Inspection on 05/09/06 for Ashbourne House

This inspection was carried out on 5th September 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashbourne House 02/10/07

Ashbourne House 16/01/07

Ashbourne House 13/12/05

Ashbourne House 17/05/05

Ashbourne House 18/01/05

Ashbourne House 20/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashbourne House 2 Henleaze Road Durdham Down Bristol BS9 4EX Lead Inspector Wendy Kirby Key Unannounced Inspection 5th September and 9th October 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbourne House Address 2 Henleaze Road Durdham Down Bristol BS9 4EX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 9628081 NONE Ashbourne House Care Homes Limited Mrs Michaela Jane Hill Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2005 Brief Description of the Service: Ashbourne House is a listed Georgian property, which is situated opposite the Downs in Bristol. It is registered to provide accommodation and personal care for up to 17 people who are 65 years and over. The house is close to local facilities and amenities, including public transport. The premises are over three floors, all of which are accessible by a lift. Some of the bedrooms have en suite facilities. The communal areas consist of a lounge and dining room, which are located on the ground floor. Whilst there are some aids and adaptations throughout the premises, the home is not purpose built and as such has some limitations. The house is not ideally suited for people who use a wheelchair. The cost per week to reside at Ashbourne House ranges from £348.00 to £420.00. Fees are reviewed annually. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted as part of the annual inspection process. The inspection was conducted over two days. Prior to the visit the inspector spent some time examining documentation accumulated since the previous inspection, including notified incidences in the home, (Regulation 37’s) and the unannounced reports conducted by the Registered Providers (Regulation 26’s). The inspector sent questionnaires “Have your say” to all residents in the home prior to the inspection and two were completed and returned. Relatives and visitors “Comment Cards” were also sent and three of these were completed and returned. Four comments cards were completed and returned from visiting health care professionals. All of the information received as been detailed throughout the report. The inspector spent time throughout the course of the day in discussions with the manager and staff. A number of records and files relating to the day-today running and management of the home were examined. Four residents were case tracked. Their care plans and care files were examined. The inspector had discussions with the residents and observed them indirectly going about their daily routines. The inspector toured the premises accompanied by the manager. Time was spent observing residents in the home throughout the course of the visit and many were spoken with at length. Feedback was given to the manager on the outcome of the inspection. What the service does well: Admission procedures were resident focussed and supportive to residents. Preadmission assessments are comprehensive covering all activities of daily living, a full health screen and personal history background. Staff demonstrated an awareness of individuals needs and treated the residents in a warm a respectful manner, which means that residents can expect to receive care and support in a sensitive way. There are safe systems of medication. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 6 Meals were well presented and verify a healthy well balanced diet for all residents. Staff had used their expertise and knowledge of the residents, personalities, preferences and ability to eat independently, when seating them for lunch. Staff training is well attended and should ensure that residents are supported by competent and qualified staff. The recruitment procedure is robust and serves to protect vulnerable residents. Good accounting methods are adopted and policies and procedures are followed correctly when handling residents’ pocket money. The home was well organised and managed by an effective, stable management team that promoted the views and interests of the residents. What has improved since the last inspection? What they could do better: The residents must be given opportunities for stimulation through leisure and social activities, which suit individual needs and preferences. On the second day of the inspection this requirement had been partially met and will be looked at in more detail at the next inspection. To further ensure the resident’s health, safety and wellbeing a number of requirements have been made regarding the environment and equipment in the home. These are detailed at the end of the report. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 7 Ancillary staffing levels are not adequate and provision for this must be made to ensure that the home is clean, hygienic and pleasant to live in. On the second day of the inspection this requirement had been partially met and will continue to be closely monitored. Adequate provision must be made to restore safe temperature levels where identified and risk assessments must be developed for each water outlet where the water is too hot to ensure that residents, staff and visitors are safe. 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 DS0000026494.V310199.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 DS0000026494.V310199.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective residents and/or their families receive relevant information to make a decision about the nature of the home. Residents receive a contract/statement of terms and conditions on admission. Prospective residents’ needs are assessed prior to admission to determine the suitability of placement to ensure that their needs can be met. Trial visits give prospective residents an opportunity to assess the nature of the home. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 10 EVIDENCE: A statement of purpose and service user guide is made available at the initial stage of enquiry to prospective residents/families. The service user guide includes valuable information on the facilities and services available to them within the home. Residents’ surveys stated that they had received enough information prior to admission. They stated that they were invited to visit and spend time at the home dependent upon their wishes, to assist them in making a decision about whether the home would be somewhere they would like to live. One resident said, “On my visit to Ashbourne House I was extremely impressed by the wonderful atmosphere; moving to the home was the best thing that ever happened to me”. During the case tracking process of three residents it was noted that all residents had a contract/written terms and conditions. Residents’ surveys also confirmed that they had received a contract on admission. Needs are thoroughly assessed by the manager pre admission to ensure that the home can meet those needs. The prospective resident, family and carers are involved in this process. Where relevant the manager also obtains comprehensive assessments and care plans from other professionals involved for example, social workers and hospital staff. Through her knowledge the manager and her staff were able to demonstrate a sound knowledge of the current residents, their medical history, personal background and their subsequent needs. The information gathered preadmission provides a sound benchmark of the resident’s ability and state of health prior to admission. Ashbourne House DS0000026494.V310199.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The service has good systems for meeting and monitoring residents’ health and personal care needs in consultation with residents. There are safe systems of practice in receiving, storing, administering, and disposing of drugs. Staff have a good awareness of individuals’ needs and treat the residents in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. EVIDENCE: Following admission to the home, the staff gradually assess the residents needs and develop a long-term care plan. Four residents records were looked at in detail, including pre-admission assessments, care plans, personal history profiles and risk assessments. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 12 Each resident had comprehensive person centred assessments, which means that staff put the views, wishes, likes and dislikes of each resident at the centre of all care provided. Records of the General Practitioner (GP) visits/contact with residents and the outcomes were also available. Specialist referrals and visits from other professionals were evidenced in care files including Community Nurses, Chiropodists, Opticians and Dentists. Results from the residents’ surveys evidenced that they feel that they receive all the medical support they require. One resident stated, “The manager and staff have very good relationships with the doctors and district nurses”. The inspector was informed that each resident was referred to a GP of his or her choice on admission to the home and an initial first visit was then set up. Good working relationships with GP’s and District Nursing teams have been formed and they will visit on request. Visiting health professionals had completed comment cards and statements included, “A well run family home”, “On visiting the home I am always made to feel welcome and informed of any problems with the residents I am visiting” and “Staff work well with the district nurses enabling continuity of care”. Risk assessments include the risks of falling, manual handling and selfmedication. In addition to this there are risk assessments written specifically tailored to individuals for example Insulin dependent Diabetes. Opportunity was taken to inspect the medication system. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by the local pharmacist. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. Records held in relation to the storage and administration were accurately maintained and met with the requirements of the legislation. The home also keeps an accurate stock check of medicines given on an as required basis. All staff receive Medication Competency training annually. The manager and her staff are continuing to make every effort to establish resident’s wishes concerning palliative care and any provision residents and their families would wish for by developing end of life care plans. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 13 The manager explained that the plans are sensitively completed with residents and their families/significant others. The manager has discussed further development of these with community health care professionals and has had regular contact with the hospice nurses. The inspector looks forward to examining their progress at the next inspection. The atmosphere in the home on the day of the inspection was relaxed. Staff, the manager and residents were observed to have good relationships. Staff responded to residents in a sensitive and professional manner. All residents’ rooms have a lock on their door. Staff were seen knocking on residents doors before entering confirming respect for the residents individual privacy and dignity. All rooms have a telephone point from which residents can make and receive calls and private telephone lines can be installed. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents benefit from an activities programme, however further provision should ensure that individual preferences and expectations are met. Residents maintain family contact and staff encourage family and friends to join in with household activities. Relatives feel they can advocate openly on behalf of their relative. Residents receive a varied and wholesome diet that they are able to influence. EVIDENCE: The staff at the home work hard to try and ensure that residents benefit from a varied activities programme. Such activities include Bingo, reminiscence, and games. One visitor to the home conducts a weekly exercise class with the residents and three musicians visit once a month. The manager and her staff make plans for special occasions such as Halloween, Easter and Christmas, which include decorating the home, and party food. During the summer month’s residents have enjoyed barbeques in the garden. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 15 It was evident through discussions with residents and staff that further provision of activities would be welcomed. Residents told the inspector that one lady used to visit weekly and do activities such as arts and crafts but that since her retirement earlier this year she had not been replaced. Residents minutes from previous meetings were looked at and it was noted that requests were made for more trips and activities and included “outings to the Mall”, quizzes and games. One resident spoken with said that she would love to go out in her wheelchair occasionally to the local shops and around the Downs. Several residents are fortunate that they can meet with each other during the day for company and stimulation, however it was evident that staff resources limit their availability to meet and interact with residents in their rooms on a one-one to basis. One resident in particular has become isolated from fellow residents through a health condition and chooses to spend all day in their room. Staff are vigilant in “popping” in to her to check that she is ok but are limited to how much time they can spend with the resident due to their workload. Residents are supported to attend their local place of worship. Residents are free to worship as they wish and any arrangements for services or communal prayers within the home are made in accordance with residents’ wishes. As mentioned previously the residents have a monthly meeting to discuss any concerns, items of interest and any other issues. The meetings are a popular social gathering for residents and are well attended. The agenda is prepared by the manager and residents. The residents elect a chairperson; minutes demonstrated that residents are able to influence individual choices and preferences, including menu choice and redecoration in the home. The home operates an open door policy to visitors. One relative stated in their comment card, “There is a super atmosphere between residents and staff and it is a pleasure to visit the home”. The size and layout of the dining room enables residents to enjoy the social advantages of dining together. The dining room was light, spacious and the tables were attractively laid with placemats, condiments and napkins. The inspector spent time with the care staff whilst preparing lunch and inspected the kitchen and the food store area in the cellar; details of her findings are documented later in the report. The care staff are responsible for providing all meals for the residents and were able to demonstrate an awareness of individual requirements and needs of the residents, including special dietary requirements and personal preferences. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 16 Although there is a menu rota displaying traditional meals, choice is available at each sitting. One resident told the inspector that she doesn’t like meals with sauce or gravy, yesterday the meal had been chicken casserole and she was immediately offered an alternative; “How caring is that?” she said. The menus are reviewed to reflect seasonal trends and availability of produce. Staff are vigilant in trying to provide meals using fresh produce however, tinned food, frozen foods and packet mixes are relied upon to assist with managing time constraints. Frustrations are apparent in that the staff would like to make more home made lunches, puddings and cakes for the residents. Fridge and freezer temperatures were recorded regularly and the temperature of food is probed, meeting with health and safety requirements. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are robust and comprehensive policies in place to manage complaints and residents can be confident that their concerns will be listened to and acted upon. There are good arrangements in place for staff training and awareness of protection of vulnerable adults. EVIDENCE: Ashbourne House has a well-established complaints procedure that contains contact numbers and timescales for action. It is included in the residents guide and displayed on the home’s notice board. Relatives comment cards confirmed that they were aware of the home complaints procedure. Evidence must show that the policy is reviewed and up to date as it was written in 2002 and refers to the Commission for Social Care of Inspection as the National Care Standard Commission. There have been no complaints received by the home since the last inspection. Any concerns that residents or visitors may have are dealt with on the spot and recorded in the daily record and complaints log; this information is cascaded to all staff during handover time. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 18 Residents’ surveys said that they knew who to speak to if they were not happy. Residents confirmed during the inspection that they would speak to the manager if they wanted to make a complaint. One resident stated, “I’ve never had reason to complain”. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and understanding of their role in protecting vulnerable adults who live at the home. The staff attend training in the Protection of Vulnerable Adults through Bristol City Council on an annual basis. A number of staff are undertaking the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 19 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): 19,21,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Some areas of the home are not well-maintained. There are not adequate bathing and toilet facilities. The hygiene and cleanliness of the home is not adequate. EVIDENCE: The inspector had a tour of the home with the manager and examined all areas and most bedrooms. From the tour the inspector will make a number of requirements regarding the environment to further ensure the safety and wellbeing of the residents. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 20 Ashbourne House is a large listed Georgian property with many original characteristic features. The garden is accessible to a veranda with armchairs for residents to use, and enables access to the main part of the garden. The residents’ lounge and dining room are spacious, homely and welcoming, corridors and the reception hall are tastefully decorated with plush carpets. Some bedrooms had been decorated and others were in the process of redecoration. The colours used were tasteful and gave warmth to the rooms and residents had personalised their rooms with ornaments, personal furniture and pictures. However many of the rooms were in need of redecoration and refurbishment. Bedroom furniture was not adequate to provide suitable storage for residents’ belongings; consequently some rooms were cluttered which made it difficult to clean. En-suite facilities and the downstairs communal toilet were cold in appearance, dirty and in need of redecoration and refurbishment in places. The toilet pans were badly stained and it was noted that some of the plastic concertina doors to the en-suites were broken and cracked. Various areas of inadequate cleanliness were identified which included the residents’ bedrooms. These were particularly poor, very dusty and in some rooms there was a musty odour. Time constraints and staff resources also affect other house keeping duties and curtains were stained and had not been washed for some time. The kitchen, although well equipped was at best very shabby with major shortfalls in the cleanliness, fitted units and worktops were beyond repair and in need of replacing. The flooring was dirty, split in places and coming away from the floor. Much of the dirt in the kitchen is ingrained and beyond cleaning, some areas, for example the oven will benefit from a deep steam clean. The cellar accommodated several fridges and freezers to store fresh and frozen foods. Some of these were plugged into extension sockets and not directly into wall-sockets, a qualified electrician must investigate the safety of these. There was a leak on the floor coming from some pipe work and the manager was instructed to request a visit from the maintenance man to resolve this. The cellar was filthy and behind all the appliances were large mounts of dust, rubbish and dirt. As a result of the previous inspection held in December 2005 a requirement was made to refurbish the kitchen. This has not been actioned and the health safety and wellbeing of residents, staff and visitors to the home is at risk. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 21 The above are examples of what was seen during the inspection. Failures in terms of the environment are too numerous to list in this report. The organisation must urgently conduct an environmental audit of the premises and produce a plan of refurbishment and redecoration, agreed by the CSCI with realistic timescales for completion if enforcement action is to be avoided. The care staff are responsible for cleaning the home on a daily basis. Through observation and discussion with staff it was evident that they are unable to meet adequate hygiene standards due to the other tasks they must perform throughout their shifts. At present the staff are able to conduct a surface clean in most areas of the home, but have no time available to conduct deep cleaning. The homes overall appearance and size of the home suggests that relying on care staff to complete domestic duties is not sufficient to cover all areas of the home effectively and does not allow for a regular ‘blitzing rota’. The standard of the laundry service provided was not inspected on this occasion but will be examined at the next visit. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The tasks required of the care staff does not ensure that the needs of the residents, staff and home environment are being met. Additional staffing levels need to be reviewed and deployed. The home’s recruitment practices are well maintained to protect the residents. Staff training is provided to meet the needs of the residents. EVIDENCE: It was evident throughout the inspection that the staff are unable to perform their roles effectively due to the staffing levels. Major shortfalls have been identified with regards to the cleanliness in the home. Another area that shows weakness is the lack of activities, stimulation and quality time staff spend with the residents. At present seventeen residents require some assistance with all personal care including, bathing, washing and dressing. Several residents need help with maintaining adequate fluid and nutritional intake including, preparation, cutting up food, feeding and prompting. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 23 One resident needs help with mobilising and several require supervision. Residents are left unsupervised throughout the day whilst staff are making every effort to fulfil their various duties. Staff stated that they felt frustrated particularly in the mornings and that they had to rush residents’ care in order to keep up. Care staffs roles include, housekeeping duties, laundry, and cooking and domestic duty. All staff demonstrated their commitment to the residents and their loyalty to the registered provider, however their frustrations were obvious and they felt their own practice was inadequate because of their circumstances. Previous concerns were discussed and subsequent requirements/recommendations were made at the last two inspections, however additional deployment has not been provided. Consequently standards around residents’ personal care, activities/stimulation and cleanliness in the home have deteriorated. Although there are adequate numbers of staff on duty to provide care during the busiest periods of the day additional ancillary hours must be deployed. It is therefore a requirement that the registered provider urgently reassess staffing levels to ensure that staff are able to carry out their jobs effectively in order to meet the residents needs. On the second day of the inspection the inspector was informed that an ancillary member of staff had been employed on a full time basis following the concerns raised above. The staff member confirmed with the inspector that her first priority was to conduct a deep clean of the home and to develop a cleaning rota in order to maintain the desired standards at all times. Areas in the home already completed were examined by the inspector which had made a vast improvement to the overall cleanliness. Discussions with the manager confirmed that the provision of an ancillary staff member had made a vast difference. This had enabled care staff valuable time to fulfil their roles and responsibilities when delivering care to the residents. Staff stated that they were no longer rushing residents’ personal care in the mornings, residents were receiving more one to one interaction and a comprehensive activities timetable had been devised with the residents. Residents were very pleased with the outcome and were looking forward to the activities they had arranged. The inspector will continue to monitor the staffing levels with the manager to ensure that the additional ancillary provision is adequate. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 24 The recruitment process was examined and all staff records examined showed that the home follows correct recruitment procedure and policies. Records contained application forms, references, and a CRB (Criminal Records Bureau) disclosure. There is an induction programme, which covers all mandatory training, including Fire, Manual Handling, and Health and Safety. The home continues to support their staff with NVQ training and the enrolling programme continues. The manager and her staff are conscientious in attending training relevant to the care needs of the residents, including infection control and first aid. The inspector spent some time throughout the day observing staff carrying out their duties and assisting residents. Staff were respectful, warm in manner, good humoured and sensitive towards the residents. All residents spoken with expressed how wonderful the staff were. Relatives comment cards stated, “There is a wonderful friendly atmosphere and the staff and manager always make time to address visitors”. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 25 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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ needs and best interests are central to the management approach in the home. Good accounting methods are adopted and policies and procedures are followed correctly when handling residents’ personal money. The health and safety of residents, staff, and visitors will be further protected promoted, however, residents will be further protected when the water temperatures in their rooms were within the safe recommended levels. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 26 EVIDENCE: Ashbourne House continues to be well run. The manager throughout the inspection had displayed a good awareness of her responsibilities. She has worked at the home for eleven years; has completed her NVQ Level 4 in Care Management and is an NVQ Assessor. The manager has a dedicated team who work with her to try and ensure that the highest standards of care are achieved and maintained. There was a high degree of satisfaction expressed by residents, relatives and visitors who experience the services provided. Based on the comments received from residents surveys and visitors comment cards and through the inspectors observation it is evident that residents feel the home is run in their best interests to ensure their needs are being met. The Quality Assurance system has been developed since the last inspection, whereby residents have completed surveys on subjects such as, catering, personal care and daily routines. Although the information gathered could be documented to clearly identify strengths and weaknesses some of the written notes evidenced outcomes for residents who were dissatisfied and how these were resolved. As mentioned previously in the report the residents benefit from regular meetings and are also given the opportunity to discuss any concerns during the arranged care plan reviews. The policy and procedure for holding residents personal money was examined and four individual accounts were looked at. It was evident that good accounting methods are adopted which account for all transactions documented and receipts for sundries were available to see. Some of the Health and safety records in the home were examined. With the exception of water temperatures all documentation showed that relevant checks were maintained correctly and at the required intervals including fire alarms and equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, the lift, gas and electrical services. Although staff were monitoring bath water temperatures before use, random regular tests were not being conducted on water outlets in residents sinks and in the toilets. An adequate thermometer was not available so the inspector tested water temperatures with her hand. The water temperatures in some rooms were far too hot and a requirement will be issued to ensure adequate provision is made to restore safe temperature levels. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 27 The manger was asked to provide a suitable thermometer and in the interim a risk assessment must be developed for each water outlet where the water is too hot to ensure that residents, staff and visitors are safe. Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 28 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X 1 X X X X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 29 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 OP12 Regulation 16(2)(n) Requirement Ensure that residents are given opportunities for stimulation through leisure and social activities, which suit individual needs and preferences. (Partially met 09/10/06) Timescale for action 31/10/06 2. OP19 OP21 23(2) 23(2) l, j, m Following an environmental audit 31/10/06 an action plan must be sent to CSCI detailing the timescales and priority areas to: 1. Refurbish and redecorate ensuite facilities and communal toilets. 2. Repair or replace en-suite doors. 3. Refurbish and re-decorate bedrooms, replace flooring where appropriate. 4. Provide adequate storage facilities for residents’ belongings. 5. Refurbish the kitchen and replace the flooring. 6. Submit to CSCI an Action Plan as to how adequate hot water facilities are to be restored throughout the home so that needs are met and safe practice is resumed. DS0000026494.V310199.R01.S.doc Version 5.2 Page 30 Ashbourne House 3. OP26 16(2)j 18(1)a 23(2)d 4. OP38 13 (4) (c) 7. Ensure that the identified leak in the cellar is fixed. 1. Urgent provision must be made to deep clean all areas of the home. 2. Develop a cleaning rota to ensure that hygiene standards are maintained and send a copy of the rota to CSCI. (Partially met 09/10/06) Risks assessments must be completed by the manager with regards to excessive hot water temperatures to ensure residents, visitors and staff safety and a copy should be sent to CSCI 17/10/06 17/10/06 5. OP38 13 (4) (a) A qualified electrician must check 10/10/06 the use of extension leads in the cellar for safety and a report of the outcome must be sent to CSCI. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. Extracts may not be used or reproduced without the express permission of CSCI Ashbourne House DS0000026494.V310199.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!