Inspection on 17/01/08 for Ashbourne Nursing Home

This inspection was carried out on 17th January 2008.

CSCI found this care home to be providing an Good service.

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 Nursing Home 09/11/06

Ashbourne Nursing Home 05/01/06

Ashbourne Nursing Home 02/12/04

Ashbourne Nursing Home 03/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashbourne Nursing Home Ashbourne Street Norden Rochdale Lancashire OL11 5XF Lead Inspector Val Bell Unannounced Inspection 17 and 25 January 2008 10:00 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 Nursing Home DS0000017314.V351622.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 Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbourne Nursing Home Address Ashbourne Street Norden Rochdale Lancashire OL11 5XF 01706 639944 01706 860629 christinekay@btconnect.com 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) Bamford Care Limited Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 43 service users to include:up to 43 service users in the category of OP (Older People) The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 9th November 2006 Date of last inspection Brief Description of the Service: Ashbourne Nursing Home is a privately owned care home providing nursing and personal care for older people. It is situated in the village of Norden, two miles from Rochdale town centre. Accommodation is provided in 41 single and 1 double room. Nine of the single rooms have en- suite shower and toilet facilities. A large communal area provides lounge and dining facilities from which access to the garden and patio area is available. A car park provides space for 12 cars and further car parking is available in the lane at the side of the home. The home makes the following charges over and above the weekly care and accommodation fees that are listed after this section: Chiropody £ 8.00 Hairdressing £4.00 to £30.00 Newspapers as charged Weekly fees charged by the home in January 2008 are in the range of: Personal care only £339.00 to £379.90 Personal care with nursing £479.25 to £551.25 Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Site visits to the home form part of the overall inspection process and the lead inspector conducted two site visits during daytime hours on Thursday 17th and Friday 25th January 2008. The purpose of this inspection was to look at the core standards of the National Minimum Standards (NMS). This inspection will also be used to decide how often the home needs to be visited to make sure that the required standards are being met. During the visit, time was spent talking to twelve people living in the home; four visiting relatives and two relatives were contacted by telephone. Discussions were held with the manager, deputy manager, a nurse, a senior care assistant, four care assistants and laundry and kitchen staff. An Annual Quality Assurance Assessment (AQAA), which is a self-assessment document, had been completed and returned to the Commission by the manager prior to the inspection visits. Three members of staff, three relatives and six people living in the home completed and returned satisfaction surveys to the Commission. Relevant documents, systems and procedures were assessed and a tour of the home was undertaken. What the service does well: Staff working in the home, are friendly and welcoming and work hard to provide a clean, homely and safe environment for the people accommodated. Comments made by visitors and people living in the home included, ‘The staff are very welcoming and the manager is always available to talk to,’ ‘The home is spotless’ and ‘It’s the cleanest place I have ever been to.’ Equipment, décor, furniture and fittings are well maintained and at the time of the visits, bathrooms were being modernised to provide a pleasant bath-time experience for the people accommodated. People spoken to praised the standard of care provided. These are some of the comments made, ‘If I am not feeling well some days, I only have to ask and one of the staff will provide the help I need. Quite rightly though, the staff encourage us to be as independent as possible’ and ‘I get on well with staff and they provide a good standard of care for my aunt.’ Significant progress in providing an activity programme had been made since the appointment of the current manager in June 2007 and this was commended as an area of best practice in meeting individuals’ social and Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 6 personal interest needs. Regular theme nights and stimulating daily activities were being provided. The activity programme had been included on the agenda for discussion at residents meetings. The manager said that she was planning to further develop this by inviting relatives to become involved. A theme night had been provided the night before the second inspection visit and one person said, ‘We had a Burns night last night and everyone had a wonderful time.’ This was discussed with three people living in the home and they agreed that the food provided on the night was exceptional. Several people praised the imaginative and creative meals provided on these occasions and the opportunity to sample dishes from around the world, such as Mexican, Caribbean and Scottish food. The views of people living in the home are important to staff and the feedback is used to make continual improvements to the service provided. Robust systems are in place to safeguard people from harm and people spoken to said that they felt safe in the home. What has improved since the last inspection? What they could do better: One immediate requirement and nine good practice recommendations were made during this inspection. The immediate requirement related to a person admitted to the home for respite care without an assessment of need or care plan in place. It appeared that staff were relying on their knowledge of this person from previous admissions to the home. However, this did not take into account the fact that her needs may have changed since her last admission. It was pleasing to note that the required assessment of needs and care plan had been written in consultation with the individual by the time of the second days inspection visit. Four good practice recommendations related to ensuring that people had thorough assessments of need prior to admission and that care plans and the outcome of providing care was clearly recorded. Furthermore, recording the social histories of people accommodated would provide written evidence that care is provided in a person-centred way. Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 7 A minor shortfall was found in the medication records for two people receiving personal care in the home. This related to two occasions where staff had failed to sign that the individuals had been administered prescribed medication. Additionally, two medication trolleys were being stored next to a hot radiator. Medication should to be stored below 25 degrees Celsius. Medication systems should be monitored regularly so that such omissions can be detected and rectified. Two recommendations were made for staff supervisions to be recorded and for sufficient support to be provided to staff in developing their skills in writing the new style care plans being implemented. The remaining two recommendations related to ensuring that fire alarm tests were recorded weekly and to consult with people accommodated and their relatives on the quality of the laundry system in place. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashbourne Nursing Home DS0000017314.V351622.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 Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. Assessments enable decisions to be taken on whether the needs of people admitted to the home can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care records belonging to five people living in the home were examined for evidence that their needs had been assessed prior to moving into the home. Care manager assessments of need had been obtained and in-house assessments had been undertaken for four people. Staff had failed to assess the needs of the fifth person who had been admitted for a period of respite care for which she was paying privately. Staff were able to describe the needs of this person as she had been admitted to the home on previous occasions. However, individual’s needs change over a period of time and this must be assessed prior to each admission to ensure that current needs can be met. It Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 10 was encouraging that by the time of the second inspection visit the required assessment of needs had been done. This home does not provide an intermediate care service. Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. People living in this home receive a good standard of health and personal care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five care plans belonging to people living in the home were looked at for evidence of how individuals’ assessed needs were to be met. At the time of the first inspection visit, new care plans were being completed. The manager explained that she had audited existing care plans and had found that the paperwork in use did not provide staff with enough information to ensure that individuals’ assessed needs would be met adequately. Three of these care plans were in the old format and a fourth had been completed using the ‘Standex’ format. It was a cause for concern that the fifth person, admitted for respite care during December 2007, did not have a care plan in place. From conversations with staff it appeared that they were relying on their Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 12 knowledge of this person’s needs from previous admissions. An immediate requirement was issued and it was encouraging that staff had completed the required care plan by the time of the second inspection visit. The remaining four care plans lacked essential information to guide staff in meeting needs safely. For example, toileting care plans did not guide staff on how often they should encourage people to use the toilet. Moving and handling assessments needed more information on what tasks carers must undertake to assist people safely. Three care plans stated that the individuals’ needed bed rails to stop them falling out of bed. During a tour of the home it was observed that two of these bed rails had not been fitted with bumper pads to protect people from the risk of accidental injury. One of the residents told the inspector that she had refused bumper pads because they impeded her view of her television. She said that staff had talked to her about the risks involved although this has not been recorded in her care plan. A risk assessment and management plan must be agreed with this person to keep her safe. The manager could not explain why bumper pads had not been fitted to the other person’s bed rails. The third set of bed rails had been fitted with bumper pads, although the person’s care records did not contain a risk assessment for this. Furthermore, this person had suffered a recent chest infection, which may have affected his moving and handling needs. However, his moving and handling assessment had not been reviewed since November 2007. These issues were discussed at length with two nurses on duty and they confirmed that they were keen to make the required improvements. It was encouraging to note that the improvements had been made by the time of the second inspection visit. From conversations with people living in the home it was evident that staff included them in the development of their care plans. One person who had signed her care plan said, ‘I am always consulted about how my needs should be met.’ Health monitoring in such areas as pressure care, nutritional and continence needs was recorded in care records and records provided evidence that people living in the home had access to the full range of community healthcare services. Staff had developed good working relationships with healthcare professionals, such as the skin integrity nurse, diabetic liaison nurse and the Parkinson liaison specialist. A good practice recommendation was made to include clear guidance for staff in health records on the frequency of positional changes and toileting regimes for people who have been identified risks in these areas. Furthermore, it is recommended that daily records detail the actual care tasks undertaken in line with individual care plans. Medication administration was assessed for the five people being case-tracked. All medication was stored in a locked room. It was noted that the two medication trolleys were stored adjacent to a hot radiator. This was discussed with the deputy manager and a recommendation was made to monitor the temperature to ensure that it is kept below 25 degrees Celsius. Senior care Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 13 staff administer medication to people accommodated for personal care only and nurses administer medication to people with nursing needs. Medication records held for people with nursing needs were accurate