Inspection on 18/06/07 for Ashbourne Residential Home

This inspection was carried out on 18th June 2007.

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

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

Other inspections for this house

Ashbourne Residential Home 29/11/07

Ashbourne Residential Home 24/07/06

Ashbourne Residential Home 11/10/05

Ashbourne Residential Home 20/04/05

Ashbourne Residential Home 20/01/05

Ashbourne Residential Home 12/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Ashbourne Residential Home Lightwood Road Dudley West Midlands DY1 2RS Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 18th June 2007 07:40 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 Residential Home DS0000024969.V333538.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 Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbourne Residential Home Address Lightwood Road Dudley West Midlands DY1 2RS 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) 01384 242200 01384 231407 Southern Cross Care Centres Limited Mrs Ann Margaret Gomersall Care Home 38 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (26) of places Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That no more than 2 persons who are wheelchair users are accommodated (rooms 30/34) within the additional 10 places. That the additional staffing resources be secured prior to any service user being admitted. One service user in the category of OP may also be A(E). This will remain until such time that the current service users placement is terminated. One service user with sensory impairment elderly SI(E) to be admitted. This wil remain until such time that the current service users placement is terminated. 24th July 2006 Date of last inspection Brief Description of the Service: Ashbourne care home is a detached property. It is situated off the main Sedgley to Dudley Road. The home is located in a residential area. It is close to a main bus route and a number of small shops. The home has large gardens to the front and rear and a car parking area. Since the last inspection the home has refurbished one unit in the home to care for residents who have dementia. The home is now registered with the Commission for Social Care Inspection (CSCI) to provide care to Twenty-six residents falling within the category of Old Age and twelve residents who have a diagnosis of dementia. The home comprises of two floors. Communal space is on the ground floor offering a number of different lounges and a dining room. The ground floor houses the reception area, a number of bedrooms, bathing facilities, the main office, the kitchen, laundry and toilets. The first floor accommodates bedrooms, toilets and bathing facilities. The staff group comprises of a manager, deputy manager, seniors and care assistants, a handyperson, an activities co-ordinator, catering, laundry and domestic personnel. Weekly fees for this home range from £ 343- £491. 07 ( Highest rate for self funder). There are additional costs as follows; chiropodist £8 and hairdresser set £5, perm £15 and cut £5. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. I carried out this unannounced key inspection on one day between 07.40 and 19.00 hours. I carried out most of the inspection in lounge areas where I could observe routines, meals and involvement between staff and service users’. Before the inspection I sent questionnaires out to be completed by the manager, service users’ and relatives’ to give me information about the service provided by the home and the views of some people involved with the service. During the inspection I spoke with two staff, two relatives’ and six service users’ who gave me information and shared some of their views on the home with me. I looked at three service user files to assess assessment of need processes and care delivery. I looked at four staff files to assess recruitment processes, supervision and training received. I looked at records concerning health and safety and equipment service records. I looked at medication systems to assess their management and safety. I observed part of the breakfast and lunchtime on the dementia unit. I randomly looked at the premises which included the; laundry, four bedrooms, living areas, dining rooms, garden on the dementia unit and bathrooms and toilets to assess infection control processes. What the service does well: The home is owned by an organisation that has numerous other homes’ and is therefore able to offer support and guidance at a local and national level. The manager has been in post for some considerable time offering stability to the home. She is at the present time working to achieve her Registered Managers Award. Fifty five percent of the care staff team have achieved NVQ level 2 or above in care which means they have been assessed as competent to carry out their work. Staff I observed during the inspection were kind and caring. They worked very hard. Visiting times are open and flexible. Service users’ are encouraged to maintain contact with family and friends. I received positive comments about the home from completed questionnaires and from talking to people as follows; “ My last home was not as good”. “ Staff Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 6 always give me full support”. Been here for five years, am happy”. “ Nice here”. “ Think it is very good”. Questionnaires asked relatives to give their view on the areas they think the home does well the following comments were received; It treats all residents with respect and dignity that they deserve and show concern for all. Makes relatives feel welcome at all times and encourages visiting at any time of the day. Always has a nice homely atmosphere. As is meant to care for and provide what is required. What has improved