Inspection on 16/07/07 for Ash Cottage

This inspection was carried out on 16th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ash Cottage 09/06/06

Ash Cottage 01/11/05

Ash Cottage 03/05/05

Ash Cottage 19/10/04

Ash Cottage 11/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ash Cottage Crow Woods Edenfield Ramsbottom Lancashire BL0 0HY Lead Inspector Mrs Christine Mulcahy Unannounced Inspection 16th July 2007 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000009498.V338625.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000009498.V338625.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ash Cottage Address Crow Woods Edenfield Ramsbottom Lancashire BL0 0HY 01706 826926 01706 826926 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Margaret Mary Holt Ms Ann Josephine Zieme Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places DS0000009498.V338625.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should employ a suitably qualified and experienced person who is registered with the Commission for Social Care Inspection as manager of Ash Cottage only. Date of last inspection Brief Description of the Service: Ash Cottage is registered with the Commission for Social Care Inspection to provide care and accommodation to 20 older people. Ash Cottage is a detached residence in its own grounds, located in a semi-rural area in the village of Edenfield, on the outskirts of Rawtenstall. The home has a large purpose built extension, and opened in 1989. There are views of open countryside on one side of the home. Public bus routes to Rawtenstall, Ramsbottom and Bury are nearby. In the nearby village are a number of small shops, and a public house. Banks, larger stores and other amenities can be found in Rawtenstall approximately 2 miles away. There are three separate lounge and dining areas giving the people who use the service a choice of where and who to sit with. Toilets and baths are conveniently located to communal rooms and bedrooms, and have various aids and adaptations to assist and promote mobility and independence. Accommodation is offered in 12 single rooms, 5 of these have en-suite facilities, and four double bedrooms 1 with en-suite facilities. People who are new to the service receive a service guide and Statement of Purpose. Fees range from £360 - £390 per week and residents are billed separately for hairdressing, newspapers, magazines and chiropody. DS0000009498.V338625.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection included a visit to the home and took place on 16th July 2007. Information was obtained from care plans, staff records, management systems, observations, residents and relative surveys and policies and procedures. The inspector also spoke to 5 residents, 2 staff and the manager. Since the last care inspection the Commission for Social Care Inspection have received complaints about the service relating to lack of recreational activities for the people who use the service and the outbreak of an undiagnosed skin infection. The manager carried out full individual investigations and reported the outcomes of each complaint to the CSCI. What the service does well: What has improved since the last inspection? People who use the service are now given an up to date guide about the home and a statement of purpose so that prospective residents know what the service can offer. All care staff are now trained in safeguarding adults. This means that care staff are aware of their role to ensure that the wellbeing and interests of the people who use the service is promoted and protected. Bedrooms of the people who use the service were found to be clean and smelled fresh. Staff personnel files now contain the information required to confirm the identity of the worker. This system should improve the protection of the people who use the service There is now a staff training and development plan that identifies the staff training needs. This means that care staff are better qualified and skilled to meet the changing needs of the people who use the service. DS0000009498.V338625.R01.S.doc Version 5.2 Page 6 It is commendable that all care staff are trained in safeguarding adults. Records of hot water temperatures are recorded at frequent intervals to ensure the people who use the service are protected from the risk of scalds and burns. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000009498.V338625.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000009498.V338625.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service have the information they need about the home before they move in and are only admitted following a full assessment. EVIDENCE: The people who use the service and their relatives receive an up to date guide and statement of purpose before moving into the home. This means that people are clear about the overall service and what is provided in the fee. The information guide had been reviewed but needed to include an up to date copy of the homes complaints procedure and views from some of the people who use the service. Case tracking confirmed that new residents admitted to the home had undergone a full needs assessment and letters to confirm that the service DS0000009498.V338625.R01.S.doc Version 5.2 Page 9 could meet their needs were seen. This meant that prospective residents knew that their needs could be met prior to moving into the home. Intermediate care is not provided. DS0000009498.V338625.