CARE HOMES FOR OLDER PEOPLE
Ashbourne House 213 St Marychurch Road Torquay Devon TQ1 3JT Lead Inspector
Mark Sharman Announced 26 and 27/4/05 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 D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Ashbourne House Address Ashbourne House, 213 St Marychurch Road, Torquay, Devon, TQ1 3JT 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) 01803 327041 01803 310587 Mr Robert Gisburn WilliamsonMrs 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 D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: One named Service User who is not within the age range. Date of last inspection 7/12/04 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 are 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 may be able to join in activities. Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and took place over about ten hours. A completed pre-inspection questionnaire was received prior to the inspection. Also received were five comment cards from residents and four comment cards from relatives/friends. During the inspection seven residents and six staff were interviewed, and a partial tour of the building was made. What the service does well: What has improved since the last inspection?
Further improvements have been made to the environment, in particular the creation of a new activities area. This will allow residents to engage in crafts activities away from the main lounge, and to use a communal area with no television if that is their preference. Some other communal areas have also been redecorated, including the quiet visitors’ room which may also be used for residents to use the telephone in private. This work has given the ground floor of the home a much smarter appearance. The standard of record keeping, such as the residents’ individual files and care plans, has improved in recent months.
Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 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 D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 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) 3 and 5. Standard 6 is inapplicable. The management is now taking care to ensure 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, have the opportunity to make prior visits to the home to see if the services and facilities are suitable. EVIDENCE: The sample of residents’ files inspected contained local authority Care Management assessments and Care Management care plans. In the case of one of the newest residents his placement in the home had been recently reviewed by a local authority care manager. This person summarised that the placement had so far been very successful “due to the patience and sensitivity of the staff and management of Ashbourne House”. However in the case of one resident who has lived in the home for some time it is clear that the equipment and facilities available are not adequate to meet his needs, and this was discussed with the owners. Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 9 Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 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 and 10. Care planning is now satisfactory, and the residents’ health care needs were being met. The residents are treated respectfully and their dignity is respected by the staff. Although the medication system was satisfactory in most respects, it lacks proper storage for controlled drugs. EVIDENCE: Three care plans were inspected, which specified actions to be taken in respect of health, personal and emotional needs. In each case there was also a risk assessment. The daily records contained evidence that health professionals are accessed on behalf of the residents, with notes made of appointments with dentist, optician, hospital etc. A community psychiatric nurse visited one of the residents recently, and another resident described his hospital appointment the previous day. A district nurse visited a resident on the day of the inspection, and said that she had encountered no problems in the standard of care at the home over the recent months. In fact she felt that this had improved. Various items of equipment for the prevention of pressure sores are on loan to the home. With regard to the medication system, the supplying pharmacist’s last report was generally satisfactory. However the storage arrangements for any
Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 11 controlled drugs which might be prescribed do not comply with the Standard, thus placing residents at risk of harm. Residents said that the staff are caring and courteous, and are mindful of their dignity when carrying out personal care. Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, and 15. The opportunities and activities available suit the expectations and interests of the residents. They are able to maintain contact with their relatives and friends. The meals and catering arrangements are satisfactory and well appreciated by the residents. EVIDENCE: The residents who were asked said that they were happy with the activities and entertainment offered to them. Two of them said that they are not interested in joining in group activities, and that this is respected by the staff. Some said they enjoyed the chair exercises, and several joined in with the musical entertainer who visited on the day of the inspection (a monthly arrangement). Several went out on the weekly minibus trip in the morning, which they said they greatly enjoy. A number had been to the theatre with the owners on two occasions in the last few months. Those residents who were asked confirmed that they get up and go to bed at times which suit them. Several said that they receive regular visits from relatives. One resident’s daughter visited during the inspection. She said that her mother had been at the home for only about two weeks, and so far she was satisfied with the care provided. All of the residents were complimentary about the food provided, and also said that they are given plenty. The chef said that he has “almost carte blanche” to buy what foodstuffs he wants.
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The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. There is a satisfactory complaint system. With the exception of one situation there was evidence that residents feel their views would be listened to. Staff have a knowledge of adult protection issues, which should protect residents from abuse. EVIDENCE: Several residents said that they knew whom they should speak to if they had a complaint, and seemed confident that it would be dealt with. One resident and his relative were not satisfied that their views were being taken seriously, which was discussed with the owners. The care staff knew about the home’s adult protection policy, and also where the policies and individual care plans are kept if they want to refer to them. Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22 and 26. The owners have invested in a number of substantial improvements to the building in recent months, thereby making it safer and more comfortable for residents. The home is not well equipped with disability equipment, so that residents are unable to maximise their independence. The home was clean and hygienic. EVIDENCE: All radiators have now been covered and a sophisticated call system has been installed. This should ensure that calls are answered promptly by staff. A new activities area has been created, which will give residents the opportunity to take part in craft activities away from the main lounge. Some new kitchen equipment has been bought, and some redecoration of communal areas has taken place. Bathing is limited to the one bathroom with a bath hoist (on the first floor), but this is not accessible to wheelchairs. In fact access around the home is difficult for a wheelchair user, and one resident is now largely confined to his bedroom. Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 16 The home was warm and clean. The residents said that it is kept clean, and one said that his bedroom is cleaned every day. Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. Currently the residents’ needs are being met by the staffing arrangements in place, and recruitment practice is now satisfactory and should protect them. Staff training has been limited, but is now being extended. EVIDENCE: The residents felt that there are enough staff available for their needs, and they were all complimentary about the helpful and caring attitude of the staff. Those residents who use the call bell in their bedrooms reported that they are normally answered promptly, and that usually they are helped to get up/go to bed at times that suit them. One resident did say that sometimes he has to wait for assistance from staff to get up in the mornings. New staff said that they had received an induction to the home when they started, and three of them confirmed that they have achieved NVQ level 2 and are now doing level 3. The staff over the age of 25 said that the funding of NVQ was a problem for them since they receive no assistance with this. At present the induction training is not in line with the TOPSS standards. Various training certificates for current staff were displayed. Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 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) 33, 35 and 38. The procedures for managing residents’ personal money are thorough and should ensure that their financial interests are safeguarded. There is a satisfactory approach to health and safety issues. EVIDENCE: Many of the residents are unable to manage their own money and are happy for this to be done by the management. A sample of the relevant records was checked, and these were accurate and included receipts to verify expenditure made on behalf of the residents. With regard to health and safety, recent improvements have been the covering of the radiators and the installation of an improved call system throughout the home. This will make the home safer for residents. The home’s fire log was inspected. It is noteworthy that following a fire in the kitchen a few months ago, attended by the fire service, a fire safety officer commended the way in which the staff responded to the fire.
Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 19 Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 2 x 3 N/A 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 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 x 3 x x 3 Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 21 No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 Timescale for action Controlled drugs administered by 31/7/05 staff must be stored in a metal cupboard which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. The main lounge must be made 31/5/05 a smoke-free area. Requirement 2. 20 23 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 22 Good Practice Recommendations An assessment of the premises and facilities should be made by a suitably qualified person in respect of disability equipment and environmental adaptations, including additional bathing/showering facilities. Ashbourne House D54-D07 S18319 Ashbourne House V210511 260405 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 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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