Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Ashburnham House 33/35 Westminster Road Morecambe Lancashire LA4 4JA The quality rating for this care home is:
one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Dale
Date: 0 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home
Name of care home: Address: Ashburnham House 33/35 Westminster Road Morecambe Lancashire LA4 4JA 01524413508 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ashburnhamhouse@hotmail.co.uk Mr Nashir Kasmani Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 12 Number of places (if applicable): Under 65 Over 65 0 4 dementia old age, not falling within any other category Additional conditions: 8 0 The home is registered for a maximum of 12 service users to include: Up to 4 service users in the category OP (Old Age, not falling within any other category). Up to 8 service users in the category DE (Dementia). Date of last inspection Brief description of the care home Ashburnham House is a small, family type environment providing residential care for up to 12 people of either sex. At present, the home is registered to accommodate up to 8 people with dementia and up to 4 older persons. The home comprises of two terraced houses which have been developed into one large property and it is situated in the West End of Morecambe, close to local shops, amenities and the promenade. In early 2004, the home had a change of Proprietor and is now owned and managed by Mr Nashir Kasmani. The current fees at the home are in line with Lancashire County Councils charging policy and are 400 pounds a week. Care Homes for Older People
Page 4 of 29 Care Homes for Older People Page 5 of 29 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit was unannounced and took place over 5 hours. Various documents were examined including, records belonging to the people provided with a service and staff records. The registered provider who is also the registered manager was spoken with as well as staff and the people living at the home. Surveys were sent prior to the site visit. Eight surveys were returned from the people living at the home and six from staff. The findings, comments and any issues arising from the surveys have been incorporated into the report. The last key inspection took place on the 18th September 2006 and an Annual Service Review was undertaken on the 19th October 2007. Care Homes for Older People
Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The care plans have been updated and the documentation has been expanded for the initial assessment. There are eight people living at the home; there have been no new admissions since the last inspection. Decoration and refurbishment of the home continues to take place with the purchase of a new dishwasher and washing machine. Railing on the top landing has been highered to ensure the safety of the person living in that part of the home. Individual training records have been set up in order to ascertain the training staff have undertaken and a matrix has been devised to see at a glance any shortfalls. Several staff have received training in First Aid and Moving and Handling. The number of staff with a National Vocational Qualification (NVQ) has increased with five out of the eleven staff obtaining an NVQ at level 3 in Care. Staff are now receiving one to one formal supervision on a regular basis and the details are recorded. Personal allowance monies belonging to the people living at the home is now handled by relatives. Care Homes for Older People Page 8 of 29 With regard to the recruitment of staff, the application form now prompts a full employment history to be obtained on the applicant. 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 4. Care Homes for Older People Page 9 of 29 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 29 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available about the services provided by the home. The assessment process ensures that the services provided by the home are appropriate and meet individual requirements. Evidence: The Service User Guide is also the Statement of Purpose and there is also a small leaflet that can be provided to any prospective new person. There have been no new admissions on a permanent basis for a number of years, Respite care has been provided but is now to be discontinued. The assessment paperwork seen included obtaining as much background information as possible and would include a visit to the individual concerned in hospital or within their own home prior to admission.
Care Homes for Older People Page 12 of 29 Evidence: The assessment would include any specific needs connected with social interests, hobbies, religious, cultural requirements and relationships. The process includes a Personal History Summary that details the individuals Life Experiences; Family History; Employment History; Important Relationships and Bereavements and Future Hopes. The home does not provide an intermediate care facility. The assessment takes into account any risks and the registered provider/manager has strengthened this particular part of the documentation because of some recent concerns following respite care. Care Homes for Older People Page 13 of 29 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal requirements of the people living in the home are being met in a caring way by the staff within the home. Staff need to be provided with up to date accredited training in medication administration to ensure the health needs of the people living in the home are being met. Evidence: Several care plans were examined and were found to contain sufficient detail for the staff to provide care that is effective for the individual concerned. The pro-forma for recording the care plan was user friendly clear and divided into sections for ease of use. The care plans are reviewed on a monthly basis. At the last inspection, a recommendation was made that information should be obtained about the type of dementia diagnosed for the people with this condition in order to better understand how the diagnosis can effect the individual concerned. This has not been done and a new recommendation was made that staff should be provided with some training in Dementia Care that would assist them in their role to provide
