Inspection on 18/06/07 for Ashbrook Court Care 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 Adequate. 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

Ashbrook Court Care Home 17/11/09

Ashbrook Court Care Home 25/06/09

Ashbrook Court Care Home 14/07/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ashbrook Court Care Home Sewardstone Road Waltham Abbey Essex E4 7RG Lead Inspector Ann Davey Unannounced Inspection 18th June 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashbrook Court Care Home DS0000066272.V339805.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.V339805.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 www.ashbrookcourtcarehome.co.uk Carebase (Sewardstone) Limited Care Home 70 Category(ies) of Dementia (56), 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.V339805.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. Key Unannounced – 13th June 2006 Unannounced random - 25th January 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 ensuite 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 time at the time of the site visit were: - Nursing (Physical disability) - £600 - £850 - Nursing (Dementia) - £630 - £900 - Residential (Dementia) - £550 to £800 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.V339805.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced site visit which started at 10am and finished at 7pm. The last key inspection took place on 13th June 2006 and a random inspection took place on 25th January 2007. Reference to the unannounced random inspection is made within the report. The acting manager, area manager, residents and staff were spoken with. The inspector had every intention of speaking with some of the relatives who were visiting the home throughout the day, however, when the time came to do this, none were present as it was early evening. Therefore, some questionnaires/surveys (with SAE) for relatives were left by the visitor’s book. The home does not have a registered manager. The acting manager and the area manager were available during the inspection. The acting manager had only been in post for 5 weeks, but was helpful. The day was pleasant and the home was cooperative and helpful. The inspection process was undertaken without any difficulty. A partial tour of the home was made. Care practices were observed and a random selection of records viewed. A notice advising any visitors to the home that an inspection was taking place was displayed in the main entrance hallway. The notice extended an invitation to anyone who may like to speak with the inspector to make themselves known. Ashbrook Court provides nursing care and residential care. For the purposes of this report, all those accommodated have been referred to as ‘residents’. Similarly, both nurses and care staff are employed by the home. For ease of reference, those employed in either capacity, have generally been referred to as ‘staff’ within the report. All matters relating to the outcome of this inspection were discussed with the area manager and the acting manager. Full opportunity was given for discussion and/or clarification both during and at the end of the inspection. What the service does well: Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 6 The home is purpose built and 18 months old. The standard of décor and furnishing throughout is of a good standard. The secure garden area is attractive. The home is hospitable, friendly and inviting. Rapport between staff and residents was warm and natural. Staff were observed to be attentive to residents and looked professional in their uniform style dress. Care plan documentation was in good order. The home has a full complement of nursing and care staff. 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 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.V339805.R01.S.doc Version 5.2 Page 7 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.V339805.R01.S.doc Version 5.2 Page 8 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 (standard 6 is not applicable in this home) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have their care needs assessed by the home to ensure that the proposed placement is suitable. EVIDENCE: The records of the two most recent admissions to the home were assessed. Full assessments were in place and the assessed needs were clearly documented. Prospective residents wishes and preferences are sought and recorded. One resident said that her ‘move’ into the home was pleasant and that staff had done everything possible to make her feel comfortable. Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 9 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 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a plan of care drawn up by the home that details their assessed care/nursing needs. Residents can also expect to receive the services of health care professionals as appropriate, but medication administration recording practices must be improved to ensure they are safe. EVIDENCE: The home provides both nursing and residential care and as such, accommodates residents with a wide range of nursing/residential care needs. Four care plan records were assessed. The home uses a ‘Standex’ style recording system. Some aspects of the system do not ‘lend’ themselves easily to ‘residential care’, but the outcome is that care needs are assessed and recorded within a care plan, which is then reviewed on a regular basis. Health care, residential care and nursing care needs were clearly documented and the home indicates who or how these needs are to be met. All other associated risk assessment and review documentation was in place. Records were in good order. Currently, care plans do not reference social activities or personal hobbies/interests. This aspect of care is not neglected by the home but this Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 10 ‘element’ of the care plan is being worked on as a separate entity. This work will be finished by the end of the summer. Some residents