Inspection on 16/01/09 for Ashbourne

This inspection was carried out on 16th January 2009.

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

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

Ashbourne 18/10/06

Ashbourne 06/10/05

Ashbourne 10/06/05

Ashbourne 23/11/04

Ashbourne 23/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashbourne Byways Selsey West Sussex PO20 0HY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 1 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Ashbourne Byways Selsey West Sussex PO20 0HY 01243604612 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Susan Mary Wilford,Mr John Viret Wilford Name of registered manager (if applicable) Mrs Natasha Gould Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Up to 18 older can make their home in Ashbourne (the Service). The property is a detached house. There is a small enclosed garden at the back. Everyone has their own bedroom. All of the bedrooms have a private toilet and wash hand basin. There is a passenger lift between the floors. There is also a call bell system. This has call points in each of the bathrooms and toilets as well as in all of the bedrooms and their private bathrooms. This means that people can ring for assistance. The Service is in a quiet residential street. Its close enough to the seafront for people to walk there in the summer. There are no shops within easy walking distance. The Service doesnt have its own car. The Registered Providers are private individuals. If you want to find out more about the Service and about the fees charged, you can phone the Service and speak with the Manager. Care Homes for Older People Page 4 of 34 care home 18 Over 65 18 0 Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was Key Inspection. We arrived at the Service at about 8 oclock and were there for about seven hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Providers in their self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with five of the people who live in the Service. We also spoke with one of the Care Homes for Older People Page 6 of 34 Registered Providers. For convenience, in this Report we just refer to him as being the Registered Provider. We spoke with the Manager, with the deputy manager and with two care workers. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked ten of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Ashboune. Six of the people who live there and four members of staff kindly sent them back to us. Later on in our report, well tell you what people say in these questionnaires. What the care home does well: What has improved since the last inspection? What they could do better: Quite a lot of the paperwork is complicated and longwinded. This might make it difficult for people who live in the Service to fully take part in deciding things that are about themselves. Some people dont feel that they have enough social things to do. The written staff roster is not accurate. This is important because we need to be able to tell you how the place is being staffed in practice rather than in theory. The system used to provide care workers with training is not well organised. There is no clear account of who has done which training courses. This might result in care workers not having some of the skills and knowledge they need. The quality assurance system doesnt fully involve all of the people who live in the Service. This is important because they are the experts on what it is like to live in Ashbourne. They need to have a direct say in how things are going. Also, they need to be told what is going to be done to respond to any improvements they may come up with. Care Homes for Older People Page 8 of 34 There is a shortfall in one of the system used to handle one persons spending money. This means that we cant reassure you at this point that everything is above board. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 3 and 6. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. Evidence: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving into Ashbourne is the right thing for them. She also talks with family members and with people like care managers (social workers). Recently, this process has been made a bit more detailed. The Manager has introduced a new form that family members are asked to fill in. This is so that they can give extra information about quality of life things. This means the sort of things that might sound unimportant, but which often make all the Care Homes for Older People Page 11 of 34 Evidence: difference to the person moving in. All of this information is collected so that the Manager can build up a really good picture of how the person can best be supported. After shes got all of this information, she can then decide if Ashbourne can meet the persons needs for help. We looked at the information that has been collected for one person who has recently moved into the Service. We wanted to see what sorts of things are being considered. There is lots of useful information. There is stuff about practical things such as the help needed in the bathroom. But there is also other information about quality of life things. Such as how the person may need to be supported in relation to their family arrangements. The Manager says that when she gets the information she shares it with care workers. This is done so that care workers know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Manager recognises that moving into a residential care setting is a big step for anyone to take. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the introduction process, people are invited whenever possible to visit Ashbourne. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. In our questionnaire we ask people who live in the Service, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Everyone says that yes they did. When we were in the Service we asked one person about their experience of moving in. They say that the care workers did know about the support they need from the start. They also say that they were made welcome and that this made a big difference to them. One care worker summarises the general tone when they say, (the Manager) and all the team always talk about someone who moves in so that we know what care we have to provide and so we can welcome the person. We always put the person first. Moving into somewhere even to Ashbourne, must be a big thing and we dont want it to be Care Homes for Older People Page 12 of 34 Evidence: stressful. We like to greet people with a smile. Nearly all of the people who move into the Service do so with the intention of making it their longer term home. However, there is the chance that someone will only want to stay for a shorter period. