Inspection on 15/04/10 for Ashlett Dale Rest Home

This is the latest available inspection report for this service, carried out on 15th April 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashlett Dale Rest Home 31/03/08

Ashlett Dale Rest Home 21/08/06

Ashlett Dale Rest Home 16/11/05

Ashlett Dale Rest Home 04/11/04

Ashlett Dale Rest Home 03/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Ashlett Dale Rest Home Stonehills Fawley Southampton Hampshire SO45 1DU     The quality rating for this care home is:   one star adequate 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: Michelle Presdee     Date: 1 5 0 4 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 34 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Ashlett Dale Rest Home Stonehills Fawley Southampton Hampshire SO45 1DU 02380892075 02380890573 fred.liddington@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Fredric William Liddington,Mrs Maureen Mary Liddington Name of registered manager (if applicable) Mrs Collette Willis Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 16. The registered person may provide the following category 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) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP). Date of last inspection 0 9 1 1 2 0 0 9 16 16 0 Over 65 0 0 16 Care Homes for Older People Page 4 of 34 Brief description of the care home Ashlett Dale is situated in a semi rural area in Fawley on the outskirts of the New Forest. There is a public house within a short walking distance and a number of other amenities and leisure activities a short car journey away. The home is a two-storey building having a reasonably good sized garden in which the residents spend some time during the warmer months. There are parking spaces in the grounds close to the home. In addition to the homes fees there are additional charges for hairdressing, chiropody, newspapers, magazines, medical requisites, luxury items and toiletries. Care Homes for Older People Page 5 of 34 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: one star adequate 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: The unannounced inspection took place on 15th April 2010 between 9:30AM and 6:10PM. The Commission (we) took two inspectors and were assisted by the manager, Mrs. Willis. Mr. Liddington one of the registered providers also called into the home. Fourteen people are currently living in the home. The majority were involved with the inspection, some in more depth than others. Six care staff on duty were part of the inspection. Two visitors and one health professional visiting the service on the day of the inspection have contributed to this inspection. Surveys prior to the inspection were sent to some people living in the home, health, and social care professionals and staff members. At the time of writing this report nine surveys had been received from people living in the home, all had been completed with the help of a relative. Nine staff members and three social, health care professionals had returned surveys. In parts of the surveys people are asked to tick boxes with judgements ranging form always, usually, sometimes and never. These are referred to Care Homes for Older People Page 6 of 34 in this report. The home sent us their Annual Quality Assurance Assessment (AQAA) back on time, which detailed information on the home. Paperwork including assessments, care plans, menus, staffing records and safety checks were seen. A tour of the home including all communal areas, the kitchen and all occupied bedrooms was taken on the day. All this information has helped form judgements in this report. Care Homes for Older People Page 7 of 34 What the care home does well: 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 Care Homes for Older People Page 8 of 34 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 9 of 34 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 10 of 34 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. People will have their needs assessed before they move into the home, to ensure their needs can be met. People have access to information to guide them on the services the home provides. Evidence: In the entrance of the home a range of information is available. Included in this was a brochure on the home and a new statement of purpose and service user guide. These documents detailed all the necessary information and copies of the last two inspection reports were available to view. Copies of the service user guide and statement of purpose were also available in residents rooms. The manager explained some residents were not interested in the information whilst others had read the material and asked questions on the information. Two pre-admission assessments were viewed; one belonged to a resident who had been in the home before the previous inspection and the other to a person who had Care Homes for Older People Page 11 of 34 Evidence: been admitted since the last inspection. Both followed the same format. The manager informed us she had changed all pre-admission assessments since the last inspection. Both assessments had been signed by the senior carer and dated, neither had been signed by the service user. Both gave a picture of the service users needs prior to admission. Neither of the pre-admission assessments included the views of any other people involved in their care prior to admission. We were advised the home does take into account the views of others, but where the pre-admission assessments had been re-written this information had not been included. It was also not possible to view care management assessments but we were advised these are requested and copies are kept in peoples files. Two visitors stated they were very happy with the way their relatives had been welcomed and settled into the home. One reported they felt their relative had improved from the moment they came into the home. The home does not provide intermediate care. Care Homes for Older People Page 12 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are not being adequately identified in care plans of sufficient detail to enable staff to meet these needs in a consistent fashion in the way the people themselves would like. Medication administration procedures currently put people at risk. Evidence: Since the last inspection in