CARE HOMES FOR OLDER PEOPLE
Ashbourne House 147/149 Gatley Road Gatley Stockport Cheshire SK8 4PD Lead Inspector
Kath Oldham Unannounced Inspection 6th December 2005 08:10 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 DS0000008537.V270351.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 DS0000008537.V270351.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ashbourne House Address 147/149 Gatley Road Gatley Stockport Cheshire SK8 4PD 0161-491 1201 0161 491 1201 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) Casequest Limited Mr. Martin Sorrell Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 23 OP. Date of last inspection 12th July 2005 Brief Description of the Service: Ashbourne House is a 23-bedded care home for older people, situated close to Gatley village. Public transport and the motorway network are within easy reach of the home. The accommodation within the home consists of 19 single and two shared bedrooms. There are four domestic size lounges and a large dining room. There are televisions in three of the lounges. The fourth lounge acts as a quiet reading/visiting room. There is a loop system available for service users who are hearing impaired. The dining room overlooks a well-established, enclosed garden where seats/ chairs are available for service users and their visitors. The home also provides a small, purpose-built, domestic size, kitchen in addition to the central kitchen used to cook meals for the service users. The small kitchen is available for service users and their visitors to make hot drinks. There is a multi-purpose function room for hairdressing, chiropody and other consultations. The hairdresser visits the home on a weekly basis. Within the same room there is a public telephone available to service users. Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the day on 6th December 2005. The inspection focused on the past requirement and recommendations to see how the home had developed. The pharmacy inspector also attended the inspection where she undertook a thorough inspection of the administration, storage and recording of medication. The pharmacy inspector’s comments are included in this report. Time was spent in conversation with the manager and the deputy and the examination of records which the home is required to keep. Comment cards were left at the home for distribution to service users and their friends, relatives and visitors. The comments received are also included in this report. The majority of the standards were assessed on the inspection undertaken in July 2005 and were reported on at that inspection. Readers are referred to the previous inspection to get a fuller picture of the overall running of the home. What the service does well:
Service users continue to be at the forefront of the service provided at the home. Some service users have been at the home for a number of years and are happy with their lives. Service users said they were looking forward to Christmas and the celebrations organised by the home. The home has a happy atmosphere and a number of service users actively contribute to the inspection process through conversation and the completion of comment cards. All comment cards received that made comment were positive about the care service users receive and the staff team. Visitors and relatives’ comment cards made reference to the home being happy and the staff being welcoming. One comment card said they look forward to coming to visit their cared for relative as staff make them feel so welcome. Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection?
Reminiscence sessions take place each week with service users talking about past times and events and how this had shaped their lives. The manager said he uses the opportunity of the get together to discuss topics with service users and develop the service provided. It was reported that these topics include the menu, food and entertainment. Every other week an art and craft session is arranged by an external facilitator. Knitting, flower arrangement and arts and crafts are just some of the activities service users take part in. A new television has been purchased for the front lounge, which provides improved viewing for service users. Further bedrooms have been redecorated and another bedroom had been totally refurbished prior to a new service user coming to live at the home. The bedroom has been redecorated, new carpeting had been fitted and new furniture purchased. Service users commented on being comfortable in their bedrooms. One of the bedrooms has had a new window fitted to improve the appearance of the room and provide better draught proofing. The home has been awarded the Environmental Health food safety award again, which provides the staff with some recognition of the work that they have achieved. The award is given after a series of inspections over the 12month period to establishments that meet the required standard. The home has also been awarded the Heartbeat award, which is also certified through the Environmental Health department; this award looks at the content of the food and concentrates on healthy menu options. The service users’ contract has been amended to include their right to complain directly to CSCI and references to the local authority and other out of date information has been updated which ensure service users have the correct information about their rights and choices. Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 7 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 DS0000008537.V270351.R01.S.doc Version 5.0 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 DS0000008537.V270351.R01.S.doc Version 5.0 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 Service users are provided with sufficient information to inform them of the terms and conditions of residency. The assessment process provides assurance that service users’ needs can be met by the home. EVIDENCE: The care files examined contained a contract from the placing local authority and, for private service users, a terms and conditions from the home. For service users who have no next of kin or key relative, there was evidence that the service user’s solicitor had seen the terms and conditions of residency. Service users’ files contained an assessment undertaken by the placing local authority social worker; an initial referral form was completed by the home, which was supplemented by the home’s assessment of the individual and their needs and abilities. Ashbourne House DS0000008537.V270351.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&9 Service user care plans were not sufficiently detailed. Procedures for administration, storage and recording of medication need to be improved. EVIDENCE: Examination of care plans identified a care plan format, which included day and night time needs. The format detailed the aims and objectives and desired outcome, and the care staff instructions to achieve the aims and objectives. A daily care plan details comments from staff on the support and interventions provided. Some of the care plans did not record that a review had been undertaken of the care since August 2005. Others were recorded as having been reviewed most recently in October 2005. The manager said all care plans are reviewed and updated monthly or more frequently if service users’ care needs change. A service user whose health care needs had deteriorated did not have an up to date care plan. It was therefore not possible, through examination of the records, to know what care and support interventions were being provided.
Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 11 Staff were aware of the service user’s care needs and described the changes and additional support the service user was receiving. Service users said they were well cared for and were looked after. A service user said the home calls the doctor if they are unwell and take them to hospital appointments. One service user said they had repeated doctor consultations, which were organised by the manager to just make sure everything was all right and they were improving. A further service user commented on wanting to see a particular doctor and was confident the manager had this in hand. Risk assessments were in place for specific service users. The record was not dated and didn’t indicate whether the risk had been reviewed or if there were any changes. Service users were not recorded as having been weighed since October 2005. The manager said that there should be a record for November 2005. This could not be located. The weights of service users are currently maintained in a weight book, with everybody’s weight detailed on the same page. This detail would be better placed within individual service users’ care files. A service user said they eat so well they keep the same weight or put on a pound or two. The home has produced a good medication policy but must ensure that its contents are reflected in actual practice. The storage of medication at the home was found to be poor and the home must initiate regular checks to reduce possible risk to service users. Evidence of good practice was seen in medication administration records and administration procedures but some improvements are necessary. All staff members involved in medication administration had not been provided with appropriate medication training. Ashbourne House DS0000008537.V270351.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): These standards were not assessed at this inspection. Readers are referred to the previous inspection report of July 2005 when these standards were reported on. EVIDENCE: Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 13 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 & 17 Service users are able to raise any concerns within the home and receive an appropriate response. Service users have their legal rights protected and are enabled to participate in the political process if they wish. EVIDENCE: Examination of the comments and complaints book found service users’ comments in relation to specific aspects or problems they have had. The record detailed the action taken by the home to remedy the comments. The record demonstrates that the home takes service users’ views and opinions seriously and the action taken to develop the service they provide at Ashbourne House. Service users said if they have any comments or suggestions to change things, they have only to mention this to the manager, the owner, who comes in daily, or to one of the staff and things are sorted. Service users said they had never made complaints as such, but if they were not happy with something someone was doing or if they didn’t like something they would let the manager know. All service users are registered to vote, the majority of them have been registered for a postal vote. Advocacy services can be made available to service users through Age Concern. Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 14 Families are actively involved with service users who are residing at Ashbourne House. Some service users have legal representatives. No evidence was identified at this inspection to indicate that any service users had their legal rights infringed. Ashbourne House DS0000008537.V270351.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): These standards were not assessed at this inspection. Readers are referred to the previous inspection report of July 2005 when these standards were reported on. EVIDENCE: Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 16 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): These standards were not assessed at this inspection. Readers are referred to the previous inspection report of July 2005 when these standards were reported on. EVIDENCE: Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 17 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): 35 & 38 The home is run in the best interests of service users, whose financial interests are safeguarded by the home’s procedures and practice. EVIDENCE: Examination of the records maintained of service users’ personal monies identified that receipts were in place for any purchases made on behalf of service users. A balance was indicated within the records and details of monies paid in were clearly detailed. The manager does not act as an agent or appointee for any service user at present. Secure facilities are available for the safekeeping of money and valuables if this is needed. Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 18 Examination of the fire safety records identified the checks were undertaken at the regularity required by the fire authority. It was reported that all staff had received practical fire drill or practice, which is scheduled six monthly. Staff do not currently sign the fire register to confirm receipt of this training, which is best practice. Staff spoken to were aware of what to do in the event of an emergency. The manager said that an individual record is kept of staff attendance at fire training, practice and drills within their personal files. Accident recording detailed two service users who had experienced an accident since the last inspection. The record was completed fully, however was not maintained in keeping with data protection legislation. A separate record is kept of incidents and occurrences. Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 19 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 20 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 15 Requirement The registered person must further develop the care plan to include all areas of the assessment and the standards. (Timescale of 1/10/05 not met). The registered person must ensure that an accurate dated record is maintained of all medication received, administered or disposed of by the home. These records must be signed at the time of completion. The registered person must ensure that if the prescriber amends the dosage of medication, the current record is discontinued and a new record is commenced. If the new record is handwritten, it must be signed and dated and the details validated by an additional member of staff. The registered person must ensure that monitored dosage systems received by the home are appropriately labelled with a description of medication contained.
DS0000008537.V270351.R01.S.doc Timescale for action 31/03/06 2 OP9 13(2) 17(1)(a) 09/01/06 3 OP9 13(2) 17(1)(a) 09/01/06 4 OP9 13(2) 09/01/06 Ashbourne House Version 5.0 Page 21 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. 5 Standard OP9 Regulation 13(2) 13(4)(c) Requirement The registered person must ensure that medication in the custody of the home is stored securely and is not accessible to unauthorised persons. The registered person must ensure that medicines that require refrigeration are stored at a safe temperature. The registered person must ensure that all items of medication which have exceeded their expiry dates, do not belong to current residents or are not labelled with prescribed directions are returned to the supplying pharmacy. The registered person must investigate the discrepancy in the controlled drugs register and record the outcome on the appropriate page in the register. The registered person must ensure that all staff members employed by the home, with responsibility for medication administration have received appropriate training and administer medicines using a recommended procedure. Timescale for action 19/12/05 6 OP9 13(2) 09/01/06 7 OP9 13(2) 09/01/06 8 OP9 13(2) 17(1)(a) 09/01/06 9 OP9 13.2 06/03/06 Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 22 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 OP7 Good Practice Recommendations The registered person should arrange for all service users to be weighed at a minimum of monthly, or more frequently if their health care needs dictate, and that a record is maintained of the weights within individual care files. The registered person should ensure that risk assessments are dated and that the content is recorded as having been reviewed at a maximum of monthly or more frequently, as is identified within the risk assessment. The registered person should ensure that the section of the medication policy referring to the administration of non-prescription medication is re-written in line with current guidance. The registered person should ensure that the directions of medication prescribed as ‘as directed’ are clarified with the service user’s General Practitioner and the prescriptions altered accordingly. The registered person should ensure that photographs of service users used for identification purposes are fixed permanently to a named document. The registered person should ensure that the medication administration record charts of those service users who self-administer medication are annotated to show that this is the case. The registered person should liaise with the supplying pharmacist to ensure that all medication received by the home is labelled on both the inner container and the outer box. The registered person should ensure that the date of opening is recorded on all items that have a limited shelf life once opened, to ensure that the health of residents is not put at risk by the administration of expired medication. The registered person should ensure that medication storage areas are used solely for the storage of medication. 2 OP7 3 OP9 4 OP9 5 6 OP9 OP9 7 OP9 8 OP9 9 OP9 Ashbourne House DS0000008537.V270351.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 10 11 12 Refer to Standard OP33 OP38 OP38 Good Practice Recommendations The registered person should record the content of discussions and meetings with service users. The registered person should arrange for staff to sign next to their printed name in the fire safety records their attendance to fire drill training/practice/drills. The registered person should arrange for accident records to be maintained and retained in line with data protection legislation. Ashbourne House DS0000008537.V270351.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
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