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because they been in hospital and arent quite ready to go home yet. When someone moves into a residential care setting theres always the risk that their stay might become longer than is necessary. The Manager is aware of this. She says that people are helped to make any arrangements that are necessary for them to go home as planned. This has recently been done for one person who went home just before we called to the Service. They had been in hospital and just needed some time to rest and recover before going home. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. Some of the paperwork is complicated and not user friendly. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to staff so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one person finds it difficult to get about and needs to be helped in a certain way to get into and out of a wheelchair. Another Care Homes for Older People Page 14 of 34 Evidence: person cant see very well and needs a little bit of extra help when they are having their meal. They also need support to walk about a bit so that they dont get stiff from sitting down too much. We asked three care workers about some of these things. We wanted to know what all of this written information means in practice. Whether its used or not. They know all about it. The person who needs help because of their poor sight says that they are helped to be up and about. Also, they say that they are helped to know where things are on their plate at meal times. In our questionnaire, we ask, do you receive the care and support you need? Five people say that they always do and one of these says that the support they receive is excellent. One person says usually, but they dont then go on to tell us what they mean by this. One person who has recently left the Service seems to sum up the overall mood when they say, nice greeting on arrival, shown to a light airy room, nice and clean. Stay was most enjoyable, staff very friendly, nothing too much trouble, lovely home cooking, lovely to hear staff laughing as they are working, lovely atmosphere. The support plans are kept up to date so that they are accurate. This involves care workers making daily notes about how things are going. There are then monthly reviews. This is when the Manager checks out with the care workers how things are going and what might need to be changed. All in all, theres a lot of written information. Members of staff are spending must be spending a good deal of time writing things down and filling out various forms. This then results in there being lots of complicated looking paperwork to wade through. It even took us some time to get to grips with it all and were used to this sort of thing. Its very unlikely that the people who its written about will find it easy to use. Or, that they will think it to be interesting enough to spend time on. Were not surprised to hear that people dont really bother about it that much. This is a pity because its all about them. The Manager recognises this to be an issue. She is going to look into what can be done to make the whole process more straight-forward and more user friendly. Sensible steps are taken to ensure that people dont have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a care worker so that they dont lose their balance. One person is worried about rolling out of bed at night. Their bed has been fitted with special rails so that they feel more reassured that this wont happen. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, a number of people have seen their doctors, some on more than one occasion. There Care Homes for Older People Page 15 of 34 Evidence: have also been visits by other professionals such as district nurses. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. In our questionnaire we ask, do you receive the medical support you need? Four people say that they always do and two people say this is usually the case. These latter people dont say any more about what they mean by their replies. One person handles their own medication. The Manager helps them to do this. She orders it for them. Also, she checks out with them now and then that things are going okay. Most of the people who live in the Service prefer to have members of staff to manage medication for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. We asked a care worker about bits of this procedure to see if they know what it says. They do. There is a record that is completed on each occasion that a medicine is given. We examined six sets of these records for a period of four recent days. They are correctly completed. We looked at four medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. We asked a number of people what they think of the care workers. They praise them saying that they are courteous and attentive. In our questionnaire we ask, do the staff listen and act on what you say? Everyone says yes. When we were in the Service we talked with people a lot about this. They are very positive about the care workers. One person summarises the general mood in their comments to us. They say, the staff are wonderful and helpful. I get all the help I need. I came her because its small and its got a family feeling to it. You get to know the girls and they all care about us not like its just a job. They never mind helping you even if theyre very busy, which they usually are. They are really very caring. Care workers are relaxed and informal in how they are. Things are orderly without being too much so. When people want to use the bathroom, they are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. There are some interesting things for people to do, but some people might like to do more. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The Manager says that the plan is that each weekday there is a social thing that people can do. This is in addition to outside entertainers who come in every week or so. They do things such as playing music and leading gentle exercises. The everyday events arent planned as such and there isnt an activities person. This means that the care workers have to fit in activities after theyve finished everything else. We saw care workers being busy doing other things. Such as helping people to get dressed, supporting them in the bathroom and then serving lunch. We made a point of noting what people were doing when we were there. Most people for most of the time werent doing that much really. There was quite a lot of sitting around and not being engaged in things. There is a record that shows roughly what each person has chosen to do. We looked at the records for two people for several recent weeks. Only one of them seems Care Homes for Older People Page 17 of 34 Evidence: to have done one of the social activities in that time. We asked people about what activities they do and we got different accounts. One person says, I like to stay in my room and I dont want to be doing things in the lounge. I like my own space and the staff know that. However, the other person says, I like talking to people. Theres not that much to do, we sit quite a lot here in the lounge. We have the music session at the weekend but apart from that theres not that much to do. We watch the television but it can be a long day if you know what I mean. In our questionnaire we ask, are there activities arranged by the home that you can take part in? Only two people say that there always are. One person says usually and three people say that there sometimes are. Theres a balance to be struck between people being able to do interesting things and not being pushed into doing what they dont really want to do. Were not sure that the balance in Ashbourne is quite right at the moment. The Assessment says that the Home provides a variety of stimulation within the activities programme and encourages residents involvement. In line with this, we think that it would be a good idea for the Manager to take a fresh look at the activities calendar. As part of this review, it would be helpful to ask people if there is anything new and different they would like to do. The Manager says that she is going to do this by 1 April 2009. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. We received some comments from relatives. They were all positive about this matter. One person says, I come (regularly) to see my (parent) and Im always made welcome. Theres no us and them here, its all very relaxed which is how it should be. People talk with me about how (my parent) is going and I can have a chat with them if there is anything concerning me. No, Ive no concerns at the moment and I am pleased that this place is here. The Registered Providers dont get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. These can sometimes lead to complicated misunderstandings about who has the right to do what. Instead, most people get help from members of their family. The Assessment says that people are encouraged to make their bedrooms their own private space. They are asked to bring in things for their own homes so that they can have personal items around them. We saw lots of examples of this. People have their own photographs and ornaments so that their bedrooms feel more like being home. Care Homes for Older People Page 18 of 34 Evidence: People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. One of the questions we ask in our questionnaire is, do you like the meals? Five people say that they always do and one person says usually. This latter person doesnt give any more detail. One of the former people adds the following to their reply,good home cooking, no frozen foods and excellent variety. Portions are very generous. We asked people about the meals when we were in the Service and the answers are very positive. One person sums it up when they say, the meals are really good and we always have more than plenty to. The meals are very good and we have lots of things that we all like. We never go hungry here thats for sure. There is a choice of dish at each meal time. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is reasonable balance, the main lunchtime dishes including things like omelette, fish and stew and dumplings. Care workers say that people can have drinks and snacks throughout the night. This is important. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18. There is a complaints procedure but it needs to be strengthened. Complaints are dealt with properly. There are arrangements in place that are designed to safeguard people from being bullied or taken advantage of. Evidence: We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. In our questionnaire we ask, do you know how to make a complaint? Everyone says that yes they do know about this. There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. Its best for complaints to be sorted out informally at a local level whenever possible. This is so that things can be put right with the minimum of fuss. However, people can come to us if they dont want to go the Registered Providers. They have the right to tell us whats going on and whats concerning them. This is not clearly explained in the current procedure. The Registered Providers are going to sort this out by 1 March 2009. Its very important that people are confident that they are safe from being taken advantage of. For example, they need to know that theyre not going to be bullied or Care Homes for Older People Page 20 of 34 Evidence: pushed around in some way. The Assessment commits the Registered Provider to guarding against this. We asked some care workers about this matter. They know what to look out for. None of them have any concerns about how things are going. Since we were last in the Service, the local authority has looked into a complaint from a relative about bits of the care that someone living in the Service received. In particular, they were concerned about an incident when