Inspection on 21/01/10 for Ashbourne House

This is the latest available inspection report for this service, carried out on 21st January 2010.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashbourne House 26/04/07

Ashbourne House 11/07/06

Ashbourne House 20/12/05

Ashbourne House 26/04/05

Ashbourne House 07/12/04

Ashbourne House 08/06/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Ashbourne House 213 St Marychurch Road Ashbourne House Torquay Devon TQ1 3JT     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: Alan Pitts     Date: 2 1 0 1 2 0 1 0 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: Ashbourne House 213 St Marychurch Road Ashbourne House Torquay Devon TQ1 3JT 01803327041 01803310587 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Diana Dolorse Enilde Williamson,Mr Robert Gisburn Williamson care home 28 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The home can admit one Service User, who is within category, but under 65 years of age. Date of last inspection Brief description of the care home Ashbourne House is a large detached property in a level residential area close to St Marychurch precinct, which has shops and other facilities. The home can accommodate up to twenty-eight people some in shared rooms from the age of 65. They may be physically andor mentally frail, but the home does not cater for people in advanced stages of dementia or those exhibiting extreme behavioural problems. The double bedrooms are normally occupied singly. There are extensive communal areas on the ground floor, including a large lounge, dining room, quiet visiting room and an Care Homes for Older People Page 4 of 26 0 0 0 Over 65 28 28 28 Brief description of the care home activities area. There are stair-lifts on the main staircase to the first and second floors. However there are several bedrooms, which can only be reached via a few steps, and so are suitable only for residents able to walk updown some steps. One of the bathrooms first floor is fitted with a bath hoist. There is an attractive level garden, a courtyard and a small car parking area. A minibus is available to residents for outings. The owners also manage a day centre separately staffed adjoining the home, where more able residents of the home may be able to join in activities. The weekly costs of care at Ashbourne House are currently lowest GBP320.00 and highest GBP440.00. 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 unannounced key inspection was undertaken on 21st January 2010. A tour of the home was undertaken and samples of care records were examined. People that live there and visitors were asked for their views of the service provided. The inspector spoke with the registered providers, residents, and staff, toured the premises, and inspected documentation. Ashbourne House offers a friendly environment. Residents expressed their satisfaction with the services provided by the home, and the inspector had the impression that the registered providers and staff held a genuine concern and regard for the welfare of the people that live there. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: At the time of the last inspection the need for additional assisted bathrooms for residents was discussed with the proprietors. However, the home has had substantial work undertaken inside and it has not been possible for the bathrooms to be provided. This was discussed again with the registered providers, who said that they were still considering the options available (including possibly closing the adjacent day-centre, which has an assisted bathing facility). More could be done to provide information in alternative formats for people with a sensory deficit. Improvements are needed to ensure the safety and security of the medicine administration process. More could be done to ensure the care records accurately reflect the lifestyle of the people that live there. A National Training Organisation compliant induction programme should be in place for new staff. Staff are supervised, but the frequency of this needs to be increased. Care Homes for Older People Page 7 of 26 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 home accepts admissions on the basis of a full care needs assessment. Standard 6 is not applicable, as the home does not provide intermediate care. The people who are thinking about a move to Ashbourne House are provided with information to help inform them about their choice of home. Evidence: There is a Statement of Purpose provided to each person on admission. The information provided in this is now available as an audio tape, though the registered provider should consider providing the information in alternative formats (e.g. video). People are provided with a copy of the homes Statement of Terms and Conditions of residence. A full and proper assessment is undertaken prior to admission of a new resident. Prospective residents have an opportunity to visit the home, and the home works closely with families and other agencies to ensure that all parties are happy with the Care Homes for Older People Page 10 of 26 Evidence: placement. One resident and a visitor confirmed that they were given the information they needed. Historically, a number of residents are admitted following previous attendance at the homes adjacent day centre, which gives people the opportunity to get to know the home. The home does not offer intermediate care. 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. Many of the people who live at Ashbourne House feel that they are offered a good standard of care. Each resident has a care plan that is written in plain language, is easy to understand and considers all areas of the individuals life. The home ensures that each residents plan is reviewed regularly and involves the resident and/or their family (where possible). Evidence: The inspectors spoke with the manager, and staff, and inspected care documentation and care plans. Each resident has in place a care plan, which identifies care needs and how these are being met. The care plan identifies all aspects of care (including religious, cultural and social needs, personal and oral hygiene, pressure area care, and access to specialist services). Evidence is in place of monthly reviews taking place, and, where possible, resident involvement in this process is recorded. The care plans identify the health care needs of the residents with evidence of health care professional involvement, for example optician and chiropodist visits. Care documentation is written in clear language. Whilst generally comprehensive in their Care Homes for Older People Page 12 of 26 Evidence: coverage of individuals