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all the care needs of the people who use the service were included in a regularly reviewed plan of care. Residents were protected by the homes medicines policies and procedures. Care practices observed showed that privacy and dignity was respected. EVIDENCE: Case tracking and examination of 4 care plans showed that care plans included information about the residents sleep pattern, preferred term of address, preferred retiring and rising time, aids and adaptations used, mobility, personal hygiene needs, sensory needs and health care needs. The care plan also addressed the issues of the resident’s sexuality, pride and appearance and described how this is promoted and managed by the resident and the care staff. The last wishes of the resident and, their religion were strongly identified in the care plan and described how these are supported and promoted by the resident, their relatives and the care staff at the home. DS0000009498.V338625.R01.S.doc Version 5.2 Page 11 The care plan had been completed in June but it had not been signed by the resident or named key worker. This means that it could not be shown that the resident agreed to the care being delivered. There was no photograph on the care plan to identify the resident and there was not enough information written in the cultural needs, personal history and activities section. This means that care staff would not be able to meet these needs fully. Another care plan examined showed there was no risk assessment for a resident who had bedrails. This means that care staff would not be fully aware of the purpose of the bedrails and the risks around this equipment. Observations of the care provided showed that although there were gaps in the health care and treatment records care staff displayed their skill and competency when delivering care and were seen patiently supporting a resident when she needed to move from one area of the home to another. Throughout the day care staff were seen treating the people who use the service with respect and considering their dignity when delivering personal care. Aids and equipment to provide support and maximise independence were seen to be in place for the people who needed them. Daily record sheets were written clearly and were up to date. The people who use the service have access to health care services within and out of the home. The manager said that there had been a lot of recent activity with outside professionals who had visited the home in succession to diagnose a skin infection. Telephone contact between the CSCI and these agencies confirmed this was the case but there was no written evidence on the care plans to acknowledge the skin infection and to confirm the contact with other agencies. Therefore the lack of up to date records at the home about the skin infections means that it could not be shown how the infection was being managed and the number of residents who were actually infected. The home has a medication policy which is accessible to staff. The medication records seen were up to date and medicines received, disposed of and administered were recorded correctly. Care plans seen held an administration of medication declaration that delegated the responsibility to the appropriate care staff at the home. Five senior care staff are trained in the safe handling of medication. DS0000009498.V338625.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12, 13, 13 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of leisure and recreational activities meant that the autonomy and choice of the people who use the service in relation to social needs and interests were not maximised and were not being fully met. EVIDENCE: Case tracking using resident’s care plans showed they held limited information about the activities of living and how these activities affected the resident’s health and wellbeing. However some areas of the care plan had not been fully completed and lacked information about recreation and interests. This meant there was not enough information to provide needs led, life-enhancing activities. Observations made throughout the day highlighted the need for more activities to be in place to satisfy the social cultural and recreational needs of the people who use the service. The care staff were very busy keeping up with the work that needed to be done and there were not enough staff to offer support with recreational activities. The manager said that she had recently purchased a poly greenhouse for a resident who enjoyed gardening and reminiscence flash cards with a view to beginning activity sessions with those who wanted. DS0000009498.V338625.R01.S.doc Version 5.2 Page 13 Visiting was flexible and relatives of the people who use the service were seen at various times during the day. A resident who was spoken to confirmed that she was comfortable at the home and enjoyed spending her time in her bedroom. “I’m happy in my little room, I’ve got my own TV”. She apologised for still being in her night attire and said, “I’ve just got up as I can get up when I want, there’s no rush. The girls will help me when they’re ready”. Menus were changed regularly and there is always a choice of meals. The meal served on the day of the inspection was chicken chasseur and seasonal vegetables. Residents were heard commenting positively to each other about the meal while they were eating. Hot and cold drinks were available throughout the day and these were given out when needed. DS0000009498.V338625.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service and their relatives have access to a complaints procedure and are protected from abuse. EVIDENCE: There is a reviewed complaints procedure that specifies how complaints can be made and who will deal with them. There is an assurance that complaints will be responded to within a maximum of 28 days. There have been 3 complaints made to the CSCI since the last inspection and the registered manager has forwarded details of the investigation and action taken to the CSCI. Policies and procedures for safeguarding people who use the service are in place. The home understands the procedures for safeguarding adults and all staff have received POVA training. DS0000009498.V338625.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables the resident’s to live in a safe and well-maintained environment that is clean, tidy and free from malodours. EVIDENCE: A tour of the building showed that the home provides a physical environment that is appropriate to the people who live there. The well-maintained environment provides specialist aids and equipment to meet the needs of the people who use the service. The home is pleasant and safe and communal rooms meet the NMS. 5 bedrooms have en-suite facilities and all bedroom doors have locks on them. The people who use the service are encouraged to personalise their bedrooms and all of the bedrooms seen held residents own furniture and belongings. DS0000009498.V338625.