since the last inspection? What they could do better: Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 7 I identified that the care plan of one service user admitted back from hospital had not been adequately reviewed potentially placing her at risk. I identified concerns about shortfalls in the identification of risk in terms of pressure sores and dehydration regarding two service users,’ one of whom is no longer at the home. Triggers are not place for staff to know when to alert management if they identify a concern or risk and for appropriate processes to be put in place to reduce risks to prevent the health, welfare and safety of services users being compromised. I identified that medication systems have improved but still need further improvement particularly in the area of counting and recording medication being received by the home. Activity provision within the home must be addressed to ensure that it fully meets the recreational and stimulation needs of each service user. All complaints received by staff should be referred to the management team immediately and dealt with appropriately. Staff must all be fully conversant with protection processes to ensure that service users’ are safeguarded. A review of staffing levels must be carried out. Staffing levels on the dementia unit must be maintained to two at all times. Cover must be available for break times. Questionnaires asked relatives to give their view on the areas they think the home could do better the following comments were received; It would help if there was a nicer place to sit outside with relatives or to push them around the garden, also if the car park was bigger. Needs an activity person as soon as possible to help stimulate residents. The last person left last year although they have tried to get someone it has not materialised. I do not think it is being treated as priority. 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 Residential Home DS0000024969.V333538.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 Residential Home DS0000024969.V333538.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): 1,3. Quality in this outcome area is Good. Prospective service users’ have the information they need to make an informed choice to weather the home will be suitable for them. No service user moves into the home without having had their needs assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I saw that a range of written materials were available in the front entrance hall including the service user guide and information about the home’s organisation. I used questionnaires to help me gain views of a number of service users’ before the inspection. Thirteen of thirteen responses from service users’ confirmed that they were given enough information prior to their admission to help them make the decision about the home’s suitability for them. Comments received included;” I was offered a full day”, “ Came for the day”. “ My last home was not so good”. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 10 This evidence indicates that processes such as giving information and allowing service users’ to experience the home first hand shows that the home does try to ensure that service users’ are equipped with information or insight to enable them to decide if the home will be right for them. On each service user file that I looked at I saw written evidence to confirm that an assessment of need had been carried out before the service users’ were offered a placement. Information from funding authorities had also been obtained to help the home decide if they could meet the needs of these proposed service users’. Ashbourne Residential Home DS0000024969.V333538.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): 7,8,9,10. Quality in this outcome area is Poor. Fairly comprehensive care plans are in place for each service use but these are not always reviewed when changes occur potentially placing service users’ at risk. I identified omissions in the health care delivery of two service users’ which had seriously compromised their health and well-being. Generally, medication systems are adequately managed however, a number of shortfalls were identified which need to be addressed to prevent risk to service users’. Service users’ are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I looked at three service user files and saw that a care plan was in place for each. It was reassuring to see that one of these care plans was for a newly admitted service user who had been admitted for a short stay, showing that care plans are produced for all service users’ regardless of the time they are to spend in the home. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 12 The care plans that I saw were detailed and covered most risks, needs and wants. I did note for the new service user admitted onto the dementia unit that although needs such, as personal hygiene and falls were included in her care plan there was no reference to needs concerning her dementia which could prevent appropriate care being provided. I identified that care plan reviews are not always being carried out as they should. For example; one service user had been admitted back from hospital. I saw that this person looked very frail and of a small build. I looked at this person’s records and saw evidence to confirm that she had been very frail and at risk nutritionally and in respect of tissue breakdown before she went into hospital. On return from hospital her risk assessments showed that she was even more at risk yet, these increased risks had not been highlighted into a revised care plan. For example it was apparent that this person had lost weight; March 07, 51.1 Kg, May 07, 44.2 kg, June 2007, 43.8 kg yet her care plan reviews just said; 20.4.07 has lost 3.7 weight ( same as when came in ). Care team monitoring diet and weights. On return from hospital where she had lost more weight her care plan updates 20.5.07 and 7.6.07 just said; ‘No changes continue with care’. I saw that processes and tools are in place to identify and reduce risks in all areas, which is positive. However, staff are not always using these tools properly. Where risks are identified they are not reporting these or putting into place practices to manage or reduce risks that they have identified. I saw written evidence to prove that risk assessments had been carried out for the service user returning from hospital, which is positive. But the opportunity to put processes in place to reduce the high risks identified had been missed in some areas. For example; her tissue viability risk assessment had risen from 10 on 14.4.07 to 16, 20.5.07 but a pressure, relieving mattress had not been provided which may have prevented the breakdown of skin which did occur after this risk assessment was carried out. On 30.4.07 when she was admitted back from hospital rightly so, staff had assessed her and recorded that she had a bruise on her left wrist and also right lower arm, however; notes did not make reference to any pressure sore. Records show that her skin broke down after this time as per an entry made on 1.6.07; “ Rang DN today about sore on bum.” This sore still needed attention a week after as per entry made on 4.6.07 “ Dressing”. 7.6.07; “ DN has been out to put dressing on bum”. Even after this breakdown of tissue had occurred a pressure relieving mattress still was not provided on this person’s bed. This omission I witnessed my self during the inspection on 18.6.07. I looked at this person’s bed and there was no pressure-relieving mattress. Similarly, weights recorded as detailed in the previous paragraph show that this person lost significant weight but records I read did not confirm that new concerns about weight loss had been referred to her doctor or a dietician. Further, although staff had put this person on a food and fluid recording chart management were not informed of days when fluid intake was poor. For example; records for the 13.6.07 showed that she had five drinks, but there were long gaps between mid afternoon and supper when there was no Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 13 evidence that she had a drink. Similarly, there was no evidence that she had a drink between supper and breakfast time the following morning. On 16.6.07 records show that she only had four drinks in a 24 hour period which, should have alerted staff that this service user could have been at risk from dehydration. There were no records to confirm that staff had identified any concern. Fortunately, for this person there was no evidence of diagnosed dehydration. Which, may mean that drinks were given more frequently, but staff were not recording these as they should have done. However, for another service user who no longer lives at the home this was not the case he did become dehydrated. When his health deteriorated, records showed poor fluid intake for example; between mid- night on 7.4.07 and 15.00 hours on 10.4.07 he only took approximately 1,800mls of fluid , which is less than a person should consume in a day to be free from risk of dehydration. I was further concerned when I read records for this service user to determine that a doctor was not called even though the family conveyed their concerns and there were delays in getting the doctor another day although it was clear that his condition had changed as follows; 8.4.07 “ .. telephoned today suggesting that we admit .. to hospital with the intention of having IV fluids. .. stated that she had been awake most of the night and was very concerned about.. health. Gave reassurance that if .. had not improved or that if there was further deterioration emergency GP would be requested. .. Has appeared bright today. He has interacted well with staff. Taken fluids well .. 10.30 telephoned wife and informed her about condition.. would continue to monitor and that if deterioration GP would be called. 12.30 .. is now in wheelchair.. appears to have lost a little of his co-ordination. ..is attempting to fed his self but appears not to be coping. At 12.45 … sister visited advised of .. condition ..? TIA. 2.30 visited by .. although .. is a lot better .. still concerned that he did not recognise her. .. stated she felt ‘ better today” as .. appeared better. 9.4.07 at 7.30 this morning found.. on the floor, checked over for any mark or cuts none at present. 9.4.07 .. Remains the same refused fluids this morning. 9.4.07 DN visited today.. bit more fluid today. 10.4.07 night report … Refused to drink. 10.4.07 On close observation ..this morning I noticed deterioration so I called GP out , the doctor came and stated he was dehydrated, admitted to hospital. With the changes recorded over previous days and the poor fluid intake records it is clear that the doctor should have been called at least on 8.4.07. I told management about my findings and concerns as soon as I identified them and issued an immediate requirement for improvements to be made. Management responded by the time the inspection ended by giving me a written action plan informing me what they would do to prevent future omissions of this kind. Before the inspection concluded management told me that a full review of the first service user mentioned would be undertaken, a referral would be made to social services for her needs to be reassessed and a referral had been made to the dietician. A pressure-reliving mattress had been put on her bed. