Inspection on 02/10/07 for Ashbourne House

This inspection was carried out on 2nd October 2007.

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 16/01/07

Ashbourne House 05/09/06

Ashbourne House 13/12/05

Ashbourne House 17/05/05

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 John Clarke Key Unannounced Inspection 2nd October 2007 09:45a 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 DS0000026494.V350527.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 DS0000026494.V350527.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbourne House Address 2 Henleaze Road Durdham Down Bristol BS9 4EX 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) 0117 9628081 NONE Ashbourne House Care Homes Limited Mrs Michaela Jane Hill Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2007 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 accommodation and personal care for up to 17 people who are 65 years and over. The house is close to local facilities and amenities, including public transport. The premises are over three floors, all of which are accessible by a lift. Some of the bedrooms have en suite 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. The house is not ideally suited for people who use a wheelchair. The cost per week to reside at Ashbourne House ranges from £359.00 to £445.00. Fees are reviewed annually. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home as part of an inspection the manager was present throughout the visit. As part of this inspection visit a number of documents were looked at including care plans, daily records, staffing records, medication administering records. There was also an opportunity to talk with individuals who live and work in the home. Have Your Say questionnaires were sent to individuals who live in the home, relatives and staff. There were responses from 5/15 residents, 4/15 staff and 4/10 relatives. The manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA and questionnaires have been used to help make a judgement about the quality of care provided in the home. What the service does well: What has improved since the last inspection? Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 6 A requirement was made at the last inspection about improvements which needed to be made too the environment of the home. As a result of refurbishment of some of the rooms and bathroom this requirement has been met. 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. The summary of this inspection report can be made available in other formats on request. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose provides the required information about the home, the facilities, staffing arrangements, admission procedure and aims and objectives of the home so that individuals can make an informed choice about the suitability of the home. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 9 EVIDENCE: The home’s Statement of Purpose was looked at and it provides information about the home’s facilities, staffing arrangements and routines. It sets out the aims, objectives and philosophy care. It also outlines the home’s complaint’s procedure importantly stated that individuals have the right to contact the Commission for Social Care Inspection if they wish to discuss any concerns they may have about the quality of care they receive. A number of admission assessments were looked at and showed that full and detailed information is obtained about the health and social care needs of perspective residents. Where an individual is known to the local authority a copy of their assessment is obtained. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are good providing staffs with the necessary information so that the health and social care needs of residents are met. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: A number of care plans were looked at and showed that there is comprehensive information available to staff. Risk assessments had been completed e.g. where individual had history or was at risk of having falls, use of oxygen by individual. Keyworkers undertake monthly reviews so that care information is up to date. There was also evidence that individuals had been involved in their care plans with details about personal history, likes and dislikes. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 11 Individuals who live in the home have full access to community health services and evidence from care plans recorded visits from chiropodists, optician and dental. Community nurses visit the home as required to provide care and support for those whom have medical needs. All respondents to the survey said that they received the medical support they needed. A relative commented “my relative always received her medication and there was never any hesitation in contacting her doctor. We were always kept informed as to what was happening” and “at the end of her time here my relative required much extra care which was willingly given far exceeding the expectations of normal residential care”. The arrangements for the storing and administering of medication were looked at and showed that there are satisfactory secure and safe storage in place. Administering records accurately recorded medication which had been given to the individual. However in one instance the administering record (MARS) only indicated, “as directed” and there was no specific dosage recorded on the medication. The manager was advised to contact their pharmacist to remedy this and that MARS should show actual dosage to be given. Staff who administer medication receive the necessary training. I spoke with a number of individuals who all spoke positively about how they were treated by staff: “you couldn’t complain about them” “very kind and very patient” “kindness itself”. One spoke of how she felt that they “always treat you well and with respect”. This was also observed during the visit in that staff always spoke to individuals in a sensitive and professional way. All individual’s rooms have locks on their rooms however I spoke to two individuals who did not have a key to their room and therefore given the choice to lock their room if they wish. This should be made available to all individuals who live in the home and recorded if they do not wish to hold a key. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: In talking with a number of individuals who live in the home they spoke positively about activities arranged in the home: “never get bored” “always something if you want” one individual told me they still attended a local club. Activities ranged from physical exercise, creative activities such as cake making to board games and “just having a chat”. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 13 The home welcomes visitors and encourages contact with relatives and friends this was confirmed by one resident who told me “relatives can come at any time, there are no restrictions, really made to feel welcome”. Relatives who responded to the questionnaire all said that the home “always” helps to keep in touch with relatives and friends. I looked at the menu and meals provided and they were varied and appetising and on the day of my visit the meal was well presented. Individuals all commented about the good quality of the food provided in the home “food always very good” “I always enjoy my meals here”. A relative said, “my mother enjoyed the food so much. There are always plenty of vegetables to be seen. The residents have quite a lot of say in what is served and are able to make requests for their own favourites” this was also commented on by an individual I spoke too who said “ there is always a choice” “can have something different if you want”. Changes have been made to the menu following suggestions made by residents. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures in place enabling individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: There had been one complaint made since the last inspection. This was responded to as required and resulted in a change of practice to reflect the rights and routines of that individual. Individuals I spoke with all said they were aware of the home’s complaints procedure. Importantly they spoke of how the manager was approachable and someone they would go to if they had “any worries about anything” “staff always listen to what we have to say” Residents and relatives response to questionnaire was that that they were all aware of the home’s complaints procedure. The home has policies and procedures in place around Safeguarding Adults. Staff undertake Protection of Vulnerable adults training through Bristol City Council. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and hygienic environment for individuals who live and work in the home. The home provides a warm, welcoming and wellmaintained environment. EVIDENCE: Since the last inspection further improvements have been made to the environment and facilities of the home including re-decoration of the downstairs communal toilet. This is now much improved as have rooms in the home which have been decorated this was commented on by a relative in their questionnaire response. There remains an ongoing programme to improve and update furnishings and decoration of the home. At the time of my visit the home was clean and free from offensive odours individuals I spoke with said how the home is “always clean” and respondents Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 16 to the questionnaire also confirmed this. Staff have received infection control training and there are procedures in place to make sure that good practice is maintained in maintaining hygiene and control of any infections that may occur in the home. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are good so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: Staffing of the home is senior plus 2 care assistants am (9-1:30) senior plus 1 1:30-6, 6-10 2 care assistants and sleep-in staff. There is no waking night staff in that the needs of residents do not require this support however should this change the home would need to review their night staff arrangements. A strength of the home as noted is that there is very good retention of staff and most if not all staff have been working in the home for 3 years or more. The previous inspection confirmed that the home follows the required procedures in relation to recruitment of staff and obtains Criminal Record checks, full employment history and references. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 18 Training records for 3 members of staff were looked at and they evidenced that all had completed “mandatory” areas of training: moving and handling, fire training first aid. In addition other training included Person Centred Care, Diabetic Awareness. A number of staff have completed NVQ qualification and over 50 have achieved this professional award with other staff currently undertaking this qualification. The manager and senior have NVQ Registered managers award. Comments from staff included: “ On going training and support from the manager and staff I feel I’ve all the necessary support, experience and knowledge” and “the necessary training is always given and updated regularly”. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for residents and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff are protected. EVIDENCE: The manager of the home has been in this position for eleven years has achieved NVQ level 4 Registered Manager Award. There was a high degree of satisfaction expressed by those I spoke to about her ability to be “approachable” “someone we can always go to”. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 20 Individuals who live in the home complete quality assurance surveys, which provide an opportunity to comment on various aspects of the service they receive such as activities, menus, personal care and routines of the home. In addition residents meeting are held and suggestions made such as post box being made available which has been acted upon. Health and Safety records confirmed that the required checks and maintenance of equipment and safety systems such as fire takes place as well as regular checks of fire alarm and emergency lighting. There are service contracts in place for items such as lift, gas appliances and electrical services. Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 X X X X X X 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 3 X 3 X X X X 3 Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashbourne House DS0000026494.V350527.R01.S.doc Version 5.2 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. 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