Inspection on 14/07/08 for Ashbrook Court Care Home

This inspection was carried out on 14th July 2008.

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

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

Ashbrook Court Care Home 17/11/09

Ashbrook Court Care Home 25/06/09

Ashbrook Court Care Home 18/06/07

Ashbrook Court Care Home 13/06/06

Similar services:

165 Putnoe Lane

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Ashbrook Court Care Home Sewardstone Road Waltham Abbey Essex E4 7RG Lead Inspector Michelle Love Unannounced Inspection 14th July 2008 09:00 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 Ashbrook Court Care Home DS0000066272.V368331.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. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbrook Court Care Home Address Sewardstone Road Waltham Abbey Essex E4 7RG 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) 0208 524 5530 jennie.worthington@carebase.org.uk www.ashbrookcourtcarehome.co.uk Carebase (Sewardstone) Limited Care Home 70 Category(ies) of Dementia (57), Dementia - over 65 years of age registration, with number (56), Physical disability (34), Physical disability of places over 65 years of age (34) Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical disability (not to exceed 34 persons) Persons of either sex, aged 60 years and over, who require nursing care by reason of dementia (not to exceed 36 persons) Persons of either sex, aged 60 years and over, who require residential care only by reason of dementia (not to exceed 20 persons) Three named persons, under the age of 60 years, who require care by reason of dementia The total number of service users accommodated in the home must not exceed 70 persons The layout of the home will ensure that service users with dementia who have nursing needs will not have their bedrooms in the same areas of the home as those residents with dementia needs who do not require nursing 18th June 2007 Date of last inspection Brief Description of the Service: Ashbrook Court Care Home is a purpose built 70 bedded home situated on the outskirts of the Essex town of Waltham Abbey, in close proximity to the M25 London orbital motorway. It is registered for a total of 70 residents who need personal and nursing care. The beds are multi registered to allow for flexibility of admission to the home. The home accepts residents over the age of 60 years of both genders who require nursing care by reason of physical disability; nursing care by reason of dementia; and residential care by reason of dementia. All accommodation is in single occupancy en-suite rooms on two floors. The decoration and equipment throughout the home is of a high standard. It is homely in decorative style and many occupied rooms are personalised to the residents taste. There are a number of communal areas throughout the home, including a dining room on each floor. The range of fees given at the time of the site visit were people who are privately funded, £800.00 per week, people who are funded by Social Services, residential (dementia) £550.00 per week, nursing (dementia) £630.00 per week and people who solely require nursing care £600.00 per week. Ashbrook Court’s Statement of Purpose and Service Use’s Guide/brochure can be obtained from the home upon request. Ashbrook Court Care Home DS0000066272.V368331.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 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 10 hours, with all but one of the key standards inspected. Additionally, the manager’s progress against previous requirements from the last key inspection was also inspected. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment. This is a self-assessment document detailing what the home does well, what could be done better and what needs improving. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the inspection surveys were forwarded from us to the home for distribution to residents next of kin, healthcare professionals and staff who work within the care home. It was positive to note that we received 3 completed surveys from relatives, 2 surveys from staff and 8 surveys from residents. Where surveys have been returned to us, comments recorded have been incorporated into the main text of the report. The senior manager and other members of the staff team assisted the inspector on the day of the inspection. Feedback on the inspection findings were given throughout and summarised at the end of the day with the senior manager. The opportunity for discussion and/or clarification was given. What the service does well: The home environment is well maintained and decorated to a high standard and provides people with a homely, comfortable and safe place in which to live. The home was observed to be clean, tidy and odour free. Residents are supported to maintain contact with family and friends. Visitors to the home are made to feel welcome and some staff were observed to have a good rapport with residents. Residents feel able and comfortable to raise concerns or queries with staff and generally feel confident that they will be listened to. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 6 There is an appropriate system for assessing the needs of prospective residents prior to their admission to the care home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashbrook Court Care Home DS0000066272.V368331.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 Ashbrook Court Care Home DS0000066272.V368331.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. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect that they will be properly assessed prior to admission and assured that their care needs can be met. EVIDENCE: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective resident’s needs. In addition to the formal assessment procedure, supplementary information is sought from the individual resident’s placing authority and/or hospital. On inspection of two care files for those people newly admitted to the care home, evidence showed that pre admission assessments were completed by the management team of the home prior to the person’s admission. Information recorded was observed to be detailed and informative, however care must be taken to ensure that information from the pre admission Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 10 assessment document is transferred to the individual person’s care file. The Annual Quality Assurance Assessment (AQAA) under the heading of `what we do well` details that the pre admission assessment process is thorough and consistent and confirms that wherever possible prospective residents and their families are involved in the process. It also details that over the past 12 months improvements have been made to ensure that “more time is spent prior to admission with the prospective resident and their family to ensure the placement is appropriate and meets all the expectations of the resident and their family”. Of the two care files examined, there was information recorded to indicate that the pre admission assessment had been undertaken with the resident and/or their representative and that people were provided with the opportunity to visit the care home prior to admission. One resident confirmed to the inspector that their next of kin/family friend and social worker visited the home, prior to their admission. They also advised that the admission to the home had gone smoothly and staff had made them feel welcomed. The management team of the home, hope within the next 12 months to encourage prospective residents to “experience a day in the home enabling them to make a much more informed choice” as to its suitability. Confirmation from the management team to the resident and/or their representative verifying that it can meet the person’s needs was not available for either person case tracked. The senior manager present at the site visit was advised to ensure that this is reviewed for the future. The home does not provide intermediate care. Ashbrook Court Care Home DS0000066272.V368331.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 adequate. This judgement has been made using available evidence including a visit to this service. Although residents are happy with the care provided, shortfalls in care planning and risk assessing were highlighted, which could potentially have an adverse affect on outcomes for residents and their wellbeing. EVIDENCE: At this inspection a random sample of 3 care files were examined in full and 3 care files were partially examined in relation to a specific care need related to the individual person. There is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by care staff, however not all areas of identified need were recorded within each person’s care plan and in some cases there was limited information recorded as to how staff were to proactively manage the person’s care needs. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 12 In addition to the care plan format, formal assessments relating to pressure area care, nutrition, moving and handling and dependency are completed for individual residents. Care records showed that further development of the care planning and risk assessment process is required as shortfalls identified, potentially place residents at risk of not having all of their care needs met and provides staff with inaccurate and not up to date information about individual residents. Particular attention must be afforded to individual’s nutritional needs, refusal of medication and the management of people’s inappropriate or aggressive behaviours. Additionally staff who compile resident’s care plans must ensure that information recorded is not conflicting e.g. one care file identified the resident as having a reduced appetite and requiring support and assistance from staff to eat their meal. One part of the care plan made reference to the resident being weighed monthly and another part made reference to the person being weighed weekly. It was difficult to decipher as to which piece of information was current/accurate and staff when asked were unclear, however the weight chart evidenced this was undertaken monthly and not weekly. Observation of the lunchtime meal for this person showed that they were not offered support/prompting to eat their meal by staff as recorded in their care file. Information recorded within one person’s care file showed they were at high risk of falls, suffered from panic attacks and had bed rails/bumpers fitted to their bed, however no care plan had been devised for the above areas. Additionally, there was a care plan related to them being at high risk of developing pressure sores, but no risk assessment as to how this risk should be minimised had been compiled. Medication Administration Records (MAR) for one person (randomly selected) showed that they refuse some of their prescribed medication on a regular basis. This was not highlighted within the person’s care plan and no risk assessment had been devised identifying how the risk was to be minimised. There was no evidence this was being monitored by staff, or that appropriate discussion and/or review had been undertaken with the person’s GP. Care records showed that all people who reside in the care home have access to a range of healthcare provision and services as and when required. The home’s nursing staff provide assistance and care to those people admitted for nursing care, whilst arrangements are in place for the community nurse/district nurse services to provide care and support to those people accommodated for residential care. Nursing staff spoken with at the time of the site visit, confirmed that there is a good relationship with the visiting doctors surgery and other healthcare professionals. In some cases there was little evidence to show that the care plan was drawn up with the involvement of the resident and/or their member of family. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 13 The AQAA details under the heading of `what we do well`, “Each resident has a comprehensive care plan which includes health, personal and nursing care well documented”. This did not fully concur with the inspector’s findings on the day of the site visit. The senior manager present at the time of the inspection confirmed that she had noted shortfalls within the care planning processes and efforts were being made by the management team of the home to review and update records accordingly. Two residents spoken with during the inspection stated they were happy with all aspects of their care and advised that staff working at the care home were “lovely and very supportive”. The service’s quality assurance audits recorded comments from relatives regarding care as, “The day staff understand my relatives needs and will inform me of their wellbeing” and “I am very happy with [name of resident] care”. Comments from relative surveys were mixed and included, “The whole package of care and consideration for my relative is carried out with patience and understanding”, “My relative has only been in the home a short while and I am very pleased with the care they receive” to “ I see them able to walk when they come in to the home but because they sit in armchairs all day, they very soon lose the use of their legs”. It was positive to note that out of 8 resident surveys returned to us, 4 confirmed that they always receive care and support that they require, 1 confirmed that usually they get the right care and support and 3 recorded that sometimes they received the right support. Rapport between staff and residents was inconsistent within the home, with some staff interacting well with residents, whilst other staff were observed to be very distant, to not talk with residents and to only verbalise with residents when conducting a task e.g. carrying out personal care and/or when relocating a resident from one area of the home to another. The majority of surveys returned to us from residents stated that they felt that staff listened and acted upon what they said, however surveys also commented that staff were too busy and there were not always sufficient numbers of staff at different times to listen to them. The majority of medication is managed through a monitored dosage system (blister pack). Administration of medication to residents was partially observed during the morning and at lunchtime, and this was seen to be satisfactory. Medication Administration Records (MAR) were examined and these showed that records were completed and up to date. An audit of controlled drug medications was checked against records and these were seen to be in good order. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 14 The senior manager was advised of some medication discrepancies. This refers specifically to one person having their prescribed medication, (to be administered 3 times daily) administered 4 times on one day and not in line with the prescriber’s instructions. Additionally prescribed medication (night time sedation/other medication) was noted to be administered as PRN (as and when required medication) for some people. On inspection of the dedicated fridge used for the storage of medication(ground floor) records showed fridge temperatures as being regularly above the recommended levels of 2-8 degrees centigrade e.g. 9-12 degrees centigrade. Both the senior manager and nursing staff on duty were advised that the failure to store medicines at the proper temperature could result in service users receiving a treatment that is ineffective. The senior manager advised the inspector that an internal medication audit was conducted in June 08 and the issues as described above had been highlighted. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. The activities programme at the home does not meet the social care needs of all people living at the care home. Not all residents have their nutritional needs met and this means that some residents do not receive a varied and balanced diet, which could affect their health and wellbeing. EVIDENCE: The home has an activity co-ordinator employed at the care home. The AQAA details that within the last 12 months, the number of hours provided for activities has increased. It is also hoped that within the next 12 months a training programme for the activities co-ordinator, will be developed so as to incorporate a range of person centred activities for people living at the care home and that the activities co-ordinator will liaise closely with NAPA and develop links with the local Alzheimer’s Society. A programme of weekly activities were displayed within each of the three units in both a written and pictorial format. Activities provided to residents included coffee morning, bingo, reminiscence, sing-a-long, film show, quoits, arts and crafts, indoor bowling, hoopla, board games, cards etc. There was limited Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 16 evidence both during the site visit and from records to show that the social care needs of those people with dementia are proactively managed and/or pursued. The AQAA concurs with the inspector’s findings and under the heading of `what we could do better` details, a wider range of activities for people with dementia is required. It also states that better links within the local community need to be encouraged and enhanced. Of those care records inspected not all recorded individual people’s preferences relating to their social care needs, however two residents spoken with confirmed that they are enabled and offered the opportunity to participate in a range of activities and these are available on a regular basis. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. The senior manager advised the inspector that residents are encouraged and supported to maintain contact with family and friends. There is a rolling four week menu and this evidences that residents are provided with three hot meals a day, including a cooked breakfast. On inspection of one week’s menu, this was observed to offer people a varied diet. The Service Users Guide details that a menu is displayed on each unit, however on the day of the site visit, no menu was available and both staff and residents spoken with on the first floor were unable to advise as to what was available for the lunchtime meal. On observation of the lunchtime meal on the first floor, meals provided to residents were attractively presented and portions of food seen to be plentiful. No choice of drink was offered to residents, however 4 residents were offered a glass of wine with their meal. The latter was seen as positive. Tables were attractively laid with tablecloths, matching crockery, cutlery and glasses. It was disappointing that no condiments were placed on the table for people to help themselves to. It was observed that people were brought into the dining room at 12.35 p.m., however the lunchtime meal was not served until 1.05 p.m., some 30 minutes after being seated. It was evident during this time that some residents found the wait too long and became restless. One resident expressed this by shouting out and trying to gain staff’s attention, however of the 6 members of staff evident within the dining area, only 1 member of staff was noted to provide some verbal interaction and support to this resident. The resident continued to shout out by stating, “not a sod will help me”, “please help me”, “oh god please help me, someone please help me” and “this is not the way to treat me, please help me, help me god”. Once the person received their meal, the shouting stopped. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 17 The lunchtime experience for some people was observed to be poor. There was very little verbal interaction by staff with individual residents and staff, were observed to not work as a team when serving the lunchtime meal. Additionally, one resident was provided with a bowl of soup, however they were asleep and no support/verbal encouragement was provided for a period of 15 minutes. On inspection of their care plan this clearly recorded that they were below average weight, had a reduced appetite and required assistance and lots of prompting to eat their meals. No residents were offered additional helpings of food and not all residents were asked if they had finished their meal before plates were removed. By contrast the teatime meal was observed on the ground floor. Staff, were observed to work cohesively together and to interact well with individual residents. However, comments from residents in relation to the main teatime meal were noted to be negative. One resident was overheard to state, “that’s horrible, that’s got no taste at all, you know what they can do with that bloody horrible mess”. Several other residents were also observed to not complete their meal and requested an alternative choice. Several resident surveys also made mixed comments about the food. These included, “ I always like the meals provided” and “the food is lovely” to “I don’t like the dinners, no ordinary foods like roast dinners”, “always too spicy”, “could be better, more English food” and “when soup comes out the staff do the medicines first and the food goes cold”. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. Appropriate systems are in place to ensure that residents are safeguarded and that any concerns raised are dealt with proactively. EVIDENCE: The complaints procedure was observed to be displayed within the home’s main reception. The senior manager was advised this needs to be reviewed so as to inform people that the Commission for Social Care Inspection (CSCI) no longer investigate complaints and these should be referred either to the management team of the home or to the Local Authority. The AQAA details that within the last 12 months the management team of the home have dealt with 18 complaints. A random sample of complaints were inspected and records showed the specific nature of the complaint, action taken, investigation where appropriate the outcome. The AQAA details that staff are actively encouraged to report any concerns immediately and residents, their families and other parties are encouraged to report concerns. Since the last inspection there have been 2 safeguarding issues relating to poor care practices by staff. There was evidence to show that appropriate action had been taken by the registered provider to address the above. Staff spoken with demonstrated an awareness and basic understanding of safeguarding procedures and advised that should an issue arise, information Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 19 would be passed to the person in charge of the shift. The staff, training matrix evidenced that not all members of staff had up to date safeguarding training, however this was planned to be undertaken for August 2008. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 20 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 judgement has been made using available evidence including a visit to this service. Ashbrook Court provides a clean, comfortable and safe environment for residents, which meets their needs. EVIDENCE: A partial tour of the premises was undertaken throughout the day. The home is divided into three separate units (residential, nursing and nursing for those people who have a formal diagnosis of dementia). All residents are provided with a single room, which is equipped with en-suite facilities. Of those individual bedrooms inspected, all were seen to be individualised and personalised. The standard of the décor and furnishings throughout the home were of a good standard and well maintained. The home was observed to be odour free, clean and tidy and no health and safety issues were highlighted on the day of the Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 21 site visit. There are 3 secure courtyard garden areas, which are well maintained and accessible for residents use. The AQAA details that within the next 12 months sensory areas will be created within the home. We recognise that there is some signage around the home, however this needs to be improved so as to aid orientation for people residing at the home, especially for those people with dementia. The AQAA details under the heading of `what we could do better`, “Furniture, signage, colour and equipment within the environment needs to be improved to assist people with dementia and to help them to maintain their independence”. It is also hoped within the next 12 months that individual bedrooms will have photographs and/or pictures placed on the doors so as to increase the chances of residents being able to find their rooms independently. Resident’s and relatives comments relating to the home environment were generally very positive. The only areas of discontentment related to the home’s laundry. The home’s Quality Assurance Audits detailed, “[name of resident] clothes are often creased, some of their clothes seem to go missing”, “clothes are not washed according to instructions, ironing is non-existent” and “It seems to take a while before clothes are back in the wardrobe”. From