Inspection on 28/06/07 for Ashcroft

This inspection was carried out on 28th June 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

Ashcroft 09/06/06

Ashcroft 01/03/06

Ashcroft 26/05/05

Ashcroft 06/01/05

Ashcroft 23/06/04

Ashcroft 10/02/04

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

CARE HOMES FOR OLDER PEOPLE Ash Croft Halstead Road Eight Ash Green Colchester Essex CO6 3QH Lead Inspector Sara Naylor-Wild Unannounced Inspection 28th June 2007 09:30 X10015.doc Version 1.40 Page 1 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 Ash Croft DS0000017750.V345500.R03.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. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ash Croft Address Halstead Road Eight Ash Green Colchester Essex CO6 3QH 01206 767367 01206 573970 barbara@ashcroftresthome.freeserve.co.uk 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 Noeline Barbara Crowley Mrs Noeline Barbara Crowley Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th June 2006 Brief Description of the Service: Ash Croft is a family run home providing personal care for 24 older people with dementia. Owned and run by Mrs Crowley, and her family, the home has been open since 1986. A detached property, located in the village of Eight Ash Green, on the outskirts of Colchester, residential accommodation is all at ground floor level. There is a large communal lounge/dining area, 18 single rooms and 3 shared rooms. The home has a large secure garden to the rear of the property and ample parking to the front. The home has a Statement of Purpose providing information for prospective residents, which is available upon request. The current fee, confirmed at the time of inspection is £367 - £408 per week, reviewed annually. Hairdressing and chiropody services are provided at an additional cost. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report includes the unannounced inspection site visits on 26th June 2007, 6th July 2007 and 27th July 2007. The evidence contained in this report was gathered from discussions with managers, staff and relatives, a visit to the home, observation of residents’ interaction, questionnaires completed by residents’ relatives and professionals visiting the home and information provided to the Commission for Social Care Inspection (CSCI). During the second visit to the service the inspector conducted an observation of Residents using the Short Observational Framework for Inspection tool or SOFI. This tool was specifically designed to be used to consider how Residents with dementia experience the delivery of the service. The Deputy Manager Andrea Crowley assisted the inspector at the site visits. Feedback on findings was given during the visit with the opportunity for discussion or clarification. The inspector would like to thank the Ms Cowley, the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the service does well: The home is owned and run by Mrs Cowley who shares her commitment to the home with the staff team. The staff spoken with during the inspection demonstrated a good understanding of the residents in their care and spoke of them in a respectful manner that recognised them as individuals. The way in which staff engage and deliver activities to residents is positive and empathic. Residents gained a great sense of wellbeing when staff were working with them and this enhances their lives. The residents enjoy the home cooked food and meal times are a great social event. Relatives of those living at Ash Croft were encouraged to visit at any time and were warmly welcomed to the home. They were confident that any issues of concern would be listened to and acted upon. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 6 The service operates a robust system for the administration of medication and staff responsible for this task are trained. This supports the wellbeing of residents living at the home. What has improved since the last inspection? 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. Ash Croft DS0000017750.V345500.R03.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 Ash Croft DS0000017750.V345500.R03.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): 2 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect their needs to be assessed to assist the service in understanding how the can support them. EVIDENCE: On the inspection visits to the home assessment documentation was seen by the inspector on the services computer system, although the deputy manager stated that there was a format printed off when staff go to carry out an assessment and this was provided as additional evidence following the inspection. The format on the computer asks for yes,no responses in aspects of daily living such as mobility and continence with some areas allowed to add comment. In general this is a basic format that indicates an area of need that will require support, but it is not always clear from the sample of existing residents Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 9 assessments as to what level the support is required. So for example the forms identify that a resident needs support in meeting their personal care needs, but does not provide detail as to how much help is actually required. The copies of handwritten assessments provided following the inspection gave a greater sense of the holistic needs of prospective residents and reflected discussions with them and their relatives in relation to their needs and wishes. There are additional assessment forms used in other parts of the assessment such as a Waterlow assessment of skin conditions, moving and handling assessment and general risk assessments. The service does not provide intermediate care. Ash Croft DS0000017750.V345500.R03.