Inspection on 25/03/09 for Ash Lodge

This inspection was carried out on 25th March 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

CARE HOMES FOR OLDER PEOPLE Ash Lodge Londonderry Lane Smethwick West Midlands B67 7EL Lead Inspector Amanda Lyndon Key Unannounced Inspection 25th March 2009 09:45 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 Lodge DS0000071889.V374424.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 Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ash Lodge Address Londonderry Lane Smethwick West Midlands B67 7EL 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) 0121 558 9808 0121 558 9808 Care First (Smethwick) Ltd Mrs Lynne Turjman Care Home 54 Category(ies) of Dementia (14), Old age, not falling within any registration, with number other category (54), Physical disability (54) of places Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 54 Physical Disability (PD) 54 Dementia (DE) 14 The maximum number of service users to be accommodated is 54. 2. Date of last inspection New service Brief Description of the Service: Ash Lodge is a care home offering both nursing and residential care for up to 54 older people with general care needs and 14 of these people may also have dementia care needs. There is a separate unit on the first floor for 8 people who have more complex dementia care needs, requiring residential care. The home is located in a residential area, close to shops and public transport links. There is ample off road parking at the front of the building and there is one garden used by all people living at the home. Accommodation is provided over two floors and bedrooms offer single occupancy. There is a passenger lift so that people with restricted mobility can access these areas of the home. En suite facilities are not provided in the vast majority of bedrooms however assisted toilet and bathing facilities are provided. Corridors are wide and equipment is available to assist people to move around the home. The home operates a no smoking policy within the building. There is information of interest to people living at the home and their visitors on display at the home. This is the first visit to Ash Lodge since registering with a new owner, therefore previous inspection reports were not available at the home. The range of fees charged to live at the home is not included within the service user guide but can be obtained from the home on request. Items excluded from the accommodation fee include private chiropody, hairdressing and personal toiletries. Ash Lodge DS0000071889.V374424.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 one star, and this means that people who use this service experience adequate quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on areas that need further development. This was our first inspection at Ash Lodge since it was registered with a new owner in April 2008. Prior to the visit taking place, we looked at all the information that we had received or asked for. This included any complaints made or notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. In August 2008, we received a comprehensive Annual Quality Assurance Assessment (AQAA). This tells us how the home think they are performing in order to meet the needs of people living there. We sent out random questionnaires to fifteen people who live at the home in order to obtain their views about the service provided. Eight people returned questionnaires to us and comments received are included in this report. The visit to the home was undertaken by one inspector over one day and We, the commission, were assisted throughout by the acting deputy manager and staff team on duty that day. The manager was on a period of leave however chose to come into the home half way through the visit in order to obtain specific information required for the inspection. The owner was also available for part of the visit. The home did not know that we were visiting. There were fifty four people living at the home on the day of our visit and we were told that there was a waiting list of other people wanting to come to stay there. Three people were case tracked. This involves discovering peoples’ experiences of living at the home and focuses on the outcomes for these people. We spent time speaking with eight people living at the home, five staff, three visitors and a health care professional about the care provided to these people. We observed care practices and sampled care, staffing and health and safety records. We looked around the areas of the home used by people case tracked. No immediate requirements were made at the time of the visit. This means that there was nothing urgent that needed to be done to make sure people stayed safe and well. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 6 What the service does well: People know prior to admission that their care needs could be met living at the home. People are supported by staff who are familiar with their individual care needs and are deemed to be suitable to work with older adults. People have access to a range of health and social care professionals and this should ensure that their health care needs are met. People are supported to keep in touch with their families and friends so that they can maintain relationships that are important to them. People are able to exercise control over their daily lives and this promotes their independence and individuality. A variety of healthy meals are served, and these meet any special requirements for reasons of health or taste preferences. People living at the home and the people important to them are confident that actions will be taken to address any concerns that they may raise to the staff team. People are provided with a homely living environment and are encouraged to personalise their rooms with items that are familiar to them, so that they are relaxed in their surroundings. People living at the home and their families told us: “The home suits me for my needs”. “This is the home I wanted my husband to come to as it was highly recommended”. “Overall I believe that the home takes my care very seriously and I am well looked after” “ The nurses ring me if there is any problems. As soon as anything is wrong they let us know”. “It’s up to me what time I get up”. “We can please ourselves here. There are no rules”. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 7 “The staff are marvellous, I don’t have to wait long for the staff”. What has improved since the last inspection? What they could do better: The health, safety and welfare of people living at the home have been compromised due to managerial arrangements. Current systems in place for the recording of medication to be given to people living at the home may lead to medication administration errors as it was not always possible to read the instructions recorded on the chart clearly. Systems in place for moving and handling does not always ensure that people receive support in a safe manner in this area. This may result in serious injury to both people living at the home and the staff team. The health, safety and comfort of people within the first floor lounge is compromised as the call bell system is not within their reach. Information about the home should include details of the range of fees so that people know what they will have to pay if they live there. Activities on offer do not meet the needs and expectations of all people living at the home. This means that some people are not supported to lead fulfilling and stimulating lives. Current facilities provided mean that peoples’ privacy and the security of their personal items are compromised. People living at the home told us: “The staff can’t find the key for my lockable drawer”. “ I do my puzzles, there are no organised activities here”. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 8 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 Lodge DS0000071889.V374424.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 Lodge DS0000071889.V374424.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): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough and people have enough information in order to decide whether they would like to live at the home. EVIDENCE: A statement of purpose had been produced and this included the majority of information about the services and accommodation provided at the home. A “welcome pack” had been created and this included a service user guide, giving brief information about the home. An additional “welcome leaflet” gave specific information about the staff and accommodation provided at the home. Details of the costs involved in living at the home were not included in these documents however were available on request. The home operates a no Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 11 smoking policy within the building, however people coming to live there may not be aware of this, as it is not included within the information available. These documents were produced in a large print format and available in the reception area of the home so that people could access them easily. We were told that the statement of purpose and service user guides could be produced in other formats and languages on request so that everyone can access the information. People and their families are encouraged to visit the home in order to sample what it would be like to live there. One person met during the visit said “My Daughter came to have a look around as I was in hospital”. Senior staff undertake comprehensive pre admission assessments in order to determine whether people’s individual care needs could be met at the home. Following this a letter is sent out to the person or their family to confirm whether their care needs could be met there and a comprehensive contract of terms and conditions of the stay is issued. This means that people are aware of all costs included and excluded from the accommodation fee. One person who completed a survey prior to our visit said “The home suits me for my needs”. Another person said “This is the home I wanted my husband to come to as it was highly recommended”. People come to live at the home for a trial period of twenty eight days and after this time a review is arranged involving the person living at the home, their family, the home’s staff and social worker. This provides all involved with the opportunity to discuss whether the person’s care needs were being met and whether they wished to remain at the home. Following periods away from the home, for example, hospital admissions, re assessments of peoples’ care needs are undertaken prior to returning to the home, in order to determine whether their care needs could continue to be met there. Intermediate care is not provided at Ash Lodge. Ash Lodge DS0000071889.V374424.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): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not always in place to ensure that peoples’ personal and health care needs are met. EVIDENCE: An assessment of peoples’ individual care needs is undertaken on admission to the home. This includes an “admission pack” consisting of a dietary intake chart, weekly weight chart, toilet chart and skin assessment and is completed during the first four weeks after coming to stay at the home. Care plans are derived from this information. These are individual plans that should be written with the involvement of people and their representatives about what people can do for themselves and in what areas they require support. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 13 The nursing staff are responsible for the care plans for people receiving nursing care, and the designated residential care staff are responsible for those relating to people receiving residential care. We sampled care plans for both nursing and residential care, and found that the care plans completed for people receiving residential care included details about the specific support required by the staff team so that care should be provided in the ways that people prefer. Care plans completed for people receiving nursing care were of a pre printed format, and the majority had not been personalised to reflect the preferences and abilities of individuals. There were brief instructions for staff about the support to be provided to people living at the home, for example, “Needs assistance,” and abbreviations were used instead of actual words. This means that some people may not understand what is written and people may not receive care in the ways they prefer. We saw that an individual “daily record” was completed for each person living at the home and this included information about how they had spent the day and the care provided. Care plans, however, had not always been updated to identify changes in care to be provided, and care plan reviews stated “Care as plan” instead of an assessment of the care need being undertaken. This may prevent people from receiving the appropriate care and support required. Manual handling assessments had