Inspection on 23/06/08 for Ash House Residential Home

This inspection was carried out on 23rd June 2008.

CSCI found this care home to be providing an Adequate service.

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 House Residential Home 09/12/09

Ash House Residential Home 08/06/09

Ash House Residential Home 17/05/06

Ash House Residential Home 07/12/05

Ash House Residential Home 27/04/05

Ash House Residential Home 15/08/04

Ash House Residential Home 14/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

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 07:40 23rd June 2008 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.V362365.R01.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 House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ash House Residential Home Address Ash House Lane Dore Sheffield South Yorkshire S17 3ET 0114 262 1914 0114 235 6107 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.V362365.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The 15 DE/E / MD/E beds are in a separate wing. Date of last inspection 17th May 2006 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 are single and people were able to bring their own possessions into the home with them. There were pleasant communal areas for people 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 fees from April 2008 were £327 £368 per week. Additional charges included newspapers, hairdressing and private chiropody. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This was an unannounced key inspection carried out by Sue Turner, regulation inspector. Jan Colombo, an expert by experience, accompanied the inspector. An expert by experience visits the home with an inspector to help them get a picture of what it is like to live in the home. She spent time talking to people and making observations of daily life. This site visit took place between the hours of 7.40 am and 3:00 pm. The registered manager is Julie Shaw, who was present during the site visit. Mr Zahur is the registered provider and was also present for part of the visit and to receive feedback. Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Questionnaires, regarding the quality of the care and support provided, were sent to people living in the home, their relatives and any professionals involved in peoples care. We received one from a person living in the home, four from relatives, two from health professionals and nine from staff. Comments and feedback from these have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. Time was spent observing and interacting with staff and people. Nine staff, two relatives and twelve people living in the home were spoken to. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in May 2006. The progress made has been reported on under the relevant standard in this report. The inspector wishes to thank the people living in the home, staff, and relatives for their time, friendliness and co-operation throughout the inspection process. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 6 What the service does well: People living in the home made comments such as: “We are looked after all right. I have my own room, which is very nice. I cannot grumble.” “Its nice here. We are looked after well.” “It is good being here and we’re looked after well.” “I’m looked after wonderfully.” “I cannot grumble. It is better then being on your own. I have a nice bedroom.” “They treat me very well.” ““It is very good here.” Comments received from questionnaires and from talking to relatives included: “Staff show compassion and understanding”. “The care my mum receives is very good and she is well cared for. The home is very clean, all the staff are friendly”. “I have had no complaints about care but did mention to the staff that I was concerned that laundry was not being returned to its rightful owner even though clearly named. This does seem to have been rectified”. “The staff are very good, smashing.” Health professionals said: “The standard of care appears to be good. The staff are always approachable and helpful to myself and the residents”. “Very caring and respectful to residents”. “As a visitor to Ash House for many years a lot of things have improved under the current management and will carry on doing so if funds are available. A resident’s happiness is paramount and I seem to find that at Ash House”. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 7 The Expert by Experience said: “My overall observations were that Ash House was a comfortable home. Overall, I felt that they were trying to do a good job, but something was lacking.” Care plans were in place for all. They set out all aspects of personal, social and health care needs. People’s health care was monitored and access to health specialists was available. People said that they had a choice of food and that the quality of food served was “good”, “not bad” and “I love the food”. There was a complaints procedure and adult protection procedure in place, to promote people’s safety. People said they had confidence in the homes manager and staff, who would listen to any concerns and take them seriously. What has improved since the last inspection? At the previous inspection nine requirements were issued. Two requirements are carried over into this report. Appropriate action had been taken for five of the requirements. Two requirements have been carried over as recommendations. The Service User Guide and Statement of Purpose had been reviewed and updated. It contained useful information for people who could be considering living in the home. Information within the care plans reflected peoples current health, personal and social needs. The floor covering on the EMI corridor had been replaced. This made the unit look more homely. People were seen being supervised during the site visit, however one relative said this was not always the case. The relative’s comments are included in the report. Staff, resident and relatives meetings were being held and minutes from these meetings were recorded in writing. However these weren’t very detailed and the same information was repeated following several meetings. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 9 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.V362365.