the person became anxious and then had to be restrained. The investigation concluded that the matter could have been handled better by the care worker concerned. The member of staff concerned doesnt work in Ashbourne any more. The Manager says that she and the Registered Providers cooperated fully with the investigation. The records we looked at support this account. The local authority recommended that a number of things be done to help prevent a similar situation happening again. Nearly all of the recommendations have been done. For example, a new assessment thing has been introduced. This is being completed for each person who lives in the Service. It outlines a number of things to consider that may make someone more vulnerable to being pushed around. It then helps the Service sort out what can be done to counteract this so that the person stays safe. Recently, about half of the care workers have done a training course about keeping people safe. The remaining care workers are due to do the training in the very near future. The people who live in the Service say and show us that they feel safe in Ashbourne. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 22, 25 and 26. Most bits of the accommodation are comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. Evidence: The building is well maintained on the outside and the gardens are neat. When you walk down the street, theres nothing that sets the place apart from the other houses nearby. On the inside, the accommodation is generally well decorated and furnished. Overall, the place has a homely, lived-in feeling to it. Having said this, the bathrooms and the toilets are a bit bare and uninviting. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that with two exceptions the system meets the national standard. The exceptions were identified some time ago and they involve the need to make some minor repairs. The Manager says that these were completed quite soon after they were raised. The Registered Providers have a system of doing regular fire safety risk assessments. This is where one of them goes around the place to check out that everything is still working in the Care Homes for Older People Page 22 of 34 Evidence: right way. We looked at the records of the most recent one. It says that things are still okay. Its a good idea for the assessment to be sent to the fire brigade people. This is so that they can have a look at it to check that its detailed enough. The assessment is due to be updated quite soon now. After this is done, the Registered Providers are going to send it in the fire brigade. This is going to be done by 1 March 2009. The people from the local Department of Environmental Health called to look at the kitchen in 2007. We looked at their report. It says that in general things are okay. However, it does ask for some improvements to be made. The Registered Provider says that all of these have been done. We checked out two of these things. One is to do with making sure that the fridge and the freezer are cold enough to store foods safely. We looked at the records that are now kept about this. They say the temperature is low enough. Another thing was making sure that foods dont go beyond their use by dates. We checked a couple of items and they arent out of date. We looked in the kitchen. Its well equipped, clean and well organised. The cook does sensible things to ensure good food hygiene. For example, once food is opened its covered. Then a date is written on it to make sure that things are not allowed to hang around too long. People who need it are helped to get about. In one of the bathrooms there is a bath with a hoist. This means that there is a seat that goes up and down. You can sit on it outside the bath, then it can be raised to go over the side of the bath before its lowered once youre over the bath. There is also a walk-in shower. There is a mobile hoist that can be used in the bedrooms. This might be needed if someone cant manage at all to get out of bed. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. When someone moves into the Service, the Manager makes a note of what assistance they need to get about. She looks at things such as the help someone needs in the bedroom and in the bathroom. We asked care workers about this. They know what theyre doing. We asked people how warm the accommodation is kept. They say that they are always Care Homes for Older People Page 23 of 34 Evidence: comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has a commercial grade washing machine. This has an extra cycle for items that need an especially hot wash. There is a large dryer. We looked in the laundry and its well organised and clean. New rules have been introduced to help make sure that used water doesnt leak back from things like washing machines into the drinking water supply. It looks like the Service already meets these rules. However, just to be on the safe side the Registered Providers are going to contact the local water supply company to find out. They are going to do this by 1 March 2009. The Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. There are enough care workers around. Care workers know what theyre doing. However, parts of the training arrangements are rather muddled. Security checks are completed on new members of staff. Evidence: There are three care workers on duty from early in the morning until the afternoon when the number reduces to two. There are other people around who do most of the catering and most of the housekeeping. There is a waking staff presence at night. When she is on duty, the Manager often spends some of her time out of her office and helping the people who live in the Service. She was doing this when we arrived. We think that this is a very good idea. This is because it helps her know in detail whats going on. The Manager says that all of the shifts are being reliably filled. We looked at the written roster for three recent days to check this out. Things seem to be okay. At the moment, the Managers shifts are not being included in the roster. We have asked her to make sure that they are in the future. This is because we need to have an accurate record of how the Service is actually being staffed. In