November 2009, where the home was assessed as providing poor quality outcomes for health and personal care, the manager reported that all care plans had been redone using a new format. She explained that support had been sought from outside the home to redevelop the care plans. Three peoples care plans were examined in detail and others looked at in less detail. Care plans were kept in folders for each individual. They contained a photograph of the person, an information sheet, review documentation (none had been completed at the time of the visit as the new care planning process had only recently been introduced), care plans, risk assessments, records of baths/showers, weight, visits Care Homes for Older People Page 13 of 34 Evidence: and outcomes of appointments with health care personnel, and that weeks daily notes referring to the person. To promote privacy the folders were kept in a locked filing cabinet. Care plans covered such areas as; socialising, communication, mobility, dressing/undressing, recreation and leisure, washing, bathing and drying, toileting needs, food and drink, sleep. The care plans still contained little information about the people being cared for or about how to deliver their care despite the Annual Quality Assurance Assessment (AQAA) completed by the manager on 1st March 2009 stating, At Ashlett Date we now undertake a more in-depth assessment and the resulting documentation informs the content of all care plans, risk assessments, short and medium term goals, future life goal planning and health action plans. The initial pre-admission assessments have improved and provide sufficient information to identify peoples care needs. The working care plans did little more than explain what these needs were. For example, that a person needed support with washing and dressing. A carer would not know from the care plan if this involved verbal prompts or if the person needed to be washed by the carer. And if so, in which order and in what manner the person wished to be washed. It wasnt clear whether they could tell the carer what clothes they wanted, or could choose between two separate items or were not able to choose at all. In which case the sort of clothes the person used to like to wear in the past should have been recorded so that staff had information to make the sort of choices the person would have made had they been able. Whilst in the lounge at lunch time it was noted one service user was left alone and became anxious. We were advised by the manager this person prefers to eat alone. When looking at the care plan for this person it detailed the person was under nourished, but had a normal appetite and took fortisips. It detailed they had smacked people and stolen food from other peoples plates. It was noted in another section of the care plan over three months the person had lost almost ten kilograms. There was no detail in the care plan how any of this should be managed. No fluid or food chart was maintained, daily notes included comments like eaten well. The care plan also detailed concerns over physical aggression, verbal aggression, irritability, agitation, restlessness, confusion and mood swings. However again there was no detail how this behavior should be managed and there was no associated risk assessments. Without detailed information it is likely that people do not receive care in the way they would like and do not receive consistent care. Care Homes for Older People Page 14 of 34 Evidence: Staff spoken with said that they were aware of the care plans but they learnt about peoples care needs by asking or shadowing other staff. Therefore if someone is not getting care in the way they would like this is perpetuated by staff passing misinformation. The manager said that she had spoken to the families of the people living at Ashlett Dale with regard to providing their life histories. However staff had not been sufficiently proactive in sitting down with the person and their relatives to discuss the persons life so as to produce pen pictures of the people at the home and details of their lives. Some relevant information in the pre-admission assessments had not been transferred to the care plans, for example mental health needs and personal likes and dislikes. A carer unfamiliar with the people living there, for example a new member of staff, would therefore not know vital information about how to support the person and may respond inappropriately when these needs were expressed, to the detriment of all concerned. Risk assessments were found to be minimal with small boxes available for; description of risk, who could be harmed, risk score, control measures in place, additional control measures needed, signature and date. There was no description of positive outcomes for managing risk, or links to care plans to carry this out. Without this it is possible that staff are not aware of strategies decided upon for managing risk and would not follow agreed approaches thus leading to peoples needs not being properly met. The manager explained that the records of peoples medication were kept with the medication and the medication administration record (MARS) sheets. It was noted for one person their pre-admission assessment stated they were on two types of medication but were now on nine types of medication. This information was not detailed in the care plan. The medication policy had been rewritten since the last inspection. This was available along with the homes other policies on the dresser in the dining room. The policy folder contained a lot of background information including the Pharmaceutical Society of Great Britains guidelines for managing medication in care homes. However the homes policy, although strong on underlying principles did not refer to the specific procedure in the home. For example it said that if the home used a monitored dosage system ... The home does in fact use such a system so the policy should be specific to the home saying which system is used and what processes the staff must follow in Care Homes for Older People Page 15 of 34 Evidence: using it. The monitored dosage system used by the home contains one months medication. It had been delivered the day before the visit and was observed on a chair in the homes office in the boxes it had been delivered in. The office is a locked wooden