Inspection on 03/10/05 for Ashbourne House

This inspection was carried out on 3rd October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashbourne House 08/06/07

Ashbourne House 06/05/06

Ashbourne House 07/02/06

Ashbourne House 23/03/05

Ashbourne House 15/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

SignHealth

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

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

CARE HOMES FOR OLDER PEOPLE Ashbourne House 230 Lees New Road Oldham Lancashire OL4 5PP Lead Inspector Michelle Haller Announced Inspection 3rd October 2005 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 DS0000005486.V249616.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 DS0000005486.V249616.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashbourne House Address 230 Lees New Road Oldham Lancashire OL4 5PP 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) 01616241013 0161 665 2413 Werneth Lodge Limited Mrs Diana Clark Care Home 35 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (17), of places Physical disability over 65 years of age (4), Sensory impairment (4) Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 17 OP, up to 18 DE (E), up to 4 PD (E) and up to 4 SI (E). 23rd March 2005 Date of last inspection Brief Description of the Service: Ashbourne House is a large detached property, set in it’s own grounds, located on the outskirts of Lees, approximately three miles from Oldham town centre. The home is registered to accommodate up to 35 people aged 65 years or above. The majority of rooms are single and have en-suite facilities. The home has three lounges a dining room and a room used for functions. The home is owned by Werneth Lodge Ltd. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted over a period of 14 hours spread over two days. In the course of the inspection eight service users files and other records concerning the support and care of service users where examined fully. Policies, procedures and other documents concerning the running of the home where also assessed. Six service users, two service user representative and two members of staff where interviewed. The interactions between service users, their representatives and staff where also observed. In addition a tour of the private and communal areas of the building was undertaken. Ten service-user, eight relative/visitor and five General Practitioner comment cards were returned to the CSCI, none contained adverse comments. Management representation was present throughout the inspection process. During this inspection Ashbourne House was warm and welcoming and service users appeared well groomed. It was evident that the manager, who is relatively new to her post, has developed a positive relationship with those involved with the home and is keen to improve her managerial skills. The majority of requirements for action to be taken at the previous inspection had been met. What the service does well: The home ensures that basic information about the service user is available prior to their admission and also ensures that opportunity is provided for a visit to the home either by the proposed service user or their representative. Routine health care and checks are made available to service users, and when specialist care is identified this too is provided to a satisfactory level. The service enables service users to maintain contact with their friends and family. The home is flexible in enabling service users to personalise their rooms and enjoy a variety of well-prepared meals. The staff at Ashbourne House are seen as caring, patient and careful to maintain the dignity of service users. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 6 Safety checks such as routine fire safety checks are carried out in the home. What has improved since the last inspection? 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 DS0000005486.V249616.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 DS0000005486.V249616.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): 3,4 and 5. All of the service user’s needs are not fully assessed, therefore the home cannot confirm they can meet the needs of service users prior to admission. Prospective service users and their representatives are given the opportunity to visit the home prior to accessing the service. EVIDENCE: In order to determine the homes ability to ensure that service and their representatives make an informed choice about the home the care files of eight service user files where examined, six service users and two relatives where interviewed and in-depth discussion with the manager undertaken. All files that where examined contained assessments that had been completed by the social worker or care manager prior to admission to Ashbourne. The information varied in detail according to type of assessment format that was used. The home also completes its own admission checklist; this further highlights the physical, social and psychological needs of service users. The information from the assessment and checklist is then brought together through development of a care plan and, on occasion, risk assessments. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 9 Care plans where completed in sufficient detail to enable staff to meet basic needs, however intervention required for complex or specialist needs was not always assessed on or soon after admission. The home is registered to provide support to 18 service users with dementia and four with sensory impairments. It was clear from discussion with the manager, staff and observations made during the inspection that, there is insufficient dementia care training and expertise in the home. A number of service users also have sensory impairment and again it was evident, from care files, reports and records, that that the needs of these service users where not catered for in respect of staff training or provision from other specialist services. It is a priority for the registered to person to identify how the specialist needs of the service users in the home will be take into account and met. Service users and their relatives confirmed that opportunity to visit Ashbourne House had been provided prior to taking up residency. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 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 the following standard(s): 7, 8,9 and 10 The development of care plans is inconsistent and does not always provide sufficient information to meet complex or specialist needs. The homes policy and procedures for dealing with the administration and storage of medication is safe. Service users at Ashbourne House are treated with dignity and respect, and their rights to privacy is maintained. EVIDENCE: In the course of this announced inspection eight service users files where examined, along with other reports and records concerning the well-being and welfare of service users living in the home. In addition six service users, two relatives and two members of staff where interviewed. Observation was also made, throughout inspection, of the interaction between service users, staff and other visitors to the home. Information was also gathered from: ten service user, eight relative/visitor and five General Practitioner comment cards which where returned to the CSCI. