CARE HOMES FOR OLDER PEOPLE
Ash House Residential Home Ash House Lane Dore Sheffield South Yorkshire S17 3ET Lead Inspector
Sue Turner Key Unannounced Inspection 17th May 2006 7:15 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 House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 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 House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ash House Residential Home Address Ash House Lane Dore Sheffield South Yorkshire S17 3ET 0114 2621914 0114 2356107 walker-jean@btconnect.com None Ash House (Yorkshire) Limited 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) Ms Julie Elizabeth Shaw Care Home 40 Category(ies) of Dementia - over 65 years of age (15), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (15), Old age, not falling within any other category (25) Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The 15 DE/E / MD/E beds are in a separate wing. Date of last inspection 7th December 2005 Brief Description of the Service: Ash House is a home that provides care for 40 people (over the age of 65) of which there are 15 beds for people with dementia and 25 personal care beds. The home is situated in the Dore area of the city. The detached building is in its own grounds, which were very pleasant and well maintained. There was an outside sitting area that was easily accessible and overlooked the grounds. Local amenities were a short drive away, providing a range of shops, pubs and a picnic area close by. All but two of the rooms were single and service users were able to bring their own possessions into the home with them. There were pleasant communal areas for the service users to sit and a large separate dining room. A copy of the previous inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The manager confirmed that the range of monthly fees from 10th April 2006 were £303 - £341 per week. Additional charges included newspapers, hairdressing and private chiropody. Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this inspection, which was unannounced and took place over 7 hours from 7.15 am to 2.30 pm. An inspection of the environment was undertaken. Records were examined, including: 3 care plans, complaints, staff recruitment and training, menu and fire records. All the Commission for Social Care Inspection (CSCI) key standards were checked. Interactions between staff and service users were observed. The inspector spoke with a proportion of the staff on duty (9), and 13 service users. Discussions with the homes registered manager and the provider also took place. Prior to the site visit 6 service user questionnaires were received. What the service does well: What has improved since the last inspection?
Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 6 At the previous inspection six requirements were issued, of which five had been fully actioned. One bathroom had been refurbished and a hoist had been fitted, which the service users said had ‘made bath time easier’. The registered provider had started to carry out Regulation 26 visits, in which the quality of the service provided is monitored. These visits were on a monthly basis and recorded in writing. Staff said that they were receiving one to one formal supervision from their line manager, which was organised at a time suitable to themselves. All staff had undertaken fire training and the manager had a record of when staff were due to carry out any refresher fire training or other training necessary. A large patio area and water feature had been provided to the dementia (DE) wing. Outside seating and a barbeque had been purchased for this area and service users said they had enjoyed ‘sitting outside in the sunshine’. What they could do better:
The home did have information available for prospective service users, however this information would be much improved if it was put together in a user friendly way and could then be used as an incorporated Statement of Purpose and Service User Guide. The information recorded in care plans needed further work to ensure that the service users current health, personal and social needs were fully met. One requirement relating to replacement of the floor covering on the DE wing has been carried forward through several reports. The inspector believes that new floor covering would greatly enhance the appearance of the DE wing and would benefit the service users who regularly move around this area. The provider has agreed a date when this will be completed. The deployment of staff should be managed to ensure that service users are supervised at all times, reducing any risk to their well-being. The number of staff trained in NVQ Level 2 or above, falls extremely short of the recommended 50 as required by the Care Homes Regulations. Staff, service user and relative meetings were not taking place and reports from the provider were not in sufficient detail. These meetings, visits and reports would offer the opportunity for the manager and providers to receive feedback about the service they are providing and aid improvements. Any substances that could be hazardous to health need to be kept in the lockable cupboards available.
Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 7 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 House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 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 House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 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): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was not providing sufficient updated and relevant information to inform service users about their rights and choices. Each service user had a written contract, which enabled them to be clear about what services were included in their fee and what services must be purchased separately. Assessments prior to admission took place and trial visits to the home were encouraged. This enabled staff to be aware of service users needs to ensure that they could be met. EVIDENCE: Copies of a combined Service User Guide and Statement of Purpose were seen in each service users bedroom and on display in the entrance hall. The guide consisted of loose-leaf information about some of the services and policies at the home. Some of the information within the guide was out of date and not always written in a user friendly way.
Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 10 Copies of service user contracts were seen on the files checked. Each clearly stated the terms and conditions of the home and funding arrangements. Staff spoken to said that assessments were undertaken prior to admission to ensure the home could meet prospective service user needs. The home’s manager or senior staff carried these out. Copies of care management assessments and the homes own assessments were seen on the files checked. Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Not all care plans had sufficient recorded information to ensure that the service users health, personal and social care needs were truly reflected and could be met. The homes medication practices protected the service users from being administrated inappropriate medications. Service users privacy and dignity was respected, ensuring that their rights were upheld. EVIDENCE: Three care plans were sampled. These contained varied information on aspects of personal, social and health care needs. Care plans seen did not build up a picture of the service user and state the staff action required to ensure assessed needs were met. The information in the daily records was very repetitive and did not always marry with the care plans. Health care records were kept in a separate file. Records were available which detailed any health care professionals that had visited, weight charts and bathing routines. For one
Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 12 service user, the bathing record confirmed that he/she had not had a bath since February. The manager said that she was aware that he/she had been bathed on a regular basis. The inspector spoke to the service user who said they were bathed ‘too often’. For one service user the weight chart recorded a substantial weight loss in a three-month period. The service user had not been weighed again for several weeks and no action had been taken. The manager was asked to weigh the service user immediately and take any appropriate action necessary. The home had a policy and procedure regarding the safe receipt, recording, storage, handling, administration and disposal of medication. Senior staff administered medications when they had completed competency training. Medication was checked for three service users and found to be recorded, administered and stored appropriately. No service users were prescribed controlled drugs; however there was a controlled drugs cabinet and register available should they be needed. Staff were observed respecting privacy by knocking on doors before entering. The interactions between staff and service users appeared respectful and caring. Service users spoken to said the staff were ‘very nice’ and ‘they attend to all your needs’. Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 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 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. Service users were able to make choices about daily living and social activities. A range of activities was offered which suited the preferences of the service users. The home had an open visiting policy, which assisted in maintaining good relationships with service users family and friends. A varied diet was provided and sufficient drinks were offered, which promoted the service users well being. Service users would enjoy being served fresh fruit on a more regular basis. EVIDENCE: Service users said they were able to get up and go to bed when they chose, and were seen to use different areas of the home according to their choice. Service users with dementia lived in one area of the home, which was on one level and they were able to move freely around the wing. The home had a leisure programme, which included activities both inside and outside of the home. Several service users spoken to were looking forward to a trip to the coast and on the day of the inspection a gentleman came and played the keyboard, to which the service users sang along to. A popular activity was ‘the
Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 14 shop’, which was a trolley taken around the home from which service users could buy sweets and toiletries. Service users said that that they were able to see their visitors in private and that visitors were made welcome at any time, which helped them, maintain contact. Service users were able to bring personal items with them into the home. All of the bedrooms seen were individually personalised and homely. This was important to service users as it helped them retain control over their immediate environment. Service users on the DE wing were observed in a discreet and sensitive way being given time and assistance to eat their meal. All service users spoken to said that they were satisfied with the food served and the number of drinks they were offered. When describing the food on offer service users made comments like ‘ we have nice meat and vegetables’, ‘there’s always a choice’ and ‘mealtimes are a good activity’. Two service users spoken to said that they would like more fresh fruit. They said they used to be offered fruit, which was cut up nicely for them, which made it more appealing. Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 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 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. The homes record of complaints evidenced that appropriate action was taken following any concerns raised. Staff had been provided with essential training in adult protection procedures, which assisted to ensure service users were safe, and informed staff of the procedures to follow if an allegation was made. EVIDENCE: The homes complaints policy was on display in the entrance area of the home. It contained relevant information and informed the reader who to contact external to the home, should the complainant wish to do so. The manager said that there were no outstanding complaints at the home. Since the last inspection CSCI have received one complaint about the service. The provider investigated this and appropriate action was taken to address their findings. Staff spoken to were aware of their responsibilities in reporting any complaints or allegations and said they had confidence that the management team would deal appropriately with any issues raised. The homes adult protection policy included information on local procedures. Staff spoken to said that they would report any allegations of abuse to their senior manager. Staff spoken to had received formal training in adult protection procedures and were able to describe types of abuse that service users could be susceptible to. All of the service users said that they felt very safe living at the home.
Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 16 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 location and layout of the home was suitable for its stated purpose. Communal areas appeared comfortable. Service users bedrooms met individual’s needs in a comfortable and homely way. The DE wing floor covering was worn and would benefit from replacement to enhance the environment. Sufficient and suitable bathrooms and toilets, which had adaptations installed to maximise independence were made available. EVIDENCE: The grounds around the home were very striking and service users said they appreciated the lovely scenery when they were sitting outside in the summer. The newly laid patio area outside the DE wing was very pleasant. A water feature, barbeque, planters and seating all added to the character and enabled all service users to safely enjoy time outside.
Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 17 All areas of the home were clean and tidy. There were no unpleasant odours noticeable in the home and service users said that their rooms were kept clean. Lounge and dining areas were domestically furnished. The bedrooms seen were comfortable and homely. Service users spoken to said that they had all they wanted in their rooms. The floor covering in the DE wing was worn and tired looking. Service users living on this wing spent a lot of time walking up and down and brighter, more appealing floor covering would benefit the service users. The provider agreed a date when this work would be completed for. Refurbishment work to one bathroom was completed and service users spoken to said there were sufficient bathrooms and showers to ensure they could bathe when they wished. Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 18 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. Staff were employed in sufficient numbers, however staff were not situated, at all times, where necessary to fully meet the needs of the service users and ensure their safety and well-being. Recommended levels of NVQ trained staff had not been achieved, which did not ensure staff had the competencies to meet the service users needs. The details held and recorded in staff recruitment files were accessible and complete, therefore ensuring the protection of service users. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained to meet the needs of service users. On the morning of the inspection the inspector noted that the DE wing was left unsupervised for a short period of time. The manager said that this was not common practise and safe-working practises would be put in place to ensure this did not happen again. Of the 22 care staff, 2 staff had achieved NVQ level 2 or above in care. A further 8 were in the process of completing. This falls extremely short of the requirement that a minimum ratio of 50 staff is trained to NVQ Level 2 or above. Three staff records were checked. All of the information required to be obtained was seen on each file checked.
Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 19 Staff spoken to said that they had undertaken induction training prior to commencing their duties at the home. They said they had covered such things as fire, health and safety, COSHH, moving and handling and personalised care. Staff spoken to said they were offered training in many specialised topics. One example was training that was provided about ‘managing people living with dementia’, which was very valuable as the home had a number of service users with dementia. Training undertaken took different formats and was offered both on site and off site. Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 20 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, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a positive style of management in the home, which benefited everyone living in, working in and visiting the home. Quality monitoring systems need to continue to develop to ensure the home is run in the best interests of the service users. Service users monies were safely handled, which ensured that finances were accurate and safeguarded. In the main the homes policies and procedures promoted the health, safety and welfare of service users and staff. Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 21 EVIDENCE: All of the service user and staff spoken with said the registered manager was approachable and supportive. The registered manager had completed NVQ 4 in management. Recorded quality assurance visits by the registered provider were seen at the home, these did not include all of the detail required to be reported upon in Regulation 26 of the Care Homes Regulations, neither had the reports been forwarded to the CSCI. The manager said that she had carried out a quality assurance audit in December 05. Relatives and professionals were sent questionnaires; the results were then summarised and appropriate action taken. Since this there had not been any service user, staff or relative meetings. The manager confirmed on pre inspection information that the fire officer last visited the home on 02.08.05. All fire equipment was last checked on 09.08.05 with the exception of the alarm, which is tested each week. The Environmental Health Inspector last visited on 10.02.06 and any recommendations made have been actioned. Gas, electrical and moving and handling equipment had all been checked as required. Staff spoken to said that they had received formal supervision from the manager, which they had found useful and informative. Three service users monies were checked. Receipts, records and money all tallied and all were kept securely. Whilst undertaking a tour of the environment a number of cupboards, in bathrooms, that held hazardous substances had been left unlocked. Staff were asked to lock the cupboards immediately. Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 22 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X 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 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 23 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 OP1 Regulation 456 Requirement There must be a Service User Guide/Statement of Purpose that includes all of the detail required in Regulation 4 and 5 of the Care Homes Regulations. The Service User Guide/Statement of Purpose must be kept updated and under review. Information within all care plans must be reviewed and updated to reflect each service users current health, personal and social needs. Records must be kept up to date. The registered manager must monitor service users weight loss/gain and take any appropriate action. The floor covering on the EMI corridor must be replaced. (Previous timescales of 01/08/04 to 31/03/06 not met) Timescale agreed with the provider on the day of the inspection. Timescale for action 01/07/06 2. OP7 15 01/08/06 3. OP8 12 17/05/06 4. OP19 23 01/04/07 Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 24 5. 6. 7. OP27 OP28 OP33 13 18 26 8. OP33 26 9. OP38 13 Service users must be fully supervised at all times. There must be 50 of the care staff trained to NVQ Level 2 or equivalent. Regulation 26 reports must be provided, as detailed in the Care Homes Regulations and forwarded to CSCI Sheffield office. Staff, service user and relatives meetings must be held. Minutes from these meetings must be recorded in writing. All substances that may be hazardous to health must be securely stored at all times. 17/05/06 01/12/06 01/06/06 01/06/06 17/05/06 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 OP15 Good Practice Recommendations Fresh fruit should be offered to service users on a regular basis. Ash House Residential Home DS0000044374.V294429.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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