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 14 I informed management that if omissions of this kind were ever repeated in the future then the Commission would consider enforcement action. Other people surveyed or spoken to during the inspection had somewhat more ‘positive’ experiences of the personal and healthcare services provided by this home. Seven of thirteen completed service user questionnaires confirmed that they always receive the care and support they need four answered usually, and two answered ‘sometimes’ to this question. Eleven of thirteen service users’ confirmed that they always receive the medical support they need, two answered sometimes to this question. Two of two completed relative questionnaires confirmed that the home always gives the support or care to their relative/friend that was expected or agreed. A comment was received as follows; ‘As is meant to care for and provide what is required’. One relative told me; “ They care for him well. Been poorly one or two times. Called me in the night. He has had a new set of dentures, new glasses and regular chiropody”. Another relative told me; “ Satisfied, nurse been in today”. Comments were received about the lack of a bath on the dementia unit. The unit only has showering facilities. One person said; “ Older people do not like showers therefore a bath suitable for the elderly is needed”. I assessed medication systems and was pleased to identify improvements made from the previous inspection. The manager told me; “ All staff who have responsibility for medication have received accredited medication training”. This was confirmed when I viewed staff training certificates. A detailed care plan has been produced for one service who has diabetes controlled by insulin. And a new staff example initial list has been produced to enable identification of staff giving medications at any given time. A medication key handover process has been implemented to allow clear identification of who has/had responsibility for medication keys at any given time. Two requirements from the previous inspection remain as; ‘ not fully met’ and a number of other shortfalls were identified; for the one service user identified as being at risk from weight loss a prescribed ‘Forti’ drink had been prescribed by her doctor on 20.1.07 yet there were no staff initials to show that this drink was being given at all. Allendronic Acid was being prescribed for a number of service users’. This medication has stringent administration instructions for example; it can not be given at the same time as other medications and postural instructions; not to lie down for a certain amount of time after taking’ Medication records did not highlight these administration instructions and Staff I asked were not aware of any specific administration instructions for this medication. This means that in all probability this Alendroinc Acid was not being administered correctly presenting a risk to those service users’ it was being prescribed to. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 15 There were irregularities in medication totals. All medication packets I looked at were date labelled, all medication received into the home was recorded which is positive as this allows audits to be carried out yet, the number of tablets left against records in a number of cases were incorrect as there were too many. Clopidogriel 17 tablets and 17 initials yet there were 6 tablets left. Co-amilofruse 17 tablets 17 initials yet there were 8 tablets left. Promazine between 17-18 tablets more than there should have been. Diazepam 16 tablets more than there should have been. This means that either staff are; signing for medications without giving the tablets, giving incorrect doses or that incoming medication is not being counted or recorded accurately. Staff I observed during the inspection were kind and caring. They were polite to service users’ and relatives alike. I saw that toilet and bathroom doors were shut when in use. Records I looked at confirmed that the preferred form of address is determined for each service user. A relative made the following comment in a questionnaire; “ It treats all residents with respect and dignity that they deserve and show concern for all”. One service user told me; “ I do a lot for myself. I go out on my own when I want to”. This evidence proves that the home strives to promote privacy, dignity and independence. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 16 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): 12,13,14,15. Quality in this outcome area is adequate. Not enough attention is being paid to ensure that the lifestyle experienced by the home suits all service users’. Visiting times are open and flexible. Service users’ are very much encouraged to maintain contact with family and friends. The food is of a satisfactory quality but, more attention is needed to make sure that the dietary needs of each service user are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I went into the dementia lounge at 08.00 hours. I saw, that four service users’ were up and dressed, they did however, look tired. I saw see records to confirm that the preferred rising and retiring times are recorded for each. However, in the area of dementia care understanding can be limited and like everyone preferences regarding personal routines can change, daily. One man kept saying; “ I’ve been here for an hour, I’ve been here for an hour”. It may have been better if he had an extra hour in bed or his bedroom rather in the lounge. Someone made the following comment; “ It depends who is on regarding routines”. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 17 One service user told me; “ I’ve got my own routines”. Another said; “ I get up at seven and I like that”. It is a pity that the full time activities co-ordinator has left the home since the last inspection. The manager told me; “ We have advertised. People have started but not stayed”. In the interim one of the laundry staff who has an interest in this area is ‘bridging the gap’ regarding activity provision. But this is limited as she has her main job to do. Plans are in progress to improve gardens in both the dementia and other unit, which will increase activity time for service users’ and give them somewhere to sit and enjoy the nice whether. During my time on the dementia unit I saw some interaction between staff and service users’, but this was limited. For much of the time they sat in the lounge with the television on not positive in terms of stimulation or the promotion of well- being. I was interested to see the ‘nursery room’ in the dementia unit. A small room that has a cot with dolls and a rocking chair which service users’ use whenever they want which, research has shown can be therapeutic.. The manager told me that a wall is being moved to allow better access to the sensory room which will increase therapeutic activity in the unit. About activity provision one service user told me; “ I used to enjoy the sessions with B”. Another said; “ I go out when I want”. A relative made the following comment; “Needs an activity person as soon as possible to help stimulate residents. The last person left last year although they have tried to get someone it has not materialised. I do not think it is being treated as priority”. Another relative said; “ lacking stimulation”. The home has an open visiting policy. Service users’ are encouraged to maintain contact with family and friends. One service user told me; “ My family visit me”. Another said; “ My son and his children come to see me”. A relative told me; “ Homely. Can make drinks when we come. Welcomed”. Bedrooms I looked at held a range of service user belongings making them feel personalised and homely. Information was available in the home relating to external advocacy services. Information is provided to the local council so that service users’ can vote if they wish. The home has a set menu, which is varied and interesting and provides choices each meal. I was pleased to see that the home is in the process of complimenting the written menu with pictures to aid understanding of what food is on offer. Nine of thirteen service users’ surveyed confirmed that they like the meals at the home, four said that they did usually. Comments received about food included the following; “ Good meals”. “ Good choice”. “ We have choices”. “ I’m still given meals that I can not eat. I am Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 18 diabetic and have to be careful what I eat”.” Could be a better variation at tea time. Sandwiches and fairy cakes, could do with more hot options”. I observed the breakfast time on the dementia unit. All service users’ were given choices. Hot and cold food was available. After breakfast a staff member went around and asked everyone what he or she would like for his or her lunch. I was concerned when I went into the dementia lounge early in the morning, before breakfast. One man kept saying that he was hungry. I asked staff if he had been given anything to eat when he first got up. No one was able to confirm that he had. I looked at food intake records and there was no evidence to confirm that this man had been given anything to eat since getting up and before breakfast. Shortly after this the man was given his breakfast which he clearly enjoyed as he kept saying; “ Beautiful”. On examination of the food/ fluid intake charts I discovered that they do not encourage staff to record meals other than those offered from breakfast onwards to supper. There is no provision on these forms for entering food and fluids outside of these hours, which may be prevent accurate records being maintained. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 19 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): 16,18. Quality in this outcome area is adequate. Both complaints and protection procedures need to be improved to ensure that service users’ and their relatives are assured that their concerns and complaints will be listened to and acted upon and that service users’ are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has received four complaints in the last twelve months, two of which were forwarded onto the home by the Commission for investigation. All four were investigated and substantiated, action has been taken or is being taken to resolve. The home has a written complaints procedure, which is available in the home for service user and relative information. Eleven of thirteen completed questionnaires confirmed that they know who to speak to if they are unhappy, one answered usually to this question and one sometimes. Eleven of thirteen completed service user questionnaires confirmed that they know how to make a complaint, one answered no to this question and one answered as ‘ unsure’. Two of two completed relative questionnaires confirmed that they know how to make a complaint. One service user told me; “ No, complaints I’d see Ann if I did”. A relative told me; “ Complained once. About the television. I went to Ann and it was sorted”. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 20 Another relative told me; “ Speak to .. first, then I would go to Ann. I would feel comfortable to do that”. This evidence is positive as it shows that a high number of service users’ know how to make a complaint or would feel comfortable to make a complaint if they had the need. I did note however; from records that an issue and a concern had been raised by one relative. 9.3.07 ‘.. stated that she asked staff what time drinks were served and they shrugged their shoulders..’ 