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment process did not fully ensure the protection of the people who use the service. Staff were trained and competent to do their jobs and were employed in appropriate numbers. EVIDENCE: Observations of the care provided and examination of the staff rota showed there was just enough care staff to meet the resident’s needs. The manager recognises the importance of training and supports the staff development by following a training plan that was examined by the inspector. All care staff with the exception of 1 new recruit had received mandatory training in moving and handling, health and safety and food hygiene. This meant that care staff was trained in safe working practices to meet the needs of the residents. Observations of some care staff at work showed they were competent and clear about their role and what was expected of them. One relative stated, “The girls are under staffed and over worked and more staff are needed.” The manager said that the care staff have worked very hard especially due to the outbreak of the skin infection. “They’ve been working flat out to help the residents and to keep them comfortable”. DS0000009498.V338625.R01.S.doc Version 5.2 Page 17 Case tracking of one care staff showed that not all pre employment checks to protect the people who use the service had been properly carried out and a CRB did not include a POVA check. The manager said that this was an oversight on her part and she would ensure the correct information would be requested the following day. 75 of the care staff are trained to NVQ Level 2 and 3 DS0000009498.V338625.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run in the best interest of the people who use the service. The health, safety and welfare of the people who use the service and the staff is not always fully promoted and protected. EVIDENCE: Observations of care staff assisting the people who use the service to move around the home showed that care staff were moving residents inappropriately. The manager also observed these actions and said that she would address this matter at the end of the inspection. Residents’ finances were poorly recorded. The amount held for 1 resident was checked against the records and found to be correct. However the system used DS0000009498.V338625.R01.S.doc Version 5.2 Page 19 to record financial transactions were inadequate and did not protect the resident from risk of financial abuse. Records required by CSCI to ensure compliance with regulations have not been forwarded since the last inspection. However following a reminder a record to notify the CSCI of the outbreak of the skin infection was received prior to the inspection. The CSCI have no records of monthly visits to the home made by the registered provider despite daily visits to the home being made. There are no records of these visits kept in the home either. A freestanding radiator seen in a resident’s bedroom was unguarded. This means that the resident was at risk of scalds or burns and her safety was not fully protected. The policies and procedures had not been reviewed since 2004. This means that care staff would not be able to give safeguarding high priority to promote and protect the people who use the service. The manager has the necessary experience to run the home and meet the requirements of the National Minimum Standards to do so. She is aware of the need to keep up to date with practice and regularly arranges training for herself and the care staff. When asked about the manager the people who use the service and their relatives said they were confident about her abilities. Examinations of records and documents confirmed that regular checks were done on appliances and fire equipment. Entries in the accident book were infrequent and recorded accurately. The fire alarms were checked weekly and servicing of gas, appliances and the moving and handling equipment had been done regularly. Water, fridge and freezer temperatures were also recorded accurately and were up to date. Records to confirm that there were regular care staff meetings and meetings for the people who use the service were examined and topics discussed focussed on the aims and objectives of the service. This meant that the residents and care staff were able to make their views known. DS0000009498.V338625.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 2 X X 2 DS0000009498.V338625.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1)(2) b,c Requirement To ensure that the health, personal and social care needs of the people who use the service are fully met the registered person must provide each resident with a plan of care that is accurate, up to date and reviewed regularly. Timescale of 31/08/06 not met. The registered person must operate a thorough recruitment procedure and maintain appropriate staff records so that the people who use the service are supported and protected. Timescale of 27/07/07 not met. The registered person must visit the care home and interview the people who use the service and their representatives and staff working in the care home to form an opinion of the standard of care provided in the care home. Timescale of 31/01/07 not met There must be appropriate recording systems in place to DS0000009498.V338625.R01.S.doc Timescale for action 02/11/07 2. OP29 Reg 19(1) 16/07/07 3 OP32 Reg 26 28/09/07 4 OP35 Sch 4 17(2) 16/07/07 Version 5.2 Page 22 safeguard and protect the financial interests of the people who use the service. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The registered person should ensure that the people who use the service are consulted about their interests and these are recorded so they are given opportunities to take part in recreational activities which suit their needs, preferences and capacities in and out of the home. To ensure the health safety and welfare of the people who use the service the registered person should ensure there are safe working practices in the home. 2 OP38 DS0000009498.V338625.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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