building in the grounds of the home. The regulations and guidelines governing the management of medication in residential care homes apply at all times throughout the home and medication must be kept in locked cabinets, or similar, that meet with these requirements. There were some medications that were being administered as PRN (when needed) that the instructions on the MARS sheet said should be four times a day. The doctor should be contacted to confirm that PRN is correct and alter the prescription and instructions accordingly to ensure that people are getting their medication as their doctor intends, to ensure their wellbeing. There were no guidelines in the files of those people receiving medication PRN to indicate when this should be administered. For example there was no information on how someone was able to communicate they were in pain and required medication. One persons daily notes recorded that a topical cream had been applied to itching legs on several occasions over three days. Not all of these had been signed for on the MARS sheet. If the person had received the prescribed cream at the times mentioned in the daily notes this would have been in excess of what had been prescribed. On discussing this with the staff it transpired that that the application not signed for was probably for a different cream that the person kept in their room. It also came to light that although one member of staff had signed for the cream on the MARS sheet they had in fact applied a different prescription only cream that the person had used in the past but had been discontinued. The old tube of cream had been left in the drugs cabinet and not been disposed of once it had been discontinued. This demonstrated that peoples care needs were not being properly met and that more detailed guidelines and properly followed procedures could have prevented this. Since we visited the home the registered manager has informed us that PRN procedures have been reviewed. In the AQAA completed by the manager she stated that, We have recently introduced health action plans. There was no evidence of these in the folders seen at the time of the visit to the home. Two health professionals completed surveys and both felt they were called appropriately. Comments included, Good feedback from staff when I ask Care Homes for Older People Page 16 of 34 Evidence: about specific patients, appear to know the resident well. Another stated, They take good care of their residents physical and psychological well being. The dignity of the people living at Ashlett Dale was seen to be being supported. Staff were friendly and caring and responded to peoples individual preferences. The activities provided did not appeal to all present in the lounge at the time and their desire not to participate, or to carry out another activity was respected. People were encouraged to keep mentally and physically active and this was done in a very enabling way and resulted in a cheerful friendly atmosphere amongst those living and working there and a lot of interaction between them. Peoples privacy was respected, someone had a visit from a health care professional during the visit and received their treatment in their own room. People had the choice of seeing their visitors in their own room or in the communal areas of the home. People were well presented and agreed their clothes were well laundered and always kept clean. Care Homes for Older People Page 17 of 34 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. The majority of people enjoy the activities offered by the home. Visitors can call at any time and are made welcome. People receive home cooked meals, but the choice at lunchtime could be increased. Evidence: In the AQAA we were informed, Our residents are encouraged to voice their preferences and choices around routines of daily living and activities, either independently or via relatives/advocacy services. It was clear from observations on the day that people had flexible and varied routines, which suited them. On our arrival to the home one gentleman was reading the paper in the dining room. Other residents were in the lounge, one lady had chosen to stay in her pyjamas and dressing gown. Throughout the day it was clear people were offered choices and spent time how they wished. The majority of service users joined in with the homes activities in the morning, but not all. These people reported it was their choice. Throughout the day people were seen reading newspapers, books, embroidering, knitting and having coffee with their visitors in their room. We were advised one resident spends a lot of time in bed throughout the day, but this is what they want to do. People spoken to felt there was plenty of activities in the home. The Care Homes for Older People Page 18 of 34 Evidence: home has an activities co-ordinator who works five mornings a week. It was clear they had a good rapport with the residents and the majority enjoyed the activities. In a survey one resident had recorded, They felt they were very well looked after. We were advised a wipe board in the dining room was used to advertise the days activities. On the day of the inspection this was blank, but we were advised this had been done by the night staff. In the lounge a board was used to detail the date, day and year. A photocopy of the days menu was also displayed, but this was a print-out and the typing was very small. It was noted social activities were not recorded in peoples care plans. We were advised visitors can call at any time to the home. Three visitors spoken to all confirmed they could call at any time and were always made welcome, with a cup of tea or coffee. Service users could see people in their own room or in the communal areas of the home. Visitors reported they enjoyed taking their relative out of the home but also visiting as it felt like a home. In the AQAA we were informed, The registered manager ensures that a varied and nutritional diet is offered which is suitable to each resident and meets their needs in terms of likes and dislikes. We provide a varied menu which is run on a 28 day cycle. We ask each individual resident on a daily basis what they would like for the next day. On the day we saw menus, which recorded the main meals for the day. However these had not been dated, making it difficult to establish