Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Ambleside Bank Care Home High Street (Off Ince Green Lane), Lower Ince, Wigan, WN3 4RL Tel: 01942321112 Date of Inspection: 03 June 2014 Date of Publication: July 2014 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Staffing Assessing and monitoring the quality of service provision Complaints Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Century Healthcare Limited Mrs Lesley Cook Ambleside Bank is registered to provide accommodation with personal care for up to 40 people. The home is set within its own grounds with car parking facilities.it is close to Wigan town centre and local transport networks. Care home service without nursing Accommodation for persons who require nursing or personal care Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 6 Our judgements for each standard inspected: Respecting and involving people who use services 7 Care and welfare of people who use services 9 Staffing 11 Assessing and monitoring the quality of service provision 12 Complaints 14 About CQC Inspections 15 How we define our judgements 16 Glossary of terms we use in this report 18 Contact us 20 Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 3 June 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information given to us by the provider and reviewed information sent to us by other regulators or the Department of Health. What people told us and what we found We considered our inspection findings to answer the questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? This is a summary of what we found. Is the service safe? Both the people who lived in the home and their relatives were pleased with the care provided and felt that their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. There were enough staff to meet the needs of the people living in the home and a member of the management team was available on call in case of emergencies. One relative said: "I feel he's safe and well looked after." Staff personnel records contained all of the information required by the Health and Social Care Act. This meant the provider could demonstrate that staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any incidents of abuse. Is the service effective? People told us that they were happy with the care that had been delivered and their care Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 4
records were up to date and signed by them. One relative said: "My dad is getting belting care. He's well looked after and well fed." Care records confirmed people's preferences and needs had been recorded and care and support had been provided in accordance with people's wishes. One relative said: "It's the best thing we ever did (bringing him here)." We heard that information was shared effectively between staff. Several ways of sharing information included management team meetings, handovers, daily records, and monthly reviews. Is the service caring? People were supported by kind and attentive staff. We saw that care workers showed patience and encouragement when supporting people. One relative said: "They really care for the residents." One person who lived in the home said: "I think it's absolutely brilliant." Is the service responsive? People's needs had been assessed before they were admitted to the home. Their needs for support and treatment were carefully described so that care workers knew exactly what tasks to undertake. Changes in people's care needs were reported to the senior carers and they briefed care staff. One person said: "They ask me questions to check if I have any problems." A recent survey had highlighted some suggestions for day trips which the activities coordinator had actioned. Is the service well-led? Staff had a good understanding of the culture of the home and quality assurance processes were in place. People told us they had received satisfaction surveys and we saw evidence that feedback had been acted upon. The registered manager had introduced grumble and praise boxes to encourage more feedback and comments. Staff told us they were clear about their roles and responsibilities and were well supported. One said she had gained two qualifications whilst she had been working at Ambleside and commented: "I've got a lot out of working here." You can see our judgements on the front page of this report. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 5
More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 6
Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. Reasons for our judgement During our inspection we talked with four people who lived in the home, three relatives, three staff who were on duty and an advanced nurse practitioner and a district nurse who visited the home. We also spoke with the registered manager and the director of nursing services of the provider group. Two of the relatives we spoke with had become volunteers at the home since their loved one had passed away. Those people we talked with felt they were consulted about what happened in the home by regular updates from staff and by attending review meetings. One person said: "They have a joke with me. That makes you feel good." Relatives we spoke with were complimentary about the standard of care and said: "If there is anything going on, they telephone me and let me know." We saw the home had a number of policies to guide staff to involve people using services and their families. These included a participation policy and procedure which guided staff in their interaction with people. Additional guidance on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) was also in place for staff reference. Each person was assessed to ensure their rights were protected and there were no unnecessary restrictions. One person who lived in the home was a keen gardener and each year was taken to choose plants for the summer season and was then helped to plant them. The registered manager told us they had regular contact with families many of whom visited every day. Relatives were regularly invited to take part in the activities run in the home and we saw relatives helping with meals. The provider had sent out feedback questionnaires to both people who used the service and their families. The number of forms returned was low so the registered manager had introduced a grumble box and a praise box to encourage more comments and suggestions. One relative said: "We have a good relationship." Each person was allocated a coordinator and a key worker who consulted them and their relatives about their preferences and life story. This information was used to guide Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 7
people's choices of for example food, clothing, activities and what time they chose to get up in the morning. Review meetings were held monthly with the person living in the home and their relatives to review their needs and discuss any concerns. When relatives were unable to attend review meetings they received a summary in the post and were asked to sign and return to indicate they had read it and were happy with the contents. We saw in the care records that families were asked to participate in the care planning process and they were consulted about end of life care. Mental Capacity Assessment forms had been completed and a best interests checklist used where families were not involved. We observed staff talking with people with respect and patience encouraging their response and involvement wherever possible. A person who lived in the home said: "The carers are excellent." Another said: "They knock at my door. They ask my permission to do things." We heard from staff care was taken to show respect to people and this ensured that their privacy and dignity was protected when personal care was being delivered. Our observations and discussions indicated people expressed their views and were involved in making decisions about their care and treatment. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 8
Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement The people who lived in the home looked cheerful and content and told us they were happy with the care they received. One person commented: "I think it's absolutely brilliant." Another person said: "I think it's a fantastic place." They confirmed that staff explained to them what tasks they wished to do and asked for their consent. One of the families we spoke with said: "I couldn't praise it enough." People who lived in the home particularly enjoyed the food at the home and one person said: "The food is champion." During our visit we looked at four care plans. These plans showed that the individuals and their relatives were involved in the planning of the care and personal preferences were discussed. The care records showed specialist nurses, district nurses and a doctor were all regular visitors to the home. This meant appropriate healthcare professionals were accessed when people required them. We spoke with a district nurse who visited the home. They said: "The staff take on board anything I suggest." An advanced nurse practitioner said: "I don't have any problems with Ambleside. It's fine." Each person had two support plans, one for day and another for night time and these were person centred and took account of people's strengths and their needs for support. We saw the care plans were reviewed monthly by the registered manager and relatives confirmed they received notes from these reviews if they were unable to attend and were asked to confirm this by signing the care record. We saw daily reports in each file which gave bulletins about the person several times each day. We noted that there were no entries for occasional days. The provider may wish to consider putting a mechanism in place to ensure that each person's care is reported on a daily basis. We observed staff were respectful and friendly towards the people living in the home. The care staff we spoke with said people chose what time they wanted to get up, what clothing they wished to wear, what food they liked on the menu and where they wished to sit during the day. There was a menu on the dining room wall and we saw staff speaking with each person about what they would like to eat at lunchtime. We saw people had a choice of what activities to do including quizzes, dancing, bingo, listening to entertainers, trips out to garden centres or local places of interest or sitting quietly in their room. The activity coordinator showed us the activity plan for that month but said: "I play it by ear, see if Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 9
people want to come out on trips or if they are well enough." The home had an information pack for new people and their families which included a resident's charter describing people's rights and how they would be cared for. Our observations and discussions indicated that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 10
Staffing There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement On the day of our inspection the home provided accommodation for thirty seven people. The registered manager worked full time and was supernumerary to the care staff on the rota. We saw several rotas which showed there was a team of five staff in the morning and four in the afternoon. Three care staff covered the night shift. The provider had its own bank of staff to cover for holidays, training and sickness absence. This meant that the staff who cared for people in the home were always familiar to them. The activities coordinator worked Monday to Friday and at least two volunteers worked with her three afternoons each week. The provider also employed domestic, laundry and kitchen staff and a maintenance person. We spoke with staff who worked at the home who said it could be busy during the morning whilst many people required personal care and support but they felt there were sufficient staff on duty to meet people's needs. We spoke with people who lived at the home who said: "I'm well looked after." Another person said: "If I need a shower I just ask and they help me." The staffing levels we observed were sufficient to meet the needs of people living in the home at the time of our visit. People who lived in the home told us that they were enabled to live as they wished. There were sufficient qualified, skilled and experienced staff to meet people's needs. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 11
Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people received. Reasons for our judgement The registered manager told us about a variety of systems in place for quality assurance which helped them to monitor the quality of care provided to the people who lived in the home. An audit of health and safety was carried out every three months, the environment, infection control and the support plans was carried out every two months and a kitchen audit took place every six weeks. We saw completed audits for medication and infection control which had been done in May 2014. Information collected was used to improve care or practise within the home. The registered manager had sent out questionnaires for feedback from people who lived in the home and their visitors on an annual basis. These surveys were sent direct to the provider for analysis and any issues were discussed with the registered manager. Suggestions had been made for trips out to different places and the activities coordinator had responded to this. The relatives we spoke with confirmed they had received these questionnaires and commented that: "If I have any concerns I just come in and see her (the manager). It's very informal here." The registered manager told us that they received daily feedback during their observations of the home. Additionally they chose one person every morning and provided their personal care. This gave an opportunity to monitor people's health and wellbeing and ensure an effective service was being provided. The registered manager provided formal supervision sessions to staff every two months and monitored the training they received by checking a matrix of when updates were due. The registered manager told us that no formal complaints had been received from anyone who lived in the home. All contact with relatives was recorded on the person's care record to monitor any concerns. A grumble box and a praise box had been introduced recently to encourage people to have their say. Plans were discussed to use the volunteers to speak with people and write grumbles or praise for those who were unable to write. Our observations and discussions indicated that people who lived in the home, their representatives and staff were asked for their views about their care and treatment and Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 12
they were acted on. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 13
Complaints People should have their complaints listened to and acted on properly Our judgement The provider was meeting this standard. There was an effective complaints system available. Comments and complaints people made were responded to appropriately. Reasons for our judgement People who lived at Ambleside told us they had no problems or concerns about the service. One commented: "I did make a complaint a while ago and it was dealt with very well." Another person said: "There's nothing I can fault." The registered manager told us that no formal complaints had been recorded. Informal feedback was gathered from the monthly environment surveys and they felt that this preempted any complaints. A grumble box was in the reception area to encourage any comments or suggestions. We saw the home's service user guide which was given to all people admitted to the home and included details about the service including how to make a complaint. The procedure provided information on contact details of organisations that could help support people with their complaints. The provider may wish to consider an easy to read leaflet on how to complain which may encourage more feedback. This information may be used to improve the quality of service on a continuous basis. The staff we spoke with said they knew what to do if someone had concerns or wanted to make a complaint about the service. They were aware of who they should report to and showed no hesitation to do so. Our observations and discussions indicated that people were made aware of the complaints system. This was provided in a format that met their needs. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 14
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 15
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 16
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 17
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 18
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 19
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) 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. Inspection Report Ambleside Bank Care Home July 2014 www.cqc.org.uk 20