Inspection on 20/09/06 for Ash Hall Care Home

This inspection was carried out on 20th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Hall Care Home 15/06/09

Ash Hall Care Home 17/06/08

Ash Hall Care Home 15/11/05

Ash Hall Care Home 20/04/05

Ash Hall Care Home 15/09/04

Ash Hall Care Home 21/04/04

Ash Hall Care Home 18/09/03

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

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 Key Unannounced Inspection 20 September 2006 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 Hall Care Home DS0000026935.V312802.R02.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 Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 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 Ashhall@ashhall.fsnet.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) 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.V312802.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 41 Physical Disabilities (PD) - Minimum age 60 years on admission Date of last inspection 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. The fees charged by this home range from £370.00 to £467.00. Services available at extra cost consist of hairdressing, toiletries, newspapers, holidays and clothes. This information was contained in the pre-inspection questionnaire on 06/06/06. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out by one inspector and the field visit took 4 hours to complete. The inspector met with the registered manager of the home, the administrator and several other members of staff. Several residents were also spoken to and the inspector was made to feel welcome by all. The provider was not present during this inspection. A large number of comment cards had been returned prior to the inspection from residents, relatives, GPs and placing officers. All the comments received were positive and indicated that there was an overall satisfaction with the care and services provided by the home. With reference to the care provided a comment read – “can’t have any better” and that they were “very satisfied” with the medical support they needed. Activities were described as being “very good” as were the meals provided. Residents knew who to speak to if they were not happy stating that – “Mr Bowker was very good” and “matron – she is most helpful in everyway.” In reference to making a complaint residents indicated that they knew how to do this but that they “never need to” and “very happy with treatment, want to stop here”. In respect of the cleanliness of the home a comment read that this was – “to a very high standard.” Another resident commented that her bedroom was “beautiful.” The field visit confirmed the above and the home were found to be meeting almost all of the minimum standards with very positive outcomes for residents. Some comments received indicated that there would be a need to examine the provision of staff and that staff were usually available when needed. The field visit confirmed that the provider would need to address the numbers of staff provided in order to maintain the high standards of care, which the home had achieved. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The complaints procedure now displayed the address and telephone number of the local CSCI office. Hot water temperatures were now tested and recorded monthly and records were available for inspection. The windows on the second floor were now restricted to open no more than 100mms as in accordance with Health and Safety Requirements. PAT testing had been carried out on all portable electric appliances since the last inspection. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 7 Invoices and receipts had been maintained of expenditure in relation to residents’ personal finances. 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.V312802.R02.S.doc Version 5.2 Page 8 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.V312802.R02.S.doc Version 5.2 Page 9 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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives and placing officers were provided with sufficient information about the home prior to admission. Residents and their representatives could be assured that their assessed needs would be met by the home. EVIDENCE: Comment cards received from residents identified that they had received a contract when moving into the home. Residents’ comments also identified that either they or their relatives had visited the home prior to admission and had received adequate information about the home. Discussions with residents during the field visit confirmed the above. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 10 Examination of a random selection of care plans identified that a qualified member of staff from the home carried out pre-admission assessments before a placement was offered. Other assessments were also included, usually by placing officers such as Social Workers. The home did not provide intermediate care facilities. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 11 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): 7,8,9,10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal and healthcare needs of individuals are planned and delivered with dignity and respect and take account the diverse needs of individuals. Care plans would be improved by ensuring that all identified needs are incorporated and all deaths of residents must be reported to the CSCI. EVIDENCE: Out of the 22 comment cards received back from residents, all of them, without exception, felt that their personal and healthcare needs were being met very well by the staff at the home. Comments included – “can’t have any better” and one visitor stated that her friend’s “personal appearance” was always good and that “hair and nails receive regular attention”. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 12 Case tracking identified that personal care needs were planned and met with dignity and respect. One resident who was spoken to during the field visit commented that the staff at the home always treated her in a dignified manner and were always polite. Discussions with staff members confirmed that they were aware of the importance of maintaining dignity, independence and respect for residents in the home. One of them went on to explain to the inspector how she would ensure this during the delivery of personal care. The home uses the Resmin system of care planning, which is a computerised system. Care plans are accessible to selected staff members and copies of the care plan can be run off when required for reviews with residents and their representatives. There was evidence of participation into care plans by some families. Case tracking identified that, on the whole, individual plans were comprehensive and that care was delivered as planned. However, some needs of two of the individuals, which were documented on pre-admission assessment, did not have a specific care plan developed. These were namely Dementia, Alzheimer’s and Risk of Falls. This was discussed with the manager who explained that these needs were taken into account in the general activities of daily living. There was little written evidence to support this, however and despite the fact that the home were meeting overall needs of individuals, care plans must be developed in relation to all identified needs in order to be able to evidence that these specific needs are being fully monitored. One of the residents who was case tracked was partially sighted. The inspector visited her in her bedroom and it was identified that she had everything within reach and that she had organised her room so that it was familiar to her. This resident also had mobility problems and had been provided with a wheeled Zimmer frame, which she negotiated very well, and a wheelchair for longer journeys. The call bell was within easy reach should she require use of this. Comments were received from 3 General Practitioners who have patients accommodated in the home and all were satisfied with the overall care delivered to them. Comments from a Social Worker indicated that she, too, was satisfied with the care and service provided at the home. There was evidence, throughout the care plans, that residents have access to other healthcare professionals as and when required. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 13 The medication procedure was examined in relation to the three residents who were case tracked and this was found to meet with the minimum requirements. A discussion was held with the manager about sending in notifications under regulation 37 to the CSCI regarding deaths at the home. The CSCI had not received any copies of these since the last inspection although there had been 6 deaths in the home during this time. A requirement has been made in relation to this. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 14 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): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were enabled to exercise choice and autonomy and the lifestyle provided in the home matched their expectations. EVIDENCE: The comments received from residents identified that they considered the social and therapeutic activities provided by the home to be good and that they considered that their individual needs were met in this area. They were complimentary about the activities co-ordinator commenting that she listened to them and always “had time for them”. The field visit identified that there was a planned programme of activities, which was varied and included visits by outside entertainers. Case tracking identified that individuals had been assessed as to their wishes and abilities and activities had been recorded individually. Discussions with the manager and staff identified that the activities organiser was off sick and that staff had to oversee this for the time being. Some staff Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 15 commented that this was difficult at times as this placed an extra workload on to them. The manager was hopeful that this was only a temporary measure. There was evidence that the spiritual and religious needs of individuals were catered for by the home. This included meeting diverse needs of individuals as well as the usual religious followings. The manager explained how she had enabled a resident to access the Church that she used to belong to and some family members whom she had lost touch with. She enlisted the help of the resident’s advocate in order to do this. Comments received about the meals served in the home were complimentary and the majority of residents thought that they were given enough choice and variety and that the quality of food served to them was good. The menus were examined and found to be varied and offered a choice of nutritious food. The lunchtime meal appeared appetising and those residents needing assistance were helped with their meal by the staff. This was carried out in a discreet and dignified manner. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 16 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 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were protected from harm or abuse whilst in the home and could be assured that any concerns they had would be taken seriously and acted upon. EVIDENCE: Without exception all 22 of the comment cards identified that residents would know who to approach if they had any concerns about the home but that they did not have any. Compliments were received about the provider and the manager – stating that both were helpful in sorting out any problems. The CSCI had not received any complaints directly since the last inspection. There was a complaints procedure in place, which was both clear and accessible. The previous requirement to amend this had been achieved. The systems in place at the home helped to ensure that residents were protected from harm. Staff were very carefully selected and checked before they were offered employment at the home. Ash Hall Care Home DS0000026935.V312802.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a spacious, safe and pleasant environment for residents to live, which has been adapted to suit individual needs. EVIDENCE: A tour of the home was undertaken during which all communal areas and a selection of bedrooms were inspected. The home was found to be clean and well presented and was a credit to the domestic staff team. Some areas had been redecorated and refurbished since the last inspection. This had included the blue lounge, which had been provided with new easy chairs. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 18 Communal areas were spacious, allowing small groups of residents to sit together. This seemed to work very well with residents chatting to each other and seemingly enjoying each other’s company. Bedrooms were personalised with resident’s own effects brought in from home and had been adapted to suit the needs of individual residents. There was evidence of specialist adaptations and equipment around the home including specialist mattresses. The manager stated that there had been a selection of new mattresses provided since the last inspection. She also commented that there had been new laundry equipment purchased. The comments received from residents indicated that they considered the home to be fresh and clean. One of the residents commented – “my bedroom is beautiful”. The provider had addressed the requirement to put restrictors on the windows on the second floor. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 19 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): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents could be assured that the staff possessed the necessary skills and expertise to provide them with the care and support they required, however providing staff training in dementia awareness would enhance this. There was a requirement to refer to the existing staffing notice and to adjust the numbers of staff accordingly. EVIDENCE: Staffing rotas provided for a four-week period were examined. It was identified, through examination of these rotas, discussions with staff and some comments received from residents, that there may be times when the staff provided was just short of meeting with the existing staffing notice. This called for 2 nurses from 8am until 8pm with current occupancy and dependency. The manager was working mainly on the floor and counted in as one of the two nurses. Although she receives help with management duties, it is recommended that more management time be allocated to her due to the demands of the management role. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 20 The staff recruitment procedure was assessed and three staff files examined were found to contain all the required information. Staff had received the necessary checks before being offered employment by the home. Staff were found to be courteous and professional during the field visit. NVQ staff training was on going and the home had achieved over the 50 target, with over 70 of care staff trained to NVQ level 2 and above in direct care. The home should be congratulated for achieving and maintaining this high percentage of NVQ training. The home had an extensive staff-training programme and the three staff members interviewed confirmed that they received the help and support they needed. The previous requirement for staff to receive training in dementia had not been achieved within the timescale although the manager stated that she was trying to access this. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 21 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): 31,32,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and both residents and staff feel supported by the manager. More regular meetings would further enhance this and provide evidence that both staff and residents have a voice. EVIDENCE: The residents considered the Registered Manager to be very helpful “in every way” Staff spoken to also confirmed that the manager was very supportive and accessible. Documentation was seen to identify that quality assurance was been carried out at the home. Auditing was on going in all areas. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 22 Discussions with the manager identified that residents’/relatives’ meetings had not taken place for some time. The manager stated that residents and relatives tend to come to her on a one to one basis. Whilst this is good practice, it is recommended to recommence the meetings as this would help to ensure and evidence that residents have a voice and play a part in the running of the home. Discussions with staff also identified that there had not been a staff meeting for some time. It is also recommended that these be held more frequently. There was written evidence to confirm that the manager keeps herself updated both clinically and in her managerial role. She had attended various study days and training sessions since the last inspection. Case tracking identified that residents’ personal allowances were well managed and that the procedure for administration was open and transparent. The daughter of one of the residents managed her mother’s money for her. The administrator confirmed that no one employed at the home was acting as agent or appointee for any of the residents. The manager and provider ensured that health and safety were promoted at the home and provided a safe environment in which residents could live and staff could work. Records and documentation were examined and confirmed the above. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 23 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 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 x x x 4 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 24 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 2 3 Standard OP7 OP11 OP27 Regulation 14 (2) 37(1)(a) 18(1)(a) Requirement Care plans must be developed for all identified needs of individuals All resident deaths must be reported to the CSCI under Regulation 37 The numbers of staff provided must be sufficient to meet the needs of the residents accommodated, and as per existing staffing notice. Nursing and care staff must receive training in dementia awareness so that they are able to fully meet the needs of these residents. PREVIOUS TIMESCALE NOT MET Timescale for action 20/10/06 20/09/06 27/09/06 4 OP4 18(1)(c) 20/11/06 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 OP33 Good Practice Recommendations It is recommended that meetings are re-commenced for DS0000026935.V312802.R02.S.doc Version 5.2 Page 25 Ash Hall Care Home staff and residents. Ash Hall Care Home DS0000026935.V312802.R02.S.doc Version 5.2 Page 26 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.V312802.R02.S.doc Version 5.2 Page 27 - 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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