been undertaken however these did not always identify the support to be provided in this area. This may prevent the correct equipment from being used and accidents may occur. Risk assessments had been undertaken for people using bed safety rails, in order to reduce the risks involved in using these. We saw that staff closely monitor people deemed to be at risk of losing weight and the nursing staff seek and follow professional advice from dieticians and speech and language therapists so that people’s health needs are met in this area. We spoke with a health care professional who was visiting the home on the day of the visit. She said that she was satisfied with the care provided to the person that she was visiting and this was in line with her instructions. People living at the home also have access to a range of other health and social care professionals and people can retain their own doctor on admission to the home, if the doctor is in agreement. Otherwise the home’s staff provide support to register people with a local doctor. The majority of people living at the home wore clothing appropriate to their age, gender, culture and the time of year. We did observe however that the majority of people in the lounge on the first floor were not wearing socks, tights or stockings. We were unable to ask people whether it was their choice not to wear these because of their limited communication however staff met during the visit stated that it was possible that they had not been offered a choice about this when the night staff had assisted them that morning. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 14 The preferred names of people living at the home were recorded within the care plans, and we observed staff calling them by these names. The gender mix of staff reflects that of people living at the home so that care should be provided in an understanding manner. Despite inconsistencies in the recording of care plans, people living at the home and their visitors were happy with the care provided. One person who completed a survey prior to our visit said “Overall I believe that the home takes my care very seriously and I am well looked after” There are designated care staff responsible for the management of medication of people receiving residential care at the home, and the nursing staff manage the medication of all people receiving nursing care on both the ground and first floors of the home. We looked at the systems in place for this and sampled medication administration charts (MAR) on both floors of the home. Hand written MAR charts were being used and we saw that it was not always possible to read the medication administration instructions written onto the charts. Although no medication errors had been identified, there is a possibility that this may happen as a result of not being able to read the MAR charts clearly. The acting deputy manager had recently begun to audit the system in place for the management of medication for people receiving nursing care. In addition, the local pharmacist had recently audited the system in place for people receiving nursing care and he was due to return to audit the system in place for the management of medication for people receiving residential care. Three out of four stock balances of medicines sampled during our visit were correct. Our audit identified that one tablet had not been given for one person on one occasion, and no reason for this was identified. We sampled medication held at the home for the person case tracked receiving residential care and found that although the person had not required one of their tablets for a long period of time, repeat prescriptions had been ordered each month. As a result of this, there was a large quantity of surplus medication held at the home for this person. This was brought to the attention of the acting manager who stated that this medication required review to determine whether it was still needed. As a result of being short staffed, people received their medication late on the day of the visit. This means that they did not receive their medication at the times that they required. There is no facility to lock bedroom doors in the original part of the building, however a lockable storage facility is provided in each bedroom. One person living at the home met during the visit said “The staff can’t find the key for my lockable drawer”. There is a facility available for people living at the home to make and receive private telephone calls. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 15 Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some people living at the home do not lead stimulating lives as activities provided do not meet the needs, interests and expectations of all people living there. People are confident that they can exercise control over their daily lives. EVIDENCE: An activities person is not employed at the home and the care staff are responsible for arranging activities alongside their care duties. We were told that this post had been advertised for a long time with no success. The owner stated that actions would be taken to try to address this for the benefit of people living there. Activity plans for people receiving nursing care did not include information about peoples’ interests and there was no information about the activities they had participated in. We were told that activities are limited for people receiving nursing care. During our visit we spoke with two people who were watching the Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 17 television. One person said “ I do my puzzles, there are no organised activities here”. It was evident that a variety of activities are arranged for people receiving residential care at the home, including celebrations of special events, clothes’ parties, entertainers and progressive mobility to music. A lottery funded arts group visit to provide one to one support, artwork and music for people with dementia. Some of the art work was on display in the home. People receiving residential care were playing skittles on the day of the visit and people had a choice of whether they wanted to participate or not. The activity diary for people receiving residential care was full of information about activities arranged, who participated and feedback from people living at the home about the success of each activity. This information can be used when planning forthcoming events. The hairdresser visits each week and there is a hair salon so that people can enjoy the