CARE HOMES FOR OLDER PEOPLE
Ashby Court Nursing Home Tamworth Road Ashby De La Zouch Leicestershire LE65 2PX Lead Inspector
Mrs Gillian Adkin Unannounced Inspection 1st December 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashby Court Nursing Home DS0000001884.V270006.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. Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ashby Court Nursing Home Address Tamworth Road Ashby De La Zouch Leicestershire LE65 2PX 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) 01530 560105 01530 560173 BUPA Care Homes Limited Mrs Ruth Coales Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability over 65 years of age of places (60), Terminally ill over 65 years of age (60) Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. To admit a named person named in variation application 53748 dated 4 September 2003. To admit the named person of Category PD named in variation application V13707 dated 04/11/04 who is under 65 years of age. To admit the named person of Category TI named in variation application V22006 dated 27/6/05 who is under 65 years of age. To admit the named person of category PD named in variation application V24893 dated 19/09/05 who is under 65 years of age. 9th September 2005 Date of last inspection Brief Description of the Service: Ashby Court is a care home providing nursing care for up to 60 older people. The home is situated on the outskirts of Ashby in a residential area and is purpose built. It is easily accessed by public transport. The home provides residential and nursing care for sixty service users whose care needs fall within the categories of Older Persons and or Physical Disability over 65 years of age and terminal illness over 65 years of age. Accommodation is on two floors and can be accessed via a passenger lift. There is a choice of lounge/dining areas and all private rooms are with en suite facilities. The ground floor has spacious lounge and dining areas and the dining room opens out into the patio, which has been developed by the staff to include a herb and sensory garden. The home has fifty-four single bedrooms and three double bedrooms. All of the bedrooms are ensuite. The home employs trained and care staff. Close to the home is a large shopping centre and a number of pubs and restaurants. Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home was inspected against the Regulations as in the Care Standards Act 2000. This was an unannounced inspection, which took place over one day and commenced at 10.30 am on 01/12/05.The inspection took 6.0 hours. The deputy manager, and nurse in charge facilitated the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting three service users’ and tracking the care they received. This inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection. During this inspection a tour of the accommodation occupied by those case tracked took place and the inspector viewed internal records, and care plans. The inspector spoke to service users’, nurses, the physiotherapist working in the home and care staff. Several relatives were available during this inspection for comments. There were 49 residents accommodated at the time of this inspection of which all had been assessed as having medium /high dependency needs. Conversation with two of the service users tracked was limited due to communication difficulties, however positive comments were received from other service users and relatives as detailed below. Typical comments included: “My relative is always clean, and respectable” “Staff usually respond to requests for help in a timely way” “MY relative has been in the home for a long time so I have seen some things change but overall the standard of care is very good” “I have never had to complain since I have been here” “There is normally enough staff on duty” “Rooms are very comfortable and warm, my relative is very happy here” “The staff are very patient and very kind” “The meals are very good” “Staff always maintain the dignity of my relative”
Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 6 “I am always made very welcome” “Communication is very good” Discussion with the deputy manager indicated that a number of changes had been made recently regarding care plans and auditing processes. It was indicated by her that care plans were in the process of being fully audited with a named nurse having full responsibility. Significant improvements have been made to the management of medication since the last inspection. What the service does well: What has improved since the last inspection?
Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 7 Since the last inspection the following areas have improved: 1. Care plans have been greatly improved; most have been audited or are due for auditing. Nurses have been give supernumerary time once a month to fully update care plans. 2. Risk assessment evaluation has significantly improved. 3. The management of medication has significantly improved in terms of the day-to-day record keeping and timing of drug rounds. Discussion has been held with GPs and the Pharmacist in order to improve the system following discharge from hospital. 4. Staff have received adult protection and infection control training and evidence was found to support improved infection control management. 5. Discussion has been held with the provider of agency nurses to ensure the competency of registered nurses supplied by them and specifically in relation to medication administration. 6. The level of supervision and supported clinical practise has significantly improved; staff stated they felt more informed and confident in their roles. 7. Improvements have been made on improving the nutritional status of at risk service users by the monitoring of food and fluids (taken and refused). This is to be commended. 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. Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 The home does not admit service users with specialist rehabilitative needs this ensures that those with longer term needs can be effectively managed. EVIDENCE: The home does not offer Intermediate Care services. Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 10 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): 7.8.9.10 Monthly evaluation and audit of care records and inclusion of external professionals and relatives into care planning ensures that all care needs including specialist needs are met. Recent improvements in the management of medicines have ensured that service users are safeguarded from potential harm. EVIDENCE: The primary method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they received. Significant improvements had been made to care plans since the last inspection; the new deputy manager has facilitated this. Care plan audits have been undertaken recently and staff stated that this process had been very informative and useful. All of the three care plans inspected contained essential risk assessments. Care plans and risk assessments were reflective of current needs. It was noted that all of the three service users’ tracked had specific nursing needs including the management of infectious conditions one service user tracked had palliative care needs. Care plans were developed in accordance
Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 11 with recognised care pathways such as the “Liverpool Care Pathway” for palliative care. Care was fully detailed in care plans sampled and evidenced the input of external professionals and treatment given. A service user tracked was involved in an annual review with a specialist community nurse from the Huntington’s disease society. No service users tracked were able to confirm any involvement in their care plans, however good evidence was found to support the involvement of relatives and advocates. Adequate evidence was found to suggest that healthcare needs were being met this included discussion with a visiting physiotherapist, and by inspection of care records. Staff were observed preserving dignity during this inspection, an example of this was the use of a screen when transferring a service user in the lounge. It was noted in records that appropriate medical attention had been sought and treatment given when required by service users’ regarding the management of infections. The deputy manager stated that all service users are routinely screened for nutrition and tissue viability on admission. This was fully evidenced in care plans. Medication issues raised at the last inspection identified the need for additional audit and monitoring of procedures. The management of medication has significantly improved in terms of the day-to-day record keeping and the timing of drug rounds. The deputy manager said that she has been in discussion with GPs and the Contracting Pharmacist regarding improving the system following discharge from hospital and to ensure that medication is accurately recorded and administered. The registered provider has a contract for the safe disposal of medicines which staff were fully aware of. Discussion with staff responsible for medication demonstrated that they were aware of the medicines that they administered to individuals. Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Service users are satisfied by routines, which enable them to maintain control and experience a lifestyle, which matches their expectations and best interests. EVIDENCE: Discussion with service users’ and staff indicated that choice and autonomy is maintained where practicable. Staff gave examples of how they promoted independence. Discussion with service users demonstrated that they are empowered to make choices Two service users were observed having a late breakfast and stated that sometimes they have an early meal sometimes a later one. Discussion with kitchen staff indicated that the dining room does not close and service users can have a meal or snack when they wish. Good examples were noted of advocacy being used and the inclusion of relatives was seen in all of the care plans tracked. Ashby Court Nursing Home DS0000001884.V270006.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): 18 An adult protection procedure and appropriate training are in place to ensure staff are confident in responding to suspicion or allegation of abuse this ensures the protection of residents in the home. EVIDENCE: Discussion took place with the acting care manager in relation to provision of adult protection training, which was a requirement from the last inspection. It was stated that she has put together an internal training programme, which has been delivered to staff including student nurses working in the home. Discussion with staff Robust adult protection policies and procedures are in place, which are included in the initial induction and foundation programme for staff. When questioned about reporting alleged abuse, staff were aware of the whistle blowing policy and procedure. A member of staff discussed how she had been involved in whistle blowing. Staff training records were not available to confirm when the training had been undertaken and will be dealt with directly with the home manager. Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 14 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): 21.22.26 The home is clean, pleasant and hygienic and provides appropriate numbers of bathing and toilet facilities and specialist equipment to meet assessed needs. Procedures are in place to ensure that the risk of spread of infection to service users’ is minimised. EVIDENCE: A tour of the premises indicated that the home was clean and free from any odours. The bedrooms of those persons case tracked were inspected and found to have en-suite facilities. The home was noted to have adequate toilets and bathing facilities to meet the needs of service users’ currently accommodated. A new Parker bath, which had been recently installed, was seen. This is suitable for those persons unable to use other facilities. All of the three service users tracked had specific moving and handling needs. The environment and equipment provided appeared to meet their assessed needs and was detailed in care plans tracked.
Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 15 A discussion with the physiotherapist indicated that service users were provided with any mobility equipment required by the appropriate organisation such as the disabled services centre at Leicester General Hospital (wheelchairs etc) Access to the second floor was by a passenger lift which service users indicated they were assisted to use. Two service users were case tracked who have specific infection control needs. Records inspected and observation of their rooms and the main laundry indicated that all basic infection control measures were being taken to reduce the risks. Suitable evidence was found to confirm that external professionals had been involved and staff spoken with were aware of basic Universal Precautions. The acting care manager stated that most staff have received infection control training however this could not be clarified due to the unavailability of training records. Staff were observed carrying small bottles of alcohol rub as an extra precaution against contamination. This is considered good practise. Indications were given that an infection control nurse would be selected and would attend community training. Additional evidence was found to suggest that infection control is being vigilantly managed. Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 16 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): 27.30 Provision of suitable numbers staff who are sufficiently well trained ensures that service users needs can be met. EVIDENCE: The home was not fully occupied at this inspection having 49 service users accommodated. A calculation of staff hours over a two-week period was undertaken at this inspection and the home were found to be complying with the recommended minimum staffing hours as recommended by the previous registration authority. Discussions with staff indicated that mostly shift gaps are covered internally however agency staff are also used. Service users made no negative comments regarding staffing of the home. Discussion with the deputy manager indicated that the staff group was relatively stable. The home is an approved centre for adaptation training for nurses and is also approved as a placement centre for student nurses. Staff raised some concerns at the last inspection over working relationships and this was discussed in detail with nurses at this inspection. Indicators were that staff were now working cohesively and that relationships were much improved. Due to the registered manager being unavailable on the day of inspection training records were not available for inspection. Discussion with staff and observation of notice boards in the staff room indicated that a number of training opportunities were available for staff.
Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 17 The Organisation has recently commenced Dementia Care Training and it was indicated that a registered nurse had recently attended a two-day Palliative care course. No evidence was found to indicate when infection control training had been undertaken although the deputy manager stated that a number of staff have received this training. This standard will be inspected at the next inspection. Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 18 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): 33.36.37 Effective feedback obtained from service users and well-supervised and trained staff ensures that resident’s safety; best interests and rights are protected. EVIDENCE: Discussion with service users’ relatives, staff and external visitors indicated that the home is run in their best interests. All staff spoken with had a positive approach to their work and service users and relatives were satisfied were care provided. Quality assurance reviews are conducted annually, however the inspector was unable to ascertain the date of the last survey. Staff and residents meetings are regularly held in an attempt to seek feedback. A number of internal auditing processes are carried out by the organisation. Discussion with the deputy manager and with staff confirmed that clinical supervision and clinical practise sessions are randomly undertaken. Staff considered this to be a positive experience and helped them to develop.
Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 19 Records seen indicated that supervision had been planned for all staff over a twelve-month period. All records inspected on this occasion were well maintained and appropriate information was contained in them. These included fire, accident and maintenance records. Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 20 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X 3 X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 3 3 3 Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action 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 Ashby Court Nursing Home DS0000001884.V270006.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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