Inspection on 11/07/06 for Ashbourne House

This inspection was carried out on 11th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Ashbourne House 16/11/07

Ashbourne House 26/04/07

Ashbourne House 20/12/05

Ashbourne House 26/04/05

Ashbourne House 07/12/04

Ashbourne House 08/06/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ashbourne House Ashbourne House 213 St Marychurch Road Torquay Devon TQ1 3JT Lead Inspector James Rose Unannounced Inspection 11th July 2006 10:00 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 Ashbourne House DS0000018319.V296747.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. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbourne House Address Ashbourne House 213 St Marychurch Road Torquay Devon TQ1 3JT 01803 327041 01803 310587 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) Mr Robert Gisburn Williamson Mrs Diana Dolorse Enilde Williamson Mrs Diana Dolorse Enilde Williamson Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28), of places Physical disability over 65 years of age (28) Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can admit one Service User, who is within category, but under 65 years of age. 20th December 2005 Date of last inspection Brief Description of the Service: Ashbourne House is a large detached property in a level residential area close to St Marychurch precinct, which has shops and other facilities. The home can accommodate up to twenty-eight people (some in shared rooms) from the age of 65. They may be physically and/or mentally frail, but the home does not cater for people in advanced stages of dementia or those exhibiting extreme behavioural problems. The double bedrooms are normally occupied singly. There are extensive communal areas on the ground floor, including a large lounge, dining room, quiet visiting room and an activities area. There are stairlifts on the main staircase to the first and second floors. However there are several bedrooms, which can only be reached via a few steps, and so are suitable only for residents able to walk up/down some steps. One of the bathrooms (first floor) is fitted with a bath hoist. There is an attractive level garden, a courtyard and a small car parking area. A minibus is available to residents for outings. The owners also manage a day centre (separately staffed) adjoining the home, where more able residents of the home may be able to join in activities. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken over 7.75 hours in July 2006. A complete tour of the home was undertaken and samples of care records were examined. Four residents were interviewed individually in private for their views of the service provided and two of their visitors were also consulted. Evidence was also gathered from questionnaires that were returned to the Commission and healthcare professionals were asked for their views of the service provided by the home. The way care was delivered was observed, three carers were consulted individually and the inspection was undertaken with the assistance of the proprietors and the proposed registered manager. What the service does well: What has improved since the last inspection? Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 6 The two requirements raised in the last report have been satisfied, one referred to the need for a metal cupboard to be available to store medication subject to the controlled process and the other requirement concerned notifications that must be made to the Commission concerning events covered by Regulation 37 in the legislation. What they could do better: A discussion was undertaken with the proprietors concerning the environment at the home after a tour of the home had been completed and they advised that a refurbishment of the decoration was being undertaken and baths were being replaced and an extra hoist was going to be provided to assist residents in and out of the bath. It was also understood that a programme is being introduced to ensure that all the hot water outlets are appropriately thermostatically controlled to ensure residents are safe. It had been agreed with the proprietors that they will keep the Commission informed of the progress made. A requirement has been raised in this report for the home to develop the social element of the care planning process to ensure that the appropriate service can be provided to the individual. Some risk assessments were available in the care plans of the residents at the home; however, a requirement has been raised in this report for the risk assessment processes undertaken to be developed further for each resident to ensure all hazards are covered. The personnel files of the staff team were examined and some of the references were not available. A requirement has been raised in this report to ensure that all the personnel files have all the documentation necessary to satisfy Schedule 2 of the legislation; a timescale of one month has been agreed with the management of the home for this to be achieved. A lockable facility must be provided in all residents’ bedrooms that need to store medication; a requirement has been raised for this purpose with an agreed timescale. A recommendation is raised in this report for two staff signatures to be used to record each transaction concerning residents’ pocket monies to ensure all parties are appropriately protected. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 7 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 House DS0000018319.V296747.R01.S.doc Version 5.2 Page 8 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 Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 3 and 6 The performance in this group is good. Assessments were undertaken by the home prior to them offering a service to ensure they can provide an appropriate service to the prospective resident. Standard 6 refers to a service not provided at Ashbourne House. EVIDENCE: Detailed, comprehensive assessments are carried out of prospective residents in the areas of health, personal and social needs. This assessment is undertaken prior to a service being offered by the home to ensure that is appropriate and all needs can be met by the service provided. Healthcare professionals are also consulted when required. Four residents were consulted during the inspection process and they all confirmed that all their needs were met at the home and that they had no unmet needs. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 10 Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 7, 8, 9 and 10 The performance in this group is adequate. An individual care plan is available for each person receiving a service at the home. Some of these needed the social element and risk assessment processes to be developed further. Residents are able to self medicate if appropriate and they are protected by the administration procedures undertaken. Service users are treated with respect and care is taken to ensure their privacy is maintained. EVIDENCE: An individual care plan is available for each resident that is based on the comprehensive assessments that has been completed. Health needs and personal needs are well covered, some of the social elements lacked detail and should be developed further to ensure an appropriate service is provided to the individual concerned, a requirement has been raised to ensure this is achieved with a timescale agreed with the management. Two healthcare professionals were consulted about the service provided at the home and they advised that they did not have any concerns. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 12 The risk assessment processes seen in the five files examined at this inspection lacked detail and the range of hazards covered was limited. A requirement has been raised with the timescale agreed to ensure that a detailed risk assessment is in place for the hazards faced by each resident to ensure they are safe. Service users at the home are able to self medicate subject to a risk assessment process to ensure they have the capacity and are safe. The recordings undertaken of the administrations of medication was examined, medication was checked and booked in when received, the issue record was complete and unused medication was returned to the pharmacist and a signature recorded. These processes were complete and up to date and ensured residents in the home were appropriately protected. Four residents were consulted individually in private during the inspection. They were confident and well able to express their views. They advised that they were always treated with respect by the staff at the home and that care was taken to ensure their privacy was maintained. This was also confirmed from observations made during the inspection process. One resident said, “I’m very well looked after here and the bathing arrangements are fine” another remarked, “ The staff are very good and they give me time”. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 12, 13, 14 and 15 The performance in this group is good. A comprehensive activities and leisure programme is in place that is enjoyed by the residents. Unrestricted visiting is available and residents can come and go as they wish. Assistance and time is provided to help residents make their own decisions about matters that affect them and a wholesome and balanced diet is provided. EVIDENCE: The home has a full activities programme running which was much enjoyed by residents. One resident remarked, “There is always something going on here”. Some of the activities provided are, cooking, flower arranging, quizzes, bingo and weekly trips out are organised. Shopping is also undertaken with residents and trips out to the theatre. When trips out are organised residents’ family and friends are also invited and made welcome. No pressure is put on resident to take part in any of the activities offered. When asked residents were unable to suggest any additional activities they would like added to the programme. The home has an unrestricted visiting policy and procedure in place and residents confirmed that they could see their visitors at anytime. Two visitors to the home were asked for their views of the service provided. They advised Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 14 that their fiend who had been admitted had settled well and had told them that she like living at the home and received a good service. They stated that she was confident and enjoyed the activities on offer and sometimes preferred her own company in her room. No suggestions were made about how the service could be improved. It was clear from observations made during the inspection and from discussions held in private with residents that care was taken by the staff team at the home to ensure residents are given choice and assisted to make decisions about matters that affected them. One resident said, “Staff will always help me and give me time when I’m making a decisions or getting up” another remarked “I’m well looked after and not rushed”. Residents made unsolicited complimentary remarks about the quality of the meals served at the home. They advised that the food was to their liking and when asked could not make any suggestions of other foods they would like added to the menu. Meals are normally taken in the home dining room which residents said they liked. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 16 and 18 The performance in this group is good. Residents were confident that if they raised a matter with the management of the home it would be resolved quickly for them. The home has an adult protection policy and procedure and carers are trained in its use. EVIDENCE: Residents that were consulted in private during the inspection advised that they would have no difficulty raising a matter with the management of the home and were clearly confident that if this was undertaken it would be taken seriously and resolved to their satisfaction without delay. A copy of the complaints procedure is available in the hall of the home and a service users guide is given to each resident, which also has details of the procedure. The home has a comprehensive adult protection policy and procedure and the staff team are trained in its use, this helps to ensure that residents are safe at all times. The carers interviewed individually in private during the inspection were clear about the procedure and what action they should take if they discovered abuse taking place. No complaints were made during the inspection and there are no complaints that are currently open. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 19 and 26 The performance in this group is adequate. Ashbourne House provides a safe, comfortable environment for the people who live there. The home is clean and good standards of hygiene were apparent throughout. EVIDENCE: A complete tour of the home was undertaken during the inspection and all rooms were seen. Some items of outstanding redecoration were seen and these were discussed with the proprietors, they advised that they were aware of these matters and were about to institute a refurbishment programme that would deal with the redecoration in the home, the replacement of old baths and the provision of an additional bathroom hoist. They are also starting to ensure that all hot water taps are appropriately thermostatically controlled. It has been agreed with the proprietors that they will keep the Commission informed of the progress of the programme as items are achieved. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 17 All the residents consulted during the inspection process advised that they liked their rooms and that they felt the arrangements for their bathing and toileting were appropriate in the home. No hazards were seen in the home or the garden and it was understood that there is a protocol in place that ensures that a member of staff accompanies residents when they go out into the grounds. The whole of the home was seen during the inspection, it was found to be clean throughout with evidence of good standards of hygiene being in place. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The performance in this group is adequate. The staffing levels at the home are sufficient to meet residents’ needs. Some of the personnel files had deficits in the documentation. The home has an active training programme in place to ensure the care team is competent. EVIDENCE: The care hours available in the home remain at the same level as at the last inspection and these are adequate to meet the need of the residents. The residents confirmed in conversations that they did not have to wait for assistance when they needed it and their call bell was answered in a timely fashion. Residents were seen to have good relationships with the care team and many positive comments were made about staff. Four personnel files were examined during the inspection and some deficits were found in the documentation required under the legislation, a requirement has been raised to ensure this is rectified with the timescale agreed for completion with the management of the home. It is acknowledged that all the personnel files examined had the appropriate official checks in place to ensure residents are safe. Three carers were interviewed in private, individually; these staff had been with the home between a few weeks to several years. They advised that they had completed a comprehensive induction and were clear about the adult Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 19 protection policy and procedure in place in the home. They also confirmed that there was a good professional relationship between them and the management of the home and that there was further training available for them. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The performance in this group is adequate. The manager has many years experience of managing this home and has achieved the relevant qualifications. EVIDENCE: The registered owner/manager (Mrs Williamson) has about 30 years experience of managing the care of elderly people at Ashbourne House. She has achieved the registered manager award and NVQ level 4 in care. Residents confirm that the home is run in their interest and they felt consulted about matters that affected them. The home has an active quality assurance system in place than ensures the quality of the service provided in maintained. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 21 The home does assist some residents with the administration of their pocket money, clear records are maintained and a signature is recorded by one member of staff and the resident for each transaction that is undertaken. Receipts are retained for any purchases made on behalf of a resident. As some of the residents have an element of confusion it is a recommendation of this report that two staff signatures should record all transactions in addition to the residents’ signature; this was discussed and agreed with the proprietor at the time of the inspection and will ensure that all parties are appropriately protected. The health, safety and welfare of the residents and staff are seen as most important and are given a high priority by the management of the home. The regulations are in place concerning the use and storage of cleaning chemical and the reporting of dangerous occurrences in the home. The recordings of the fire precautions undertaken in the home were clear and up to date. There was a health and safety policy in place and copy of the new electrical installation certificate is going to be forwarded to the Commission. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 22 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 14 Requirement The registered manager must ensure that the social care needs of residents are set out in an individual plan of care. The registered manager must ensure that appropriate risk assessments are in place for the hazards facing residents. The registered manager must ensure that residents have a lockable facility in their bedroom for the storage of medication. The registered manager must ensure that all the personnel files contain all the documentation called for in Schedule 2. Timescale for action 15/08/06 2. OP7 13 31/08/06 3. OP19 23 31/08/06 4. OP29 19 31/08/06 Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 24 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 OP37 Good Practice Recommendations The registered manager should ensure that two staff signatures are used to record each transaction undertaken concerning resident monies. Ashbourne House DS0000018319.V296747.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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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