experience of having their hair done. One person chooses to go out to the hairdressers with her daughter. We were told that church services are held at the home each month and people are supported in this area by the staff team. People are encouraged to maintain relationships with the people important to them and all visitors met during the visit were satisfied with the level of communication between themselves and the home’s staff. One visitor met during the visit said “ The nurses ring me if there is any problems. As soon as anything is wrong they let us know”. Another visitor said “I have booked my place here, they make you feel welcome”. Information of interest to visitors was on display on a notice board in the “Relatives’ Corner” on the first floor of the home. People are able to exercise control over their daily lives and we saw that people were able to get out of bed at the times that they preferred. One person chose to go back to bed after breakfast and we saw that on the day of the visit this was the case. One person living at the home met during the visit said “It’s up to me what time I get up”. Another person said “I am awake when the night staff come to help me. The time that they come is fine”. We saw that people have a choice of where they spend their day. Some people chose to stay in their rooms, while others preferred to be in one of the communal areas. People have a choice of where they are served their meals. Another person met during the visit said “We can please ourselves here. There are no rules”. People are encouraged to maintain their independence and one person with dementia care needs chose to assist staff with washing up and laying the dining tables. This information was reflected in the person’s care plan so that the staff team were aware that she liked to do this. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 18 A cooked breakfast is available each day if a person chooses to have this. Both hot and cold light meal options are available at lunchtime and with the exception of a roast dinner being served on a Sunday at lunchtime, the main meal is served at tea time. No negative comments were received about this arrangement. We saw that there was a choice of meals provided and the care staff ask people what they would like to have for tea that evening. Records held at the home also confirmed this. The head Cook stated that she had recently devised new menus based on feedback from surveys completed by people living at the home. There is a four week menu in place and this included a variety of nutritious meals. It was noted however that the two main meal options each Friday were fish and this does not afford a choice of food on this day. The lunchtime meal options on the day of the visit were salad, soup, hash browns, bread and butter pudding or cream cakes. The main meal of the day, served at tea time was a choice of liver and onions or sausages. In addition, one person had chosen a lighter option of cheese on toast. The main meal of the day was well presented and we saw that staff were assisting people with this in a respectful manner. People were able to serve their own condiments and gravy, food was cut up into manageable pieces by staff on request, and adapted cutlery was available if required in order to promote peoples’ independence and dignity during their meal. Special diets can be prepared for reasons of health, culture, religion and taste preferences. We saw that the portions of pureed meals were served separately so that people could experience the different tastes and textures. As a result of a recent environmental health inspection, the home was granted a good rating in this area. This demonstrates that food is prepared in a hygienic manner. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 19 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident that complaints made are taken seriously and are acted upon so that improvements can be made regarding the care they receive. There are systems in place that should protect people from harm. EVIDENCE: The complaints procedure was on display in the home and was included within the “welcome pack” given to people when they came to stay there. We were told that this could be produced in different languages or formats on request. This means that people should be aware of how to make a complaint should the need arise. In addition we saw a “Compliments and Comments Book” in the reception area of the home, however this did not include any recent comments. This gives people the opportunity to raise any concerns and put forward any suggestions that they may have. Since the home was registered with the new owner in April 2008, there had not been any complaints made to us directly about the home. We saw that there had been five complaints recorded in the complaints register held at the Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 20 home. Four of these were of a safeguarding nature, including concerns raised about the system in place for accident reporting and, on one occasion, a persons’ hand bag that was found by the police. Records showed that the appropriate people had been notified about these, in order to protect people living at the home. We saw that actions had been taken to address the majority of issues raised, however it was of concern that on the day of our visit, we saw that no improvement had been made regarding the system in place for the recording of accidents involving people living at the home. Details of this are included in the management section of this report. The training matrix identified that the vast majority of staff had undertaken recent training about the protection of vulnerable adults and the adult protection policy was in line with local multi agency guidelines. Staff met during the visit appeared to have a good knowledge of this. One person living at the home met during the visit said “I speak my mind.” Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 21 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): 19, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with a comfortable and homely place to live. People within the first floor lounge are not able to summons assistance from staff at the times that they require, placing them at risk of harm. EVIDENCE: The main door at the front entrance leading into the home is kept locked so that staff can monitor who comes into and who goes out of the home. This is in order to protect vulnerable people living at the home. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 22 Accommodation is provided over two floors and there is a separate eight bedded unit for people with more complex dementia care needs. We did not view the garden on this occasion, however were told that there was one garden suitable for all people living at the home to use. There is a rolling programme of redecoration and refurbishment in place. New carpets have been laid in some areas of the home, however we saw that the carpet in the dining area and corridor of the dementia unit was stained in places, despite the best efforts of the staff team to clean it. A sensory room including lighting and massage chairs has been created to provide a calming environment for people with dementia and other sensory impairments. There are three small kitchen areas within the three areas of the home so that staff and visitors can prepare drinks and snacks. People living at the home have free access to these areas and people that are able to, are encouraged to use the facility as they wish. It was of concern however, that physically active people with dementia care needs have unlimited access to kettles and a hot water machine, placing them at risk of scalding injuries. This was brought to the attention of the owner and shortly after our visit, he confirmed that this had been done. Fridges are provided in these areas so that people can make snacks as they require or staff can make them on their behalf. Food stored in the fridge in the dementia care unit was not covered or labelled. This means that it may not be safe for people to consume. People have a choice of dining and lounge facilities. These are decorated and furnished to a good standard in a homely style so that people can relax in these areas. People can entertain their guests in these areas or in their bedrooms if they prefer. There is a choice of assisted bathing and shower facilities and communal toilets. Plans were in place to replace the flooring in two of these facilities as they had become damaged. We were told that aids and adaptations provided met the needs of people living at the home. There is a call bell facility in all bedrooms and an adapted call facility had been installed for a person who was unable to use his hands. One person living at the home met during the visit brought to our attention that there is no means to call for help whilst in the lounge on the first floor of the home. A cord was not attached to the call bell so that people were not able to activate the system. This person stated that there was often periods of up to twenty minutes when staff were not available in the lounge so people had to wait until they returned to ask for help. During the visit, we saw that this was the case. We saw that people are encouraged to personalise their bedrooms with items familiar to them so that they are comfortable in their surroundings. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 23 The temperature within the home on the morning of our visit was uncomfortably hot and from discussions with people in the home, this had been the case for a few days. A new heating system had recently been installed and we were told that efforts were being made to adjust the temperature to that of a comfortable level. We saw that there were individual thermostat controls in peoples’ bedrooms and one person met during the visit expressed her satisfaction that at her request, the staff had turned the temperature down in her bedroom. At the end of our visit, the temperature within the home had reduced to a comfortable level. Due to staff being unavailable for duty on the day of our visit there were no cleaning staff provided. As a result of this, hand paper towels had not been replenished in a number of hand washing facilities throughout the home. Staff told us that it was the job of the cleaner to do this and this was brought to the attention of the manager. There was an odour of urine within the reception area on arrival at the home however this was not evident once the care workers’ morning tasks were completed. One person who completed a survey prior to our visit said “I feel sometimes that my floor could be more thoroughly cleaned, there are sometimes blood stains etc, that are not cleaned to a high standard” We did not see any further evidence of this during our visit. Appropriate equipment was available for the hygienic cleaning of commode pots in order to reduce the risk of cross infection at the home. In addition there was an effective and hygienic system in place for the washing of peoples’ personal clothing and bed linen. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 24 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): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home operates a robust system of recruiting staff for the protection of the people who live there. People are supported by staff who receive training so that they should have the knowledge to meet individual care needs, however this is not always put into practice. EVIDENCE: The staffing rotas identified that there is one nurse on duty at all times and she is supported by a team of care staff. Administration, maintenance, cleaning, laundry and catering staff are also employed so that people are supported in all areas of their lives at the home. We were told that there were currently staff vacancies for a deputy manager and a part time cook. On the day of our visit, one staff member working on the first floor of the home was escorting a person to hospital following an accident. Extra staff had not been arranged, therefore the first floor of the home was short staffed from breakfast time until the carer returned at lunchtime. We asked people living in this area of the home met during the visit if they had to wait for long periods Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 25 of time for staff to assist them. One person said “I don’t have to wait long for staff at night”. Care staff met during the visit who worked on the first floor of the home stated that in normal circumstances the staffing levels in this area were adequate to meet the needs of the people living there and it was evident by speaking to them that they had a good knowledge of peoples’ individual care needs. One person receiving nursing care at the home, met during the visit said “The staff are marvellous, I don’t have to wait long for the staff”. Prior to the visit, a concern was raised about the high use of agency staff at the home and that agency staff were on duty together. This may