on what day they had been served. It was noted at lunch time there was only the main meal and the other choice was always cold meats. It was agreed this would be changed with a second choice offered. The cook and the manager reported they would consult with the residents on what choices they would like on the menu. Meals were home cooked and clearly enjoyed by the residents. It was noted one resident ate alone in the lounge, at lunch time. It appeared they became anxious when all the other residents left. We were advised the resident had eaten in the dining room, but she preferred to eat in the lounge on her own. However from their care plan it appeared it may have been because their behaviour was causing distress to the other residents. It was not possible to establish from the records if it was the residents choice to eat alone and other alternatives had been tried. Care Homes for Older People Page 19 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident they can complain and their complaints will be taken seriously. Staff need a greater awareness regarding safeguarding to ensure people are protected at all times. Evidence: In the AQAA we were informed, The registered manager of the home ensures that there is a clear, simple and accessible complaints procedure in place that shows the timescales in which complaints should be dealt with. There is a complaints procedure in the service user guide and in each of our residents rooms. Our residents are aware of how to make a complaint and how it is recorded. All complaints are recorded and dealt with and any investigation and action taken is recorded. Details of the complaints procedure were seen in the service user guide in the entrance area and in peoples rooms. The manager informed us she had received three informal complaints from service users and these had been actioned satisfactorily. Residents spoken to all felt they would be able to speak to staff members if there was a problem and they all felt they would be able to sort out their complaint. Three visitors to the home all confirmed they were aware of the complaints procedure and would feel comfortable discussing any complaints with the manager. One relative stated they had raised a small concern with the manager and the next time they visited this had all been resolved. Care Homes for Older People Page 20 of 34 Evidence: In the AQAA we were informed, The registered manager ensures that our residents are safeguarded from any physical, financial or material , psychological or sexual abuse and from any neglect, discriminatory abuse, self harm, inhuman or degrading treatment, and through either deliberate intent, negligence or ignorance. From records seen it was clear staff had received training on abuse and adult protection. However when talking to staff about safeguarding, it was clear they were not sure what this entailed. Some members of staff asked if this ensured keeping people safe in the home from falling. No staff members when asked were sure which agency should be informed if there was safeguarding concerns in the home. Care Homes for Older People Page 21 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a comfortable and homely environment. Greater attention to detail is needed in some areas to ensure people have a safe and clean environment at all times. Evidence: The home is situated in a quiet country lane on the edge of Fawley. Most of the people living at the home come from the local area. The garden was observed to be well tended with spring flowers in evidence. When asked, the group of people in the lounge agreed that they liked the garden and enjoyed being out there in the summer. In order to access the garden the lounge chairs in front of the door to the garden had to be moved. We were advised the chairs in the lounge in the summer months are repositioned to enable people free access to the garden. Paved areas at the back of the home were in need of sweeping. Although the people living in the home do not access these areas some bedrooms overlook them. All of the bedrooms were viewed on the day. It was noted none of the bedrooms had carpet, having washable hospital-style flooring. Some rooms had a rug to make them more homely. The home provided a bed and bed linen, a chest of drawers with a lockable draw, a wardrobe and an armchair in each room. It was observed in some rooms that people had brought in their own furniture such as a display cabinet to display their knick knacks. Most people had personalised their rooms to some extent Care Homes for Older People Page 22 of 34 Evidence: with cushions, pictures, photographs and ornaments. Most of the bedrooms had a toilet and wash basin which were separated from the main room by a curtain. The other two bedrooms had an en-suite toilet and wash basin. Some bedrooms had a number of picture hooks on the wall, some of which had nothing hanging from them. It was also noted the valance sheet on three peoples beds had holes in. The manager reported she was aware of this and had ordered some new ones, but the wrong size had been ordered, so more had been ordered. In one bedroom, which leads onto a conservatory it was noted two roof panes of glass were broken. The manager reported she was aware of this and new panes would be ordered. The home has a spacious dining room where meals are taken. Meals can be taken in individuals rooms if they wish and one person usually eats in the lounge. The lounge appeared to be the hub of the home and during the morning most of the people living in the home spent time there enjoying the company and conversation, and taking part in a range of activities. There was comfortable seating and a television. Tables were available to slide up to the chairs when it was time for a drink. The communal areas are carpeted. It was noted in the lounge that one of the wall sockets had come away from the wall. This was reported to the manager who advised she would have this sorted out. The manager reported that bedrooms were decorated prior to someone new moving into them and that each year one of the communal areas was decorated. She also said that there was a cleaning schedule including the regular thorough cleaning of peoples bedrooms. However this was not being followed as we observed dust and cobwebs in three of the bedrooms. Once brought to the