and up to date. There were some gaps in records for the people receiving personal care where staff had failed to sign that they had administered the particular medication. This was discussed with the staff on duty at the time and a recommendation was made to monitor medication records on a regular basis. Controlled dugs were appropriately stored and administered and staff on duty confirmed that they had received appropriate training in medication administration. Care plans paid attention to ensuring that the privacy and dignity of people living in the home was maintained. Twelve people living in the home confirmed that staff safeguard their privacy and dignity and treat them with respect. During the two inspection visits it was observed that staff had formed good relationships with people living in the home. People using the service and their relatives made the following comments: ‘They (staff) are very good and will talk to me and put a comforting arm round me when I need it. The owner, Dr Gupta, has been especially kind. He often comes and sits with me for a conversation. He has helped me to overcome my low self-esteem.’ ‘I have recently been in hospital for an operation. I am recovering well and the staff look after me and meet all my needs. I get on well with staff; they are helpful and kind. I couldn’t wait to be discharged from hospital and get home.’ This person’s daughter was visiting at the time and said that the family had been pleased to hear this, as it was the first time that their mother had referred to Ashbourne House as home. The daughter was pleased with the quality of care provided for her mother. She added that staff keep the family informed of any concerns. ‘If I am not feeling well some days, I only have to ask and one of the staff will provide the help I need. Quite rightly though, the staff encourage us to be as independent as possible.’ ‘I get on well with staff and they provide a good standard of care for my aunt. I like the way staff took time to ask me about how Parkinson’s affects my husband. The Parkinson liaison nurse has offered to provide training for the staff here.’ Ashbourne Nursing Home DS0000017314.V351622.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. People are provided with interesting activities and a healthy and varied diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new manager appointed in June 2007 had implemented a structured activity programme based on the interests and personal aspirations of people living in the home. Stimulating and interesting activities were being provided daily and links with the local community were being made. For example, a local agency was providing training to people living in the home for them to become volunteers in the community. Computers and web cams had been provided for people living in the home, enabling them to communicate with relatives living abroad. On the second day’s visit the inspector joined three people for the midday meal. One said, ‘we had a Burns night last night and everyone had a wonderful time. A Scottish dancing group and bagpipes provided us with Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 15 entertainment. I’m Scottish and I was invited to read out a Robert Burns poem, which is traditional during a Burns night celebration. The chef prepared a traditional Scottish feast, including haggis.’ All three people agreed that the food was exceptional. Relatives also attended and a bar had been provided. This was commended as evidence of best practice in meeting diverse needs and enabling people to live their chosen lifestyles. A recommendation was made to further develop care planning to include social histories for people living in the home. This will provide written evidence of person-centred care. Two relatives made the following comments, ‘the home is always clean and the food is exceptional’ and ‘the family are always made welcome by the staff and we are offered a drink when we arrive. We have also been offered a meal on occasions.’ A full assessment of health and safety in kitchen and food stores was not undertaken as the home had received a food safety inspection in December 2007 and had been given a clean bill of health. The home employs two chefs. Two people remarked that the quality of the catering is variable depending on which chef is on duty. The manager explained that she was in the process of consulting with one of the chef’s to discontinue using tinned and packets foods. The manager explained that the second chef uses only fresh food and bakes and prepares fresh soup every day. Several people stated their preference for the imaginative and creative meals provided and the opportunities to sample dishes from around the world, such as Mexican, Caribbean and Scottish food at special theme nights. A bowl of fresh fruit is available to residents in the lounge each day. The lunchtime meal is 3-course, with a choice of starter, main meal and dessert. However, people are encouraged to ask for alternatives at any time. The kitchen was found to be clean and in good order and records required for safe food handling were in place. One of the chefs was on training on the second day of this inspection to update his foodhandling certificate. Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People living in this home are afforded protection from harm by the systems in place. Their views are listened to and action is taken to make improvements where necessary. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A suitable procedure was in place for dealing with complaints and this had been posted on view in the home. Written information detailing the facilities offered by the home, including the complaints procedure was held in each bedroom. Relatives and people living in the home confirmed that they knew who to speak to if they had any concerns or complaints. A relative contacted by telephone said, ‘Whatever you want they come and sort you out straight away.’ Two people commented, ‘I would raise any concerns I have with one of the nurses or the manager.’ Another person said, ‘ If I had any concerns I would raise the issue with staff or management and if the concerns were about staff I would speak to the owner.’ A relative had expressed concerns about deteriorating standards of care to the Commission in December 2007. At the time the complainant decided to discuss her concerns with the manager to give her the opportunity to make the necessary improvements. During a telephone conversation with the inspector the complainant explained that she had delayed approaching the manager until recently, as things had improved. However, she agreed to talk to the manager to make sure that all the issues had been resolved satisfactorily. This person Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 17 was visiting the home during the second inspection visit, when she gave the inspector feedback from her meeting with the manager. She said that she found the manager very approachable and keen to make sure that any outstanding issues had been resolved. She confirmed that things had improved and been resolved. She was confident that if she had any further concerns she could go to the manager to discuss them. Rochdale local authority’s policy and procedures for safeguarding adults from abuse had been implemented at the home and staff spoken to said they had received training in abuse awareness and the action to take if abuse was alleged or suspected. Training records confirmed this. There had been no safeguarding issues at the home in the period since the last inspection. People living in the home and visiting relatives were asked if the home protected the welfare of people accommodated. Two relatives responded as follows, ‘I’ve no worries, she’s safe and happy’, and ‘my aunt would tell me if things were not right. I visit the home regularly and have never seen or heard anything untoward. The staff are very good at making sure my aunt’s needs are met and that she is kept safe.’ Three people living in the home commented as follows, ‘I feel safe in the home’, ‘I have settled well here and feel safe and valued’ and ‘Staff are respectful. My requests are listened to and acted upon. I don’t have any complaints.’ Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This home’s environment is safe, clean and hygienic and it is maintained to provide comfort for people accommodated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On a tour of the building and external areas the home was found to be well maintained, clean and hygienic. Two relatives made the following comments, ‘It’s the cleanest place I’ve ever been to’ and ‘The home is always clean.’ The following is a comment made in a service user satisfaction survey, ‘If anything is spilt it is cleaned right away. The home is spotless.’ It was evident that a rolling programme of redecoration and refurbishment was underway. As detailed in the self-assessment document completed by the Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 19 manager, bathrooms were being updated to a high standard of décor to provide a more relaxing and pleasant bath-time experience for people living in the home. Furniture and fittings in the bedrooms belonging to the five people being case-tracked were sufficient to meet their assessed needs. One of these bedrooms was being fitted with a self-closing door mechanism to enable the person to come and go in her electric wheelchair without having to rely on staff to open and close her door. This is evidence of good practice in enabling people to maintain their independence. Bedrooms had been personalised to reflect the interests and personalities of people living in the home. The manager said that she asked families to personalise the bedroom before admission as this helped people to settle in. Two people commented that they had brought a variety of personal possessions in with them on admission. Landry staff are employed to manage the laundering needs of people living in the home. A relative commented in a satisfaction survey that her mother does not always get her clothes back from the laundry. The laundry assistant on duty during the second days visit was asked about this. She said that relatives are asked to sew nametapes into individuals’ clothes and sometimes these become detached during the laundering process. The laundry assistant keeps a clothes marker for such occasions, but it is not always possible to identify unmarked clothing. A recommendation was made for this to be discussed at the forthcoming residents/relatives forum. Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. Nursing and care staff possess the relevant skills, experience and knowledge to meet the assessed needs of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several satisfaction surveys completed in October 2007 by people accommodated in the home, relatives and staff detailed concerns in relation to staffing levels provided in the home. Staff on duty on the morning of the first inspection visit included the manager, a nurse, a senior care assistant, seven care assistants, domestic and kitchen staff, plus a handyperson. Rota’s for the previous four weeks demonstrated that these staffing levels had been maintained. This appeared to be sufficient in meeting the assessed needs of people living in the home. Conversations with people during the two days inspection visits confirmed that staffing levels had improved recently. Seven members of staff were spoken to (two nurses, 1 senior care assistant, 4 care assistants and the laundry person) during the inspection. Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 21 These seven staff agreed that they received good support from the manager. Most care staff had achieved a National Vocational Qualification (NVQ) level 2 in care. One care assistant said that she was pleased that the manager had enabled her to study towards NVQ at level 3. She had been asking for this for some time prior to the new manager coming into post. Domestic staff were able to undertake NVQ level 2 in housekeeping and nursing staff received training in line with their continual professional development needs. None of the staff spoken to had been recruited since the last inspection so it was not relevant to ask them about their experiences relating to recruitment and induction. However, three personnel files examined provided evidence that suitable recruitment procedures were in place and the ‘Skills for Care Induction’ programme was available should new staff need to be recruited. All staff spoken to confirmed that they had received mandatory health and safety update training, including moving and handling, since the new manager had been in post and other training relating to conditions associated with old age had been provided as necessary. Discussions relating to the new style care plans were held with the care assistants. They agreed that they needed more training and support to complete these to the required standard. Some good practice had been found in the nurses’ care planning skills and it was suggested to the manager that these skills could be used to support the care assistants’ skills in writing care plans. It was encouraging that staff were found to be very friendly and keen to talk to the inspector. The following is an extract taken from a satisfaction survey completed by a person recently admitted to the home, ‘If I was not happy I would talk to the sister or any of the staff who are all nice girls.’ Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. The home is being managed in the best interests of the people accommodated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current manager was appointed in June 2007. She is suitably qualified and has relevant experience of managing services for older people. The manager said that she had submitted an application to become the registered manager to the Commission in December 2007. Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 23 A common theme in satisfaction surveys completed by staff and relatives during October 2007 was related to a lack of communication between frontline staff and management. This followed a period of major change and transition from June 2007 when the current manager was appointed. It was evident in conversation with the manager that staff had been required to adjust to new methods of working and this appeared to contribute to a breakdown in communication. Conversations with staff, residents and relatives confirmed that communication within the home had improved recently. It was pleasing to learn from staff that they received good support from the manager. Resident’s meetings are held regularly and a resident’s committee has been set up. The manager said she wants to encourage relatives to participate in these meetings. This will enable people living in the home to contribute to decisions relating to the management of the home. Monthly ‘surgeries’ are held by the manager to make her available to relatives for discussions and information giving. A relative commented, ‘The staff very welcoming and the manager is always available to talk to.’ Management monitoring systems need more development, particularly in monitoring staff performance and the auditing of medication systems as discrepancies are going unnoticed (see health and personal care). Staff spoken to said that they had informal supervision and could approach senior staff at any time if they needed support. It is recommended that staff be allocated individual time in one-to-one supervision sessions and that these are recorded in writing. This will provide evidence that staff performance is being monitored and any issues addressed. It will also give staff the opportunity to receive formal feedback on their performance. During the inspection visits a relative and a resident were observed to access spending money held for safekeeping in the manager’s office. Accurate records were held and receipts were issued for money deposited and withdrawn. All transactions had been signed. A sample of health and safety records was examined. This included maintenance/servicing of equipment and fire safety records. The home’s electrical installation had been tested in 2003 and a landlord’s gas safety certificate was current. The handyperson had been trained to undertake the homes electrical portable appliance testing (PAT) and this was current. The manager confirmed that the PAT testing equipment had been calibrated on a regular basis to ensure that readings were accurate. The local fire officer inspected the home in December 2007 and had made recommendations for a new entrance door and intumescent door seals to be fitted. Door seals had been fitted and a new door had been ordered. The fire officer was due to return to the home to check that the work had been carried out to the required standard. Fire records completed by the handyperson were Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 24 examined during this inspection. The most recent fire drill had been undertaken on 27/04/07 and the emergency lighting checks were up to date. The fire alarms were last tested on 31/12/07. These should be tested weekly. A detailed fire risk assessment was in place dated July 2007. Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 25 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 People accommodated in the home must have up to date care plans in place that detail how their assessed needs are to be met in a safe way. Timescale for action 19/01/08 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 OP3 Good Practice Recommendations The registered person should ensure that needs are assessed prior to people being admitted to the home. This will ensure that the service will be able to meet individual’s current needs. Care plans should detail clear guidance for staff in health records in relation to the frequency of positional changes and toileting regimes for people who have been identified risks in these areas. Daily records should detail the actual care tasks undertaken in line with individual care plans. This will DS0000017314.V351622.R01.S.doc Version 5.2 Page 27 2. OP8 3. OP8 Ashbourne Nursing Home provide written evidence of how individuals’ assessed needs are being met. 4. OP9 Medications systems used within the home should be monitored regularly to ensure that people are receiving the correct medication as prescribed by their doctors and that medication is stored at the appropriate temperature. Care plans should include the social histories of people living in the home. This will provide written evidence of person-centred care. People living in the home and their relatives should be consulted on the most appropriate way to mark clothes to prevent them going missing during the laundering process. The registered person should ensure that all members of staff receive sufficient support to ensure that they are competent and confident in completing the new style care plans being implemented. Individual time should be allocated to staff in one-to-one supervision sessions and these should be recorded in writing. This will provide evidence that staff performance is being monitored and give staff the opportunity to receive formal feedback on their performance. Fire alarm tests should be carried out and recorded each week to ensure that the system is in good working order and that people living and working in the home will be safe in the event of a fire. 5. OP12 6. OP26 7. OP30 8. OP36 9. OP38 Ashbourne Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Nursing Home DS0000017314.V351622.R01.S.doc Version 5.2 Page 29 - 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. 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