prevent people from being cared for by staff who are familiar with their needs. Staff met during the visit stated that, and staffing rotas identified that, the use of agency staff had reduced recently, and that just two agencies were used so that the same agency staff members worked at the home, thus promote continuity of care for people living there. One staff member met during the visit said “We do tend to recognise the agency staff, it is on the odd occasion that we get a new face”. There were no agency staff on duty during our visit and the staffing rotas identified that no staff worked an excessive number of hours each week. This means that people living at the home should receive care and support from people who are familiar with their care needs. In addition, an “agency staff induction” checklist had been introduced to ensure that all staff new to the home had received all necessary information to work in a safe manner. Three staff recruitment files were sampled and these contained all necessary information about the people prior to starting work at the home in order to safeguard people living there. New workers undertake a basic induction covering important health and safety issues for example fire safety and manual handling. Following this, staff undertake training specific to their job roles so that they should have the necessary skills and knowledge to provide a good standard of care. Information on the AQAA stated that “there is an ongoing programme of both mandatory and other training of interest to ensure our staff are adequately trained to fulfil their roles”. Staff met during the visit confirmed and training records identified that they had undertaken recent training including the safe management of medication and first aid. Further staff training was planned for the week of our visit in health and safety, first aid and food hygiene. Staff had undertaken training about moving and handling, however as discussed previously in this report, this knowledge was not always put into practice. Information on the AQAA and the manager stated that over 50 of staff have achieved a NVQ 2 in care qualification or above. This should mean that they have the necessary knowledge to provide a good standard of care. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 26 Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 27 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): 31, 32, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements do not always ensure that the home is run in the best interests of the people living there, or ensure their safety and well being. EVIDENCE: Evidence at this inspection indicates that managerial arrangements at the home need to improve. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 28 The manager had recently resigned from her position at the home and was due to leave her post at the end of May. She was currently in her third week of leave, and the deputy manager post was vacant. An experienced registered nurse was covering the deputy manager position, however she had not been allocated extra time to do this on a regular basis, and the owner was visiting the home daily. In addition, the acting deputy manager has been providing on call support to the nurse in charge of the shift. Shortly after our visit, the owner confirmed that he had recruited a new manager. The manager, acting deputy manager and owner assisted with the inspection. Concerns were raised by the nursing staff about the managerial arrangements at the home and the management of their work load, responsibilities for caring for people on both the ground and first floor of the home and the general running of the home on a daily basis. We were told that prior to the new registration, Ash Lodge accommodated a higher number of people with nursing care needs, therefore there is an overspill of people requiring nursing care on the first floor of the home. We identified that one person living on the first floor of the home had complex nursing care needs and had been identified as being at risk of falls. Staff met during the visit voiced their concerns about the suitability of this person living on the first floor of the home because the nurse on duty is mainly based on the ground floor. We were told that actions were being taken to address this and that two other people receiving nursing care are currently awaiting reassessment for residential care as they have become more independent. There were no plans to admit further people with nursing care needs on the first floor of the home. Prior to our visit a safeguarding investigation had been undertaken and one element of this identified poor documentation following an accident involving a person living at the home. On the day of the visit, we saw that this also was the case a neither the accident report or evaluation sheet had been completed two hours after a person had fallen. There was confusion about who’s responsibility it was to complete the documentation. In addition, once the records had been completed, the time recorded on the accident report that the accident took place was different to that recorded on the evaluation sheet. This will prevent people involved in caring for the person following the accident from having accurate information about what happened in order to implement measures to minimise the risk of a further accident of a similar nature. The emergency services were promptly contacted to examine the person who had fallen and this should ensure that appropriate the medical advice and treatment was provided. The person’s family were informed of the accident and staff met during the visit confirmed that they had undertaken recent first aid training, and with the exception of not completing the records, appeared to have a good knowledge of the care to be provided to people following accidents. A system for auditing accidents involving people living at the home Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 29 was in place in order to monitor for any trends or patterns, thus minimise the risk of further accidents of a similar nature occurring. A group meeting involving people living at the home had not been arranged for a long period of time and this will prevent people from having the opportunity to put forward their views about the service provided and suggestions forward. A survey had, however, recently been sent out to people living at the home and relatives to find out whether they would be interested in group meetings. The home’s staff were