Inspection on 17/11/05 for Ashbury Lodge Residential Home

This inspection was carried out on 17th November 2005.

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

Ashbury Lodge Residential Home 02/11/06

Ashbury Lodge Residential Home 07/06/05

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Ashbury Lodge Residential Home 261 Marlborough Road Swindon Wiltshire SN3 1NW Lead Inspector Bernard McDonald Unannounced Inspection 17th November 2005 08:30 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 Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 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. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashbury Lodge Residential Home Address 261 Marlborough Road Swindon Wiltshire SN3 1NW 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) 01793 496827 01793 525953 Coate Water Care Company Limited Mrs Geraldine Frances Smith Care Home 44 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (25), Old age, not falling within any other category (19), Physical disability (1) Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The only service user in the age range 18 - 64 years with a physical disability who may be accommodated in the home is the named, male client referred to in the application dated 26 March 2004 7 June 2005 Date of last inspection Brief Description of the Service: Ashbury Lodge is a private care home situated on the outskirts of Swindon. The owners also own another care home in the area. They operate the home as a family business. The home fulfils 3 distinct but complimentary services. On the ground floor care and accommodation is provided to older people who need less supervision and have more awareness of their environment. On the first floor care and accommodation is provide to older people who need extra supervision. For reasons of safety the egress from this floor is electronically locked. Each floor to all intents and purposes operates as a separate unit. The home provides for older people who either have dementia type conditions or experience (or have experienced) mental illness and older people who need care only because of infirmity or reasons associated with getting old. All but 4 rooms provide single accommodation, some with en-suite facilities. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over 8 hours. The inspector met with four members of staff in private and the deputy manager was available to assist throughout the inspection. The inspector viewed all areas of the home and met with all service users. The inspector interviewed service users in private and in small groups to obtain their views on the care they receive. In addition records relating to the care of service users and their safety were examined together with staff recruitment records. Following the last inspection the Commission received one anonymous complaint regarding the management and care practices at the home. The Commission and the registered providers investigated the complaint and although a substantial part of the complaint was not upheld five requirements were made on areas where practice could be improved. The CSCI pharmacist inspector examined the medication records at the home. What the service does well: There is a good admission procedure, which ensures no one is admitted without a comprehensive assessment of need. This practice ensures the home can demonstrate how it can safely meet the needs of people who are being referred. Service users, who could express their views, confirmed they were happy with the care provided. The majority of comment cards received from the relatives of service users indicated they were also happy with the care provided at the home. Where comment cards expressed dissatisfaction on the service provided at the home it was brought to the attention of the deputy manager. The home has undertaken a comprehensive investigation into an anonymous complaint, which demonstrates the homes commitment to ensure the safety of service users. In addition there is a newsletter that is available to relatives and stakeholders on developments at the home. The inspector met with the relatives of three service users and comments received were positive on the care and service provided. The environment was well maintained, clean and comfortable, furnishings are of a good standard. Staffing levels are being maintained and ensure there are two staff on each unit. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 6 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. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 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 Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home is ensuring that no service users are admitted without an assessment of their needs. EVIDENCE: The inspector examined the records of two service users recently admitted to the home. The records demonstrated the home had received specialist assessments covering the health and personal care needs of the service users. In addition there was a précis of one service users needs that had been completed by their previous residential placement. As a matter of good practice the home had also completed a daily living needs assessment to determine how the home could safely meet the needs and aspirations of individual service users. A member of the senior management team also meets with any prospective service user as part of the assessment process. Following admission, records demonstrate that the home had developed an initial care plan to ensure the needs of service users are being safely met. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9. There was no evidence in the five care plans examined to demonstrate how service users needs are being safely met. Systems are in place for the safe management of medication, however record keeping is not sufficient to ensure safety and service users’ individual needs as regards the administration of their medicines are not always met. EVIDENCE: The inspector examined the care plans of five service users and found the content and quality of recording varied. There was no evidence to demonstrate service users involvement or awareness of their care plan. Service users sleep patterns have been recorded which ensures staff are aware of the times service user are choosing to get up and go to bed. Care plans did not fully reflect the needs of service users. For example one service user had been diagnosed as having Parkinson disease. The care plan had not been updated to reflect this change and did not contain any information on how this may affect the care needs of the service user. Another service user was receiving treatment for glaucoma, and again, the care plan did not make any reference to how this service user needs to be supported. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 10 In contrast staff demonstrated an awareness of the needs of other service users. It would appear this awareness is passed by word of mouth as not all care plans fully reflected the care needs of service users. This was a requirement at the last inspection. Discussion with the deputy manager confirmed that the home has plans to involve service users and their relatives in a six monthly review. In view of some progress being made to meet this requirement the inspector has agreed to extend the timescale for compliance. However compliance must be achieved within the revised timescale to avoid enforcement action being taken. Further improvements are required in the management of risks to ensure service users safety. One service user at risk from falling had no reference to the risk in the care plan. A further example was found where one service user’s manual handling assessment identified a risk of falling, though no risk assessment had been completed. The pharmacist inspector examined the medication records in the home and found medication is stored securely in the three areas of the home. Some medication administration records were not complete or had alterations, which had not been signed. Liquid paper had been used to cover some entries. Records showed that some service users consistently refused medication or did not receive it due to being asleep at the time of the medication round. These medicines should be re-offered at a different time and advice sought from the GP about appropriate doses and times for these residents. Dosage and medication changes to ‘as required’ medication regimes were not reflected in the care plans. Medicines received into the home from the regular order were recorded, but this did not extend to new service users or medicines received during the month. Information about medicines is available in the home and staff do not administer medicines until they have received appropriate training. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 15. The home is ensuring service users are able to maintain contact with people who are important to them and that as far as possible they can exercise choice and control over their lives. Steady improvements are being made to the quality of food prepared at the home. EVIDENCE: The inspector received over twenty comment cards from the relatives of service users. The majority of comment cards confirmed relatives were happy with the care and facilities provided at the home. However not all comments were favourable and these were brought to the attention of the deputy manager during the inspection. The inspector met with the relatives of two service user’s who confirmed they could visit the home at any time and were always made to feel welcome. Comments received from service users describe staff as being “wonderful” and “very good” and we are “well cared for”. One service user said it was “alright”. It is the policy of the home not to become involved in service users finances. These are normally managed by the service user or their representative. In addition advocacy information is available at the home for the benefit of service users. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 12 The inspector shared the lunchtime meal with service users. The meal was tasty and was generally well received by service users. Improvements have been made to the preparation and quality of meals served. While service users commented meals were “good”, the inspector received two comment cards from relatives regarding the poor quality of meals. The manager has addressed these concerns and improvements to the menu are to be implemented over the coming weeks. These improvements are to include two cooked choices at the main meal and fresh fruit available at all times. There is to be more choice at tea times including more hot snacks to give more variety and choice to service users. The cook is now ensuring all soft diets or pureed food is liquidised separately to ensure they are more presentable and palatable for service users. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. The home is striving to ensure service users are protected from abuse and their views are listened to and complaints are responded to in a prompt manner. EVIDENCE: Since the last inspection the Commission has received one anonymous complaint about the service provided at the home. In partnership with the home the Commission investigated the complaint. The registered providers undertook a detailed investigation into the complaint and provided the Commission with a comprehensive report on their findings. The resulting investigation identified five requirements in areas that could be improved. These requirements have now been met. Discussion with service users confirmed they would raise any concerns with the manager or a relative if they need to complain. However comments cards indicated not all relatives were aware of the homes complaints procedures. Following the inspection the registered provider confirmed all service users and their relatives receive a copy of the service users guide, which provides details on the complaints procedures. The home was keeping a log of all complaints but there was no evidence to show how one of the complaints had been resolved. The deputy manager confirmed the complaint in question was fully investigated and action was taken to resolve the complaint but this had not been recorded. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 14 Discussion with staff demonstrated a good understanding of what constitutes abuse and what action they would take to safeguard service users. The majority of staff have completed abuse awareness training and appear to have benefited from this input. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. The home was clean, free from odour and well maintained. Laundry arrangements are sufficient for the needs of service users. EVIDENCE: The inspector viewed all parts of the home including communal living areas and service users bedrooms. The home was clean, tidy and free from any offensive odour. Furnishing and fittings were of a good standard. The home employs a fulltime maintenance person, which ensures minor repairs are dealt with quickly. Discussion with service users confirmed they were satisfied with the standards of accommodation at the home One service user commented, “they had everything they needed”. Another service user confirmed they had brought items of personal furniture to the home when they moved in. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 16 The laundry area is sited well away from food preparation areas. Red alginate bags are in place for soiled linen to reduce the risk of infection. The home employs a laundry person Monday to Friday. There are two commercial washing machines and two commercial dryers. Discussion with the laundry person confirmed these were sufficient for the home. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29. The home is making every effort to ensure there are sufficient staff on duty to meet the needs of service users and overall safe recruitment practices are being followed. However the failure to explore gaps in prospective staffs CV’s means recruitment practices are not sufficiently robust to ensure the protection of service users. EVIDENCE: Since the last inspection the home has employed three unit leaders to ensure there is a senior member of staff on duty at all times. Examination of the rota demonstrated there are a minimum of two care staff on each unit and four waking night staff. In addition the home employs an activities coordinator, laundry person, maintenance person and two domestics, which would indicate care staff are not taken away from the task of caring for service users. The hours worked by the registered manager are not being recorded and it is a requirement that these records are now kept. Service users who could express a comment on the care provided at the home were generally satisfied with the care they receive. The inspector examined the recruitment records of three recently appointed staff members. The records contained a copy of a satisfactory criminal records bureau check at enhanced level, which had been obtained prior to the staff member commencing work. In addition two written references and proof of identity had been obtained by the home. The inspector found that the home Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 18 was failing to explore gaps in prospective staff member’s curriculum vitae. It is a requirement that these checks are now made to ensure a more robust recruitment practice is followed. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 38. The home is safely managing service users personal money, but is failing to ensure they are protected from injury from hot water and hot surfaces. EVIDENCE: Discussion with the deputy manager confirmed the home was holding personal money on behalf of service users. A sample of records were examined and demonstrated the home was accurately recording money being held for service users. Fire safety records demonstrated fire drills were being completed every three months. In addition safety certificates were available for gas, electric and portable appliance testing. Training records demonstrated staff had received manual handling, first aid and infection control training. The inspector found that hot water temperatures were only regulated close to 43c in the bathrooms. Hot water outlets in service users bedrooms were tested Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 20 and found to exceed 50c, the maximum temperature on the thermometer, putting service users at risk from scalding. Risk assessments had not been completed to demonstrate this practice was safe. In one service users bedroom the inspector was warned by the service user to be “careful” as the water was very hot. In addition the inspector found radiators were not covered, a practice that puts service users at risk. These matters were brought to the attention of the deputy manager who was advised of the need to take action to ensure the safety of service users. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 21 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 1 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2)(b) Requirement The registered person must ensure that when reviewing care plans the review must acknowledge any change in circumstances. This was a requirement at the last inspection. Timescale for compliance 01/07/05. The registered person must ensure service users care plans are reviewed a minimum of once a month or earlier if the needs of the service user changes. The registered person must ensure wherever possible service users or their representative are involved in the development of the care plan. The registered person must ensure that where a service user has been assessed at risk from falling a risk assessment is completed to minimise any risk. The registered person must ensure written additions to the medication administration chart are signed, dated and checked by two members of staff to ensure accuracy. No entry must DS0000057248.V255096.R01.S.doc Timescale for action 01/01/06 2 OP7 15(1)(b) 01/01/06 3 OP7 15(1) 01/04/06 4 OP7 13(4)(c) 01/01/06 5 OP9 13(2) 01/12/06 Ashbury Lodge Residential Home Version 5.0 Page 23 6 OP9 13(2) 7 OP9 13(2) 8 9. OP9 OP16 13(2) 22(3)(4) 10 OP27 17(2) 11 OP38 13(4)(a) (b)(c) 12 OP38 13(4)(a) (b)(c) ever be obscured or indelibly removed. The registered person must ensure service users care plans reflect the current use of ‘as required’ medicines for individual service users. The registered person must ensure medicines, which are not given due to frequent refusal, or inappropriate timing must be referred to the pharmacist or service user’s GP for advice and must be recorded in the service users notes. The registered person must ensure all medicines received into the home are recorded. The registered person must ensure the outcome of any complaint investigation is fully recorded. The registered person must ensure the hours worked by the registered manager are clearly recorded. The registered person must complete risk assessments on hot water outlets in service users bedrooms and where a risk is identified action must be taken to protect service users. The registered provider has since confirmed thermostatic reducing valves have been fitted to all hot water outlets. The registered person must ensure all radiators are guarded or have low surface temperatures. 01/12/05 01/12/05 01/12/05 01/12/05 01/12/05 01/01/06 01/04/06 Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP29 OP38 Good Practice Recommendations The registered person should review service users risk assessment following any fall. The registered person should ensure gaps in prospective members of staff CV are explored as part of the recruitment process. The registered person should ensure hot water in service users bedrooms is regulated close to 43c. The registered provider has since confirmed thermostatic reducing valves have been fitted to all hot water outlets. Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashbury Lodge Residential Home DS0000057248.V255096.R01.S.doc Version 5.0 Page 26 - 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!