CARE HOMES FOR OLDER PEOPLE
Ash House Ash House Lane Dore Sheffield S17 3ET Lead Inspector
Sue Turner Unannounced 27 April 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ash House Address Ash House Lane Dore Sheffield South Yorkshire S17 3ET 0114 262 1914 0114 235 6107 Not known Ash House (Yorkshire) Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ms Julie Elizabeth Shaw PC Care Home Only 40 Category(ies) of OP Old Age (25) registration, with number DE(E) Dementia - over 65 (15) of places MD(E) Mental Disorder - over 65 (15) Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The 15 DE(E) and MD(E) beds are in a separate wing. Date of last inspection 15 August 2004 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 is 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. Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day between 9.00 am and 3.45pm. A tour of most parts of the building and grounds was carried out. A number of records, relating to those living in the home and management paperwork were checked. Time was spent talking with groups of service users in communal areas and individually with four service users. As the home accommodates people living with dementia, time was spent observing the interaction between staff and service users. The provider, manager, two relatives and five members of the staff team were also consulted. What the service does well: What has improved since the last inspection? Service users said that the quality and choice of the food served in the home had ‘really improved’ over the past few months. A number of bedrooms had new carpets and privacy nets had been fitted to some bedroom and bathroom windows. In all three lounges a DVD player had been provided and service users were enjoying being able to watch films of their choice. The DE wing also had a new television with a bigger screen that enabled the service users to see programmes more clearly. Staff said that they had received much more training, which has helped them to understand the service users care needs.
Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 6 Service users and relatives commented upon a more ‘static’ staff group who seemed to enjoy working at the home which resulted in there being a pleasant relaxed atmosphere, described by one service user as being ‘the next best thing to home’. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 2 3 and 5 The Statement of Purpose and Service User Guide provided sufficient information for prospective service users to make an informed decision about admission to the home. Staff assessed all prospective service user needs by visiting them prior to admission. EVIDENCE: The homes Statement of Purpose and Service User Guide were informative and up to date. A number of service users spoken to said that prior to admission staff from the home visited them to assess their needs and give them information relating to the home. They were also encouraged to visit the home to meet people, see the facilities available and sample the hospitality. Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 8 9 and 10 Care plans detailed a significant amount of information relating to health, personal and social needs. Accident recording and follow up care was appropriate. Service users were treated with respect and their privacy was upheld which helped to make them feel comfortable and ‘at home’. EVIDENCE: Three service users plans of care were checked. Each set out individual needs and the action required by staff to ensure those needs were met. Discussion with service users identified that a range of health professionals visited the home to assist in maintaining health care needs. Records were kept of medication received, administered and disposed of. A member of staff spoken to confirmed he had undertaken training to deem him competent to administer medication. All medication was noted to be securely stored. A pharmacist had checked the homes medication systems at regular intervals. This promoted the safety of service users. Staff were observed interacting well with service users. Service users spoken to said staff were ‘ very kind’ and ‘helpful’ and their right to privacy was always upheld.
Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 13 14 and 15 Service users on the whole were generally happy with their lifestyle within the home. Activities that matched preferences and capabilities were on offer; further activities and trips outside the home would benefit those service users who enjoy being ‘active’ and ‘busy’. There were no restrictions on visiting times and service users were able to receive visitors in private. Meals were of a high standard and served in pleasant surroundings. EVIDENCE: Information received from service user questionnaires had highlighted a wish that more activities were available both within and outside of the home. The home had arranged a new programme of activities, which service users said, they were enjoying, but they still felt ‘bored’ a lot of the time. The home is situated within pleasant grounds and several service users said they would enjoy walking around the mature gardens. As there were no local shops they also missed popping out for some sweets or a newspaper. Throughout the day friends and family were seen visiting freely and being offered hospitality, which creates a home that people want to visit. Bedrooms seen were personalised and observation of the interaction between service users and staff confirmed that personal autonomy and choice were well considered. All service users spoken to said that meals at the home had improved greatly.
Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 11 There was plenty of variety and choice and they looked forward to mealtimes. Drinks and snacks were available at all times. Observations in the residential and DE dining rooms confirmed that personal preferences were catered for, assistance was given appropriately and meals were not rushed which created a pleasant and relaxed ambience. Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Staff had an understanding of the procedures to be followed should they suspect any abuse at the home. Complaints procedures and an ethos were in place to enable service users and relatives to feel confident that any concerns they voiced would be listened to. EVIDENCE: Relatives and service users said that if they had any concerns that they would feel comfortable in talking to the staff or the manager. Staff had received in house training on adult abuse and all staff were scheduled to undertake formal adult protection training. This will help to ensure that service users are protected from abuse. Discussions with service users confirmed they had nothing to complain about, they were ‘happy’ and ‘well looked after’. Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 20 21 22 23 24 25 and 26 The location and layout of the home is suitable for its stated purpose. Service users bedrooms met individual’s needs in a comfortable and homely way. The patio area outside the DE wing was unsafe making it inaccessible to service users and prevented them from being able to walk outside should they wish. Sufficient and suitable bathrooms and toilets, which had adaptations installed to maximise independence were not made available. EVIDENCE: The grounds around the home were very welcoming and service users in the DE wing said they would like to walk outside during the nice weather. This was not possible as the patio area was unsafe and required attention. The proprietor said that work had commenced on the patio and made a commitment that this work would be completed within three months. All areas of the home were clean and tidy. Lounge and dining areas were domestically furnished. Three bedrooms were checked in detail and many
Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 14 others seen, all 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’. As service users with dementia walked up and down this corridor many times it would be favourable for this area to be more eye-catching. Refurbishment work to the bathrooms and toilets that had been required at previous inspections had not been completed. Consequently the majority of service users were utilizing one bathroom and one shower room. Service users said that this was not causing them any difficulty at present, although it would be better if there were an assisted bath available on the first floor, near to their bedrooms. Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 28 29 and 30 Staff were employed in sufficient numbers to meet the needs of service users in accordance with agreed staffing levels. The recruitment information obtained for new staff was sufficient to adequately protect the welfare of service users who lived at the home. Staff were undertaking training, which enabled them to meet the needs of the service users in the home. EVIDENCE: The manager stated that agreed staffing levels were being maintained. This assisted in making sure that service users needs were met. Service users spoken to said that staff were kind and helpful. Staff spoken to and three files checked confirmed that thorough recruitment procedures were carried out prior to employment being offered. Staff training records identified an increase in training opportunities for the staff. Four members of staff had completed NVQ training and a further eighteen were undertaking the qualification. All staff undertook an induction programme, which the manager stated, met the National Training Organisation (NTO) specifications. The skills and knowledge demonstrated by a number of staff was satisfactory. Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 32 33 37 and 38 There was a positive style of management in the home and staff moral had improved which will ultimately benefit the health and welfare of the service users. The published results of the quality assurance survey demonstrated a commitment by the manager to meet the aims and objectives of the home. An equal commitment, to carry out Regulation 26 visits was not shown by the responsible individual. Arrangements for all staff to undertake fire training and the regular servicing of the homes equipment and appliances were satisfactory which assisted the protection of service users and staff from a risk of harm. EVIDENCE: Since the last inspection the manager had sent out questionnaires to service users, professionals and relatives to ascertain their views of the home. Information had then been collated and appropriate action taken which had
Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 17 improved the service. Regulation 26 visits were carried out, but these were not at the obligatory intervals nor did they provide the information required by the regulations. A number of records were checked these were clear and up to date. Fire records confirmed that weekly fire checks, alarm systems, extinguishers and emergency lighting had been completed as necessary. All staff had received fire practices and/or drills as required by the homes policy and procedures. Risk assessments were seen on individual service user files, these had been reviewed and updated as necessary, thereby promoting the safety of service users. Nurse call systems, the lift, gas and boilers had all been services as required. At the time of inspection no fire exits were blocked and window restraints were in situ at first floor windows checked to prevent falls. Hazardous products and records were safely stored in the home. This promoted the safety and welfare of the service users. Food seen in the main refrigerators did not have a ‘use by’ date which could pose a potential risk to service users. Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 1 3 2 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 2 x x x 3 2 Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 12 Regulation 12 16 Requirement Activities must be made available which are flexible and varied to suit service users expectations, capabilities and preferences. The paving slabs outside the EMI wing must be made safe. (Previous timescales for completion of work not met 1.8.04, 1.3.04 and 1.10.03.) The floor covering on the EMI corridor must be replaced. (Previous timescale for completion of work not met 1.10.04, 1.08.04) Bathrooms must be refurbished and suitable adaptations installed to assist service users that are old, infirm or physically disabled. (Previous timescales for completion of work 1.8.04, 1.10.03, 1.3.03) Visits by the Registered Provider must take place as detailed in Regulation 26 of the Care Homes Regulations and comprehensive reports must be provided.
J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Timescale for action 1 July 2005 2. 19 13 23 31 July 2005 3. 19 16 23 1 January 2006 4. 21 22 19 1 September 2004 5. 33 26 1 July 2005 Ash House Version 1.30 Page 20 6. 38 13 16 All perishable foods must be clearly labelled with a opened on or use by date. Immediate as instructed on the day of inspection. 27 April 2005. 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 28 Good Practice Recommendations By 2005 there should be 50 of the care staff trained to NVQ Level 2. Ash House J55-J06 S44374 Ash House V187204 270405 UI Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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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