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 5. Standard 6 is not applicable to this home. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided sufficient updated and relevant information to inform people about their rights and choices. Trial visits were encouraged to enable people to look around the home, meet other people living there and give them the information needed to make informed choices. EVIDENCE: The homes Statement of Purpose and Service User Guide were available, both in the entrance hall for anyone visiting the home. These included useful information about the home and the services offered. Both the Statement of Purpose and Service User Guide had been updated recently. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 11 When someone showed an interest in the home the manager carried out a pre assessment. This meant that they could be assured that they could meet the person’s needs. People were invited to visit the home, try out the meals and spend time meeting the staff and seeing the services available. One person who returned a survey said they had received enough information about the home before they moved in so they could decide if it was the right place for them. One relative said: “We were recommended the home through friends at church. Mum came to visit and decided to stay.” When staff were asked if they were given up to date information about the needs of the people they cared for five said “always” and four said “usually”. This home does not provide intermediate care services. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by visits to the home by health care professionals. Care provided by the homes staff did not promote dignity. More attention should be given to peoples changing needs. The arrangements for the administration of medication was not robust and could pose a risk to people. EVIDENCE: People living in the home had an individualised plan of care. Three peoples plans of care were checked. Care plans contained a range of information on aspects of personal, social and health care needs. The care plan was developed at the time of the person’s admission. Staff completed daily records. These were done at the end of each shift. There was very little information in the daily records. Those seen were short, brief Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 13 comments that were repetitive. Records didn’t detail how people had spent their day, what meals they had taken, if any visitors were seen, any personal care tasks undertaken and any activities they had joined in. Daily records did not link with the information recorded in peoples care plans. One persons daily records said that they had fallen on three consecutive days. The dates of the falls did not match with those recorded on the accident records. There were no details in the daily records about any actions or observations that were necessary to monitor the person following the falls. The care plan did give information about the person’s tendency to fall; however their mobility risk assessment had not been updated. There was no evidence in the care plans seen that relatives had been involved with them. Two relatives spoken to said that staff had asked them things about their loved one when they came into the home but they had not been involved in any reviews or updates. Care plans identified that a range of health professionals visited the home to assist in maintaining peoples health care needs. People said that GP’s, dentist, opticians and chiropodists visited the home as requested. One person who returned a survey said staff did listen and act on what they said and that they did receive the care and support they needed. Relatives surveyed were asked, “Does the care service meet the different needs of people? And “does the care home give the support or care to your relative/friend that you expect or agreed? Four relatives said “always” to both questions. Health professionals said: “Whenever I have a concern regarding health care of a resident if I cannot attend to it, the matter would be always dealt with swiftly, i.e. contacting a doctor for prescription of antibiotics”. “From a dental health perspective, they appear to support all the residents”. Medicines were securely stored in locked trolleys. Medications were supplied by the pharmacist in monitored dosage. Controlled drugs (CD) were kept in a separate room and within a double locking cabinet. There was a CD register, which two staff signed when administering. Staff undertook an in-house training programme and were not allowed to administer medication until they were considered to be competent by the person assessing them. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 14 We observed the senior carer administer medications to people over breakfast. Medications were taken to individuals and the staff member waited with them until they had taken them. People were offered a drink of water with their medications. When the carer had finished administering we asked to look at the medication administration record (MAR) sheets. None of the medications administered during breakfast had been signed for. The staff member said that they signed for all medications together when everyone had been given them. We explained the risks associated with this and how people’s health and safety was being jeopardized. We observed a number of things that did not make sure that people’s dignity was respected at all times. One person was walking around with buttons missing from their clothes, some had food spillage on their clothes, most ladies were not wearing stockings or tights and one man was wearing odd socks and had his pyjamas showing from underneath his trousers. We acknowledge and advocate that people do make choices about their lifestyle, however these observations told us that people were not always receiving a good standard of care. Observations on the EMI unit showed us that staff did communicate with people during care delivery. However some staff were uncomfortable when interacting with people. There were a number of times when staff did not respond to people in a way that showed they were mindful of how to speak to someone who has dementia. The expert by experience said: “All communication that I witnessed between staff and people was appropriate. I noted that the four men in the EMI lounge were all unshaven, by several days. I was concerned about the fact that the men had not been shaved. I felt that staff could have done more about the personal care of people.” Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were able to maintain contact with family and friends. A range of activities was on offer. Meals served offered choice and were of a good quality. Drinks were not offered regularly enough to ensure peoples health and welfare. EVIDENCE: People were seen to walk freely around the home, if able. Relatives spoken to said they were able to visit at any time and were made to feel very welcome. We saw that everyone coming to the home was made to feel comfortable whilst visiting their loved one. Care plans seen included details of a person’s previous lifestyle and interests. The home employed an activities worker who worked three days each week. Examples of the activities available were crafts, quizzes and reminiscing Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 16 sessions. Outside entertainers visited the home and shopping trips were occasionally organised. When asked “are there activities arranged by the home that you can take part in?” One survey said “usually”. People spoken to said: “I like to play the games it makes you feel more intelligent and not fed up.” ““It goes in spasms. There has been a long time with nothing. I sit outside when it is nice weather.” “There has been outings, but not recently because of the bad weather.” “The only activity I like is watching TV.” ““A gentleman comes and plays the piano.” ““We used to go out. We have entertainers. I pass the time by talking to others and going into the garden. We did a quiz this morning.” One relative said: “All the staff are very caring and spend time with the residents, the ones that are able play games or listen to music, this of course helps to keep minds active”. The expert by experience said: “On the EMI unit two staff were playing snakes and ladders with 5 people, using a large mat. This game had started when I went in and continued until lunch except for a break while tea and biscuits were served. Both staff were attentive to people, helped them with drinks and tried to encourage them to take part in the game. At one point, staff blew up some balloons and tried to get other people to throw them to each other. Most people were unresponsive, but two ladies were laughing and seemed to really enjoy this game. One member of staff started to talk to a person about the garden, but did not pursue it beyond asking if he/she had liked gardening and telling them that she did not do any gardening. I felt the staff member could have continued this conversation and perhaps involved other people. Because of the homes location, I would not think it is possible for staff to take people to the local shops, etc. so outings are important. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 17 Activities seem to be mainly the responsibility of the care staff, as the activities co-ordinator works only one day in the week and then at weekends. I felt that care staff did not really know how to make the most of the activities, but did try.” When asked “do you like the meals at the home?” One survey said “always”. People spoken to said: ““Meals are good with a choice everyday.” “ Food is not bad, with a choice. There is plenty to eat.” “The food is very good and I am fussy.” “We do not have to do any shopping, cooking or washing up.” “The puddings are always good.” We sat with people in the lounge before breakfast. Four people said that they were thirsty. The night staff said that they did give people a drink during the night if they asked. The night staff worked from 9pm to 8am and during this time most people had not had a drink. As many people had dementia it is unacceptable that they were only given a drink if they asked. The manager was asked to make sure that drinks were available at all times and offered regularly. The expert by experience joined people in the residential unit for lunch. She said: “The dining room was a large and very attractive room, with a beautiful ceiling. There were tablecloths and each table had cruet. Everyone was offered a glass of orange squash. There was a stereo system and a budgie in a cage. There was a large telephone, which people could use. The menu for the day was on a board. There were two alternatives. Lunch was a hot meal. Tea was sandwiches or spaghetti on toast, then buns. Kitchen staff helped the carers serve meals. The names of the kitchen staff were written at the bottom, but in the form ‘S. Smith’. I would have thought first names would have been friendlier, especially as people living in the home are called by their first names. When I was in the lounge after lunch, I heard a staff member asking people what they wanted to eat the next day. I was offered lunch of sausage casserole. There was a good range of vegetables with it. Pudding was chocolate sponge and custard or ice cream. The portions were very ample. The two staff in the dining room were very attentive and unobtrusively helped people who required it. A lady came into the dining room after everyone had finished, but staff produced a meal for her.” Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures were in place and people felt confident that any concerns they voiced would be listened to. Staff had received adult safeguarding training and had an understanding of the procedures to be followed should they suspect any abuse at the home, so helping to ensure that people were protected. EVIDENCE: People and their families had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall. This contained details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so. When asked, “do you know who to speak to if you are unhappy?” One survey said “always”. People spoken to said: Relatives surveyed were asked, “Do you know how to make a complaint about the care provided by the home if you need to? Three relatives said “yes” and one said, “I can’t remember”. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 19 Two relatives spoken to said: “I speak to the manager or deputy if I have any concerns. They have sorted out issues I have raised with them.” “If I had a complaint I would not hesitate to talk to the Manager, but I have no complaints.” Nine staff surveys were returned. When staff were asked, “Do you know what to do if a person/relative/advocate or friend has concerns about the home? All the staff said “yes”. The homes adult safe guarding policy included information on local procedures. Staff spoken to said that they would report any allegations of abuse to their manager. Staff spoken to had received formal training in adult protection procedures and were able to describe types of abuse that people could be susceptible to. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and generally well maintained, providing a homely environment for people and their visitors. EVIDENCE: Since the last inspection some areas within the home had been refurbished. Some rooms had new carpets fitted and new lighting had been installed in some areas. New commodes and crockery had also been purchased. There was an enclosed patio area leading from the EMI unit. This had been block paved and there were benches for people to sit outside in the nice weather. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 21 The AQAA stated that the maintenance and renewal programme for the home would continue. We found that the furnishings, in some communal and personal areas were looking tired and worn. Carpets in the EMI lounge and some bedrooms were stained and marked. When asked “is the home clean and fresh?” One survey said “always”. People spoken to said: “I have my own room, which is very nice. I cannot grumble.” “I have a nice room with my own things in it. I like the decoration in the lounge.” “My room is nice, tidy and clean.” One relative said: “The home could improve by a little modernisation of bedrooms and with the addition of en-suites”. The expert by experience said: There was a notice in the hall saying that Millie was the house cat. There was also a tank of fish. In the staff toilet, there was a bucket marked ‘for fish tank only,’ which is good practice. There were birds in cages in two rooms. I think that the pets had been introduced to give a homely feeling. The EMI lounge was carpeted and well decorated. It had large windows with access to the garden. There was a TV, vase of artificial flowers, pictures on the wall and a cockatiel in a cage (a sign gave the bird’s name). They had tried to make it look homely. When I walked down the corridor, the toilets all looked very clean. In the residential unit there was a large lounge with carpet. There was a vase of artificial flowers, ornaments and plates and pictures on the wall. There was a TV, which was on, CD/radio and a keyboard. There was an attractive fireplace and a bookcase, but neither of these was accessible, as there were chairs in front of them. They had tried to make it homely, but it was a huge room, so difficult. Chairs were in a large circle round the room. There was a terrace outside. Controls of infection procedures were in place. Staff were observed using protective aprons and gloves. The homes laundry was sited away from food preparation areas. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff were provided to meet the needs of people. Recruitment information obtained for staff was sufficient to protect the welfare of people. Newly employed staff had completed induction training. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained to meet the needs of people. One relative said that when they visited the home at the weekend, they often found the staff congregating in the staff room and people were in lounges and unattended. They also said that they had seen staff washing their cars outside. The relative wasn’t sure if staff were doing this during their break time. The manager was told about this and said she would speak to the staff and other people. She said she would take any appropriate action necessary, so that she was assured that people were being observed, supervised and cared for at all times. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 23 Staff were able to talk about the various training courses that they had attended, which included all of the mandatory training, for example, Moving and Handling, Food Hygiene, Adult Protection, First Aid and Fire. We believe that staff would benefit from undertaking training in how to talk with people that are living with dementia and have communication problems. Three staff files checked identified that the member of staff had received induction training when they commenced work. When staff were asked did your induction cover everything you needed to know to do your job when you started, six said “very well” and three said “mostly”. Seven care staff had achieved NVQ Level 2 or above in care. A number of care staff had also commenced the training. This did not meet the required minimum of 50 of the staff team trained to NVQ Level 2 in Care. The recruitment records of three staff members were checked. The staff had provided employment histories and the home had obtained two written references for each of them. These were satisfactory. Protection of Vulnerable Adults (POVA) checks had been made and Criminal Records Bureau (CRB) checks had been obtained for the staff members. One staff CRB showed criminal convictions. There was no evidence that this had been discussed with the person and then their suitability for employment considered. We believe that it is necessary for a risk assessment to be completed so that the manager can feel assured that people are protected by the homes recruitment practises. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager’s approach benefited people and staff. The quality assurance systems needed further development to ensure that the home was run in the best interests of everyone. People’s monies were safely handled, which ensured that finances were accurate and safeguarded. People’s health and safety had been put at risk, in some areas. EVIDENCE: The registered manager had completed NVQ Level 4 in Care and Management. She said that she keeps herself up to date with training by attending all the Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 25 courses that the staff attend. She said that since the last inspection she hadn’t completed any training that was designed for managers. Information from questionnaires confirmed that people, staff and relatives were all happy to approach the manager at any time for advice, guidance or to look at any issues. They all said that they were confident that she would respond to them appropriately and swiftly. Nine staff surveys were received. When asked “Does your manager meet with you to give you support and discuss how you are working?” Five staff said “often”, three said “regularly” and one said “sometimes”. Staff, resident and relatives meeting had taken place. The minutes from these meetings were very brief and repetitive. For several meetings the same topics had been discussed. There was no information about if any action had been taken following the issues raised. People and staff said that the registered provider visited the home on a regular basis. When he visited he took time to speak to people, staff and relatives. As the registered provider he has a responsibility to complete a report each month about the conduct of the home. We issued a requirement for these reports to be completed at the last inspection, however these were not being completed. This requirement is therefore carried over into this report. The manager had sent out questionnaires to people asking them what they thought about the home. This information had been collated onto a report, which was on display in the entrance hall. One person said: “I completed a questionnaire and said there ought to be a bigger variety of sandwich fillings, this has happened.” The home handles money on behalf of some people. This was checked for four people. Account sheets were kept, receipts were seen for all transactions and monies kept balanced with what was recorded on the account sheet. Formal staff supervision, to develop, inform and support staff took place at regular intervals. Staff said that they found this useful and beneficial. In the main equipment at the home was serviced and maintained. However the home did not have a periodic inspection certificate to certify that the electrical fixed wiring had been checked. This is recommended to be carried out within a maximum of five years. Fire records evidenced that weekly fire alarm checks took place. Staff said fire drill training took place on a regular basis. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 26 The manager had completed a fire risk assessment on 01/06/07. As the home cares for people with dementia the risk assessment should have highlighted what particular precautions were in place to keep people with dementia safe. Whilst undertaking a tour of the environment a cupboard in a bathroom that held hazardous substances had been left unlocked. This was highlighted at the last inspection and a requirement issued. This requirement has been carried over to this report. The manager was asked to act in response to this immediately. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 27 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 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.V362365.R01.S.doc Version 5.2 Page 28 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 OP7 OP8 Regulation 17 Requirement Accurate information about any accidents that have occurred must be kept. Any accidents that have occurred should be cross-referenced to care plans risk assessments and daily records. People and/or their representative must be involved in the care planning and reviewing process. To ensure peoples health and welfare, MAR sheets must be fully completed and signed when people have received their medication. Suitable arrangements and appropriate action must be taken to ensure that people’s dignity is respected. To ensure people’s health is maintained, hot and cold drinks must be available at all times and offered regularly. So that people’s health, safety and welfare are protected, the manager must investigate the issues raised by a relative about how people are overseen. DS0000044374.V362365.R01.S.doc Timescale for action 23/06/08 2. OP7 15 01/08/08 3. OP9 13 23/06/08 4. OP10 12 (4) (a) 23/06/08 5. OP15 16 23/06/08 6. OP27 18 20/07/08 Ash House Residential Home Version 5.2 Page 29 7. OP33 26 8. OP38 13 9. OP38 13 In order to form an opinion of the standard of the care provided at the home the registered provider must complete a monthly report. The report must include information about the points detailed in Regulation 26 of the Care Homes Regulations. Previous timescale 01/06/06 not met. So that people are kept safe the fire risk assessment must highlight any particular precautions that need to be in place for people that have dementia. All substances that may be hazardous to health must be securely stored at all times. Previous timescale 17/05/06 not met. 30/07/08 30/07/08 23/06/08 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. 3. 4. 5. 6. Refer to Standard OP7 OP9 OP10 OP28 OP30 OP29 Good Practice Recommendations Daily records should give more detail. For example how people have spent their time and if they have received any personal or professional visitors. All staff that administers medication should undertake refresher/updated medication training. Staff should undertake training in maintaining peoples dignity. There must be 50 of the care staff trained to NVQ Level 2 or equivalent. Staff would benefit from undertaking training in how to talk with people that are living with dementia and have communication problems. When CRB’s identify that the person has a criminal conviction, a risk assessment should be completed to DS0000044374.V362365.R01.S.doc Version 5.2 Page 30 Ash House Residential Home 7. 8. OP31 OP33 8. OP38 assess the person’s suitability for the post they have applied for. The manager should undertake periodic training (appropriate to her role) to update her skills, knowledge and competence. The minutes recorded after staff, people and relatives meetings should detail what was discussed and any actions that will be taken following what staff, people and relatives have said. The home should have a periodic inspection certificate to certify that the electrical fixed wiring had been checked. Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ash House Residential Home DS0000044374.V362365.R01.S.doc Version 5.2 Page 32 - 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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