Random inspection report
Care homes for older people
Name: Address: Ashbourne House Nursing Home 376-378 Rochdale Road Middleton Manchester Lancashire M24 2QQ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lucy Burgess Date: 2 9 1 0 2 0 0 9 Information about the care home
Name of care home: Address: Ashbourne House Nursing Home 376-378 Rochdale Road Middleton Manchester Lancashire M24 2QQ 01616432060 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Silverdale Care Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 29 Number of places (if applicable): Under 65 Over 65 0 29 dementia old age, not falling within any other category Conditions of registration: 29 0 The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE. The maximum number of service users who can be accommodated is: 29. Date of last inspection Brief description of the care home Ashbourne House Nursing Home is a converted and extended home located a short distance from the centre of Middleton, owned by Silverdale Care Homes Limited.
Care Homes for Older People Page 2 of 12 Brief description of the care home The home is registered to care for up to 29 people with personal care needs, nursing needs and those with dementia. Accommodation is provided over two floors, the majority of it on the ground floor. Part of the first floor of the building is not available to residents because of structural defects that are being repaired but repairs have not yet been completed. The range of fees at the time of our key inspection were 347.71 pounds to 460.32 pounds per week. Additional charges are made for Chiropody and Hairdressing Care Homes for Older People Page 3 of 12 What we found:
We conducted this Random Inspection as a result of completing an Annual Service Review. The information we received at that time indicated that, the outcomes for people at Ashbourne Nursing Home had changed. We also wanted to follow up on progress in relation to the requirements and good practice recommendations made at the last Key Inspection in May 2008. An action plan had been received from the manager in September 2008 stating what action they intended to take. This stated that a renewal and refurbishment plan was being completed, the statement of purpose and service user guide were being updated and that quality monitoring systems were being implemented with regards to recruitment and practices within the home. Copies of the plan and guides would be forwarded to us on completion. These were not provided. To complete this inspection we carried out a site visit. Time was spent with the manager discussing each of the issues raised. We also spent time looking at care records, the environment, staffing arrangements, medication management, hygiene and recruitment. Care records were looked at for one person where there had been on-going health concerns. The care file was found to be orderly and included personal details, risk assessments, a care plan, professional visits and progress charts. Additional records were held separately with regards to personal care, dietary intake and medication. Whilst the assessments and plan had been updated there was no plan with regards to the persons specific health care needs detailing the current intervention being made by staff and health care professionals. The medication system was looked. We found items such as cream were stored in individual bedrooms so that they could be applied by care staff when needed. Seperate records were completed by carers to show that this had been done. On examination of some of the records administration had not been signed for approximately 3 days. Items were also not being stored safely and could easily have been accessed by anyone entering the bedrooms. All other medication is administered by the nursing staff. These are stored securely in the treatment room. Controlled drugs were looked at and found to be in order. Records corresponded with stocks held. Other items were stored in the medication trolley with additional stocks in a lockable cupboard. The trolley was tidy and blisters packs were colour coded to correspond with the time of administering. A large number of items were being stored in the stock cupboard. Some stock had not been rotated or returned to the supplying pharmacist. A large number of supplements had also been stored away however were unlabelled so it was unclear who they had been prescribed for. Medication records were also examined. There were several gaps noted, written entries had not been countersigned and some of the codes used had not been explained to show why items had not been administered. Care Homes for Older People Page 4 of 12 Whilst looking at that environment we found that requirements had been addressed with regards to the sluice area. However additional work needed in the home had not been addressed. A number of bedrooms were looked at as well as communal areas. Rooms appeared tired and in need of cleaning and redecoration, furniture items also needed replacing. Several bedrooms as well as communal areas within the dementia unit had a malodour. The upstairs bathroom was still incomplete. We were told that work in this room had commenced in 2008 however the bath or shower had yet to be fitted, the flooring had not been layed and the toilet could not be used. One of the bedrooms, room 10, was also being used to stored unwanted items, ie: old beds etc. This was very cluttered and needs to be emptied. New vanity units had been fitted in a few bedrooms however they had not been sited properly and sealed. The handyman working at the home only works 15 hours per week. Due to the work required within the home it was not felt that this was not feasible by the handyman alone. It was also noted that that information regarding staff training, vacancies, rotas and messages were displayed around the home particularly in the main hallway. The nursing station is also open to the hallway. This offers little privacy with regards to the storing of records or when making telephone calls about people within the home. Daily records were not being stored properly ensuring confidentiality. Files had been left in one of the lounges and the unused nursing station on the dementia unit. These records are confidential and should be stored away safely. Staffing arrangements were looked at. The manager explained that there had been a number of staff changes over the last year. A number of new nurses and carers had been employed. At present the manager was trying to recruit 2 new carers to replace 2 staff who are leaving and 2 part time housekeeper as the existing housekeeper is now working as a carer. Recruitment files were looked at for 3 of the new staff. Two had been recruited by the manager and the third had been employed by the Provider at one of the sister homes and had recently transferred to Ashbourne. Information on file included an application form, written references, copies of identification, terms and conditions, POVA first and/or criminal record check (CRB) and health declaration. We did however find shortfalls. One file did not have a second written reference from the person last employer and they had commenced work prior to their POVA or CRB check having been received. On a second file both references had been provided by the persons mother and a friend, they too had commenced work prior to their POVA or CRB clearance being received. Other records seen no two files were a one day induction checklist however these had not been signed off by the manager and only one person had received a supervision session. Health and safety checks were also examined. Information was looked at with regards to the annual servicing of the fire system, electric, gas, hoists, passenger lift and small appliances. Whilst some records were available there were no up to date checks for the emergency lighting, passenger or electric circuits. This had been a requirement made following our last visit.