waiting for feedback from these. As a result of the findings of previous surveys, menus had recently been revised. Staff meetings are held regularly and we saw the minutes of the two most recent of these. Copies of the minutes of these are distributed to people unable to attend the meeting so that they are aware of what was discussed. The owner is currently visiting the home on a daily basis and he stated that he undertakes quality monitoring visits, however the reports based on the findings of these were not available at the home on the day of the visit. In August 2008, we received a Annual Quality Assurance Assessment (AQAA). This included lots of information about how the home think they are performing in order to meet the needs of people living there. The home do not manage the money of people living at the home, however there is a robust system in place for the safekeeping of small amounts of people’s money. This is audited regularly and money balances sampled during the visit were found to be correct. A satisfactory fire safety audit had been undertaken by the West Midlands Fire Service in November 2008, however during our visit we noticed that there was an out of order sign on one of the fire exit doors. The manager confirmed that this door would open in the event of an emergency however was not being used as it was difficult to close. This must be repaired and the notice removed so that people know that it is safe to use. Staff had undertaken fire safety training, fire drills are undertaken regularly and the fire alarm and emergency lighting systems had been checked recently. Maintenance records identified that the hot water temperatures had not been checked since December 2008. This may result in hot water temperatures being too high and scalding injuries being sustained. All staff had undertaken recent training about moving and handling, however we saw on two occasions, two staff members assisting people in an unsafe manner. This was brought to the attention of the manager who confirmed that it had been identified that one of the staff members involved had required further supervision in this area, however this had not been arranged. This was discussed with the owner and he stated that the appropriate measures would Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 30 be put in place without delay to ensure that people living at the home were protected. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 31 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 2 X 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 2 X X 2 Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? N/A 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 Regulation 13 Requirement Manual handling assessments must include up to date specific information so that care is provided in a safe manner to people living at the home. The current system in place for the management of medication must be reviewed so that people receive their medication in a safe manner as prescribed. Arrangements must be made to ensure that staff providing care to people living at the home do so in a competent and safe manner. Managerial arrangements must be reviewed. This is to ensure that people living at the home receive a good standard of care and so that the staff team are supported to provide care in a safe manner. Action must be taken so that the fire exit door is repaired so that people know that it is safe to use in the event of an emergency. Arrangements for care provided to people requiring nursing care living on the first floor of the DS0000071889.V374424.R01.S.doc Timescale for action 31/05/09 2 OP9 13 30/04/09 3 OP30 18 30/04/09 4 OP31 8 30/04/09 5 OP38 23 30/04/09 6 OP38 13 15/05/09 Ash Lodge Version 5.2 Page 33 home must be undertaken. This is to ensure that they receive the required care and support at the times that they require, so that their health and safety are protected. 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 Refer to Standard OP1 OP1 OP7 Good Practice Recommendations The statement of purpose should include all necessary information about the home to assist people to choose whether they would like to live there. The range of fees should be available to people in the service user guide so that they know how much they will have to pay if they want to live at the home. Care plans should be personalised to include detail of the specific support required by staff so that people can receive the required care and support in the ways they prefer. The system for evaluating care plans should be reviewed so that staff can determine whether individual care needs are being met. People living at the home should be offered a choice about whether they wear socks, stockings or tights in order to maintain their dignity and comfort. Arrangements should be in place so that people living at the home have the facility to keep their private and valuable items secure. Activities should be provided that meet the needs, interests and expectations of all people living at the home. Menus should be reviewed so that people have a choice of different types of food on a Friday. Consideration should be given to replacing or cleaning the carpet in the corridor of the eight bedded unit so that people in this area are provided with a hygienic living environment. Arrangements should be in place so that food is stored in a hygienic manner within the fridges located in the satellite DS0000071889.V374424.R01.S.doc Version 5.2 Page 34 4 5 6 7 8 9 OP7 OP10 OP10 OP12 OP15 OP19 10 OP20 Ash Lodge 11 OP22 12 OP25 13 OP32 14 OP38 kitchens. This is to ensure that it is safe for people to consume. A system should be implemented so that people within the first floor lounge have a means to summons assistance from staff at the times they require or in the event of an emergency. Consideration should be given to monitoring the temperature within the home whilst the new heating system is being adjusted, so that it is at a comfortable level for people living at the home. Reports based on the findings of quality monitoring visits undertaken by the owner should be kept at the home in order to identify whether actions have been taken to address any issues raised. Hot water temperatures in areas of the home that people living there have access to, should be checked regularly so that people are not at risk of sustaining scalding injuries. Ash Lodge DS0000071889.V374424.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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