CARE HOMES FOR OLDER PEOPLE
Ash Hall Care Home Ash Bank Road Ash Bank Stoke-on-Trent Staffordshire ST2 9DX Lead Inspector
Mrs Yvonne Allen Unannounced Inspection 15th November 2005 09.30a 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 Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 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 Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ash Hall Care Home Address Ash Bank Road Ash Bank Stoke-on-Trent Staffordshire ST2 9DX 01782 302215 01782 305088 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) Geoff Bowker Limited Mrs Wilhemina Thomas Care Home 61 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (61), of places Physical disability (41), Physical disability over 65 years of age (41), Terminally ill (5) Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 41 Physical Disabilities (PD) - Minimum age 60 years on admission Date of last inspection 15th September 2005 Brief Description of the Service: The establishment is an extended two storey Grade II listed building situated in Ash Bank, within easy access to Werrington and Bucknall through good road and rail links, and a regular bus service. The establishment has an impressive vista in spacious, well-attended gardens. There is adequate parking and vehicle loading space, The establishment provides accommodation to service users requiring 24 hour care, including nursing care to elderly persons requiring personal/nursing care, the home may also accept up to five service users who suffer with Dementia. A provision is approved for the care of up to five terminally ill service users. Thirty-Eight single (13 with en-suite) and 11 double bedrooms (one en-suite) are located on the ground and first floors. First floor accommodation is accessed via stairs and shaft lift. Internally the home provides spacious accommodation, which is furnished in a homely style. Communal accommodation on the ground floor provides three lounge facilities and a separate dining room adjacent to the kitchen. An additional lounge facility is located on the first floor of the establishment. The approach to care in the home is based on integration of service users admitted under the above categories with all service users using the full range of communal space. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over two and a half hours by two inspectors. The inspectors were received by the Deputy Manager as the Registered Manager had worked a night shift and was not on duty at the time. The inspectors chatted with residents, some visitors and staff members. Relevant records and documentation were examined. Not all the minimum standards were assessed during this inspection only those not assessed at the previous inspection or those not having fully met the standard last time. Verbal feedback was given to the Deputy Manager at the end of the inspection. What the service does well: What has improved since the last inspection?
Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 6 There has been a significant reduction in the number of complaints received by the CSCI. Since the last inspection the Commission have received no complaints. The Manager and her Deputy appear to be handling complaints well. Residents spoken to stated that they knew who to go to if they had any concerns. GP visits are documented in individual care plans and residents receive regular health checks. Staff supervision has commenced although this needs to be further developed. Some of the requirements in relation to Health and Safety issues have been addressed and rectified since the last inspection. However, there are still requirements outstanding in relation to the promotion of Health and safety in the home. 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. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 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 Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 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 the following standard(s): 1,2, 4 and 5 Prospective residents and their families are able to make an informed decision on whether the Home is suited to meeting their needs. Further evidence is required on how the Home meets the needs of residents with dementia. EVIDENCE: The Home’s Statement of Purpose and Service User Guide were examined and found to be up to date with the information about the Home. These were available to all prospective and new residents as well as professionals and funding bodies. The Service User Guide contained a copy of the Terms and Conditions of the Home in relation to residents who are self funding. This outlined a trial period of six weeks during which the resident could make a decision on whether or not the Home is suited to their needs and visa versa. The deputy manager explained how prospective residents and their families are very welcome to come and view the Home prior to admission. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 9 The terms and conditions relating to residents who are funded by Social Services are laid out in the contract between the Home and Social Services. There was little evidence of how the staff meet the specific needs of residents who are suffering from dementia. A selection of staff training records were examined and there was no record of these six members of staff having received any training relating to the care of residents with dementia. Nurses and care staff will need training in dementia awareness and it would be beneficial for the activities organiser to receive some training in how to meet the social and therapeutic needs of residents with dementia. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 and 11 Safe administration and storage of medication is carried out in the home. Residents and their families can be assured that, at the time of their death, they and their relatives would be supported and treated with respect. EVIDENCE: The inspector observed the nurse on duty administering the medication to the residents in a controlled manner. Once administered the nurse signed the medication sheet. Storage of medication within the home was satisfactory and safe systems of disposal were in place. Medication sheets checked at the visit were signed and in good order. Close links with the dispensing pharmacy and the GP assists the staff to deliver medicines safely to the residents. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 11 Residents were able to discuss their wishes for the final stages of their life if they wished to. Staff were able to discuss with the inspector the importance of offering respect and dignity at all times. The staff felt they were well supported by the manager and her deputy and that they were suitably trained to deal with residents deaths and comfort their relatives. Nurse specialists were invited to the home to support the residents, staff and relatives should the need arise. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 Residents were encouraged to maintain contact with their relatives, friends and the local community. EVIDENCE: Residents spoken to at the visit all confirmed that relatives and friends are welcomed into the home by the staff. Visitors were evident during the visit and they commented that were always made to feel part of the home and were greeted by warm, friendly staff. Links with the community continue, the activity organiser invites local people to entertain the residents and organises trips out of the home for those who wish to join in. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 16 and 17 Residents and their families could be assured that their concerns will be listened to and acted upon. The complaints procedure will need to include the details of CSCI. The legal rights of residents are upheld and protected. EVIDENCE: The CSCI had not received any complaints directly since the last inspection. Examination of the complaints procedure on display identified that the details for the CSCI were not included. A requirement for this has been made. The registered Manager keeps a record of complaints made and action taken. Residents confirmed that they are able to exercise their legal rights if so wished. Postal voting is arranged as required. Advocacy services are available for those who require support. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19, 21, 23 and 26 Residents are accommodated in a Home, which is clean and well presented with sufficient and suitable toilet and washing facilities Bedrooms were personalised and suited to individual needs. EVIDENCE: A tour of the environment was conducted. Toilets and washing facilities were accessible and clearly marked for all residents. Assisted bathing facilities were available for those who were less able. Bedrooms were suitably arranged to allow ease of mobility within the space, promoting a safe environment. Bedrooms inspected at the visit were clean, tidy and personalised. Residents spoken to said they enjoyed having their own space and liked to look at their photographs and reminisce. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28 The needs of residents are met by the skills and numbers of the staff provided at the Home. EVIDENCE: At the time of the inspection there were 43 residents accommodated in the Home, 23 of whom were receiving nursing care. There was the Deputy Manager on duty who was a first level nurse, together with a second first level nurse. There were seven care assistants on duty from 8am until 2pm, then six from 2pm-8pm. The staffing rota was examined and, on some days, there were two nurses from 8am-4pm. Other days there were two nurses until 2pm. Some days there were six care staff until 8pm and other days there were five care staff until 8pm. Morning shifts were well covered with a total of nine staff on duty. On night shifts there were four care staff working with one nurse. The staffing arrangements for evening support need to be closely monitored to ensure that there are adequate staff on duty. The arrangements for ancillary and kitchen staff were satisfactory. The proprietor’s daughter was working in the office in relation to the administration of the Home. The Home also employed a part time activities person.
Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 16 There was no maintenance person employed. The proprietor took care of maintenance issues. Staff training in NVQ (Care) was on going at the Home. Records were examined in relation to this. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35, 36, 37and 38 The Home is well managed by the registered manager and her deputy with residents and staff feeling supported. Attention is required to the maintenance of residents’ finances records and there were areas of concern in relation to some Health and Safety requirements. EVIDENCE: The Registered Manager was not on duty at the time of the inspection as she had worked a night shift. Residents spoken to were complimentary about the Manager and Deputy Manager as were staff members. It was obvious that the two managers worked well together and that the Home was being well managed. Both managers kept themselves updated with training needs and PREP requirements. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 18 Examination of records relating to the maintenance of residents’ finances identified that receipts and invoices were not being maintained for monies taken out of accounts. This was discussed with the proprietor’s daughter at the time of the inspection and it was explained that any receipts and invoices for expenditure in relation to residents’ personal monies must be maintained so that auditing of accounts could be undertaken at any given time. Staff spoken to were able to discuss with the inspector that were receiving formal and informal supervision. Care staff commented that the deputy manager was very supportive with care issues including promotion of high standards. There was written evidence of supervision however this was to be further developed. Records were maintained securely and in accordance with Data Protection requirements. Most records were computerised and accessed only by selected personnel. Records and documentation were examined in relation to the maintenance of a healthy and safe environment. It was identified that, although PAT testing had been carried out for this year, not all equipment had been tested and there were labels missing from items which had undergone the testing. This needs to be addressed as a matter of some urgency by the proprietor to ensure that all portable electric appliances used within the Home are in good working order and safe to use. It was also identified that, although hot water temperatures for baths and showers are maintained to no more than 43 degrees centigrade, there were no records of the regular testing and recording of these. It was noted that, on the second floor, some of the windows were opening wider than the required 100mms. Both of these were requirements contained in the last report and it was disappointing and concerning to see that they have still not been addressed. A letter of serious concerns has been sent to the provider in relation to this. Staff receive regular training in fire safety, fire drills, moving and handling, healthy and safety, food hygiene and infection control and this was recorded. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 19 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 3 x 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 x 3 x 3 x 3 x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 2 3 3 2 Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 20 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 16 Regulation 22(7) Requirement The complaints procedure must display the address and telephone number of the local CSCI office. Hot water temperatures from baths and showers must be tested and recorded monthly and records available for inspection. PREVIOUS REQUIREMENT The windows on the second floor must not open more than 100mms as in accordance with Health and Safety Requirements. PREVIOUS REQUIREMENT PAT testing must be carried out on all portable electric appliances on an annual basis and records maintained. Equipment tested should be labelled. Invoices and receipts must be maintained of expenditure in relation to residents’ personal finances. Nursing and care staff must receive training in dementia awareness so that they are able to fully meet the needs of these residents. Timescale for action 20/12/05 2. 38 13 (4) 20/12/05 8. 38 13 (4) 20/12/05 9 38 23(2)(c) 20/12/05 10 35 Schedule 4 (9) 18(1)(c) 20/12/05 11 4 20/02/06 Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 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. 2. Refer to Standard 36 27 Good Practice Recommendations There was written evidence of supervision however this was to be further developed. The staffing arrangements for evening support need to be closely monitored. Ash Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Hall Care Home DS0000026935.V268423.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