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): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can expect their needs to be identified and supported by the services documents. However they cannot be assured that their assessed strengths would always be promoted. EVIDENCE: Although the assessments and other documents such as the daily record of residents care are maintained on the homes computer system, the residents care plans are printed off and kept in files. The format for each plan viewed varied with different styles of typeface and layout. Some typeface made the plan difficult to read with one capitalised throughout and another underlined throughout. To make sure that residents’ needs are addressed, the care plan format should be reviewed to ensure that staff have a clear understanding of the information. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 11 However, the information set out in plans sampled was informative and gave a good description of the way in which the resident should be supported by staff. The language used in the plans is a narrative style, and generally provides a person centred focus to the instructions to staff. This is a positive reflection of the individual. So for example the instructions to staff in a residents plan of care under the title of “confusion”: 1. Avoid trigger points with X; always approach X slowly and in their line of vision. They do not like people creeping up on them because they cant see or hear people. 2. Gently touch their shoulder and smile a lot as a kind face eases fears. 3. Always make sure you are in a well lit position so that shadows do not confuse X Overall the care plans tended to concentrate on the ‘needs’ of residents and how staff should support these. However it is also important to include the assessed strengths and abilities of the individual for staff to support and maintain the level of independence of residents. Daily records of staff do not reflect how staff are following action to meet the objectives of the care plan, and staff spoken with were not clear about how they linked their daily actions with care planning. Not all the staff complete the daily records and this may impact on the quality of information held. The portion of the documents relating to visits to residents by health professionals was maintained to a good standard with regular updates of the visits and outcomes. It was not always clear however how these translated into care planning and risk assessments. There was evidence that specific health needs in the care plan were not always monitored by the service. Specifically the care plan of one resident stated that there was an identified needs to push fluid intake. The records relating to the fluid intake for residents were not maintained and appeared to be sporadic when they were completed. During the second visit to the home, a Short Observational Framework for Inspection (SOFI) was carried out. This involves the two hour charted observation of staff and residents interaction. This identified that staff demonstrated a positive interaction with residents and treated them respectfully and with dignity. One resident was engaged in a meaningful task with a member of staff. The member of staff followed up completion of the task with the resident but did this from a distance from them. Staff explained the need to direct the resident and follow up on the tasks with them. This was discussed with the deputy manager on the day of inspection. Feedback from relatives stated “staff do a good job and with care and a smile for all”. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 12 The service operates a monitored dosage system (MDS) for medication administration. The manager and staff take the responsibility for medication very seriously and operate a robust system of recording, dispensing, receipt and storage of drugs in the home. The senior carer has the lead in medication and carries out monitoring of other staff as part of their induction processes. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 13 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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of residents can be assured that they will be provided with a range of activities to suit their preferences. However development is required to ensure residents with more specialist needs are provided with appropriate opportunities. EVIDENCE: The SOFI tool used during the second visit to the home gave an opportunity to understand how the staffs interaction with residents affected the quality of their lives. The observation was carried out in a two hour period immediately prior to and during the midday meal. In the first part of the observation staff engaged residents in activities that included assisting with folding washing, having their nails painted, building with bricks and dancing. In each of these activities the staff talked with residents either as encouragement for the task or in general conversation about themselves. All the residents participating reacted positively to the staff and seemed happy to engage with them. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 14 These activities were concentrated on a four residents who were the subject of the observation, and in general the other residents were not provided with the same levels of stimulation during the same period. During this time these residents had a less sociable interaction and this required a different approach to activities from the staff group. The deputy manager explained that a dog had been in the home before the observation began, and that the dog had spent time with residents. Also out of view of the inspector a member of staff was reported to have been engaged with another group of residents. The details of these activities were not fully recorded by the home. As well as the staff daily support there is a volunteer activity coordinator who visits the home weekly to provide additional activity provision. The deputy manager outlined their role and the range of activities they have provided. It was hoped that on finalising the building works that were being undertaken at the time of the inspection a range of small garden areas would be available to residents and where appropriate activities in gardening would be offered as they had in the past. The way in which communication is supported with residents continues to need exploration especially for those residents with a lower cognitive function. For example using pictures to assist staff in supporting residents to make choices should be considered. The visiting arrangements remain unchanged and throughout the inspection period relatives and friends came and went with ease. There was a good rapport with the staff. Some relatives took a more active role in the support provided to the resident, including assisting residents to eat meals, and the deputy manager stated that the service encouraged relatives to maintain an active role in the residents life following admission to whatever degree they preferred. Observation of two meal times indicated that they were a relaxed and sociable occasion where staff chatted with residents whilst supporting their needs. The ingredients available to the cook were fresh and of a good quality. The menu provided a nutritious and balanced diet, and the choices on offer were based on resident’s preferences. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 15 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): 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they will be listened to and that their concerns will be actioned. Residents can be assured that they are protected from abuse by the staffs understanding of safeguarding adults. EVIDENCE: The feedback received from relative as part of the Commission for Social Care Inspections relatives, carers and advocates survey was positive about how they home dealt with issues of concern raised with them. Statements included “this has never been a problem”. The complaints policy meets the expectation of the Care Homes Regulations 2001 and is clear in the steps the service will take to respond to complaints. This is made available to residents and relatives in the service users guide on admission to the home. The complaints log maintained by the service identified that the procedure was followed properly and recorded outcomes and actions taken to improve practice. This included the recording of ‘Minor’ complaints and their outcomes. The manager was advised that the record should have greater details of the investigation into the cause of the issue, so for example the record relating to residents clothing being misplaced, recorded that it was likely that other Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 16 residents had entered rooms and moved items or worn them. The quality of staff putting away clothes or the correct marking of clothing was not included in the considerations. Similarly the conclusion in the complaints log did not provide a broad range of possible solutions to the issue. The Commission had directed a complaint made about the home’s care of a resident to the Registered Manager for consideration under the home’s complaints policy, since the previous inspection. An investigation was carried out and the findings reported to the complainant in response to the issues raised, within the timescales set. This was also made available to the Commission. Essex Safeguarding Unit and Suffolk Social Services made further external investigations under legal obligations and their own complaints policy. All the investigations concluded that there was not an issue with the care practices within the service. However they did confirm that the service demonstrated a need to develop its practice in recording in areas such as assessment, care planning and risk management. The service has previously been the subject of complaints with similar outcomes and it is a concern that whilst they are open in dealing with the complaint, there has been a failure to learn from the outcomes of the investigations. Discussions with management and staff indicated that issues relating to the identification and prevention of abuse were understood and the home had appropriate Protection of Vulnerable Adults protocols in place. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 17 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): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in premises that are clean and maintained, but which could be developed to better support service users rights to independence and privacy. EVIDENCE: The premises were undergoing a large-scale building project at the time of the inspection with additional space being provided at the back of the building in an extension. The original plans had been scaled back in line with planning officers issues, but still provided 6 additional bedrooms and a quiet lounge for residents. The works were naturally causing some disruption to the home although the deputy manager stated that the builders had been requested to schedule works in a way that interfered the least with residents’ daily lives. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 18 It did mean that the home appeared untidy and cluttered, as items were stored in areas under stairs and in bathrooms and communal areas. The deputy manager assured the inspector that this was not normal, however the managers need to be mindful of the impact on residents and the fire safety hazards in storing items such as continence pads under stairwells. The accommodation of the computer and documents relating to residents personal information are currently in a room annexed to the communal area. The wipe board in this area, contained instructions to staff in relation to residents’ care and medical appointments. Whilst the service had made attempts to protect the individuals’ identity by using only initials this site was not suitable for this equipment. This did not promote confidentiality and protection of data and should be re-sited as soon as possible. A wider tour of the premises evidenced that resident’s bedrooms were personalised and comfortable. There are shared rooms with screens to provide some privacy. The deputy manager stated that residents only share rooms once there has been an established relationship developed between the occupants and it is beneficial to the individuals concerned. This would mean that it is the home’s policy to only offer shared rooms to existing residents, and this should be included in the statement of purpose and service users guide. Appropriate equipment was seen around the home to promote optimal independence and reduce health risks such as pressure relieving equipment. The home caters for very frail residents and specialist mobile reclining chairs are provided for those residents who would otherwise be unable to sit in the lounge. The chairs provide more support and comfort than a conventional armchair and can be easily moved around the home. The use of these chairs provide residents more choice about where to spend the day and without them those residents would experience difficulty in spending time out of bed. During the tour of the premises a significant number of residents rooms contained additional mattresses, which the deputy manager stated were either placed against residents beds or placed on the floor beside their bed in the night. The deputy manager stated that the mattresses were used as a result of assessments that identified the neither bed rails or wedges would protect the resident from falling from the bed. The risk assessments held on the residents files sampled stated that they were at risk of falls, although there was no evidence offered to support this, and that the response was to place mattresses against their bed. The fact that this is the only method used in the home and the poor level of information available to support the risk assessment do not indicate a full assessment of the risks and exploration of suitable equipment. The risk assessments also do not acknowledge the risk of using the mattresses and how this has been weighted in the decision making processes used. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 19 In two of the resident’s bedroom doorways the home had fitted childproof safety gates, normally used to restrict the access of children in a domestic setting. The deputy manager stated that these had been placed there in order to protect residents from unwanted disturbance by other residents. There was not an associated assessment for these gates on either of the residents’ files and the documents did not evidence what other resources had been considered. Although the deputy manager stated that the fire officer had been asked for advice in relation to how the gates may affect the fire evacuation procedures and that they had not thought this presented an issue. The deputy manager stated that not everybody would have the ability to use keys for locks on bedroom doors. The lack of written comprehensive risk assessments reflecting changing needs meant that it was not possible to understand what other solutions had been sought and how the service had concluded that this equipment best met the needs of residents. The building is generally all on one level, and although there are various wings to the building due to the historic additions to the original building these do not present a problem to residents accessing them. The use of signage and colours to promote residents independence and support their understanding of the use of rooms should be included in a service that specialises in providing dementia care. There were no grab rails and protective coverings to radiators in the corridors and this is an issue the home is addressing There were no unpleasant odours in the home and the infection control measures were suitable for the service. The proposed additional sluicing facility will add to this standard when completed. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 20 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are supported by staff in sufficient numbers to meet their needs, although the skills staff hold could be further developed. EVIDENCE: The deputy manager stated that the service used the Residential forum calculation tool to determine the appropriate numbers of staff required on rota. The calculation was not available at the time of the inspection but examination of duty rotas and discussions with staff gave evidence that staffing numbers provided were adequate to support the assessed needs of the residents, with four care staff on each shift in the waking day, and additional support provided by the manager, deputy manager, catering and housekeeping staff. The service has 14 staff in the care team Five staff hold the National Vocational Qualification (NVQ) level 2 or equivalent. Four hold NVQ level 3 and one holds NVQ level 4 providing the home with 57 of staff holding a recognised qualification. A sample of three staff files was examined. As at the previous inspection it would be helpful if the files were maintained in an orderly manner. Recruitment of overseas staff was handled by an external agency that ensured all Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 