CARE HOMES FOR OLDER PEOPLE
Ashbourne Court Ashbourne Court Ash Hampshire GU12 6AG Lead Inspector
Mr P Benthom Unannounced Inspection 21 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ashbourne Court Address Ashbourne Close, Ash, Hampshire. GU26 6AG 01252 326769 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashbourne Court Residential Care Home Ltd. Mrs Anusha Doorga CRH (PC) 10 Category(ies) of Old age, not falling within any other category registration, with number (OP) 10. of places Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The age/age range of service users to be accommodated will be: OVER 65 YEARS. That Mr Hemnarayansingh Doorga will be registered as the Responsible Individual subject to a satisfactory CRB disclosure. Date of last inspection 16 September 2004 Brief Description of the Service: Ashbourne Court is a privately owned care home. Personal care and accommodation is offered for up to 10 older people ion the category of old age only. Located in a quiet residential area of Ash, the home is in close proximity to shops and all other community amenities. Ashbourne Court is a large detached property with parking facilities to the front and an attractive enclosed garden and furnished terrace to the side. Accommodation is arranged over two floors with all communal facilities located on the ground floor. Service users have their own single rooms with en-suite facilities. The home benefits from a stable suitably qualified and experienced staff team and is managed by the owner. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home had a comprehensive statement of purpose, which accurately depicted the services provided by the home. The care plans in place were comprehensive and are reviewed on a regular basis to ensure that they accurately depict service users’ needs. The home provided a high level of individualised support to service users. This unannounced inspection took place over 2 hours. A tour of the premises took place. All Service Users were spoken with and staff on duty were spoken with and observed in carrying out their duties What the service does well:
The homes admission policy and procedures ensured admissions were on the basis of a full needs assessment. Staff individually and collectively had the required level of skill and experience to deliver services and care in accordance with the home’s Statement of Purpose. Care planning involved consultation with service users and/or their representatives. Files sampled on the day of the inspection contained comprehensive care plans, which were regularly reviewed. Risk assessments were seen and proven to be accurate and up to date. Service users have the opportunity to exercise choices in their day to day lives. The home had a range of appropriate activities available to the service users. The complaint procedure was seen as part of the inspection process. The procedure was simple and clear and accessible to the service users and their representatives. The home was safe and well maintained, meeting service users’ needs in a comfortable and homely way. Service users’ rooms were furnished to a good standard and they were encouraged to bring with them personal belongings. Staff training-files were seen and there was good evidence of a range of courses attended. The home was observed to operate a recruitment procedure based upon equal opportunities and adequate checks, which promoted the protection of the service users. Appropriate records were observed to be in place, which were well maintained and accurate. Service users and as appropriate, their representatives, were stated to be informed of their right to access information held by the home in personal records Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 and 6 Service users are admitted only following a full assessment undertaken by people trained to do so. The registered person was able to demonstrate the homes capacity to meet the assessed needs. EVIDENCE: The manager stated that all new admitted service users to the home receive a welcome pack that includes: objectives of the service, philosophy of care and the complaints procedure of the home. A copy of the statement of terms and conditions was sampled. Each service user was issued with a contract and a copy was observed in each service user personal file. The Proprietor/Manager demonstrated the admission policy to the inspector. There was evidence of a full comprehensive assessment procedure that was carried out by the owner and the manager of the home prior to admission. Service users and their families/representatives and relevant professionals are involved in the assessment process.
Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 9 Staff individually and collectively had the required level of skill and experience to deliver services and care in accordance with the home’s statement of purpose. As part of the assessment staff explored specialist needs and needs specific to minority and ethnic communities where applicable. Also social, cultural and religious needs to ensure these where identified and met. Aids for meeting needs included wheelchairs, hoists, seats, walking frames, and raised toilet seats. The proprietor/manager stated that emergency admissions are not normally accepted. A period of four weeks trial period was standard practice. Prospective service users were given an invitation in order to meet staff and service users prior to admission. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and10 Health, personal and social care needs are adequately met in this home. EVIDENCE: Care plans were reported to be drawn up in consultation with service users and with their relatives/representatives. Care plans sampled were comprehensive and up to date; there was evidence that regular reviews took place. Encouragement and support was given to service users to promote independence within the limitation of each individual’s capabilities The proprietor/manager stated that all service users were registered with the local primary care trust for the provision of general medical services. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 11 A policy and procedure for the administration of medication was sampled as part of the inspection process. The inspector evidenced that staff that ordered, received, administrated and recorded medication had received training. However it was noted that medication is dispensed from the blister pack into another container prior to offering it to the Service User. This procedure must cease immediately and medication must be administered straight from the blister pack to the service user. A requirement has been made to this effect. Please refer top Page 21 of this report. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 The systems in place for full Service User participation indicated that Service Users views are both sought and acted upon. EVIDENCE: Service Users spoken with expressed a positive view of day to day life in the home and staff interaction with Service users was respectful yet informal; and all staff interviewed had a thorough knowledge of Service Users and their needs. Service users stated to the inspector that they were treated with respect at all times. They confirmed that staff gave personal care in private and always considered their dignity. Staff interviewed stated that they were sensitive in their practice to the need to respect the service users privacy. Evidence of this culture was observed throughout the inspection. There were no restrictions placed on visitors and those present at the time of the inspection were made welcome by management and staff. Whilst the home does not have a designated visitor’s area privacy during visits may be secured using service users’ rooms. The home had spacious indoor and outdoor communal areas; social events were held frequently in these areas and visitors were invited.
Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 13 The proprietor/ manager stated that it was policy not to manage service users personal finances. Relatives and representatives or external agents act in their interests. Access to personal records would be facilitated on request in accordance with the Data Protection Act 1998. A high standard of catering was evidenced, which accommodated individual preferences and met dietary needs. The two-course meal served at lunchtime was substantial and well presented and enjoyed by the service users. A pleasant, unhurried atmosphere was observed with due recognition given to the social importance of mealtimes. There were ample quantities of fresh fruit and vegetables and storage of food appeared satisfactory. The large and welldesigned kitchen was observed to be functional, clean and organised. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Service Users are well protected by the companies training policies and procedures with regard to the protection of vulnerable adults. EVIDENCE: The complaints procedure was displayed in the entrance hall and was simple, clear and accessible. The procedure included stages and time scales for processing complaints and information to the local Commission for Social Care Inspection office. Members of staff spoken to on the day of the inspection were aware of the home’s ‘Adult Protection policy. Training records and displayed certificates sampled, evidenced that staff had received training for the Protection of Vulnerable Adults. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 25 and 26 The standard of décor and equipment in this home is very good with evidence of improvement through continual maintenance and refurbishment. EVIDENCE: The location of the home is suitable for its stated purpose; it is accessible, safe and well maintained, meeting service users’ individual and collective needs in a comfortable and homely way. All areas were found to be clean, tidy and well organised. The garden was observed to be well maintained and easily accessible. The home had a spacious communal sitting room and a separate dining room which was also used for activities. All areas met the required standard and were tastefully and elegantly decorated and furnished. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 16 All service users bedrooms had an en-suite facility that included: a toilet and wash hand basin. Specialist bathing facilities and additional toilets were provided suitable to meet the needs of the service users and in close proximity to communal areas and bedrooms. All rooms were bright and adequately ventilated There were arrangements in place to control the temperature of the water to prevent legionella and scalding of service users. Standards of cleanliness in the kitchen in particular, were seen to be very high. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The staff have a good understanding of the service users’ needs. This is evident from the positive relationships which have been formed between the staff and service users. EVIDENCE: Staffing levels were being maintained and it was concluded that these were consistent to meet the needs of the service users. There is very low staff turnover in the home. There was an active NVQ programme and the management was committed to staff development and training. Three members of staff were undertaking NVQ level 2. Observations made from staff files sampled evidenced the home operated a thorough recruitment procedure ensuring the protection of service users. New staff are confirmed in post following completion of satisfactory vetting processes. Staff files had photographs, references, and copy of identification. CRB-checks were sampled as part of the inspection process. A training programme was in place and sampled as part of the inspection process. Staff confirmed statutory training and specialist training. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 333, 36, 37 and 38 The proprietor/ manager has a clear development plan and vision for the home which she has effectively communicated to Service Users, staff and relatives. EVIDENCE: The registered provider/manager is competent and experienced to run the home and is a qualified nurse. Information from service users and staff confirmed that the management style in the home was open and that registered the providers are approachable at all times. Meetings were held for both staff and service users; all were encouraged to contribute to the development of the home. Staff spoken to confirmed that they all received supervision regularly. Supervision notes were not seen as part of the inspection process as they were felt by the manager to be confidential.
Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 19 Records required for the protection of service users and sampled on the day of the inspection were well maintained, accurate, and up to date. The staff-training programme includes training in first aid, manual handling, infection control, fire safety, health and safety and basic food hygiene. Systems were in place to safeguard the health and safety and welfare of the service users. Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 3 Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement It sis required that secondary dispensing of medication ceases immediately; for example medication must be provided directly to the Service User from the blister pack. Timescale for action 21/04/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that up to date Royal Pharmaceutical Society information in relation administration of medication in care homes is obtained as soon as possible Ashbourne Court H58 H09 s61309 Ashbourne Court v222953 210405 Stage 4 unn.doc Version 1.30 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey. GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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