Care Homes for Older People Page 5 of 12 What the care home does well: What they could do better:
The manager has now been in post for sometime. It was acknowledged in the homes action plan dated September 2008 that application to register with us was in the process of being completed. However this has yet to be done. Application now needs to be made to us without further delay. Information detailed within care files needs to expanded upon so that information reflects the current and changing needs of people. Where specific areas of concern have been identified a seperate plan needs to be provided showing how the person is to be supported and any intervention being made. The medication systems needs to be looked at. The manager should ensure that all medication held at the home are done so safely. Items which are unlabelled or no longer required should be returned to the supplying pharmacy ensuring good stock rotation. Accurate records also need to be maintained ensuring people receive their prescribed medication safely. Following our last visit we requested a refurbishment plan The provider and manager are again requested to provide with timescales for completion so that people living at the standard of accommodation. This will be monitored to see however this was not provided. a refurbishment plan along home are provided with a good what progress is being made. The manager must also ensure that their are sufficient ancillary staff on duty at all times so that hygiene standards within the home are improved. Recruitment practice needs to be improved. The provider and manager must ensure that anyone who is offered work with the organisation does not commence their employment until 2 satisfactory written references have been received, from appropriate parties, as well as a POVA first check or Criminal Record Check (CRB) ensuring the safety and protection pf people who live at the home. All new staff must complete a skills for care induction ensuring they are fully aware of the policies and procedures within the home so that they can carry out their duties safely. All staff must receive a minimum of six supervisions per year so that they are provided with clear direction and support in carrying out their role ensuring their continuous development. Where staff have changed roles, the manager must ensure that they have received all necessary training and have the knowledge and skills needed to carry out their duties safely ensuring peoples needs are met.
Care Homes for Older People Page 6 of 12 More suitable arrangements need to be made with regards to sharing information with staff. Posters and documents displayed within the hallway and nursing station should be kept private ensuring confidentiality is maintained. The manager must provide us with copies of up to date servicing to the emergency lighting, passenger lift and electric circuits ensuring systems within the home are well maintained and people are not placed at risk of harm or injury. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 19 23 (2) A programme to detail the 30/06/2008 maintenance and the renewal or replacement of fabrics and the timescale for completing the decoration of the home must be forwarded to the Commission of Social Care Inspection. The registered person must 12/06/2008 obtain two written references for new staff employed to protect the residents An application for a 30/07/2008 registered manager must be submitted to the Commission of Social Care Inspection so that they are assured it is being managed by someone competent to do so. The Registered Provider must 30/06/2008 provide a written report of an unannounced visit to the home each month and forward a copy of the report to the Commission of Social Care Inspection 2 29 19 (1)(c) Schedule 2 3 31 8 4 33 26 Care Homes for Older People Page 8 of 12 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 12 Information detailed within the care files must be expanded upon so that information reflects the current and changing needs of people so that the health and well being of people is not affected. 30/12/2009 2 9 13 Items of medication which 30/12/2009 are not labelled for the person they are intended for must be returned to the supplying pharmacy ensuring people are only given items which are clearly prescribed for them. The manager must ensure 30/12/2009 that medication which is currently required is kept at the home. Unwanted items should be returned to the supplying pharmacy ensuring good stock rotation so that people only receive medication for which they have been prescribed.
Page 9 of 12 3 9 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 4 19 23 A refurbishment plan must 30/12/2009 be provided detailing all areas of work required within the home along with timescales for completion. This is to ensure that people are provided with a good standard of accommodation in which to live. The manager must ensure sufficient ancillary staff are provided at all times so that hygiene standards are improved as well as minimising the risk of cross infection. 30/12/2009 5 27 23 6 29 19 The manager must ensure 30/12/2009 that new staff do not commence their employment until all relevant information and checks have been received ensuring staff working at the home are fit to do so. The manager must make 30/01/2010 application to register with us without further delay so that the home is provided with competent leadership and direction. The manager must provide us with copies of up to date servicing certificates for the passenger lift, emergency lighting and gas supplying 30/12/2009 7 31 9 8 38 23 Care Homes for Older People Page 10 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action ensuring systems are well maintained and people are not being placed at risk. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 Where codes have been used to record medication not administered these should be explained so that the needs of people can be accurately monitored. Handwritten entries on the medication administration sheets should be checked and countersigned ensuring the information recorded is correct. Where staff have changed roles, the manager must ensure that they have received all necessary training and have the knowledge and skills needed to carry out their duties safely ensuring peoples needs are met. All new staff must complete a skills for care induction ensuring they are fully aware of the policies and procedures within the home so that they can carry out their duties safely. All staff must receive a minimum of six supervisions per year so that they are provided with clear direction and support in carrying out their role ensuring their continuous development. More suitable arrangements need to be made with regards to the sharing and storing of information so that records are held securely and confidentiality is maintained. 2 9 3 30 4 30 5 36 6 37 Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - 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!