21 references and documentation was validated. All files contained references and satisfactory Criminal Record Bureau and Protection of Vulnerable Adults (POVA) First checks. The home uses the Skills for Care induction programme to provided the support new staff required and informed them of the culture of the home. The deputy manager and senior care staff carried out the induction and signed off the competency sheets. The copy of the competency sheet held in the newest recruited staff contained acknowledgement of their development and notes by the manager of further developments that were needed. The form was signed off in total on one date. This was discussed with the deputy manager who explained that it is the usual procedure that the form is signed off in total at the end of the induction period, rather than at the end of each competency assessment. This staff member’s file also contained only one record of supervision during the previous 6 months and at the commencement of their service. The supervision of staff and the development of their competency require greater consideration and documentation of their progress. Staff members spoken with said they felt that the management team supported them and that they had been provided with information and support during their induction. The sample of staff files seen at the inspection indicated that staff had participated in training in areas such as infection control, health and safety, first aid, dementia care, fire safety, challenging behaviour, advanced diabetes care and moving and handling. However all but the moving and handling had been completed more than a year ago, and the deputy manager was unable to provide evidence of a current planned training programme for this year. The following guidance is provided in the Care Homes for Older People s guidance log on the CSCI professional website under Standard 30.1 “We advise that moving and handling, first aid and fire training are undertaken with care staff on an annual refresher basis or at the intervals recommended by the organisation that accredits the training”. All of the staff health and safety and specialist training are provided in house and assessment of staff competence was evident including multiple choice tests and essays. As detailed in previous inspection reports, this level of training is adequate as an induction level of training to support staff in provision of a care service. Staff spoken with demonstrated a good understanding and a basic level of knowledge about the people living in the home. The deputy manager has been successful in obtaining a placew on a BSc in Dementia Studies, at Bradford University, to start in August 2007. The aim is to cascade the learning from this throughout the staff team. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 22 Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 23 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): 31, 32, 33, 35, 36, and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. All the residents cannot be assured that the service has developed the specialist skills to understand their experience of the service. Information such as quality assurance feedback, complaints and the requirements set out in inspection reports are not integrated and actioned through the services development plans. EVIDENCE: The Registered Manager, Mrs Crowley, has operated Ash Croft for many years. Mrs Crowley is a qualified Registered Nurse and has successfully completed NVQ level 4 in care and management. The Registered Manager is dedicated to the care of the residents in her home. She operates an open door policy to Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 24 residents, their representatives and staff. The staff felt well supported in their roles and confirmed any issues identified were dealt with as they arose. Mrs Crowley, the Proprietor and Registered manager resides in close proximity to the home. Staff confirmed that there was good contact during the day and night between the manager and the staff and the residents. Visitors to the home spoken with expressed satisfaction with the home and felt welcomed and included in their relatives care. The issues raised in this report relate in the main to the development of records that underpin the practice of staff in meeting residents’ needs. This has been a theme that has been repeated from previous inspections and the findings of the complaints investigations undertaken in the past. The management of the home must apply the learning and development from complaints and other feedback into the services development. A Quality monitoring exercise had taken place since the last inspection with surveys being given to a selection of relatives, health and social care professionals and four face-to-face interviews with residents living at the home. Where residents could not offer their views, relatives’ feedback was sought instead. The deputy manager states that the outcomes of this were collated into an audit and an action plan was developed. This could not be located at the time of the inspection although the methodology description was seen. This states “the reason that we did not give written questionnaires to our service users is because we are an EMI unit and all our client have dementia or Alzheimer’s. Therefore it was not possible to gain written information from them, even some with mild dementing symptoms have Parkinson’s or other ailments that mean writing is not possible. Some could not retain information or coherently respond and so faceto-face interviews were conducted on only four service users. The service users were chosen because they could answer questions coherently. These interviews were conducted by our volunteer to ensure