17.3.07 ‘..also has concerns about cleaning standard not good enough.. if situation did deteriorate may have to think about moving him” The manager was not aware of these and they were not recorded in the complaints book as they should have been, preventing investigation and resolve. Protection procedures and polices are available within the home which is good as these give staff instruction of what to do if an incident or allegation is made. However, one incident did occur in February 2007 where a service user hit another on the arm although this was reported to the Commission it was not reported to social service’s as it should have been. The manger told me,; “ This happened whilst I was on holiday. As soon as I came back I reported it”. This shows that staff are not as familiar with protection processes as they should be to ensure that service users’ are fully protected. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 21 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): 19,24,26 Quality in this outcome area is good. Service users’ live in a home that is homely, comfortable and reasonably safe internally. Bedrooms are at the present time being refurbished to make them brighter and fresher. Some improvement is needed in respect of cleanliness in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has a redecoration programme in place. Considerable work has been undertaken since the last inspection. All windows to the rear of the home have been replaced. Money has been secured to make garden areas safer and more accessible to service users’. Until this work is completed actions must be taken to keep service users’ safe whilst in the dementia unit garden as I did see some hazards. I saw two large paving slabs leaning against a wall and Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 22 path and kerb edgings were elevated which could cause trips or falls. I highlighted these risks to the manager during the inspection. All beds are being replaced. All bedrooms are having new carpets and furniture. Seating areas on the first floor have been provided to use as private areas where service users can spend time alone or to entertain visitors. Pictures and ornaments have been purchased and attractive shelving displays have been provided on the first floor making the environment feel more homely. A ground floor room has been converted, to give an extra, much needed toilet. A kitchenette is now available on the dementia unit so that visitors, staff and some service users can make drinks. Work is still needed such as; the refurbishment of the toilet situated next to bedroom 11 on the dementia unit, but plans are in place and work is in progress. I looked at four bedrooms. I saw that these were comfortable. The manager showed me two rooms that have recently been refurbished these looked fresh and bright. One relative told me; “ Bed and carpet is a bit old, but it’s all being done”. A service user told me; “ I am happy with my bedroom”. Overall the home looked clean. However, there were areas that need attention. One bedroom I looked at during the inspection had an odour. I saw that the dining room carpet in the dementia unit was stained. Eleven of thirteen completed service user questionnaires confirmed that the home was always clean and fresh, one answered sometimes to this question and one answered never. One comment was received about cleaning as follows; there is not enough cleaning done. Carpets are not kept clean enough. My bedroom is always smelly. My relatives despair when they enter my bedroom”. I looked at the laundry, which is fairly small for the size of the home. Which prevents full segregation of clean and dirty washing. However, the laundry did look better organised than it has done during previous inspections. Adequate machines are available capable of providing sluice cycles. I looked at toilets and bathrooms the levels of cleanliness varied. Liquid soap and paper towels were available in these areas to help prevent any infection spread. I did not see any hand washing signs which should be available to remind people to wash their hands after using toilet, again a measure to prevent infection spread. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 23 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): 27,28,29,30. Quality in this outcome area is adequate. Staffing levels must be reviewed to ensure that numbers are adequate to meet needs and keep service users’ safe. The home has over the required level of staff attaining NVQ level 2 or above in care. Induction processes are in place to equip staff with knowledge when they first commence work. Generally recruitment processes are safe only requiring some ’fine tuning’. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing is generally provided as follows; AM 6 care staff PM 5 care staff Nights 4 waking care staff. In addition the deputy manager is on site at times. The manager on site during business hours. Cleaning, catering and laundry staff are also provided. In general from speaking to people I determined that staffing levels are mostly adequate but may need some improvement at times.. Problems that occur are on the dementia unit mainly during break times when there is only one staff member. Some mention was also made about times when there is a lack of cleaning staff. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 24 Comments I received about staffing levels were as follows; “ There is not enough staff”. “ Very busy due to being understaffed”. “ There are days when there are no cleaners”. “ Not enough staff at times, sometimes a bit rushed”. “ Sometimes understaffed”. Concerns were brought to my attention about the dementia unit as although two staff are provided, when one is on their break, this only leaves one staff member on the unit. Some positive comments about staff were received, one however, needs further exploration as follows; “ All sound ok”. “ Most staff are very, very good . Caring job because they love it. Few just do it as a job”. “ Staff are nice”. “ Some can be a bit strict”. Thirteen of thirteen completed service user questionnaires confirmed that ‘ Staff always listen and act on what they say”. Which is positive as this demonstrates that staff do listen and provide an individual service. When viewing staff files I saw evidence to confirm that induction processes are in place to equip new staff with the required basic knowledge of the service. It is impressive that over 55 of the care staff team have achieved NVQ level 2 or above in care which means that a high proportion of staff have been assessed as competent to do their jobs. I looked at four staff files. Generally, these were satisfactory which is good as this shows that action is being taken to prevent harm to service users’. Evidence of required processes such as application and interview processes were documented. Written references and official sources of identity had been obtained for each. Some ‘fine tuning’ is needed to increase service user safety further. Evidence of Criminal Record Bureau checks is sent by memo from the organisations head office. These do not however, confirm that the check carried out was enhanced or that a check had been taken against the Protection Of Vulnerable Adults list. One staff file I viewed did not have employment dates completed, which means that an audit of that persons employment history could not be carried out. Ashbourne Residential Home DS0000024969.V333538.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is good. The manager has been approved as a fit person to run and be in charge of the home. Quality assurance and monitoring processes are in place but need to be increased to prevent shortfalls as identified in this report. Service users’ money is suitably safeguarded. Staff are supported and receive supervision. Health and safety observance is the home is generally good. This judgement has been made using available evidence including a visit to this service. Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Commission has approved the manager as a fit person to be in charge of the home. She has considerable years of experience of working in care homes for older people and management. The manager has yet to complete the required Registered Managers Award. Evidence gained from speaking to service users, staff and feedback from questionnaires complimented the manager. Staff told me that the manager is approachable. Relatives and service users’ confirmed that they would feel happy to approach the manager if they had a concern. Quality assurance and monitoring processes are in place within the home. I saw documentary evidence to confirm that the manager, senior manager and the organisation carry out auditing where statistics involving the running of the home and events occurring within the home such as accidents have to be forwarded monthly. From evidence gained during this inspection it is apparent that some areas such as complaints and healthcare will require more stringent auditing and monitoring in the future to prevent risks to service users’ and to keep them safe. Regular questionnaires are used to gain feedback on the service provided from service users and relatives. Recently questionnaires were sent to a number of persons involved in placing people and funding who work for the local Social Services department. The manager showed me these completed questionnaires. Only a small number had been returned at the time the inspection was carried out but feedback within these was positive. I looked at records and money for four service users’ whose money is held in safe keeping by the home. These were all accurate and correct. Money is held in a safe to which only a very limited number of people have access. I did note however, that one receipt with all service users’ names included is provided by the hairdresser. For accuracy of financial records an individual receipt should be issued to each service user, as would happen if they lived in the community. I looked at four staff files and saw that there was documentary evidence on each to confirm that they receive regular, formal supervision as they should. This was confirmed by two staff who when asked told me that they receive supervision from management. Training certificates on these files showed that most staff have received the required mandatory training. Where there were gaps training either had or was being arranged. I did not look at the kitchen in detail as Environmental Health carried out an inspection of the kitchen recently. I did see however, that a nice new floor has been fitted which looked fresh and clean. I checked a sample of certificates to ensure that regular servicing is being carried out appliances such as; the fire alarm system and extinguishers. I Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 27 found these to be in order, which is positive as this promotes safety in the home. I did see that bedroom door (number 5 dementia unit ) was not closing properly was lacking a self closing devise which could present as a fire risk. I also saw that there is no restriction to sluice rooms where hot water is available. Without suitable restriction to these rooms service users’ could be being placed at risk. Ashbourne Residential Home DS0000024969.V333538.