care plans were displayed on the front of wardrobe doors. This caused the inspector some concern as it was thought that individual residents rights of dignity might be infringed. However, on speaking with individual residents, they were very happy for this information to be displayed. This home must however seek individual consent from each resident about this practice and ensure that the response is clearly recorded within documentation. Residents are registered with a local GP practice, although they may register with another GP of their own choice if preferred. The GP has a weekly surgery at the home. The home’s nursing staff provide nursing requirements to those residents admitted for nursing care, whilst arrangements are in place for the community nurse to provide any nursing needs to residents accommodated for residential care. The home said that they have a very good relationship with all health care professionals. During the last key inspection, shortfalls were noted in the home concerning the storage of some medication and the medication administration recording system. This matter was further reviewed during the random inspection in January 2006 when improvements were noted. At today’s inspection, medication and medication administration documentation was viewed on the 1st floor. The nurse said that since the last key inspection, they were aware that a full review of medication practices had taken place. The temperature of the ‘medication/treatment room’ is now monitored and daily records of the results are held. The storage of medication was orderly and all bottles/containers seen had resident’s names on and also room numbers. A sample of controlled drugs was checked against records. These were in good order. A random sample of medication administration records (MAR) demonstrated that when nurses handwrite medication dosages and administration instruction within this document, they are not ‘double signing’ entries in accordance with current guidance. The area manager agreed that this was not good practice. It was also noted that PRN (as/when required) medication administration protocols were not within the MAR sheets or within care plans. It is current practice within the home for this information to be recorded by the GP within the ‘multi disciplinary’ section of case records. The area manager agreed that to improve practice this information should be within care plans or MAR sheets for easier access. The home has a good relationship with the pharmacist and the arrangements for the disposal of waste medication is established. It was positive to note that staff are provided with ‘end of life’ training sessions. The home understands that this is an important aspect of care and it was good to see such a positive contribution to this aspect of care. Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 11 Care practices were observed during the day. Staff were attentive to residents. There was no evidence that residents are left unsupervised for unnecessary long periods of time. Residents cared for in bed had access to call bells. There was good humour amongst staff and residents and rapport was warm and natural. The inspector overheard a conversation that was taken place between a resident and member of staff behind a closed bathroom door whilst personal care was being undertaken. The dialogue was caring, sensitive but full of good humour. Residents were dressed in keeping with their age and gender. Some residents were being cared for in bed and bedding looked clean and fresh. Residents spoken with were happy with their care. Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a lifestyle that meets their expectations but improvements must to the maintenance of nutritional records to demonstrate that residents are provided with a balanced diet. EVIDENCE: Care plans are currently being developed to include social activities/events and personal hobbies/interests. The home now has an activity coordinator who works 30 hours a week. This appointment has been received well with residents and she has quickly become a popular member of staff. Already the home has developed a varied social/activity programme and more ideas are in the ‘pipeline’. Currently, work in underway so that each resident will have a ‘profile’ of his or her personal or corporate interests/hobbies by the end of the summer. Residents said that they enjoy the new activities and are looking forward to forthcoming events. The home does not have its own transport, but arrangements are being made for the hiring of a mini bus for the specific events in the future. Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 13 The home accommodates a monthly church service for those who wish to attend and was able to demonstrate that arrangements are always made for representatives of churches and faiths to visit individual residents. During the course of the day, many visitors were in and out of the home. Unfortunately, none were available early evening when the inspector had time to speak with them, but surveys/questionnaires were left. In addition, a notice was clearly displayed explaining that an inspection was underway with an invitation to speak with the inspector. The home said that all residents have family or close friend contact to varying degrees. From discussion with staff and residents, the conclusion is that since the acting manager came, there is now a more open culture about residents’ choice and control within the home. For example, residents’ said that until recently, there has been little choice about food and that the acting manager comes and talks to them personally about such matters now. Another resident said that there had been a slight problem with a member of staff, but felt able to raise the matter with the acting manager. Residents felt that things had ‘settled down a bit now’. The inspector observed staff offering residents choice about a number of issues. For example, were they too hot or cold, what would they like to drink, where would