laid on top of shingle should be made safer for residents, to prevent tripping hazards. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 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) 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. 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