Random inspection report
Care homes for older people
Name: Address: Ashbrook Court Care Home Sewardstone Road Waltham Abbey Essex E4 7RG one star adequate service 25/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michelle Love Date: 1 7 1 1 2 0 0 9 Information about the care home
Name of care home: Address: Ashbrook Court Care Home Sewardstone Road Waltham Abbey Essex E4 7RG 02085245530 Telephone number: Fax number: Email address: Provider web address: jennie.worthington@carebase.org.uk www.ashbrookcourtcarehome.co.uk Name of registered provider(s): Name of registered manager (if applicable) Carebase (Sewardstone) Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 70 Number of places (if applicable): Under 65 Over 65 0 0 dementia physical disability Conditions of registration: 70 70 The maximum number of service users who can be accommodated is: 70 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Physical disability - Code PD Date of last inspection Brief description of the care home 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
Care Homes for Older People Page 2 of 12 2 5 0 6 2 0 0 9 Brief description of the care home 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 Courts Statement of Purpose and Service Users Guide/brochure can be obtained from the home upon request. Care Homes for Older People Page 3 of 12 What we found:
This was a focused random inspection to look at medication practices and procedures and care planning and risk assessing processes. The visit took place over one day by one inspector and lasted a total of 5 hours. At the previous key inspection to the service on 25th June 2009 we left an Immediate Requirement Notice relating to the administration of medication. We also forwarded a Serious Concern Letter relating to inadequate care planning practices and procedures. A prompt response to the issues was forwarded to us detailing the steps to be taken to ensure compliance to meet regulatory requirements. We observed the administration of medication to people on both the ground and first floors. We noted that the medication round on the first floor was completed by the qualified nurse in a timely manner. However on the ground floor the administration of medication to people living at the home did not complete until 11.10 a.m. The medication administration records (MAR) did not record accurately the time medication was actually administered which was different to the time printed on the MAR record. While we saw medication on the first floor being stored safely and securely so as to ensure peoples safety, we observed on the ground floor medication left unattended and easily accessible to people who live at the home and others who may be visiting. The qualified nurse on the ground floor was observed to lock the medication trolley in the dining room and to walk down the corridor to administer one persons medication. Although the trolley was locked, medication was left on top of the trolley. We also observed some poor medication practices by both the qualified nurse and deputy manager on the ground floor. Both members of staff were observed to handle medication. The deputy manager was observed to dispense medication from a blister pack into her hand and then to place in a medication pot on more than one occasion. The qualified member of staff was observed on one occasion to take the medication out of the medication pot and to directly place it in the residents mouth with their fingers. Additionally the qualified nurse was observed to drop medication on the floor, to pick it up and administer to the named resident. We looked at a random sample of medication records for several people resident in the home. On the whole records were completed well with few discrepancies. However we found for one person that there was a discrepancy between the amount of medication received and the amount of medication dispensed. This was discussed with the manager and the business manager at the time of the site visit however no rationale could be provided as to why this had occured. A copy of the MAR record was taken and this was discussed with a pharmacist inspector who concurred that on examination of the MAR record there was a discrepancy. As part of this site visit we looked at 3 peoples care files. Records showed that admissions are not made to the home until a full needs assessment has been undertaken. Records showed that for each person newly admitted to Ashbrook Court, a pre admission assessment was completed by the management team of the home prior to their admission and information recorded was noted to be detailed and informative. Where the person is referred from a Local Authority or NHS Health Trust, a
Care Homes for Older People Page 4 of 12 copy of their assessment was evident within their file and information recorded was seen to inform the persons care plan. Care plans examined showed that each persons care file is more streamlined, containing less historic information (which is archived) and duplication of information. Care plans examined were observed on the whole to be more detailed and reflective of peoples care needs. Records showed that efforts were being made by the management team of the home to ensure that the care plans were person centred. Formal assessments relating to nutrition, falls, manual handling and pressure area care are completed for each person. While improvements were noted, further development is required to ensure that each plan of care is fully reflective of the persons care needs. For example the pre admission assessment for one person recorded them as having a moderate diet. Their record of weight on admission recorded them as weighing 45.1KG on admission and a slight weight gain the following month, however there was no plan of care recorded relating to their nutritional care needs and how this should be monitored. This was not an isolated case and was also