you like to sit and is the music too loud? Clearly some residents would not have the ability to make choices, but there was no evidence that a resident’s ‘choice’ or ‘preference’ is presumed by the home. Residents told the inspector and the acting manager confirmed, that up until recent weeks there had been a problem with menu and food provision. Residents said that they didn’t know what they were having from one cooked meal to the next. All agreed that although things are better now, further improvements could be made. There is now a daily menu displayed. Residents said that the quality of the food cooked and provided during the week is different to the weekends. As with any large group of people, there are going to be different expectations, but clearly the acting manager needs to review the situation. The acting manager and the inspector looked at the food provision records which should state what each resident has eaten and in what quantity for each meal. There was no evidence of a systematic recording system in place and there were unexplained gaps in the records. Although a mealtime was not observed in full, the tables laid for lunch and tea were very attractive and residents were provided with clean linen tabards to protect their clothing. Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including a visit to this service. The home must review its complaints investigation tracking system to demonstrate that it takes complaints seriously. Residents are protected from abuse by staff knowledge of ‘safeguarding adults from harm’, but the procedure to follow should be accessible and in ‘user friendly’ text to prevent misunderstanding. EVIDENCE: The complaints procedure is displayed, but the content needs to be amended to reflect current guidance sent to the home by the Commission. Amendments will also need to be made to the procedure within the Statement of Purpose and Service User’s Guide. Residents said that they would approach the acting manager if they had any area of concern. One resident said that a formal complaint had been made about the food, but there was no evidence that this had been recorded in the formal complaint register. Although the resident was very clear that she felt the home had taken her concerns seriously. The complaints register was not currently maintained. A complaint received in April, had no conclusion logged, and with another complaint received in March, there was some confusion about a response letter. The area manager agreed that the home is not using the ‘complaint log form’ as required by their own internal policy/procedure. By not doing this, there was confusion about the progress of investigations and the conclusion of some complaints. Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 15 Staff spoken with said that if they suspected any form of abuse they would alert the acting manager, the acting manager said that this would then be referred to the area manager, the area manager was clear about their responsibilities regarding ‘safeguarding adults from harm’ reporting procedures. Staff were clear about what they would do, but the home’s policy on this matter didn’t accurately reflect this adopted practice. Initially the home’s policy couldn’t be located, this was because the ‘title’ of the document was not ‘user friendly’ and caused some misunderstanding. The procedure says that any suspected incident must be report to the Local Authority, which is correct, but staff practice within the home is that the ‘verbal report’ goes up through the line of acting manager and area manager. To prevent any misunderstanding, the home must review what procedure it wishes staff to follow, to make the document accessible and for it to be in ‘user friendly text’ Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 16 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical environment is comfortable, pleasant and homely, but ventilation was poor and there were some areas of risk to residents. Residents are not protected by hygiene standards within the laundry and kitchen areas. EVIDENCE: Ashbrook Court is relatively new build being 18 months old. A partial tour of the home was made late morning and a further visit to the kitchen was made approximately 4.30pm. Those bedrooms seen were very personalised, clean and comfortable. The communal areas were bright, well furnished and maintained. The standard of décor and furnishings throughout the home was of a very good standard. There were no unpleasant odours anywhere in the home. Residents have the use of a secure, well maintained garden area. Ventilation within the home is poor. The home was hot, stuffy with little fresh air ventilation. Residents and staff told the inspector that that this was quite normal and that concerns had been raised. The area manager said that the Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 17 registered provider was aware of the issue and are looking at ways and options to resolve it. Unfortunately this currently leaves a hot and sticky environment for staff to work in and an uncomfortable environment for some residents. The acting manager accompanied the inspector during the tour of the home and agreed with the following observations. Wheelchairs and hoisting apparatus had been left in main corridors creating potential obstructions for residents, the home accommodates residents with dementia care needs, but cupboards/rooms in ensuites and communal areas had been left unlocked (with keys still hanging in the locks) containing latex gloves, creams/lotions, razors and liquid cleaning materials. The majority of bathrooms doors have slide bolts on which can only be operated from the outside. This is to prevent residents entering unattended. However, the inspector noticed that some bolts were in an ‘open’ position and the risk is that a resident could enter and without staff knowledge of this, the bolt could be slipped from the outside trapping the resident inside. There were no risk assessments in regarding this