results were as unbiased as possible.” This does not fully satisfy the need for the service to develop an assessment specific to dementia care outcomes. It is important that a method to measure the way in which quality care is provided and outcomes for residents at the home is extended. Ways of obtaining the views of people with dementia needs to be explored to ensure the home is run in the best interests of the residents and the quality of life for people with dementia is promoted. Staff files seen at this inspection contained evidence of staff supervision, with supervision records that documented discussions held between line managers and staff. The records referred to staff knowing where policies were located and that they understood these, however they did not provide evidence of the Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 25 discussion of the staffs understanding of how they implemented the policy and the impact this had on the care they provided. These continue to need a stronger link to care practice issues and the integration of knowledge with practice to meet the needs and objectives of the services statement of purpose and the needs of individual residents. The dates of supervision meetings were sporadic with one staff member having one session in 7 months and another having 5 months between the sessions. These need to be more regular. The deputy manager did not maintain a matrix of the supervision required and acknowledged that they had struggled to maintain the regularity of the sessions due to other work pressures. The home takes responsibility for the management of residents monies paid to the home by relatives for the payment of items such as hairdressers and chiropody treatment that the resident receives. The records and way in which the money was held was considered at this visit. Money is given to the home either in cash or by cheque which are made payable to the Ash Crofts Residents Bank Account. The money held in the home is placed in individual paper envelopes with audit sheets attached, and these are held in a cash tin in the homes safe, with the manager being the only key holder. Examination of the money held and the records relating to the individual evidenced a confusing and disordered system of management. The paper envelopes for some residents’ monies were torn and loose change had fallen out of these into the tin. There were residents who had different amounts of monies in differ rent envelopes and also different audit sheets with separate totals on each. Overall this does not provide a clear audit trail of monies that ensures they are protected from abuse. This was raised with the manager at the inspection. Robust and comprehensive policies and procedures were in place to guide and support staff in health and safety issues and good care practice guidance. Sluicing facilities and the installation of grab rails in corridors and radiator guards must be addressed to free the home from hazards to resident’s safety. Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 26 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 2 3 2 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 1 2 X 1 Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 27 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 OP2 Regulation 5 (1)!b)(c) 17. Schedule 4 16(2)(m)( n) Requirement Residents must be provided with an individually costed contract/statement of terms and conditions of residence. This standard was not assessed at this visit. Opportunities for residents to exercise choice in relation to social, recreational and leisure interests must be supported by the staff team in their delivery of support to residents. Staff must develop skills in supporting residents in a way that upholds their rights to respect and dignity. Residents must be protected by the homes systems for checking and maintaining fire safety equipment. All parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety. Timescale for action 31/10/07 2. OP12 OP14 30/09/07 3. OP10 OP14 OP15 12 (4)(a) 31/08/07 4. OP38 23(4) 01/08/07 5. OP22 OP25 OP38 13(4)(a) 01/10/07 Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 28 6. OP16 OP33 24(1)(a)( b)(3) The service must develop tools 31/01/08 to gather the views of resident with dementia and include this in consultation such as the complaints and quality assurance system. Residents must be supported by a staff group that is appropriately supervised. The residents’ finance records must provide a sufficient audit to give a clear indication of how their money is spent. Equipment to protect residents must only be provided following a full and detailed assessment of the risks that includes consideration of a full range of solutions to reduce the risk. 30/09/07 7. OP36 18 (2) 8. OP35 16 (2)(l),17, Schedule 4 (9) 13(4) 01/08/07 9. OP22 31/08/07 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 OP7 Good Practice Recommendations The Registered Person should ensure the care planning process is service user focused reflecting strengths and all assessed needs, support required and expected outcomes. The Registered Person should ensure regular activities are provided and suited to individual needs and people with dementia to promote well-being. The Registered Person should ensure staff facilities are maintained. Residents’ independence should be supported by the design and adaptations to the environment using tools such as signage and colour. DS0000017750.V345500.R03.S.doc Version 5.2 Page 29 2. OP12 3. 4. OP19 OP19 Ash Croft Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Ash Croft DS0000017750.V345500.R03.S.doc Version 5.2 Page 31 - 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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