Inspection on 25/08/05 for Ash-Croft House Care Home

This inspection was carried out on 25th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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-Croft House Care Home 12/06/08

Ash-Croft House Care Home 10/12/07

Ash-Croft House Care Home 09/05/06

Ash-Croft House Care Home 06/02/06

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-Croft House Care Home 10-12 Elson Road Formby Merseyside L37 2EG Lead Inspector Julie Garrity Unannounced 25 August 2005 th 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 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 House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ash-Croft House Care Home Address 10-12 Elson Road Formby Merseyside L37 2EG 01704 874448 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cedars Care Group Limited Care Home 31 Category(ies) of OP - Old Age registration, with number of places Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should employ a suitably qualified and experienced manager who is ergistered with the CSCI. Date of last inspection 2nd March 2005 Brief Description of the Service: Ashcroft House is a care home registered to provide nursing care for 31 older persons. The home is privately owned and the owner has a five other homes throughout the country. The care home is situated in the Formby area. The area around the Home is mainly residential and there are local areas of interest such as the squirrel park. There are local shops directly opposite Ashcroft House and a main train and bus route within easy walking distance.The accommodation is converted from two previous houses. There are 2 main lounges, a quieter lounge, a lounge that is also used for dinning facilities next to the kitchen. There are 25 single rooms and 3 double rooms, 2 rooms have ensuite facilities. 5 of the bedrooms are situated up a small amount of stairs and do not have ramps or a stair lift to access them. Residents utilising this space must be either mobile enough to climb the stairs or do not wish to leave their rooms. Many of the residents have personalised their room space and have brought items of their own furniture, which assist in contributing to the homely appearance of Ashcroft House. There are 4 bathrooms and 3 shower rooms and sufficient WC’s for service users usage.There are gardens to the front and the rear of the establishment that are well maintained and easily accessible by service users. A large car park area is located at the front of the building. Ashcroft House is a non-smoking building. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was routine unannounced inspection, one inspector undertook the inspection over 7hours 45 minutes. A tour of the premises was undertaken and records relating to maintenance, staffing levels, medications, care plans, accidents, staff training recruitment and supervision were reviewed. 10 residents, 3 relatives, 8 staff and the manager were spoken with. What the service does well: What has improved since the last inspection? What they could do better: There is examples of very good practice in the records in the home, however this is inconsistent with several records not including information essential in the delivery of the care to residents. A number of records are not available after the change of management and as such the manager is unsure of what training the staff have received and what training they need. This has also reflected in the checks on health and safety with some essential checks not occurring. The manager is aware of these issues and is undertaking arrangements to update and locate the missing records. The recruitment of new staff and the staffs understanding of protection of vulnerable adults is not sufficient in order to protect the residents. Training and Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 6 appropriate recruitment must be undertaken in order to fully protect the residents living in the home. The manager has not submitted an application form to become the manager and is aware of the implications of this. 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. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the standards in this section were reviewed in full. EVIDENCE: Although none of the standards in this section were reviewed. It was noted that the home had information available for residents upon admission and a copy of the latest inspection report was available for review. Residents made a number of very positive comments on how their needs were met. One resident said, “ I feel very lucky and fortunate being looked after here”. Another supported this point of view and explained “ you just ask for what you want and the staff get it for you”. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 There is inconsistency in the care planning with examples of very good practice available. However the plans did not detail all the care needs of the resident and the monitoring of wounds was weak. This places resident at risk of having care needs not meet, of those needs changing and nobody being aware of this and inappropriate care being delivered. Medication records were in general very good. However some areas are in need of development in order that a safe system be maintained. EVIDENCE: Each resident has an individual care plan available. All the care plans had been reviewed and up date on a monthly basis which is good practice. However of the care plans viewed there was no evidence that they had been written with the residents or reviewed with the residents. All were very medically based and contained little to no information regarding resident’s social needs or personal preferences. The manager tries to make sure that all new residents have a draft care plan in place before they are admitted and it was evidenced that this happens on a regular basis. One of the care plans viewed was missing vital information essential to the resident’s care such as MRSA positive, pain relief and clear instructions as to dressings. The same care plan contained excellent information regarding a special diet and a detailed account of the care received by the resident on a daily basis. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 10 The manager is aware of the issues with care plans and is to introduce a new system in the near future staff will be trained and supported to deal with the system in order to maintain good, accurate and clear records. A previous requirement regarding better monitoring of residents wounds had not been addressed. Although photographs are now taken, this was no clear date, measurement, instructions as to how often these needed to be done or permission from the resident for this to occur. Although a member of staff is cited as having tissue viability training there was no evidence to support this. The lack of proper monitoring and lack of training evidence details that staff are not undertaking the best practice essential for residents care. Discussions with residents and staff detailed a number of care needs that were being addressed but were not reflected in the care plans. One resident requires regular weighing, however this was not being undertaken as staff did not have the correct equipment to do so. The care plans detailed appropriate support and intervention from outside health care agencies these were very detailed and contained a lot of good information that help staff deliver the care that residents receive. Medications are recorded when given and good records are available for this. Staff receive regular training in this area. The monitoring and recording of controlled drugs was done well. Instructions on the Medication administration Records were not in sufficient detail and label instructions were not available, additionally the recording of medications arriving in the Home was unclear and confusing. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 Activities are well managed with a variety of good choices. Staff have a good knowledge of what residents like but need to make this knowledge available for all with written records that detail residents likes, dislikes and preferences. EVIDENCE: The home provides a monthly newsletter that keeps residents and relatives informed of activities within the Home. Discussions residents detailed a variety of daily activities available on a regular basis such as knitting, newspapers and books. One resident said, “they’ve got a great selection of large print books here”. All residents spoken with had recently been on a day out to Martin Mere, all had really enjoyed it. It is unfortunate that all the good knowledge that various staff have about the residents such as one resident always wanting his television remote available is not recorded and available for all staff to review. Relatives spoke of the “warm welcome” they received when they came to see their relatives. Frequently relatives are invited to eat lunch with their relatives and there are regular “parties” organised by the home for residents and their relatives. Residents spoken explained that they were supported to do what they wanted when they wanted. One resident said, “staff are very obliging, you’ve just got to ask and you get what you want,” another said, “ staff are excellent, if I need them they are there”. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The residents are not safeguarded from abuse. EVIDENCE: General discussions with the staff detailed that they had a basic understanding of how to protect residents from abuse. However further discussion with staff and higher management detailed that they had little understanding of their roles in any potential investigation. A number of records regarding staff are no longer available and these include training records for staff including training in protection of vulnerable adults. Staff spoken with had not received any training with regard to protection of vulnerable adults. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 Ashcroft House is a pleasant, welcoming homely environment. There is a need for the development of a maintenance programme in order to keep the home maintained to a good standard. EVIDENCE: The Home is decorated in a homely manner. All of the bedrooms are redecorated as they are vacated. There has been a recent change in management and many of the previous maintenance records that were in place are no longer available. The handy man is currently identifying which areas of the Home are in need of regular checks and which areas of the home need redecoration. The lighting on the corridor outside the dinning room is missing a number of lampshades. There remains limited storage space in the home with 1 bathroom and a sluice inaccessible due to storage of commodes, towels, and wheelchairs. Residents and relatives spoken with like the way the home looks and comments such as “welcoming”, “very homely” and “clean and pleasant” were made. Three of the bedroom floors are linoleum and are not homely in appearance. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 The lack of training records prevents the manager from determining that all staff have the suitable training to undertake the activities they do on a daily basis. Training needs were identified in discussion with the staff such as diabetes and protection of vulnerable adults that have not been addressed. The current recruitment checks in the Home are not sufficient enough in order to safe guard The residents. EVIDENCE: Many of the staffing records that should have been in the home were unavailable due to a change in ownership. The new owner is undertaking action to update all the records. Subsequently a number of records that detail staff training could not be located. Several of the residents have specific needs that the staff have not received training in. an examination of the available staff records showed that a recently recruited staff nurse had no evidence of a suitable police check or evidence of qualifications. A member of staff in post since April did not have two references and a police check was dated the day after they commenced employment. About 25 of the staff have received a first supervision and this has not been undertaken on a regular basis. There is confusion around the training of staff with regards to moving and handling, a member of staff has evidence to detail that they are qualified to train the staff but discussion with staff who had received the training detailed that they had been shown the hoisting equipment in the building only. There were no details as to the contents of the course or evidence that they were competent to undertake moving and handling activities. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 15 Residents, relatives and staff said that there was enough staff. One resident said, “I am never rushed by staff. I go to bed when I want and get up when I want”. However the staffing levels are not monitored in line with residents needs in order to determine that changes in residents conditions change are responded to appropriately. Due to the lack of records it was not possible to determine that all staff had received regular fire training. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The health and safety needs of the residents are not protected or promote. Health and safety checks are not being undertaken appropriately. EVIDENCE: Over the last 6 months the home has changed both manager and owner. All residents, relatives and staff spoken with said that these changes had little impact on their day-to-day routine. One relative said “I was concerned at first but they’ve handled it so well I’ve got a lot of confidence that the care will remain good”. As yet an application form from the manager has not been submitted to CSCI for registered manager and no copies of monthly visits from the owner are available in the home or sent to CSCI. Due to the lack of records a number of areas of the home regular health and safety checks such as weekly checks on the fire alarms, emergency lighting and call systems on a monthly basis are not recorded. On the day of inspection the fire alarm went of. Staff dealt appropriately with the situation. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 17 Records relating to residents accidents were also unavailable and only been in the last month, a significant number of these accidents were for one particular resident and a falls risk assessment was not in place that covered this appropriately. Staff were using wheelchairs for several residents that did not have footrests and lap straps in place. The manager explained that one resident refused to use footrests and staff had been instructed in the means to move her safely. However risk assessments for this were not available. The risk assessments in the home have very little details have not been reviewed and do not clearly detail to staff the actions that they need to take. A number of fire doors do not close properly and the fire risk assessment has not been updated for over 18 months. Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 x x x x x x x x Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 19 YES Are there any outstanding requirements from the last inspection? 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 OP 7 Regulation 15(1)(a)( b) Requirement Timescale for action 25/11/05 2. OP 8 17(1)(a) 3. OP 18 13 (6) 4. OP 19 23(2) (a) (b) The manager must make sure that the residents written care plans and risk assessments detail how the residents needs in respect of health and welfare, are to be met. These must be regularly updated. 25/10/05 All pressure ulcers must have clear documentation detailing the actions that staff need to take in order to provide appropriate dressings. All wounds must have suitable tracking and descriptions of the nature of the wound such as photographs, wound mapping and/or clear description of size, location and grade if applicable. (this is an outstanding requirement from the previous report) All staff must be fully trained in 25/11/05 the Protection of Vulnerable Adults, this must include an understanding of their role within any potential investigation. A full maintainance plan must be 25/12/05 developed and adhered to. The missing covers on the lights in the corridor outside the kitchen must be replaced. Version 1.40 Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Page 20 5. OP 29 19(1)(a)( b) (c) (3) 6. OP 30 7. OP 30 8. OP 31 9. 10. OP 33 OP 38 11. OP 38 12. OP 38 All staff must have full employment checks, including CRB, 2 references, POVA and proof of identity before they start work in the home wether paid or unpaid. 18 (1) (c) All staff training records must be (i) updated. In house training must keep records of the content of the course and the assessment of staff competency. 18 (2) All care staff should undertake formal supervision 6 times a year, all other staff to be supervised as part of an ongoing process. (This has been an outstanding requirement on two previous reports) 8 (1) The acting manager must submit an application to be registered manager. A three month period from commencement has been agreed as a trial period by bith own and manager 26 (1) (3) The registered provider must (4) (a) (b) undertake monthly quality visits (c) (5) (a) with a copy sent to CSCI. 23 (4) (c) All fire doors must be adjusted in (i) (v) order to close properly. Advice from the fire office must be sought for this and updating the fire risk assessment. 23 (2) (n) All staff must be reminded of the appropriate means to use a wheelchair, such as foot rests and lap straps. 23 (4) (a) Monitoring records of fire alarms, (b) door guards, emergency lighting and call systems must be undertaken and recorded appropriatly. 25/08/05 25/11/05 25/11/05 11/ 10/05 25/09/05 25/09/05 25/09/05 25/09/05 Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 21 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 OP 9 Good Practice Recommendations Medication arriving in the home should be clearly documented to include dose, drug, amount and who for. Staff shoulld use medications only for the resident named on the label. All mnedications should detail the label directions. all medications records should be checked by two people in order to maintain accuracy. The practice of recording medications by box rather than over all amount should be discontinued. Consideration should be made to replacing the lino floors in three of the bedrooms. Staffing levels should be monitored in order to determine that the levels meet the dependency needs of the residents. The manager should monitor residents accidents in order to identify any residents who are at particular risk or events in the home that increase risk. 2. 3. 4. OP 19 OP 27 OP 38 Ash-Croft House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Burlington House Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 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 House Care Home F53 F03 S64981 Ashcroft House V246833 250805 Stage 4.doc Version 1.40 Page 23 - 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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