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 11 Information in the care plans and daily record sheets demonstrated that, the majority of routine health care including dental care, opticians, podiatry, influenza vaccine, personal physical care and visits to outpatient appointments where met to a satisfactory standard. Furthermore reports indicated that if specialist advice was given all instructions where followed. Service users where observed wearing glasses and hearing aids. There where, however, significant gaps in specialist health care monitoring that resulted in some delay in services users receiving specialist intervention. For example nutritional monitoring or monitoring to identify the early stages of a pressure sore had not taken place for service users who where assessed as frail or at risk for other reasons such as diabetes. In addition care plans where not reviewed and updated to reflect the observations written by care staff about the changing needs of the service user. The home has a high proportion of service users with specialist needs concerning continence. Yet specialist input has not been sought. It must be noted however that the health care professionals working into the home where satisfied with the care provided, and responses from the five general practitioner comment cards confirmed that they were satisfied with the overall care provided in the home. There was little indication in the records that the service users or their representatives where involved in the development of care plans, however one service users was aware of a ‘package deal’ been set up prior to her admission. Examination of the medication record sheets, the medication policy and medication storage demonstrated that the required standard was met. Service users, their representatives and health care professionals confirmed via the comment cards and at interview that, staff were respectful and attentive when providing health or other intimate care. Service users stated that all intimate and health care took place in privacy this was also noted during observations made throughout the period of inspection. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14 and 15 The home does not provide sufficient activities and opportunities for service users to meet their cultural and social expectations. Service users are supported and enabled to maintain contact with friends and family. Service users are enabled to exercise choices in their lives. The service users receive and enjoy plentiful and well-prepared meals. EVIDENCE: The six service users interviewed stated that there were insufficient activities in the home, this was echoed by their relatives and confirmed by the manager. The manager was keen to point out however that a number of staff would be attending an Age Concern course about activities in the near future. Service users and relatives stated that visiting could be at any time that was convenient to them. During the inspection it became evident that visits took place either in the lounge areas or bedrooms, according to the wishes of the service users. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 13 It was clear that the admission process identified that service users where called by their preferred names. Random checks of clothing demonstrated that the laundry system ensured that service users wore their own clothing. Observation also confirmed that service users are supported in maintaining a satisfactory level cleanliness. Service users are supported in making choices about their rooms, particularly concerning the contents. The process of the inspection included a tour of the private and communal areas of the home and it was observed that many bedrooms contained personal furniture and other personal belongings. The meals provided at Ashbourne House are evaluated through a computer programme that should ensure that they are nutritionally balanced. The midday meal on the day of inspection was cheese and onion pie, chips and peas. Diabetic service-users where offered an alternative meal of chips, vegetables and ham. Staff where observed successfully supporting service users to maintain their independence while eating. The menu provided indicated that meals where varied and culturally sensitive. Service users were very enthusiastic about the meals provided in the home and confirmed that a choice was offered on daily basis. One service user statement included “The chef comes up and says what is for lunch and I can have an alternative if I don’t like it.” Other comments included: “The food is very good” and ”Not bad, good really and you get a choice. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Complaints are taken seriously and diligently dealt with in the home. The home has not ensured that all steps possible have been taken to protect service users from abuse. EVIDENCE: Scrutiny of the complaints records maintained by the home demonstrated that, complaints were given serious consideration, thoroughly investigated and changes made to resolve any issues. This is an improvement since the last inspection. The complaints policy fully meets the minimum standards. The majority of service users and relatives who where interviewed stated that they would discuss any concerns with a member of the care staff. The homes adult protection policy and guidelines are detailed and in line with those developed by the local authority. Records indicated however that reports concerning alleged adult abuse were not written at the time of the incident. There is also concern that staff have not yet received adult protection training. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 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 the following standard(s): 19,20,21,22,23,24,25,26. The home is well maintained and the communal areas of the home are generally clean, comfortable and safe. Specialist equipment is available to service users. Bedrooms are for the most part comfortable, and all are furnished to the taste of the service users. EVIDENCE: The inspection process included a tour of the communal and private areas. Time was also spent in the communal areas talking to service users and observing their movements. During the tour it was observed that of the building and grounds were well maintained. The garden areas were tidy and accessible to service users. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 16 Ashbourne House is a large property and provides ample space to enable a variety of activities to take place at the same time. There are two large and one small lounge areas plus a dining room. Storage rooms are also available on all floors. The communal areas where nicely decorated and furnished with comfortable, clean furniture. A handyman employed by the company carries out minor maintenance. A maintenance plan is being developed for the home. The majority of bedrooms have en-suite facilities. In addition there are toilets, washbasins and specialist bathing facilities on each floor of the property. The bedrooms that where inspected contained the possessions of service users and had been personalised. Those interviewed were keen to confirm that they had been encouraged to bring their own possessions and buy new items for their bedrooms whenever they wanted. It was noted that not all rooms contained over bed lighting that could be switched on and off from bed. This issue was discussed with the manager. It was noted that equipment including high seats for the toilets, press-down taps for hot and cold water and grab-rails where in place and used by service users. The majority of the home was clean however the carpets in a number of areas were heavily stained, especially around the chair-legs in the main lounge. This was discussed with the manager who agreed to review the frequency for the cleaning of the carpets that have the heaviest use. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The number of staff should be reviewed to ensure these meet the needs of the service users. The provision of induction and specialist training for staff needs to be improved. Some aspects of the home’s recruitment processes require more rigour to fully protect service users. EVIDENCE: On the day of this inspection the needs of 27 service users were being tended to by three care staff, the manager and two ancillary staff. Although this ratio is within the acceptable staff to service user ratio, the needs of the service users where not been fully met in that:Observation identified that many service users where wandering around the home in an aimless manner and service users who where very confused were seen to initiate conversations with service users with mild confusion, causing further confusion and some upset. Service users who where interviewed commented on the number of confused people living in the home and their comments implied that this was leading to some isolation. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 18 All the service users interviewed stated that there seemed to be insufficient staff to enable them to participate in meaningful activities or support the development of positive relationships within the home. Comments about staff included: “They’re a bit thin on the ground”, “not enough staff especially at night”, “I feel cared for but they are short staffed- it can be difficult.” And, “seem short staff and have to wait a long time sometimes.” Observations over the period of the inspection confirmed that it was difficult for staff to spend time completing tasks with, or settling service users. This issue was discussed with the manager who agreed to investigate how the staff hours could be better distributed. A number of staff had begun to complete their NVQ 2 in care unfortunately the training company ceased trading. A training calendar is been developed and the manager is now working with Oldham College to obtain NVQ 2 in care and other essential training for staff. Specialist training including sensory impairment and dementia care is necessary. The manager also needs to develop an induction programme for staff that meets the Skills for Care guidelines. These issues where discussed during the inspection. Checking through the CRB records identified that current CRB checks are still not available for all care staff, and it was not possible to evidence where POVA First checks had been applied for in respect of the newest recruits working in the home. Discussion concerning this issue did take place. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,34,35, 36, 37 and 38. The manager is newly in post and needs additional support to be able to fully discharge her responsibilities. The accounting procedures for the home ensure service users are safeguarded. The safeguarding of service users monies could be improved. Further training is required to fully safeguard the health and safety of service users and staff. EVIDENCE: At the time of the inspection the manager was newly in post and was being supported by the manager from the company’s other home who was acting as a mentor. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 20 Areas of concern included the monitoring of service user’s needs within the home. The development of staff and the provision of inspection and specialist training for staff. It was confirmed during the inspection that these issues would be addressed through mentoring and completion of the Registered Manager’s training. Discussion with the manager confirmed that the owner was responsible for ensuring that the accounting system for the running of the home was satisfactory, she confirmed that receipts where maintained for all transactions concerning the home. Certification confirmed that the home was adequately insured. Service users money is fully safeguarded, however individual receipts are not kept for quite large transactions such as hairdressing and the podiatrist and a recommendation has been made to address this. However all other receipts are where individually maintained and other issues concerning finance appeared in order. The manager stated that service users could access their personal information and all files where stored securely when not in day to day use. All routine health and safety checks and monitoring have been undertaken on equipment and services used in the home, including fire equipment, gas and electrical appliances. Dates for completion of these checks was provided in the pre-inspection questionnaire and appeared to comply with the appropriate legislation or guidelines. Health and safety signage and posters where strategically placed in the home for example in the laundry room, toilet areas and kitchen. A record of all accidents has been maintained. Moving and handling training for some staff requires updating. Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 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 x x 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x 3 2 x 3 2 Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 22 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 OP4OP3 Regulation 14 Requirement The registered person must ensure that the needs of all service users are fully assessed and fully identified on admission to the home. The registered person must ensure that service users careplans are regularly reviewed. The registered person must ensure health risks to service users are identified, monitored and any activities identified on care plans are responded to. The registered person must consult service users about the programme of activities arranged by or on behalf of the care home, and arranged for the provision of activities having regard to the needs of service users. The registered person must ensure that staff receive training in the prevention of abuse. The registered person must review the deployment of staff to ensure that suitable staff are working in the home to meet the health needs of service users. DS0000005486.V249616.R01.S.doc Timescale for action 01/12/05 2 3 OP7 OP8 15 13 01/12/05 01/12/05 4 OP12 16 (m) (n) 01/01/06 5 6 OP18 OP27 13 (6) 18 01/01/06 01/01/06 Ashbourne House Version 5.0 Page 23 7 OP29 19 8 OP38OP30 OP28 18 The registered person must ensure that all aspects of staff vetting specified in regulation 19 is undertaken. The registered person must ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. 01/12/05 01/01/06 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 OP31 Good Practice Recommendations The registered person should continue to provide support the manager until she has the qualifications, skills and experience to successfully manage all aspects of the home. The registered person should ensure that service users receive individual receipts for any purchases they make. 2 OP35 Ashbourne House DS0000005486.V249616.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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