CARE HOMES FOR OLDER PEOPLE
Ashbourne House Ashbourne House 213 St Marychurch Road Torquay Devon TQ1 3JT Lead Inspector
Mark Sharman Unannounced Inspection 20th December 2005 11:00 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.V268005.R01.S.doc Version 5.0 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.V268005.R01.S.doc Version 5.0 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.V268005.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named Service User who is not within age range Date of last inspection 26 and 27/4/05 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. The layout and facilities of the home are not suitable for wheelchair users. 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.V268005.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, and about five and a half hours were spent at the home. Time was spent with the owners, and nine residents and five staff were consulted. Some records relating to the residents’ care and some staff records were inspected. The communal parts of the home and a few of the bedrooms were seen. What the service does well: What has improved since the last inspection?
Two requirements were made following the last inspection. One was to obtain an appropriate metal cupboard for the storage of certain types of medication, and although this has not been done yet Mr Williamson said this is on order. The other requirement made has been complied with, namely to make the main residents’ lounge a no-smoking area. This has made the lounge a more pleasant area for the majority of residents, and another area on the ground floor has now been designated for smoking for the few residents who do smoke.
Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 6 The one recommendation made at the last inspection has been dealt with, namely to have the home inspected by an occupational therapist. This should result in an improvement in facilities for people with a physical disability. The occupational therapist’s report has not yet been sent to the home. 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 DS0000018319.V268005.R01.S.doc Version 5.0 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 DS0000018319.V268005.R01.S.doc Version 5.0 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 the following standard(s): 3. (Standard 6 is inapplicable.) Evidence shows that the needs of prospective new residents are assessed before their admission to the home. Prospective new residents (and/or their relatives if more appropriate) are given the opportunity to make prior visits to the home to see if the services and facilities are suitable. EVIDENCE: At the beginning of this inspection the home owners were out seeing a possible new resident who was in hospital. They carried out their own assessment of this person’s needs and had completed their assessment form, covering the elements listed in the Standard. Following this the person’s relatives had arranged to visit the home to see if it was suitable. The files of the two most recent residents were also inspected. These both contained an assessment form completed by care managers and other professionals in respect of the resident’s care needs prior to admission to Ashbourne House. Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 9 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 and 9. The care plans inspected were satisfactory. Arrangements for the administration of residents’ medication were also satisfactory (and the storage of controlled drugs will be improved in the near future). EVIDENCE: The care plans for the two most recent residents were examined. They described the actions to be taken by staff to meet the residents’ health care and personal care needs, and included a risk assessment (including mobility). The files also included an assessment of needs completed by a care manager/other professionals. The staff on duty said that the residents’ care plans were kept accessible to them to refer to when necessary. The medication cupboard was examined and it was reported that there were no controlled drugs prescribed. In fact the storage for such drugs is not adequate at present, but Mr Williamson said that a suitable metal cupboard is on order. There has been no new report by the home’s supplying pharmacist since the last CSCI inspection. He provided training on medicines management to 12 staff very recently, and the certificates for this were seen. Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 10 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): 14 and 15. There are suitable activities and entertainment on offer, and residents are able to make choices and follow their own routines (within the constraints of communal living). The current catering arrangements are very satisfactory. EVIDENCE: The more capable residents who were consulted said that they are free to decide for themselves whether or not to join in activities, and they are not put under pressure to do so. They also said they get up and go to bed at times to suit themselves. The notice board showed an extensive Christmas programme, including musical entertainment. In fact professional musical entertainment was provided on the afternoon of the inspection, and this entertainer confirmed that this is a monthly arrangement. Since this was Christmas she had also entertained the residents the previous week. The residents said that a weekly minibus trip out is offered. On the day of this inspection a pre-Christmas lunch was served consisting of three courses plus wine or beer. It appears from the residents’ comments that a commendable standard is achieved by the chef. All of the residents who were asked said that the meals at the home are very good and that they are given plenty. The staff on duty were attentive throughout the lunch, helping the more confused residents who needed assistance.
Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 11 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. There is a satisfactory complaints system and there was evidence that residents feel their complaints would be listened to. EVIDENCE: The home has an appropriate complaints policy, a copy of which was displayed on the notice board. Most of the residents who were spoken with said that they knew whom they should speak to if they had a complaint, and seemed confident that it would be dealt with (with the exception of one). One anonymous complaint was received by the Commission for Social Care Inspection since the last inspection, principally about environmental matters such as carpets and faulty windows. A visit was made to the home and it was found that any outstanding matters had been rectified. Training for staff in respect of vulnerable adult issues is being arranged over the next few months (a staff notice was seen), and one of the staff said she is due to attend this training in January. Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 12 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): 20 and 26. The home is well provided with communal areas, and was clean and hygienic. EVIDENCE: The communal rooms were warm and welcoming and were cheerfully decorated for Christmas. There is a large amount of communal space, comprising a very large lounge, dining room, quiet visitors’ lounge and an activities area. The activities room contained a lot of materials for craft activities, and there were finished paintings and other craft work in evidence. All of the rooms seen were clean and tidy, and several residents said that the home is kept this way. One resident who prefers to stay in his own room said that it is cleaned every day. A new tumble dryer was bought recently for the laundry. With regard to disability equipment and adaptations, Mr Williamson said that the home has recently been inspected by an occupational therapist (whose report is awaited).
Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 13 Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 14 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 and 30. The current residents’ needs were being met by the staffing arrangements in place. Staff training has been substantially increased in recent months, although the NVQ training target has not yet been met. EVIDENCE: The staffing levels at the time of the inspection were adequate to meet the needs of the residents, and the residents who were asked said they felt enough staff were on duty. There were to be three carers on duty in the afternoon until 8.00pm, with the chef on duty between 4.00 and 6.00, and the staff spoken to said this was adequate. Some staff files were inspected, and these now included contracts of employment. One of the staff confirmed that she is working towards NVQ level 3. Another said that she has undertaken quite a lot of training in the last year, including manual handling, first aid, medication, incontinence. Training was discussed with the home owners, and several courses have taken place in the last few months. Certificates for all these were seen. They have included professional fire safety training (10 staff), medicines management (12) with the pharmacist, professional manual handling (3), continence management (4), nutrition (4) and stroke care (2). Vulnerable adult training and falls management training (with the NHS) will take place in the next few months.
Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 15 Currently three care staff have achieved NVQ level 2, so the 50 target is not yet met. Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 16 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. 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, and her certificates were seen. In fact the owners have drawn up a job description for a care manager, and are again advertising to fill this post. Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 17 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 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x x 3 x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x x Ashbourne House DS0000018319.V268005.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes. 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 Timescale for action Controlled drugs administered by 31/01/06 staff must be stored in a metal cupboard which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. (Previous timescale of 31/07/05 not met, but now on order.) Notice in writing must be given 31/12/05 to the Commission for Social Care Inspection of any event listed in the Regulation, including the death of any service user. Requirement 2. OP37 37 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 DS0000018319.V268005.R01.S.doc Version 5.0 Page 19 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
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