health care needs, improvement is possible with regard to the number of forms entitled care plan. The information sought, though present, is not always readily to hand and requires searching through the documentation. Comments received from the people that live there, on the standard of care delivery at the home were very positive. There were no concerns expressed. Appointments are seen as important and there are systems in place to make sure residents are reminded and appointments are not missed. Records show that the home arranges for health professionals to visit frail residents in the home and provides facilities to carry out treatment. The registered providers and staff maintain good relations with local GP surgeries. The staff were observed to knock on residents doors prior to entering. Residents were complimentary of the care and kindness of the staff, and also confirmed that they would feel able to express any concerns. Residents that wish are able to self medicate subject to a risk assessment process to ensure they have the capacity and are safe. There were no residents self-medicating at the time of the inspection. Medicine Administration Records (MAR) were seen to be in order, though the registered providers should ensure that where entries are handwritten they show two staff initials (to indicate the entry has been checked as correct). Medication is checked and booked in when received and returned. Secure storage is in place. Medicines were observed to be administered from the lounge adjacent to the dining room, this process meant that medicines were left unattended on the sofa and table while the staff member was away. This was discussed with the staff member and the registered providers. The registered providers recognised the potential risk inherent in the current practice and agreed to research alternatives, liaising with their pharmacist and CQC inspector. All the residents spoken with said that they were always treated with respect and that care was taken to ensure their privacy was maintained. Comments received were, without exception, positive about the quality of care provided and the attitude and caring approach of the staff and management. 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 were seen to receive visitors and the visitors book shows they often do so, and that they are free to determine their own lifestyle. There is an infrequent programme of activities at Ashbourne House. The residents were complimentary about the quality of the food provided. All were positive in their comments about life at Ashbourne House. Evidence: Visitors are encouraged into the home and visitors were observed at the home during the course of the inspection. Visitors are free to visit without restriction. Residents are able to keep in contact with family and friends living in the community. Residents can choose to entertain visitors in their own rooms or perhaps in the lounge or garden areas (in more clement weather). Routines are flexible and residents can make choices. There insufficient evidence of the frequency and range of activities offered and available to all. We were advised by the registered providers that activities are more frequent and varied than the records would lead us to believe. The records do not reflect the efforts made in this regard. We discussed the benefits of individual entries being made in residents records, to reflect their participation in activities and also whether they enjoyed the activity. The Care Homes for Older People Page 14 of 26 Evidence: records should also show that people were aware of the opportunity, and where activities are offered and rejected. People spoken with said that they generally had enough to do and to keep themselves occupied, but one did say there were times when they felt it would be nice to have more. All the people spoken with, including a visitor to the home, were complimentary of the quality of life at Ashbourne House. Residents are encouraged to be responsible for their own money for as long as they wish, and are able to maintain their independence, for example, collecting their own pension, paying for shopping and managing their own bank accounts. Observations of the interaction between the residents and the staff (including the registered providers) were positive. Residents confirmed that they would feel able to voice any concerns if they had any. Residents were seen to have personal possessions. Dietary needs, and likes and dislikes, are included in the residents care plans. Residents were complimentary about the standard of cooking at the home. Meals are prepared in a modern kitchen. Local retailers are used and fresh produce used for all meals. The menu offers an alternative meal and residents confirmed that an alternative is available. The menu choices are sought every day, and a record of the choices made by people kept. We discussed the benefits of photo menu cards to assist people in making a choice. 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 people at Ashbourne House are confident that their concerns will be listened to and acted upon. The people that live at Ashbourne House are protected from abuse by a robust safeguarding procedure, staff training, and staff supervision. Evidence: Residents said that the staff and the registered providers are respectful and that their rights are protected. Residents confirmed that they would feel able to express any concerns. The complaints policy is included in the homes Statement of Purpose, which is provided to each resident. The complaints policy has been updated. The home has a policy for the protection of vulnerable adults, which has been reviewed since the last inspection. Safeguarding training has been provided to staff (and continues to be arranged). The registered providers said that they would continue to encourage attendance on local authority safeguarding training. Residents are protected by the homes adherence to a robust recruitment procedure, and staff have been supervised (though improvement is needed in the frequency of supervision). The majority of care staff are qualified to NVQ Level 2 or above. Residents are protected by the day-to-day involvement of the registered providers. Care Homes for Older People Page 16 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. Ashbourne House provides a pleasant, clean, well-maintained, and safe environment for residents to live in. Evidence: A tour of the home was undertaken at the time of the inspection. Substantial work has been undertaken with the homes electrical wiring. This work required a long time to complete and the home has not had the opportunity to provide the