apparent within another care file examined. Although there was no care plan and/or risk assessment for another person relating to their nutritional needs , their formal nutritional assessment tool made reference to them being weighed weekly following a recent weight loss. There was no evidence to show this was being undertaken and daily care records confirmed on occasions that the person refused some of their meals. The care file for one person recorded them as refusing medication on occasions and this being covertly taken with food so as to ensure their health and wellbeing. The care plan made reference to this having been agreed by the persons family representatives and their GP. No evidence was available to confirm that the above had been formally agreed and no archived file was evident as the person was newly admitted to the care home. Daily care records showed that this person since their admission refused their medication on occasions. Care must be taken to ensure that where people have a formal diagnosis of dementia, there is clear information recorded as to how this impacts on their activities of daily living, including their strengths, abilities and weaknesses. Each care file examined also included risk assessments for the majority of areas. In general terms information recorded included the specific area of risk and how this was to be minimised so as to ensure the persons health and wellbeing. In some instances more information is required detailing specifically what the risk is and how this is to be managed. For example a risk assessment was devised for one person who suffers with poor mental health on occasions and who can become aggressive. While the risk assessment made brief mention of this, there were no clear guidelines for staff should the persons mental health and/or aggression escalate and become unmanageable. Staff interactions with people living at the home were observed in general terms to be positive. During the morning people were offered a choice of tea and coffee. People were offered more drinks and no one was hurried and/or rushed to finish their drinks. What the care home does well:
Some aspects of care planning and risk assessing have improved ensuring that
Care Homes for Older People Page 5 of 12 information is person centred and reflective of the persons care needs. The care files have been streamlined to ensure that information located within the file is current and up to date. Additionally care has been taken to ensure that the duplication of information recorded is kept to a minimum. Risk assessments have been devised for the majority of assessed risk. Medication is now administered to people in a more timely manner which ensures that the gap between each medication round is in keeping with the prescribers instructions and guidance. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15(1) Care planning at the home 11/01/2010 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. Previous timescale of 1/10/2008 and 1/9/2009 not met. So as to ensure that staff have the information they need to deliver good care. 2 7 13(4) Risk assessments must be devised for all areas of assessed risk. Previous timescale of 8/9/2008 and 1/8/2009 not met. So that risks to residents can be minimised. 11/01/2010 3 9 13(2)12(1)(a) People must be protected 21/12/2009 from harm by having their medication administered safely and in accordance with the prescribers instructions. Previous timescale of 14/7/2008 and 26/6/2009 Care Homes for Older People Page 7 of 12 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action not met. So as to ensure peoples safety and wellbeing. 4 9 13 Ensure that medication is not 21/12/2009 left unattended and easily accessible to people who live at the care home. Previous timescale of 26/6/2009 not met. So as to ensure their safety and wellbeing. 5 12 16 All people who live at the 01/09/2009 care home must be given the opportunity to engage in a varied programme of activities. This refers specifically to those people who have poor cognitive ability and/or dementia. Not inspected on this occasion. So as to ensure that people are enabled to maximise their potential. 6 27 18 Ensure there are sufficient staff on duty at all times. Not inspected on this occasion. So as to ensure the needs of people living at the care home are met according to their specific needs and dependency levels. 06/07/2009 Care Homes for Older People Page 8 of 12 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 7 30 18 Ensure that all agency staff working at the care home have an induction and that this is recorded. Not inspected on this occasion. This will ensure that staff feel supported and able to carry out their role. 06/07/2009 8 30 18(1)I and (i) Ensure that staff, receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people. Previous timescale of 1/11/2008 not met. Not inspected on this occasion. This will ensure that staff, have the competence, confidence and ability to meet resident?s care needs. 01/11/2009 9 36 18(2) Ensure that staff, receive regular supervision. Previous timescale of 14/7/2008 not met. Not inspected on occasion. So that staff feel supported and residents know that staff are appropriately managed. 01/09/2009 Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must not be handled directly by the person administering the medication. As this could potentially alter the properties of the medication. 21/12/2009 2 9 13 If medication is dropped on the floor, this should be destroyed. So as to safeguard peoples health and wellbeing. 21/12/2009 3 9 13 The MAR record must record 21/12/2009 accurately the time that medication is administered if it differs greatly from the time printed on the MAR record. So as to provide an accurate record of when medication was actually administered. Care Homes for Older People Page 10 of 12 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
