CARE HOMES FOR OLDER PEOPLE
Ashbourne House Ashbourne House 213 St Marychurch Road Torquay Devon TQ1 3JT Lead Inspector
James Rose Unannounced Inspection 26th April 2007 09:00 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.V333411.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ashbourne House Address Ashbourne House 213 St Marychurch Road Torquay Devon TQ1 3JT 01803 327041 01803 310587 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Robert Gisburn Williamson Mrs Diana Dolorse Enilde Williamson Mrs Sandra Brown 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.V333411.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home can admit one Service User, who is within category, but under 65 years of age. 11/07/06 Date of last inspection Brief Description of the Service: Ashbourne House is a large detached property in a level residential area close to St Marychurch precinct, which has shops and other facilities. The home can accommodate up to twenty-eight people (some in shared rooms) from the age of 65. They may be physically and/or mentally frail, but the home does not cater for people in advanced stages of dementia or those exhibiting extreme behavioural problems. The double bedrooms are normally occupied singly. There are extensive communal areas on the ground floor, including a large lounge, dining room, quiet visiting room and an activities area. There are stairlifts on the main staircase to the first and second floors. However there are several bedrooms, which can only be reached via a few steps, and so are suitable only for residents able to walk up/down some steps. One of the bathrooms (first floor) is fitted with a bath hoist. There is an attractive level garden, a courtyard and a small car parking area. A minibus is available to residents for outings. The owners also manage a day centre (separately staffed) adjoining the home, where more able residents of the home may be able to join in activities. The home does not wish to have the weekly cost of care published. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken over 12 hours in April 2007. A complete tour of the home was undertaken and samples of care records were examined. Four residents were interviewed individually in private for their views of the service provided and two of their visitors were also consulted. Evidence was also gathered from questionnaires that were returned to the Commission and healthcare professionals were asked for their views of the service provided by the home. The way care was delivered was observed, three carers and one auxiliary staff member were consulted individually and the inspection was undertaken with the assistance of the proprietors and the registered manager. What the service does well: What has improved since the last inspection?
Two new stair lifts have been provided for residents since the last inspection, which has improved their mobility between the floors of the home. Some redecoration has been undertaken and new carpets have been provided. A lockable facility has been provided in residents’ rooms to give them secure storage for medication and the recommendation for two staff signatures to be used for all financial transactions undertaken in the administration of residents’ pocket monies has been introduced. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 6 What they could do better:
A detailed discussion was undertaken at the last inspection and during this inspection with Mr and Mrs Williamson the proprietors concerning issues that needed to be addressed in the building. Some progress had been made in the redecoration required; however work remains. Mr and Mrs Williamson have agreed that all the redecoration in the home will be completed within six weeks of the inspection. The replacement of baths was also highlighted and although this work had not been completed, one bath was being replaced at the time of this inspection and an undertaking was given by Mr and Mrs Williamson that the other baths would be replaced and an assisted bathroom would be made available to residents on the ground floor of the home within six months. Quotations have been obtained by the home to fit thermostats to all hot water outlets and Mr and Mrs Williamson have given an undertaking that the work will be completed within the next four months. Mr and Mrs Williamson have also given an undertaking that they will ensure that the home has an electrical installation certificate available within three months to ensure residents are safe. Some progress has been made in addressing residents social needs, however these were not detailed in the care planning examined at this inspection and the requirement for this work to be undertaken has been repeated in this report. A requirement was raised in the last report calling for appropriate risk assessments to be in place for all residents this has not been achieved and the requirement has been repeated here. The need for close monitoring of the administration of medication in the home was most apparent at this inspection and a requirement has been raised to ensure that all carers follow the correct procedure for the administration of medications in the home at all times. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is adequate. Assessments were undertaken by the home prior to them offering a service; however the recording of social elements needs more detail. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Assessments were completed on a prospective resident prior to them being offered a service at the home, health and personal elements were comprehensive. Social elements need more detail to enable an appropriate comprehensive care plan to be constructed. Four assessments were examined in detail at this inspection and all had deficits in the social element. Health needs were well covered and personal needs were also included. The need for the development of the social needs element of the assessment was discussed with the proprietors and the registered manager and they have
Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 10 agreed to develop this element further to ensure that all a residents needs are included and addressed by the home. Standard 6 refers to a service not provided at Ashbourne House. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. Care plans were available for each resident in the home. Health and personal needs were detailed; however social needs required more development. Residents are able to self medicate at the home. Some deficits were apparent in the administration of medication in the home, which has the potential to put residents at risk. Residents are treated with respect in the home and care is taken to ensure their privacy is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individual care plans were available for each resident in the home based on the assessments that had been completed. Four service user plans were examined at this inspection, health needs and personal needs were well covered, the social elements lacked detail and would not allow the home to provide a comprehensive service to the individual resident concerned. This was discussed in detail at the last inspection and the discussion was repeated again with the registered manager and the proprietors. Some progress has been achieved and
Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 12 it has been agreed that further development will be undertaken to ensure that all the social needs of a person are addressed and form part of the service provided. A requirement first raised in the last report has been repeated here. Two healthcare professionals were consulted about the service provided at Ashbourne House and they advised that they did not have any concerns they wished to raise. The risk assessments undertaken by the home and form part of the care planning process continue to have deficits. Currently the risk assessments that are undertaken just records a decision but no analysis has been shown of the hazard considered. This was discussed with the proprietors and the registered manager and it has been agreed that an appropriate approach will be undertaken in the home to ensure residents are safe. The requirement calling for appropriate risk assessments to be completed has been repeated in this report. The recordings of the administration of medication in the home were examined by the inspector and the senior carer on duty as part of the inspection process. There were substantial unexplained gaps in the issue record and two preparations were not given as per prescription. The code system has also been used on the medication administration sheets but had not been clarified to explain what it meant. A requirement has been raised in this report to ensure all carers that administer medication do so appropriately and that residents are safe. Four residents were consulted individually in private during the inspection; they were all confident and well able to express their views. One resident commented, “I’m well looked after and I enjoy the food” another remarked, “The staff are very good to me, everything’s fine.” They also advised that they were always treated with respect and that care was taken to ensure their privacy was maintained. It was also clear from observations made during the inspection that residents’ privacy was seen as important and that they were always treated with respect by the care team. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. A leisure and activities programme is in place in the home that is enjoyed by residents. There is an unrestricted visiting policy and procedure in the home and residents can come and go as they please. Residents are supported and assisted to make their own decisions about matters that affected them. A wholesome balanced diet is provided at the home and meals are served in a dedicated dining room. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does have an activities programme running that is much enjoyed by the resident who can take part of not as they wish. The nature of the activities are currently general and not tuned to the individual concerned, however this will be rectified when the care planning processes in the home are developed further. All the residents consulted both individually and in groups advised that they were happy at the home and enjoyed the activities that were available. One resident remarked, “There’s always something to do here.”
Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 14 Although some of the social detail was missing on care planning documentation there are examples of good social care being delivered. One resident who was depressed and has been used to keeping lots of pets was taken to the local dogs home and was able to pick out a small dog to keep. This approach has enabled this person to improve and feel fulfilled. When this kind of approach is recorded and repeated to provide a detailed ‘client centred’ approach for each resident the home will be able to offer a very high quality service. Three visitors to the home were consulted in private to obtain their view of the service provided. They stated that they felt the service at the home was of a good quality and that it suited their relatives very well. Residents were asked if they felt their views were listened to by the home. One resident said “Yes, I’m given time and help if I need it but they definitely want to know what I think” another stated, “When I express my view it is responded to”. This position was also confirmed by observations undertaken during the inspection. All the residents interviewed in private and others advised that they were very happy with the food provided at the home and liked the make up of the menu offered. When asked they could not suggest any additions they would like. Meals are served in the homes dedicated dining room at tables that seat up to four persons, residents advised that they liked these arrangements. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. Residents were confident that if they raised a matter with the home it would be taken seriously and resolved fro them without delay. The home has an adult protection policy and procedure available. Carers would benefit from a refresher course. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents that were consulted individually in private advised that they were well able to raise an issue in the home if required and felt that when this was undertaken they would be listed to and what they said would be taken seriously and the matter resolved fro them without delay. Residents are given detailed information when they are admitted into the home and the complaints procedure is included in their welcome pack, there is also a copy available on the wall in the hall of the home. The home has available an adult protection policy and procedure and carers have been trained in its use. Three carers were interviewed in private as part of the inspection process and some were not clear on all the elements of the adult protection procedure and would benefit from a refresher course. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. Ashbourne house provides an environment that is safe and comfortable. Some items of maintenance are outstanding. The home is clean and there are good standards of hygiene in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complete tour of the home was undertaken as part of the inspection process and all rooms were seen. As previously stated in this report there were some items of decoration that remain outstanding and an undertaken has been given by Mr and Mrs Williamson that this will be addressed and completed within six weeks. The baths in the home are being replaced and an assisted bathroom will be provided on the ground floor, this work will be completed in six months.
Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 17 An electrical installation certificate is going to be provided within three months and thermostats are going to be fitted to all hot water outlets in four months. Residents consulted during the inspection advised that they liked their rooms and the lounge area and dining room in the home. No hazards were apparent in the tour of the building that was undertaken and it was understood that there is a protocol in place to ensure residents are accompanied when they go out into the home’s garden. All the rooms in the home were seen at the inspection and the building was clean throughout with good standards of hygiene apparent. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. The staffing levels at the home are sufficient to meet residents’ needs. Residents are in safe hands and are protected by the home’s recruitment policy and practices. The home has a training programme in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care hours at the home are sufficient to meet the needs of the residents and residents stated in conversations that the staff met their needs appropriately and always answered the call bell system when it was used. It was clear from observations made during the inspection that there were good relationships between carers and residents. Some personnel files were examined during the inspection and in general they were complete and complied with the legislation which ensures that the residents are in safe hands at all times. Three carers were interviewed during the inspection this was undertaken individually and in private. They advised that they had completed an induction in the home and were enthusiastic and wanted to provide a good service to the residents. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 19 Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is adequate. The new manager has settled well, is of good character and is able to discharge the responsibilities of the position appropriately. Residents’ benefit from the management approach taken. The home is run in the best interest of service users. Improvement is needed in some areas of health and safety that has a financial implication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new registered manager at the home has eleven years experience of care and is qualified with NVQ 4 and other qualifications and is currently completing the registered managers award. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 21 Both residents and staff advised that they had a good relationship with the manager of the home. Residents felt they were consulted about the issues that affected them and they said the manager had their confidence. The home has an active quality assurance system and residents are given opportunities to make their own choices abut what they would like to eat and what they would like to do. The home assists some residents with the administration of their pocket monies, clear recording was in place and all monies were checked and found to be correct. The home used two staff signatures for each transaction. Health and safety issues are given appropriate priority by the registered manager, the regulations referring to the use and storage of harmful chemicals were in place and appropriate reports were made when incidents occurred in the home. The fire precautions undertaken by the home were well-maintained and clear records kept. The home still does not have available a current electrical installation certificate, this was discussed with Mr and Mrs Williamson and they have given an undertaking that this will be completed within three months. Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 14 Requirement The registered manager must ensure that the social care needs of residents are set out in an individual plan of care. (Date agreed in last report 15/08/06 not met) The registered manager must ensure that appropriate risk assessments are in place for the hazards facing residents. (Date agreed in last report 31/08/06 not met) The registered manager must ensure that all staff follow the procedures for the correct administration of medications. Timescale for action 07/06/07 2. OP7 13 07/06/07 3 OP9 13 02/06/07 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.V333411.R01.S.doc Version 5.2 Page 24 Ashbourne House DS0000018319.V333411.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 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
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