practice. Waste bins containing unwanted food scraps in kitchenette areas didn’t always have lids on. This issue was raised during the last key inspection. In the laundry area, the bin lid was missing, soiled clothing was left laying strewn across the floor, residents clean tabards were falling from the table to the floor and clean bedding was draped over the ironing board falling onto the floor area. The inspector was told that arrangements are in hand to provide suitable containers for soiled and clean laundry. However, on the day of the site visit there was a significant risk of cross contamination issues from dirty to clean laundry and the home could not demonstrate adequate management of hygiene and infection control standards in this area. Current practice places residents at potential risk. Late afternoon the acting manager accompanied the inspector into the kitchen area. The acting manager agreed that here too, hygiene standards were inadequate. The kitchen assistant said that everything would be cleared up within an hour, but the situation as found, demonstrated inadequate management systems within this area. For example, surfaces throughout the kitchen area were not clean, there was bits of food of the floor and on most of the working areas. Three bins containing waste food had no lid, two sink wastes were full with waste food, unused potatoes from lunch preparation in the morning were found in a plastic container full of murky water under the sink, two scourers were in a container with a liquid substance, chipped potatoes cooked four/five hours earlier were still in the deep fryer, left over food was on the side unprotected and soiled cleaning cloths were on draining boards. Used and soiled kitchen utensils and knives were seen on surfaces around the kitchen. There was no evidence that the kitchen had been properly cleaned since the lunchtime period. Sandwiches were on the side ready for tea, but the inspector voiced concern about the hygiene standards under which they may have been prepared. The home could not demonstrate adequate management of hygiene standards within this area. Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be cared for by a team of trained nursing and care staff in numbers that are adequate to meet assessed needs. EVIDENCE: The home has three designated working areas i.e. ground floor left is residential care for those with dementia care needs, ground floor right and back is for those with general nursing needs and the 1st floor is for those with those who require nursing needs associated with dementia needs. Both nursing areas have designated nurses on duty at all times who are supported by care staff. On the residential area, a senior carer is on duty at all times and is supported by care staff. The home employs a 7-day cover for housekeeping staff, kitchen staff and laundry staff. Also maintenance and administration staff provide a 5-day cover for the home. The home has one generic staff rota which was clear in detail and accurate on the day. Staff spoken with were clear about their areas of responsibility and the current working area delegation system, seems to work well. The acting manager’s hours actually worked in the home must be recorded on the rota. Also the full names of all staff employed should also be on the rota. The area manager spoke of some staffing issues in the past months but was pleased to report that this was now resolved. Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 19 The home has recently undertaken a recruitment drive and now do not have any staff vacancies. It was noted that many staff work ‘double shifts’ on a regular basis. It was explained that due to the location of the home, unless staff have private transport, getting to and from the home is not easy. This has been a major factor for the home when recruiting has taken place. The recruitment records of the two most recently recruited members of staff were viewed. Records were in good order. Induction records were also made available. The home was able to demonstrate that it has well developed staff training programme. All nurses are trained to RGN level, three care staff have achieved NVQ level 3, seven care staff have achieved NVQ level 2 and a further 10 care staff are booked to begin their NVQ training. Staff supervision sessions taken place regularly and the home has a well developed staff meeting schedule. Staff looked very smart and clean in their uniforms. Different staff wear different colours and the style of uniform depends on their contracted role and function. This assists residents with dementia care needs in identifying staff as the inspector was told by one resident who has dementia care needs, that ‘the one in dark blue is in charge’. This member of staff was a nurse, so the system benefits residents. Those residents able to express a view were honest and open about their views on the staff. Naturally, with such a large group of residents and staff there are ‘favourites’. The positive aspect was that no resident was negative about any member of current staff. The area manager said that the staff team had ‘settled down’ now following a difficult period a couple of months ago. It was reported that staff turnover and sickness level are minimal now. Staff impressed the inspector as being helpful. All were happy to speak to the inspector. Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 20 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): 31,32,33 & 38 (standard 35 was not assessed on this occasion) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a home where there has been significant changes in management personnel since it opened and these changes have influenced continuity of management style within the home. Residents may continue to experience further changes in the style and manner in which the home is managed. EVIDENCE: The home opened in January 2006 and since that time there has been five managers. Some have been registered, others have been in an acting capacity. The current acting manager has been in post for five weeks, but will not be seeking registration for the home. This means that the home will have another new manager in the near future. The acting manager demonstrated Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 21 commitment and dedication and was able to evidence that during her short time in the home had reviewed many of the safe working and environmental risk assessments. In addition, it was evident that the acting manager has played a huge role in consolidating staffing matters and residents feel comfortable with her presence in the home. The scoring of standards 31 and 32 of ‘almost met’ (see next page) has been based on the ongoing and presenting situation within the home and not on the personal performance of the acting manager. The home could not demonstrate that all aspects of the home are being managed adequately for the benefit of residents. Matters have been referred to in this report. For example, the management of the kitchen and laundry areas, the complaints procedure, nutrition records, environmental risks and medication issues. The acting manager also agreed that the office management systems need review, as things were ‘a bit cluttered and disorganised’. This was because the five other managers have influenced policies, procedures and management matters. There is also the issue that the acting manager is not a registered nurse. A registered manager of a nursing homes does not have to be a registered nurse, but the registered provider must be able to demonstrate that arrangements are in place to provide adequate clinical and professional supervision for all nurses working in the home. The home was able to demonstrate that regular Regulation 26 (visits to the home by the owner or representative) take place. The area manager said that because of all the management changes within the home, she visits several times a week to support the acting manager and to give general direction and advise. The home has recently completed a Quality Assurance report and will forward this to the Commission once it is available. The next Quality Assurance cycle will also include the view and opinions of other stakeholders i.e. GP, social workers and other processionals. Accidents records were seen and maintained in good order. It was also positive to note that the home undertakes a regular audit of all accidents and incidents to establish whether or not there is a pattern emerging. This is good practice and the home should be commended on this. The home does not safe keep any personal monies for residents. Records demonstrate that the home facilitates regular residents and relatives meetings. A random section of service and maintenance records were sampled and found to be in good order. In addition the home undertakes a monthly internal ‘health and safety checklist’ process. Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 22 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X X X X 2 Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13 Requirement Current medication practices must be reviewed to ensure that all practices are in line with legislation and guidance for the safety and wellbeing of residents. This was in respect of ensuring that all handwritten dosage and administration details made by the home are checked and recorded as being correct by two members of staff. The home must maintain a form of record to demonstrate that residents are provided with food and drink (fluids) which are in adequate quantities, suitable, nutritious and varied. The home must review the management of how complaints are recorded, investigated and concluded. The complaints procedure and any subsequent record must contain elements that are required by regulation and be in accordance with the home’s complaints policy/procedure. DS0000066272.V339805.R01.S.doc Timescale for action 15/08/07 2 OP15 16 & 17 15/08/07 3 OP16 22 15/08/07 Ashbrook Court Care Home Version 5.2 Page 24 4 OP19 OP26 12,13 & 16 For the safety and wellbeing of 15/08/07 residents, adequate infection control, cross contamination and health and safety measures must be put in place and reviewed to ensure compliance. This is with particular respect to the kitchen and laundry areas and cupboards containing potentially harmful substances/items must be kept locked. For the comfort and wellbeing of residents (and staff as it is their workplace), adequate and suitable arrangements must be made to improve the air ventilation systems/fresh airflow within the home. It is recognised that the home may not be able to provide a permanent solution to the matter within the timescale, but a temporary measure must be in place and there must be evidence of a reasonable attempt to find a full solution. Corridors used by residents must be kept clear of any obstruction. 5 OP31 OP32 12,13,16, 22 & 23 The registered providers must ensure that there is a consistent management approach to the day-to-day functioning of the home. The situation since the home opened has not been conducive to continuity or stability. This has had an unsettle effect on staff and residents and the improved management of health/safety/hygiene matters in particular is paramount for the wellbeing of residents. For the safety and protection of residents all risk assessments in DS0000066272.V339805.R01.S.doc 15/08/07 6 OP38 13 15/08/07 Ashbrook Court Care Home Version 5.2 Page 25 respect of the health, safety and welfare of residents must be reviewed. This included health & safety within the kitchen and laundry areas, cupboard containing potentially harmful items kept locked, risk assessment regarding outside bolts being used on bathroom doors, corridors being kept clear. Full details are within the report. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashbrook Court Care Home DS0000066272.V339805.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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. 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