inspection of complaint records, it was evident that some of these related to laundry issues for residents. The registered provider must ensure that laundry arrangements at the home are appropriate and suitable to meet residents’ needs and that people feel assured that their personal items will be returned in a timely manner and in a reasonable condition. A maintenance person is employed at the care home for 30 hours per week, Monday to Friday. The senior manager advised that these hours are flexible and can be utilised at weekends if the need should arise. A random sample of safety and maintenance certificates showed that equipment and services in the home were kept in good order. The home has a fire safety risk assessment in place and all other fire safety records were seen to be in order, however the record of fire drills undertaken by staff was not available at this site visit. The registered provider must ensure there is a record available showing staff’s participation in regular fire drills so as to evidence their competency, ability and knowledge should an emergency arise. The training matrix showed that the maintenance person has undertaken training relating to health and safety, manual handling, fire awareness and safeguarding. The manager of the home should also consider the maintenance person attaining training relating to infection control, basic first aid and COSHH (Control of Substances Hazardous to Health). Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst outcomes for residents are generally sound, some shortfalls in staff training pertaining to those conditions associated with the needs of older people mean that some staff may not be able to meet the needs of the residents living at the home. EVIDENCE: The senior manager and nurse in charge advised the inspector that the home’s staffing levels remain at 1x RGN (Registered General Nurse) plus 3x care staff (Nursing Unit), 2x care staff (Residential Unit), 1x RGN and 6x care staff (Nursing/Dementia Unit) during the day and at night there are 5x waking night staff. In addition to the above, the manager’s hours are supernumerary Monday to Friday. On inspection of four weeks staff rosters, it was evident that staffing levels as detailed above have been maintained. Rosters were observed to be clear and identified cover by bank/agency staff on occasions. As highlighted at the last inspection to the home, the full names of staff were not detailed on the staff roster and this related to both permanent and agency staff. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 23 The AQAA details that there has been a high usage of agency/bank staff at the home and over the past 12 months 27 people have left the home’s employment. Relatives surveys returned to us were noted to record mixed comments pertaining to staffing levels at the home e.g. “Staff are available at every visit to respond to our questions and concerns” and “I do not think they have enough staff on duty at weekends, I thought someone should always be in the lounge with residents, but this is not so”. At this site visit 4 staff files were randomly inspected for those people newly employed at Ashbrook Court. It was positive to note that the majority of records as required by regulation were available, however gaps were noted in relation to one person not having a written reference from their most recent employer, no evidence to show that one person’s right to remain in the United Kingdom had been granted and/or renewed and no evidence of one person having received an induction. Additionally 3 out of 4 files did not have a recent photograph of the employee. It was positive to see records of the interview process and these included a written exercise devised by the organisation requesting that the prospective employee explain in 100 words “What motivates you to excel in your work”. All new members of staff receive a comprehensive and detailed staff hand book. The training matrix provided to the inspector evidenced that the majority of staff have received training relating to manual handling, health and safety, food hygiene, safeguarding, dementia awareness, fire awareness, death and dying, care planning, mental capacity act and basic first aid. The matrix also showed where updates are required for staff. The matrix was also crossreferenced with a random sample of staff files. The senior manager was advised that consideration must also be undertaken for training relating to those conditions associated with the needs of older people e.g. Parkinson’s disease, sensory impairment, diabetes, nutrition, falls management etc. The AQAA details that within the next 12 months, it is hoped that all new staff recruited will receive basic dementia training during their first month working in the home and to ensure that `key` staff deliver a high standard of dementia care and support to people living at the home. Records presented to the inspector indicate that at the time of the site visit, only 1 person had attained NVQ Level 1, one person had attained NVQ Level 2, one person had achieved NVQ Level 3 and 3 members of staff were working towards NVQ Level 2. The AQAA, which was completed and submitted to CSCI in May 2008, recorded only 6 members of staff having attained a NVQ qualification. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 24 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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst management arrangements in some areas are good, shortfalls identified could potentially affect outcomes for residents. EVIDENCE: The manager was on annual leave on the day of the inspection and as a result of this the inspection was undertaken with a senior manager from the organisation. It is recognised as stated within the previous inspection report that there have been several manager’s at the home over a relatively short period of time, however the manager in post has been employed at Ashbrook Court for the past 8 months and is the longest serving manager since the home opened. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 25 This has provided much needed stability for both residents and staff. The Statement of Purpose details that the manager is a RGN and has attained NVQ Level 4 in Management, several qualifications in relation to dementia care and is currently undertaking a diploma in dementia care. It also states that the manager has over 15 years experience in working within a `care field` setting. The AQAA records that the manager has a good knowledge of dementia person-centred care and other conditions associated with old age. It is planned for the manager to submit an application so as to be formally registered with CSCI, in due course. The senior manager advised the inspector that the manager operates an open door policy enabling staff, residents, their families and other interested parties the opportunity to speak with her about any concerns they may have. Staff spoken with confirmed that they felt the manager was approachable and the staff team supportive and caring of one another. Residents also spoken with stated that they liked the new manager. Mixed comments were again recorded within relative’s surveys in relation to the management of the home. Some stated they found the manager to be approachable, whilst one stated the reverse. The senior manager advised that the ethos of the service is to “improve the quality of life for people residing at the care home, to encourage independence where appropriate and to keep people safe. In addition to this there is a generic mission statement and this is, “To improve and make a difference to the lives we touch through the delivery of high quality healthcare and a deep sense of compassion”. The senior manager also stated that through discussions with the manager, her aim is to achieve high standards of care for all residents, wherever possible for residents to maintain existing skills and independence and for all residents to be integrated into the home environment. The AQAA details under the heading of `what we could do better`, “All the staff team to understand the philosophy of the home”. Although there are some areas as highlighted within the main text of the report, which are good and evidence proactive management and positive outcomes for people, there are some areas which continue to require, further development and these refer specifically to care planning/risk assessing, some medication practices and procedures, ensuring that all residents have their social care needs met, that the dining experience for all people in the home is positive and ensuring that staff receive additional training associated with the needs of older people. Of those supervision records randomly sampled, there was evidence to show that in most cases staff had received regular supervision, however 2 staff files showed that they had received a limited number of supervisions and this was not in line with National Minimum Standards recommendations. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 26 A Quality Assurance System is in place and this was seen to be detailed and comprehensive. Reference to comments from both residents and relative’s, have been incorporated into the main text of this report. The home has a health and safety policy and procedure. Resident accident records were observed to be well maintained and information recorded satisfactory. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 27 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 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 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 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 3 Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and ensure that these are regularly updated/reviewed to reflect the most up to date information. Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. Ensure residents are given medication in accordance with the prescriber’s instructions. Ensure medication is stored under suitable environmental conditions to prevent residents being put at risk of harm by receiving unsuitable medication. This refers specifically to medication stored within the dedicated fridge. Ensure that all residents receive a varied programme of stimulating and interesting activities both `in house` and within the local community so as to ensure people have their social care needs met and do not DS0000066272.V368331.R01.S.doc Timescale for action 01/10/08 2. OP7 13(4) 08/09/08 3. 4. OP9 OP9 13(2) 12(1)(a) 13(2) 14/07/08 14/07/08 5. OP12 16(2)(m) and (n) 01/09/08 Ashbrook Court Care Home Version 5.2 Page 29 6. OP15 12(1)(a) 7. OP29 19 8. OP30 18(1)I and (i) 9. OP36 18(2) become bored. People who live at the care home must receive adequate quantities of food so as to ensure their health and wellbeing. Ensure that robust recruitment procedures are adopted at all times for the safety and wellbeing of residents and that all records as required by regulation are sought. Ensure that staff, receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. Ensure that staff, receive regular supervision so that they feel supported and residents know that staff are appropriately managed. 14/07/08 14/07/08 01/11/08 14/07/08 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. 2. 3. 4. Refer to Standard OP3 OP7 OP10 OP15 Good Practice Recommendations Evidence should be available in writing from the registered provider to confirm that residents needs, can be met. Evidence should be available to show that the care plan has been conducted wherever possible with the resident and/or their representative. Interaction between staff and residents should be improved as a matter of good care practices and not solely based tasks and routines. Consider devising a pictorial menu and displaying this within each dining area so as to assist people living at the care home to make an informed choice about meals. DS0000066272.V368331.R01.S.doc Version 5.2 Page 30 Ashbrook Court Care Home 5. 6. OP19 OP19 Improve signage within the home environment so as to assist people, particularly with dementia to familiarise and orientate themselves with Ashbrook Court. Improve the laundry service for residents so that people feel assured that they will receive their laundry back in a timely manner and that their items of clothing will not be spoiled. Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Ashbrook Court Care Home DS0000066272.V368331.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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