managers attention this was remedied immediately. Proper monitoring and supervision of the cleaner would ensure that the people living in the home did not have to live in rooms that werent clean. All toilets and wash basins were seen to be clean as were the communal areas of the home. It was noted in one persons bedroom the wash basin was cracked. We were advised this would be replaced. The people living at Ashlett Dale have the choice of two bathrooms, we were advised most use the assisted bath which is located in the downstairs bathroom. The manager explained that she hoped to convert the upstairs bathroom to a walk-in shower as some people would prefer to have a shower than a bath. Whilst walking around the home it was noticed there were signs to assist staff, such as a cleaning schedule and a bathing rota. When questioned about the appropriateness of notices in the bathroom saying which days people wished to be bathed and reminding staff to check the water temperature, and the image this presented, the manager removed them immediately. It was also noted that more appropriate signage to help confused people find their Care Homes for Older People Page 23 of 34 Evidence: way around the home had been introduced following the previous inspection. Although the home had fitted thermostatically controlled valves to the two baths, the water coming from the hot taps was far hotter than recommended. During the course of the visit it was determined that the valves werent working properly, and when asked, the manager agreed to secure the baths and call a plumber who advised new valves could be installed the following day. There is one staircase in the home and this has a stair-lift fitted to enable people to access both floors. Care Homes for Older People Page 24 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has well motivated staff on duty to meet peoples needs. Not all staff have up to date training to ensure they are working in line with current legislation. Recruitment checks are not satisfactorily carried out to ensure the safety of service users. Evidence: In the AQAA we were advised, We have a staff rota showing members of staff on duty at all times. We ensure that there are adequate staff on duty during busy times of the day and that they meet the needs of our residents. We have two waking night staff on duty. There are sufficient domestic staff on duty to ensure the home is clean and that all meals are nutritional and well presented. The manager explained the duty rota follows the same pattern each day. Two staff members work a waking night duty. Three carers are on duty for the first hour in the morning, with one staff member delegated for being in charge of morning medication. Three carers are then on duty in the morning; one carer being designated the therapist, who is responsible for activities in the morning. A cleaner and cook are also on duty during this time. In the afternoon and evening two carers are on duty and are responsible for giving out the evening meal; which we were advised had usually been cooked or prepared by the cook. The manager reported she is available in the home every weekday. At weekends the providers are in the home. The manager reported Care Homes for Older People Page 25 of 34 Evidence: that when she is not in the home she is always on call. Whilst in discussion with residents, due to their confusion, it was not always possible to establish if their needs were met all the time. However it was possible from discussions and observations to establish they had a good rapport with staff members and they reported they were lovely. In discussion with three relatives visiting the home they reported, All staff are good and equally helpful. A comment from a survey stated, All the staff treat everybody with respect, nothing seems to be too much trouble for the staff. All felt there was always adequate staff on duty to meet peoples needs. One relative confirmed they called at different times and stated they were, Confident there was always someone in charge. Staff confirmed that in their view there were always adequate staff on duty to meet residents needs in a non-rushed manner. Staff confirmed they worked well as a team and would support each other. One health professional visiting on the day described staff as, Enthusiastic with a genuine knowing and awareness of the residents. In the AQAA we were advised, Currently we have six members of staff with a qualification at National Vocational Qualification (NVQ) level 2 or 3 and six staff members still undertaking their NVQ level 2 course. Details of training staff have undertaken is kept in their staff files. When looking in staff files we were advised some certificates were missing. However it was evident a wide variety of training is undertaken, mostly provided by one company who call into the home. In surveys staff had indicated they are given training which is relevant, up to date and helps them understand the individual needs of people. Training included deprivation of liberty, fire, medicines, mental capacity act, moving and handling and dementia. When looking in one staff members file who had worked in the home for over two months the only training undertaken could be found was on medicines. This person reported they had worked in the care industry before and had done some training in a previous home. It was clear for the majority of staff, training in infection control and basic food hygiene was out of date. We were advised this had already been booked for some dates later in the month. When looking in staff files it was clear staff do not follow an approved induction course. We were advised new carers will work as an extra on shifts until they feel they are ready to work unsupervised. An induction is done in one day and covers the building, residents, management, organisation and daily routines. Three staff members recruitment files were looked at. It was noted all had completed application forms and formal identification had been photocopied and details recorded. All people had two references. It was noted checks with the criminal records bureau (CRB) had now been undertaken for two people who at the the time of the last inspection were working in the home without these checks being undertaken. For the third person it was clear they were working in the