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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 x x x 3 x 2 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x 3 Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 29 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 13(4)( c) Requirement Care plans must be fully reviewed when service users’ are readmitted back from hospital. Care plans must include all needs for example needs arising from dementia conditions. This requirement has been made to prevent risk and to keep service users’ safe. All staff must be aware of any service user who is at risk of dehydration and that alert systems are put into operation for seniors or managers to be informed where concern is identified. This requirement has been made to reduce risk and to keep service users’ safe. Food and fluid balance charts must be designed to identify risk and concern such as fluid intake over any 24 hour period being added up. These totals must then be assessed against the acceptable in take limit for each service user. DS0000024969.V333538.R01.S.doc Timescale for action 10/07/07 2 OP8 13(4)( c) 10/07/07 3 OP8 13(4)( c) 10/07/07 Ashbourne Residential Home Version 5.2 Page 30 Concerns then to be highlighted to seniors and manager. This requirement has been made to prevent risk and to keep service users’ safe. All risk assessments must be current and up to date. Risks must be managed by for example; providing the required equipment such as pressure relieving mattresses, commencing fluid intake charts. This requirement has been made to prevent risk and to keep service users’ safe. A concern letter was issued in which this shortfall was detailed. Appropriate medical attention must be secured if changes are noticed to any service users’ health, welfare or safety. This requirement has been made to prevent risk and to keep service users’ safe. A concern letter was issued in which this shortfall was detailed. The registered person and manager must ensure that residents’ are given their medications as prescribed. (Timescale of 11/10/06 and 28/07/06 not fully met). Example beings; Alendronic Acid before other medications and Fortijuice. A concern letter was issued in which this shortfall was detailed. 4 OP8 13(4)( c) 10/07/07 5 OP8 13(4)( c) 10/07/07 6 OP9 13(2) 10/07/07 Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 31 7 OP9 13(2) This requirement has been made to prevent risk to service users and to keep them safe. The registered persons must ensure that all medications are signed for at the point of administration. ( Fortijuice) Timescale of 18/08/07 not fully met. This requirement has been made to ensure that medications are given as prescribed and to keep service users’ safe. Checking and recording of incoming medications must be precise to ensure that all totals of tablets available are correct against recorded totals of medication received and the number of staff initials confirming that medication has been given. A concern letter was issued in which this shortfall was detailed. This requirement has been made to prevent risk to service users and to keep them safe. 10/07/07 8 OP9 13(2) 10/07/07 9 OP12 16(2)(m) (n) 22(3) 10 OP16 11 OP18 13(6) Suitable activity provision must 20/07/07 be available to meet the recreational and stimulation needs of the service users’. All concerns/ complaints received 10/07/07 by staff must be reported to the senior or manager on duty. Recorded in the complaints book and investigated accordingly. The registered person and 25/07/07 manager must ensure that all staff are familiar with their new organisations policies and procedures in respect of adult DS0000024969.V333538.R01.S.doc Version 5.2 Page 32 Ashbourne Residential Home protection. Timescale of 01/09/06 not fully met. An incident occurred and there was a delay in reporting as the manager was on holiday. The registered persons must ensure that the garden in the dementia unit is made safe and is usable. Timescale of 01/09/06 not fully met. This requirement has been made to reduce risk and to keep service users’ safe. 13 OP27 13(4)( c) 18(1)(a) 10/07/07 Staffing levels generally need to be reviewed. One specific area are break times on the dementia unit which must be adequately covered to ensure that there are 2 staff at all times. This requirement has been made to reduce risk and to keep service users’ safe. The full dates of employment for all proposed staff must be obtained in order for a complete employment history analysis to be undertaken. The memo to managers must be revised to confirm that the CRB undertaken was enhanced and that a POVA list check was carried out. These requirements have been made to ensure that service users’ are fully protected from harm. 12 OP20 13(4)( c) 01/08/07 14 OP29 19(1)( a) 10/07/07 Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 33 15 OP38 13(4)( c) Access to the sluice rooms must be suitably restricted. A suitable closing devise must be provided on bedroom 5 door ( dementia unit). 15/07/07 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 2 Refer to Standard OP8 OP8 Good Practice Recommendations Serious consideration must be given to providing a bath in the dementia unit to give service users’ a choice. Staff should be careful to use appropriate terminology when recording about healthcare issues and not use words such as ‘ bum ’. Evidence must be available at all times to confirm when service users’ have been given something to eat if they want for example; early before breakfast. Food and fluid intake charts should be revised to allow the recording of food and fluid intake outside of breakfast to supper times. Priority should be given to the redecoration and flooring replacement of the toilet situated next to room 11. The odour in the bedroom identified during the inspection is managed and eradicated. Appropriate hand wash signs should be available in all toilets to prevent infection transmission. 3 OP15 4 5 OP19 OP26 Ashbourne Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Residential Home DS0000024969.V333538.R01.S.doc Version 5.2 Page 35 - 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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