Care Homes for Older People Page 14 of 29 Evidence: effective care. A couple of staff had received some Dementia Awareness training. Because the people living in the home have been receiving care for a number of years, staff are very familiar with their needs. Comments received by staff included: Care plans are being updated regularly according to changes. The use of daily log and communication book and hand overs works very well. I have the right support from staff and the manager; experience and knowledge are from being updated about change of each individual I care for. There was evidence on the care plans of liaison with health care professionals and a record of weight was being recorded. One of the persons living at the home is receiving nursing care by the district nurses because the family do not want her moved. The medication records and storage of medication was examined and found to be in good order; currently there are no controlled drugs being administered. The registered provider/manager conducts an audit of the medication once a month. Staff have not received accredited medication training; training has been cascaded from experienced trained staff. Staff who provide assistance with medication must receive appropriate accredited training and become familiar with the up to date legal guidance on medication administration. Staff are taught the importance of privacy and dignity at induction and it was observed that the staff members on duty were aware of the principles of care. People spoken with living in the home spoke well of the staff and the care received. A staff member made the following comment: We give our utmost care and love. The homes Philosophy of Care stresses the importance of meeting needs in a caring and sympathetic way so that their privacy and dignity is respected. Care Homes for Older People Page 15 of 29 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables the people living in the home to have a standard of lifestyle that meets their expectations and choices. Evidence: The care plans reflect individual routines and preferences. According to the registered provider/manager the home no longer employs an activities co-ordinator. One of the reasons for this is the lack of interest from the people living in the home. Some activities take place such as dominoes and a staff member spoken with says she gets them dancing in an afternoon. According to the registered provider/manager activities also include, making Christmas Cards, a Christmas party is to be provided, skittles and catching balloons. A hairdresser attends the home once a fortnight. There are no structured activities and no trips out. Some of the people in the home are taken out by their relatives. One of the people living in the home stated that she was bored and spent most of her time reading. The registered provider is aware of the Advocacy Service and has used the service in the past for one of the persons living in the home. Care Homes for Older People Page 16 of 29 Evidence: Dementia Care training, as previously referred to in the last section, could provide staff with information about appropriate activities that could provide encouragement for people who have no interest in hobbies previously experienced. Relatives and friend are able to visit the home at any time and are able to see the people living in the home in private if they wished. Individual routines are respected and staff are very familiar with the wishes and choices of the people living within the home. The staff member on duty prepares the lunchtime meal and when spoken with confirmed that she has enough time to cook as well as care for the current people within the home. The people spoken with confirmed that the food provided was good and offered choice; special diets would be catered for. Care Homes for Older People Page 17 of 29 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a need to strengthen the existing training and procedures operating at the home in order to ensure the protection of the people living at the home and the staff. Evidence: The home has a formal complaints procedure which is publicised in the Service Users Guide and is also on display. There have been two concerns raised with Social Services under the Safeguarding procedures within the last twelve months. Consequently an investigation was conducted by Contracts at Lancashire County Council Social Services at which a review was conducted of the people living at the home and the training and procedures being operated. There were no concerns raised about the care being provided but, a number of recommendations were made for the safety and protection of the people living in the home as well as the staff. Some of those recommendations have been put into place including, Moving and Handling Training, a Training Needs Analysis of the staff and formal one to one supervision of staff. The registered provider/manager is also aware of the importance of a risk assessment being conducted on all areas of potential risk when a new person is admitted to the home. Staff have received some training in how to recognise the different types of Adult Abuse at their National Vocational Qualification (NVQ); a staff member spoken with
Care Homes for Older People Page 18 of 29 Evidence: had received this training but, had only scant knowledge of the subject and had to be prompted. Staff are aware of the complaints procedure and a comment was received on a survey: Concerns will be documented and the manager will be informed. There is still a need for staff to receive training in Safeguarding including how to recognise and report and Adult Abuse. Recommendations were also made for training in Dementia, Medication, Challenging Behavior and Infection Control, these still need to be put into place. A central record had not been kept of these complaints and it is necessary for a record to be kept of all complaints and the action taken in respect of each complaint and the outcome. Care Homes for Older People Page 19 of 29 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and homely environment for the people living in the home. Evidence: A tour of the home confirmed that the home is well maintained and homely with two lounges and an open fire. The home was warm, clean and tidy. The rooms showed evidence of personal belongings and treasured items in place. The home has a passenger lift and stair lift in place. Most areas of the home are accessible although one person without mobility problems is located on the top floor where there is only access by staircase. The railing on the top landing has been highered as recommended at previous inspections to ensure the safety of the person on the top floor. There was evidence of toiletries on display and it was recommended that any toiletries that could be ingested are are placed out of reach to ensure the safety of the people living at the home. There is an outside space that provides seating for the people living at the home when the weather is good. Since the last inspection refurbishment has continued with new carpets and a new