our questionnaire we ask members of staff, are there enough staff to meet the Care Homes for Older People Page 25 of 34 Evidence: individual needs of all the people who use the Service? Three people say that there always are and one person says usually. This latter person doesnt give us anything else to go on. When we were in the Service one care worker told us, I think that there are enough staff on duty because we know all of the residents so well. (The Manager) is very hands on and she always seems to be here. We know how things work and we work as a team. If we did need more staff. Im sure that (the Manager) would just go ahead and bring someone in. Its not like a formal business, this place is friendly. In our questionnaire for people who live in the Service we ask, are the staff available when you need them? Everyone says that they always are. We kept our eyes and ears open when we were in the Service. We saw people being helped to use the bathroom in good time without having to wait. Also, we noticed that when the call bell rings care workers respond to it straight away. Its very important that only honest and trustworthy people are employed as care workers. With this in mind, the Registered Providers complete a number of security checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for two care workers who have been appointed since our last inspection. Most of the checks that we need to see have been done. However, we cant tell you that all of them have been done. This is because the information that both people have given about their previous jobs isnt detailed enough. Therefore, we cant be sure that all of the necessary references have been obtained. The Manager is going to sort this out by 1 March 2009. New care workers have introductory training before they work on their own. In our questionnaire we ask about this. We say, did your introductory training cover everything you needed to know to do the job when you started? Everyone says that they were very well trained. There is a checklist of the subjects that new care workers are told about. We looked at one of these checklists and that has recently been completed. It shows that important things were done. For example, the person was told about how to use the individual plans of support. Also, they were shown how to go about things such as helping people get about safely. The Manager says that this initial training is just to get the care workers started. Theres a lot to learn after that. The Manager says that all care workers are expected to do regular training in important subjects. For example, in how to safely support people move about, in food hygiene and in basic first aid. She says that most of this training is done by trainers coming to the Service on a regular basis. We looked at the records of who has done what courses. There are no records at all for before 2008 and there are only two recorded courses for last year. Not all of the care workers went along even to these. However, in our questionnaire, everyone says yes when we ask, Care Homes for Older People Page 26 of 34 Evidence: are you being given training that is relevant to your role and that keeps you up to date with new ways of working? There doesnt appear to be any real plan to deliver ongoing training. The Assessment says that all existing staff receive ongoing training to meet the requirements of the standards and are subject to regular reviews and appraisals that identify training needs. The Home actively encourages staff to undertake training to keep knowledge and skills up to date in order to meet the service users needs. Overall, we dont think that this claim is justified. We think that it would be a good idea for the Manager to review who has done what training. This is so that any gaps can be sorted out. When doing this, it would be helpful for her to have a look at a new national model. This is all about how to assess what skills and knowledge care workers actually have already. When its used in the right way it gives a good idea of what additional training each person might need. Its quite a big piece of work to do. The Manager says that she is going to complete it by 1 December 2009. The Manager says that six of the care workers have completed a National Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care. Two more are on with doing it. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. Three care workers dont want to do the qualification. The Manager says that all new care workers will be encouraged to study for the award. We spoke with three care workers to find out what they know about particular bits of the support they will need to give people. As we have said earlier in this Report, they know a lot about how each of the people who live in the Service likes to be supported. More generally, they know about helping older people to take care of their skin. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35 and 38. In general things are well managed. People are asked what they think, but this needs to be a bit more organised. People are helped to buy what they want. However, one of the records of this isnt accurate. There are sensible health and safety things. Evidence: The Manager has a detailed knowledge of how things are going. In general, when we ask her questions she knows the answers without having to fiddle about looking for things. She has both of the qualifications that are required for people managing residential care settings. These are important. This is because they are designed to help managers ensure that high quality support is reliably provided. Both of the Registered Providers are qualified and practicing nurses. The care workers say that there is good team work between them. There are handover Care Homes for Older People Page 28 of 34 Evidence: meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every month or so. We looked at the records of the sorts of things that are being discussed. Theyre practical and relevant. For example, they talked about how to make it easier to sort through the medication that is in store. In our questionnaire we ask care workers, do the ways you pass information about people who use the Service between staff (including the manager) work well? Everyone says that they always do. Its really important that the people who live in the Service have a direct say on how things are going. After all, theyre the experts because they live there. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. In addition to this informal thing, the Registered Providers each year ask the people who live in the Service and their relatives to fill in a questionnaire about how things are going in Ashbourne. We looked at some of these questionnaires that were returned last year. Nine people who live in the Service responded. All say yes to the questions, did the home meet with you expectations and do the staff treat you with respect all? Six relatives sent their questionnaires back. All of them say yes when answering the question, does the home continue to meet your expectations? The Assessment says that the Registered Providers intend to deliver a better quality assurance package. They dont say what they mean by this, but we can give some pointers here that they need to think about. More needs to be done to make sure that everyone who lives in the Service can have their say on how things are going. This means that extra things will need to be done to get the views of people who dont want to or who cant fill out one of the current questionnaires. We also think that members of staff should be asked their views. After all they work in the Service and theyre bound to have lots of useful things to say. Another thing that needs more work is how to tell people who live in the Service what has been said and what is going to be done to introduce any suggested improvements. The Registered Provider and the Manager say that all of these things will be done in time for us to be told about it when the Registered Providers next sends us their Assessment in 2009. The Service holds some cash for two people. This is done so that they have enough on hand to buy things like toiletries and to pay for when they see the hairdresser. There are records that show what money has been given to the Service and when it has been used. We looked at one set of these records. We wanted to see if the paper balance matches the cash balance. It doesnt and the discrepancy is a large one. The Manager looked into this while we were in the Service. She says that some of the cash in question was given back to the relative concerned. This was done because it wasnt needed in the Service and it had been hanging around for a while. The Manager Care Homes for Older People Page 29 of 34 Evidence: accepts that this transaction should have been recorded. She is now going to sort this out with the relative concerned. This is so that there is written confirmation that the amount in question was indeed give to them in the manner described. She is going to do this by 1 March 2009. Some of the other people who live in the Service are helped in a different way to manage their money. This involves the Registered Providers paying for things for them and then sending a quarterly bill to their relatives. The Manager says that each of the people concerned and their relatives have agreed to this in advance. The arrangement seems to be working okay. We looked at the records for one person. We wanted to see if the amounts claimed to have been spent are reasonable. They are. We also wanted to see if the purchases are supported by a receipt to prove that the money in question has been spent. Again, we found things to be in order. Regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed checks are completed every now and then by an engineer. There are regular fire drills. At the moment, these arent unannounced. Its important that they should be. This is because they are supposed to make sure that everyone knows what to do when the alarms are ringing and when things need to be done quickly and in an orderly manner. The Manager is going to make sure that in future the drills are unannounced. There is a system to double check that each member of staff knows how to follow the Services fire safety procedure. This training is more detailed than the things that are done in a fire drill. Also, not everyone will be around in future for the drills because they will be unannounced. The Manager says that there is an annual fire safety lecture and that in addition to this there is a six monthly update. We looked at some of the records of this and things seem to be working okay. We asked two care workers what they will do if there is a fire safety emergency. Both correctly said about the need to contact the fire brigade. There are up to date reports from engineers about the gas appliances, the electrical installation, the mobile hoist and the lift. They say that everything is in good working order. We looked at the record of accidents that have occurred in the Service over the past month or so. There hasnt been that many. Most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what has happened. This is done so that she can do something if there is a particular problem that is causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. Care Homes for Older People Page 30 of 34 Evidence: The Registered Provider says that he regularly checks the accommodation. He does this to make sure that nothing is broken. Also, he wants to see that there are no hazards that might cause someone to have an accident. The records of these checks are kept by the handyman. He wasnt around when we were in the Service so we couldnt see them. However, the Registered Provider says that he checks things such as whether or not all areas are well lit. We kept our eyes open when we were walking around. We didnt notice any particular hazards. We were looking for things such as frayed carpet seams and trailing wires that might cause someone to trip over. We were also on the look out for anything sharp that might catch someone walking by. We checked to see that cleaning products like bleach are stored safely when they are not being used. This is necessary because some people might mistake them for something you can drink. We found things to be okay. Care Homes for Older People Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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