home unsupervised without a Care Homes for Older People Page 26 of 34 Evidence: completed CRB check. The manager advised us she had requested a check but was awaiting a response. The manager reported because an ISA check had been undertaken she thought the person could work in the home. Concerns over recruitment checks being carried out appropriately have been raised in the last two key inspection reports. Care Homes for Older People Page 27 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the management of the home but there are concerns regarding the health and safety of people, which could potentially put them at risk. Evidence: In the AQAA we were informed, The registered manager has a NVQ (National Vocational Qualification) Level 4 and an RMA (Registered Managers Award) qualification and 28 years experience in the Social Care Sector. She is experienced, skilled and knowledgeable and is competent and able to manage the day to day running of the home. Staff, visitors and residents confirmed this on the day. Staff felt the home was well managed and supported the manager in her claim that she is always available. Staff reported in her absence the proprietors are in the home. Visitors reported there was always someone in charge of the home and available if they wanted to talk to someone. It is of concern to the Commission the organisation and manager seem unable to be proactive and meet areas of concern, which have been detailed over the last two inspection reports regarding care plans, medication issues and staff recruitment. Care Homes for Older People Page 28 of 34 Evidence: In the AQAA we were told, We send out a stakeholder survey to all our residents, staff and professionals that visit the home. The outcome of these are recorded and acted upon and all outcomes are available to be seen by our residents, their families, our staff and prospective clients. We regularly speak with our residents and their families regarding their care and the updating of new legislation and policies. In the AQAA the manager stated, that in the last 12 months they have reviewed their stakeholder survey, yet when shown the survey and asked if the same one was always used, the manager confirmed that it was. We were advised on the day that the home does not become involved in any of the finances of the service users. The manager reported all the residents in the home have families who help residents with their finances. The manager reported if the resident does not have family members an advocate can be found. All service users have a locked drawer or cabinet in their room where they can store their valuables. Residents can also have a lock to their bedroom. We were advised none of the current residents have requested a key to their room. It was evident from records seen that he home has started a progamme of supervision for staff. Records are maintained and signed by both parties. One member of staff who has been in the home for two months had received no supervision but the manager was aware of this and stated it would be booked in. One staff member when asked if she had received formal supervision reported she had not, however records were seen that they had received and signed to say they had had supervision. Issues raised through out the day did raise concerns over the manager being aware of the health and safety of people living in the home. Examples of these include the lack of detail in care plans regarding risk assessments and acting on areas of concern identified. An area which was identified at the last key inspection report. For example the nutrition needs of a resident who is identified as loosing weight. Care plans do not identify and state how social needs are being met. These are clearly met for those who join in the activities arranged by the therapist , but without adequate records it is not possible to establish this for those who do not join in. Care plans give no detail of a persons on-going medication. Whilst walking around the home small areas were identified as in need of attention. The wall socket in the lounge needing to be fixed to the wall. The temperature of the two baths was excessive, a plumber was called out on the day, but only when identified by us. The temperature of the fridge and freezer in the kitchen not being recorded. One member of staff working in the home despite not having all the relevant checks back, which was an area highlighted at the last inspection. It was noted in the dining room the accident book was with the policies Care Homes for Older People Page 29 of 34 Evidence: and procedures. This had the details of a confrontation between two residents, which should have been put in their respective files. Care Homes for Older People Page 30 of 34 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 31 of 34 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 7 15 Care plans and associated risk assessments must be completed for each person so their needs can be identified and responded to. Without detailed care plans staff do not have the information to ensure they are meeting a persons needs. 02/06/2010 2 9 13 The recording, storage and 02/06/2010 administration of medication must be carried out in a safe way to ensure the safety of people. A clear policy must be available for staff to follow to ensure the storage, administration and recording or medication is carried out safely. 3 29 19 Staff must not work in the home unsupervised until all the necessary checks have been completed. 02/06/2010 Care Homes for Older People Page 32 of 34 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 Without all the necessary checks being completed it is not possible to establish staff are safe to work with residents. 4 30 18 All staff must have in-date training in the key areas of infection control and basic food hygiene. Staff must have in date training to ensure they are working to safe and current practices in line with legislation. 5 30 18 All staff must undergo an induction in line with Skills for Care. Staff must be given the opportunity to have a basic understanding of what their job entails. 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 02/06/2010 02/06/2010 Care Homes for Older People Page 33 of 34 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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