additional assisted bathroom that was discussed at the last inspection and again at this inspection. This work remains outstanding. Ashbourne House is registered for up to 28 residents, but effectively operates at around 23 to 24 maximum occupancy as a number of large double rooms are used as single rooms. Rooms were seen to be personalised to varying degrees, and the registered providers said that there is a rolling programme of redecoration and refurbishment. Bedrooms and communal areas were pleasantly decorated and provided comfortable seating. The sun lounge has been redecorated since the last inspection, and new carpet has been laid in the ground floor hallway and stairs. All but one room were free of untoward odours, and the home was seen to be clean throughout. The kitchen was seen to be clean and organised, and of a good size. The laundry is Care Homes for Older People Page 17 of 26 Evidence: located in an external building. Personal clothing is washed on site, with bedding contracted out. Portable electric fires are in use in a small number of rooms whilst the registered providers arrange for work to be carried out on the central heating system. The registered providers agreed to ensure that the portable fires were fixed to the wall while in use. Thermostatic control valves are fitted on all hot water outlets. People were seen to be comfortable in their rooms and those spoken with confirmed that they were happy with the facilities provided. Care Homes for Older People Page 18 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. There were sufficient staff on duty at the time of the inspection, and there is staff training taking place. The home protects residents by adhering to a robust recruitment procedure. Evidence: At the time of the inspection there were 17 people living at Ashbourne House. At the time of the inspection there were two care staff on duty along with a cook and cleaner (the duty rota shoed that 3 staff should have been on duty, but one staff member had called in sick and alternative cover was arranged). The registered providers were also available. Numbers will increase during the day as the registered providers confirmed that a new manager is starting on Monday 25th January. The majority of the care staff have achieved NVQ Level 2 or above. Certificates and records of training are kept in staff personnel files. Staffing levels are consistent, and the care documentation indicates that these are generally sufficient to meet the needs of the people that live there, though the registered provider should continue to monitor this. We were shown a staff training matrix that provides an at a glance summary of staff training achievements and needs. Residents and a visitor to the home were complimentary of the care provided by the staff. No concerns were expressed. Two staff personnel files were examined during the inspection; they had the necessary documentation and complied with the legislation, which ensures residents are in safe Care Homes for Older People Page 19 of 26 Evidence: hands at all times. New staff receive an induction to the home, but a National Training Organisation (NTO) compliant induction is not in use at the moment (www.skillsforcare.org). This was discussed with the registered providers. Care Homes for Older People Page 20 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. There is no registered manager at present, though an imminent appointment is expected and the home is efficiently managed by the registered providers. The home does use a quality assurance process, such as questionnaires. Staff are supervised. There are ongoing maintenance and safety checks. Evidence: The home does not currently have a Registered manager. The registered providers are in day-to-day control at the moment, and they confirmed that a new manager is starting shortly. Residents finances are safeguarded. The home will hold small amounts of money for residents if requested to do so, but otherwise has no involvement in the management of peoples finances. Staff are appropriately supervised, though the frequency should be increased to ensure compliance with the regulations. Care Homes for Older People Page 21 of 26 Evidence: The health, safety and welfare of residents is protected by relevant checks on equipment and supplies. Residents comments about staff were positive. The inspectors observed staff attending to residents needs in an appropriate and respectful manner. The registered providers said that staff are provided with a copy of the General Social Care Council handbook. The home has undertaken quality assurance questionnaires to residents, family, and other relevant agencies. We discussed the options for summarising the findings, presenting this information, and for publishing the findings and any action taken as a result of the findings. The registered provider maintains current invoices and records to show ongoing maintenance and safety checks. Fire training is in place for staff and the fire equipment was checked by an outside contractor at the time of the inspection. The insurance cover in place ensures that the home is well able to fully meet any loss or legal liabilities. Care Homes for Older People Page 22 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 23 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 1 9 13 The registered providers 19/02/2010 must make arrangements to ensure the safe and secure administration of medicines. This is to protect residents and ensure good practice. 2 30 18 The registered providers 01/03/2010 must make arrangements for new staff to receive NTO compliant induction training. This is to ensure a consistent quality of care provision and to protect the people that live there. 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 2 1 9 The registered provider should consider providing information in alternative formats (e.g. audio/video). The registered providers should ensure that where MAR entries are hand-written they show two staff initials (to Page 24 of 26 Care Homes for Older People 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 indicate the entry has been checked as correct). 3 12 The registered providers should ensure the care records accurately reflect the lifestyle of the people that live there, and the opportunities offered in respect of social/recreational activities. The registered providers should summarise the findings of their quality assurance processes, and publish these. The registered providers should ensure that staff are supervised at least 6 times a year. 4 5 33 36 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. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!