Care Homes for Older People Page 20 of 29 Evidence: washing machine and dishwasher. Policies and procedures are in place with regard to Infection Control but, there was no evidence that staff had received Infection Control training. Care Homes for Older People Page 21 of 29 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient trained staff on duty to provide a good level of care for the number and needs of the current people living at the home. Evidence: Staff are on duty at a specific time that is not changed and they are therefore able to plan their home life more effectively. There was one staff member on duty at the beginning of the site visit who was then joined by the registered provider/manager. According to the registered provider, he and his daughter are available at all times because they live next door. Extra staff are employed for the busiest times which are: 7:30 till 8:15 am when there are three staff on duty, two staff until 11:00 am, one staff until 5:00 pm and then 2 staff until 6:00 pm. One staff member is on duty after 6:00 pm with the assistance of the registered Provider or his daughter. The staff member spoken with confirmed that she had sufficient time to carry out her duties and care for the current people living at the home. Currently there are eight people living at the home and the majority are fairly mobile and their behaviour and needs are manageable. More staffing may be necessary if there is an increase in numbers or their needs require more staff assistance. The home has a suitable recruitment policy and checks had been undertaken with the
Care Homes for Older People Page 22 of 29 Evidence: Protection of Vulnerable Adults Register (POVA) and the Criminal Records Bureau (CRB). Some of the references seen were inappropriate with To whom it may concern instead of a written request from the home; the registered provider confirmed that he always followed references up with a phone call. Staff had all received induction training and staff training has now been placed on a training matrix which clearly indicates the shortfalls in staff training as well as that achieved. A recommendation was made to include, Medication, Safeguarding (Adult Abuse), Dementia Awareness and Infection Control to the training matrix. Three staff have received First Aid Training and six staff have received Moving and Handling Training. There are currently eleven staff and six staff have a National Vocational Qualificational (NVQ) in Care at level 2 or above. Comments received by staff included: I have to shadow the most experienced carer before starting any duty. Most of the staff are all NVQ trained. First Aid and Moving and Handling are all up to date. Care Homes for Older People Page 23 of 29 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and the people living in the home are protected by the policies and procedures that are in operation. Evidence: The registered owner is also registered as manager and has obtained the Registered Managers Award. The home is managed as a family concern with the day to day management of the home covered by the owner and his daughter. Surveys returned by staff and comments on the day of the site visit indicated that staff feel well supported and are happy to work at the home. Comments included: We are only a small residential home, we are fully staffed and all care needs are met. I have the right support from staff and the manager. Supervisions are conducted every six months with a questionnaire.
Care Homes for Older People Page 24 of 29 Evidence: Staff turnover has been low over the past twelve months. Any finances belonging to the people living at the home are dealt with by relatives and the advocacy service would be contacted as necessary. There is a safe available for the safekeeping of any valuables. There was evidence that staff are receiving one to one supervision and the format used is clear and signed by both the supervisor and the supervisee. Informal discussions take place constantly over the happiness of the people living at the home who when spoken with expressed their satisfaction with the care provided. Comments included: I like living at the home. and The staff look after me very well. A formal quality assurance system is in place - ISO 9001 that measures the level of quality support provided by the home. All the care records seen within the home were up to date and kept in good order. A record was seen to be kept of any accident or incidents occurring within the home. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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, Care Homes 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 Staff must be provided with accredited medication administration training. To protect the health care of the people living in the home 09/06/2009 2 16 17 A record should be kept of all complaints and include details about the investigation and any action taken In order to protect the people living at the home. 06/01/2009 3 18 13 Staff must be provided with 09/06/2009 training in Safeguarding and how to recognise and report any Adult Abuse. In order to protect the people living at the home and staff from harm. 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 Care Homes for Older People
Page 27 of 29 improving their service.
No. Refer to Standard Good Practice Recommendations 1 1 The Service User Guide should be reviewed to ensure it includes all up to date information about the services provided by the home as detailed in the Care Home Regulations for the Statement of Purpose and maintained thereafter as a separate document. All Staff should receive training in Dementia Care in order to provide appropriate and more effective care to the people living within the home. Staff should be provided with training that will assist them to provide suitable activities for the people living in the home. Staff would benefit from receiving training in Challenging Behavior in order to help protect from harm the people living at the home as well as staff. Any toiletries, shampoo or bath gel that could be ingested by the people living at the home should be kept out of reach. Staff should be provided with training in Infection Control to ensure a safe environment for the people living in the home and staff. A written request for reference should be made on behalf of each potential employee to ensure that suitable information is obtained before staff are employed. 2 7 3 12 4 18 5 19 6 26 7 29 Care Homes for Older People Page 28 of 29 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!
