Inspection on 17/05/05 for Ashbourne House

This inspection was carried out on 17th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 02/10/07

Ashbourne House 16/01/07

Ashbourne House 05/09/06

Ashbourne House 13/12/05

Ashbourne House 18/01/05

Ashbourne House 20/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashbourne House 2 Henleaze Road Durdham Down Bristol BS9 4EX Lead Inspector Sam Fox Unannounced 17 May 2005 09:30 th 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 House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashbourne House Address 2 Henleaze Road Durdham Down Bristol BS9 4EX 0117 9628081 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 House Care Homes Limited Mrs Michaela Jane Hill PC Care Home only 17 Category(ies) of OP Old age (17) registration, with number of places Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate 1 named person with MD(E), certificate will revert to OP when this person leaves. Date of last inspection 18 January 2005 Brief Description of the Service: Ashbourne House is a listed Georgian property which is situated opposite the Downs in Bristol. It is registered to provide accomodation and personal care for up to 17 people who are over 65 years of age. The house is close to local facilities and amenities, including public transport. The premises is on three floors, all of which are accessible by a lift. Some of the bedrooms have ensuite facilities. The communal areas consist of a lounge and dining room which are located on the ground floor. Whilst there are some aids and adaptations throughout the premises, the home is not purpose built and as such has some limitations - notably bath rooms are small and not ideally suited for people who use a wheelchair. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over one day. The main purpose was to ensure that the environment was clean and well maintained, to spot check key records and to consult with residents to make sure they were happy with their care. Requirements and recommendations made at the last inspection were also followed up. Evidence was obtained from discussion with eight residents and participation in the lunchtime meal. Additional information was gained from inspection of care plans, some health and safety records and through discussion with senior members of the staff team. What the service does well: What has improved since the last inspection? Improvements continue to be made to the care planning systems in the home and they now more clearly detail personal care needs. This enables the home to be more consistent and to provide support that is tailored to individual preferences. The dining room and lounge have recently been re-decorated- thus improving the ambience in these areas. In addition to this the home has been made safer by the replacement of some of the electrical wiring. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 6 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 House D56_26494_AshbourneHouse_226838_170505_Stage4.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 House D56_26494_AshbourneHouse_226838_170505_Stage4.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, 3 & 5 There is sufficient information available for residents to make an informed choice about moving to the home. The admissions procedure includes an initial assessment which enables new residents to feel confident that the home will have the resources and skills to meet their need. EVIDENCE: The manager explained that the home has a Statement of Purpose and service user guide which are combined. These are given to all residents considering taking a place at the home and were seen in residents’ bedrooms at the time of the visit. There are some areas where this document could be improved to make it more user friendly and it was agreed that this would be discussed in greater detail at the next announced inspection. One resident who has recently moved to the home confirmed that she had the option of a trial visit before making a decision to move to there. She said that she got her daughter to look around on her behalf. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 9 New residents have a four-week settling in period and then there is a review to see if they would like to take a permanent place. Minutes of these meetings were seen and evidenced that social workers and families are invited along. The home accommodates people who are relatively independent and who do not have complex needs. The primary support is given in relation to their personal care. This suits the skill mix of the staff team and it was apparent that the home is not accommodating anyone whose needs they cannot meet. The manager said that she made it clear on admission that if residents were to require nursing care then the home would no longer be able to accommodate them. This would also be true if they had mental health needs unless staff received the appropriate training. In addition to the above the home employ two sleeping night staff whose assistance can be sought via the home’s emergency call bell system. Prospective new residents must be aware of this as they would need to be relatively independent throughout the night. The manager was asked to ensure this information is included in the service user guide. Some discussion took place with the manager about the terms and conditions of living in the home and the contract. Residents who are funded by social services do not have an in- house contract. This will be the subject of further discussions at the next inspection. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.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, 10 Care planning records continue to be improved which enables residents to be re-assured that they will receive more consistent and individualised support. There are adequate systems in place for accessing health care and for the administering of medication which means that residents’ health care needs are met. EVIDENCE: Opportunity was taken to view two personal files. These included essential information about the resident and care plans. These have been reviewed and expanded since the last visit – thus meeting with a requirement made at the last inspection. They gave clear detail of the personal care needs and family links of residents. The manager should continue the process of reviewing these. Each resident has a key worker – who is a named member of staff who plays a more central role in co-ordinating the services they receive. No residents spoken with were aware of who their key worker was. It is recommended that this be discussed with them in more depth. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 11 In addition to the above each key worker fills out a monthly report. Some of these were found to be out of date and the information on them was repetitive and not necessarily useful. It is recommended that the manager further develop this recording system. Records and discussion evidenced that residents are supported to see the relevant health professionals including district nurses, chiropodists and dentists. All those spoken with at the time of the visit were satisfied with the service they received in this respect and said they could see the GP on request. Residents spoke warmly about the staff team and positively about the help they gave them. They said they felt they were respected and never spoken to in an abrupt manner. Relationships between staff and residents were observed to be respectful and friendly at the time of this visit. Ashbourne House operates a monitored dosage system for the administration of medication that is delivered at regular intervals by the local pharmacist. Records held were generally found to be well maintained and met with the requirements of the legislation. An accurate stock record is also kept of any tablets held on the premises. The home does not hold any controlled medication. It was noted that two residents have oxygen – one spare canister was being stored inappropriately – this was moved at the time of the visit and the manager has subsequently been asked to secure this and store it in a well ventilated cupboard. One resident self medicates and there was an up to date risk assessment about this – thus meeting with a requirement made at the last inspection. It is good practice that the home is encouraging residents to maintain their independence if they are able to do so. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.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) 15 Residents benefit from receiving food that they enjoy. The home must, however, ensure that residents are given meaningful choices and that menus include a good balance of freshly prepared food. EVIDENCE: Opportunity was taken to join with residents for their lunchtime meal. This was served in an unhurried and sensitive manner. Many residents commented that they were satisfied with the quality and quantity of meals provided. Members of staff are now more fully recording menu choices – thus fulfilling a requirement of the last inspection. Discussion with the manager also took place about ensuring that residents get a good balance between freshly prepared and processed food. The home do not employ a chef and as such care assistants regularly take turns to cook. The limitations on time and lack of training means that they may not be as creative as they would like to be. It was observed that whilst there was a choice of two main meals, residents were not offered an alternative and it was not clear that they had been asked. The manager must ensure that residents are offered real choices in this respect. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 13 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 & 18 The home fosters a positive atmosphere in which residents can air their views without being afraid. The staff team need to receive protection of vulnerable adult training so that they can monitor for signs of abuse and further protect residents. EVIDENCE: Ashbourne House has a complaints procedure which is incldued in the service user guide. This, however, has some inaccuracies and does not include the address and contact number of the CSCI to whom concerns can also be raised. (Leaflets, published by the CSCI, were left at the home for distribution which give further information about this). The manager must update the complaints policy so that it meets with requirements of the legislation. There have been no complaints received since the last inspection. Residents said that they would speak with the manager if they had any problems. They spoke openly and did not appear to be afraid to speak their minds. They said that there was a regular monthly residents meeting during which time they were asked their opinions. The home holds some monies for safekeeping. A spot check was made of these and found to be accurate. Staff must, however, retain receipts for any purchases made on residents’ behalf. There was information in the office regarding the protection of vulnerable adults. The manager must ensure that all staff receive training about this. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 14 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, 23,24, 25 & 26 Residents’ benefit from living in a homely, well maintained and clean environment. EVIDENCE: Ashbourne House was found to be well maintained, comfortably furnished and homely in appearance. The lounge and dining room have recently been re decorated and the residents were pleased with the results – saying that it improved the ambience. The home also benefits from a large garden and residents said they were looking forward to using this area in the summer months. One resident said she is keen to do the gardening. Opportunity was taken to view a number of bedrooms. Residents are able to bring small pieces of their own furniture with them to remind them of their home. All those questioned said they were satisfied with the quality and quantity of furniture in their rooms. It was observed that they were personalised and reflected individual tastes, indicating that choice and independence are promoted in this respect. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 15 Residents confirmed that they could have a bedroom door key if they wished for security and additional privacy. The house has two main bathrooms on the first and second floors and a toilet on the ground floor. The top floor bathroom is small and has no natural light. Some residents said they did not like to bathe in this room because it was claustrophobic and airless. The bathroom on the first floor was slightly larger and both baths have a specialist seat which can be electronically raised. The resources in relation to bathing are limited due to the age of the building. It is, however, recommended that consideration be given to redecorating them and updating the facilities to make best use of the room available. There are some aids and adaptations throughout the premises, including wheelchair access to the rear, raised toilet seats, various grab rails and an emergency call bell system. It is an old, listed building and as such some developments in this respect have been limited. The house has one large lounge and a dining room. If residents want time to themselves they use their bedrooms. It was understood that the proprietor had applied for planning permission to build a conservatory but that this has been refused. This is disappointing as residents could benefit from having more communal space. The manager and staff team do not have an office. It is recommended for the comfort and privacy of staff, that additional, more appropriate, space be sought for them. The home was found to be cleaned to a good standard and there were no unpleasant smells. Staff should be commended for their efforts in this respect, especially as the home do not employ a housekeeper. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 16 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) 27,29 & 30 Staffing levels are kept to a minimum and this limits the amount of quality time that staff can spend with residents apart from when they are assisting them with their personal care needs. The review of training needs to be improved so that residents can be assured that they will receive a service from a skilled staff team. EVIDENCE: There are three staff on duty in the morning, reducing to two in the afternoon, then an hour over tea time when there are three, again reducing to two in the evening. Two members of staff sleep on the premises at night. The home does not employ any ancillary staff and care assistants are expected to clean and do the cooking. Discussion with staff indicated that most of their time is spent supporting residents with their physical personal care or household chores. In addition to this the minimum staffing levels can cause difficulties if there is an emergency. If the home were to employ, for example, a chef and a housekeeper, this would free up staff to spend more meaningful time with residents and as such greatly improve the service. A requirement is made that staffing levels are reviewed to ensure their adequacy. This will be the subject of further discussions with the manager. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 17 Brief discussion took place about the home’s recruitment procedure. This involves the use of application forms and the obtaining of references and CRB checks. Staff personal files were spot-checked and found to have CRB checks. It was noted at the last inspection, however, that the last recruit did not have two references and it was unclear whether the home had sought one from their last employer. The manager has not employed anyone since the last inspection – this, however, will continue to be a focus of future visits and the manager must make sure there is a robust recruitment procedure in place for the protection of vulnerable adults. The manager has developed training profiles for each member of staff. It was noted that whilst some staff have had statutory training of first aid, food hygiene and manual handling some had this many years ago and require refresher training. The manager was asked to carry out a training needs audit and arrange formal training where necessary. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.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) 36 & 38 There are effective systems in place for the monitoring of health and safety so residents can be assured that risks to their well being will be reduced. EVIDENCE: Records and discussion with staff evidenced that there is an effective formal supervision system within the home. In addition to this each staff has an annual appraisal during which time developmental issues are discussed. This is good practice. The fire logbook evidenced that the home tests and checks the system at the appropriate intervals. The Fire Officer visited the home in January and was satisfied with existing arrangements. The manager was asked to arrange refresher fire training for all staff. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 19 All portable electrical appliances had been tested in May – thus meeting a requirement made at the last inspection. In addition to this the electrics have been tested on the premises and works to update some of the wiring is currently being carried out. When these are completed the manager has undertaken to send the CSCI a copy of an up to date electrical compliance certificate. Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.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 2 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x x x x 3 x 2 Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.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. 2. 3. 4. 5. 6. 7. 8. 9. Standard 1 15 9 16 18 18 27 30 38 Regulation 4(1)(b) 16(2)(i) 13(4)(a) 22(7) 17(2) 13(6) 18(1)(a) 18(1)(a) 23(4)(d) Requirement Include in the Statement of Purpose arrangements for staff support during the night Ensure residents are given a meaningful choice at meal times Ensure Oxygen is stored appropriately at all times Update the complaints policy and include contact of CSCI Retain receipts of all purchases made on residents behalf Ensure all staff have Protection of Vulnerable Adult training Review staffing levels Timescale for action 30\5\05 17\5\05 17\5\05 30\5\05 17\5\05 30\6\05 30\6\05 Carry out stautory training needs 30\6\05 audit Arrange re-fresher fire training 30\6\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 7 Good Practice Recommendations Discuss keyworking role with residents and develop the monthly keyworking report so that it becomes a more meaningful record. D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 22 Ashbourne House 2. 3. 21 19 Update bathing facilities Establish a larger office space Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG 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. Extracts may not be used or reproduced without the express permission of CSCI Ashbourne House D56_26494_AshbourneHouse_226838_170505_Stage4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!