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Inspection on 09/09/05 for Ashby Court Nursing Home

Also see our care home review for Ashby Court Nursing Home for more information

This inspection was carried out on 9th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Home provides a homely environment for service users`. There is an established management team. The organisation promotes individual staff achievements through BUPA`s Personal Best Awards programme. The home provides high quality meals and service users spoken with praised the food quality. The home provides a good range of activities and external outings. The organisation provides good quality training for staff. The home recruit staff from other countries as an equal opportunities employer. The home provides a good level of information to new residents moving into the home.

What has improved since the last inspection?

The level of dependency monitoring has improved since the last inspection. The home has purchased a new assisted parker bath to ensure bathing facilities are suitable for residents needs. Staff have been issued with alcohol gel rub to ensure infection control is in accordance with local guidelines and good practise.

What the care home could do better:

The level of communication with relatives could be improved by the introduction of intermediate care meetings between interested parties and family members. The level of communication between internationally appointed staff and residents could be monitored during supervision sessions to improve outcomes for residents.The level of service user/ relative input into care planning would ensure that all parties are fully informed. The outcomes for service users would be improved by more robust follow up/ investigation following incidents and accidents occurring. The outcomes for service users would be improved by ensuring that agency staff receive appropriate instructions regarding their responsibilities on a shift in particular in relation to administration of medication. The outcomes for service users would be improved if staff were to receive adult protection training. The outcomes for service users would be improved if the manager monitored the skill mix on each floor and where required support and further deployment of staff initiated, this is considered vital in view of the level of internationally recruited nurses who have been given senior posts and are responsible for the management of established staff. Outcomes for service users would be improved by the appointment of an internal infection control link nurse who delivers training to staff.

CARE HOMES FOR OLDER PEOPLE Ashby Court Tamworth Road Ashby De La Zouch Leicestershire LE65 2PX Lead Inspector Gill Adkin Unannounced 9 September 2005 09:30 th 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 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 C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ashby Court Address Tamworth Road Ashby De La Zouch Leicestershire LE65 2PX 01530 560105 01530 560173 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited Mrs Ruth Coales Care Home 60 Category(ies) of OP Old age(60) registration, with number PD(E) Physical disability - over 65(60) of places TI(E) Terminally ill(60) Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 4.1 To be able to admit the named person of category PD named in variation application V 13707 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 27/06/05 who is under 65years of age.. Date of last inspection 10.02.05 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 C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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 9.30 am on 09/09/05.The inspection took 8.5 hours. The deputy manager 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. This inspection whilst being a statutory inspection was also undertaken as a result of concerns raised from an anonymous source and received by the Commission for Social Care Inspection prior to the inspection and regarding: 1. Management of infectious conditions. 2.Staffing levels and staff deployment. The primary method of inspection used was ‘case tracking’ which involved selecting four residents and tracking the care they received through review of their records, discussion with them (where practicable), and their relatives, care staff and observation of care practices. The inspector addressed requirements and recommendations made at the last inspection. All were considered to be met. During this inspection a tour of the accommodation occupied by case tracked residents internally took place and the inspector viewed internal records, and care plans. The inspector spoke to residents, nurses, care and ancillary staff, and relatives. Comments were received from several residents including those selected for case tracking. Additional comments made by some residents and relatives about the service were mostly positive. Concerns were raised with the deputy manager regarding communication difficulties experienced by internationally recruited staff and residents, and their ability to be sufficiently assertive to manage other staff. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The level of communication with relatives could be improved by the introduction of intermediate care meetings between interested parties and family members. The level of communication between internationally appointed staff and residents could be monitored during supervision sessions to improve outcomes for residents. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 7 The level of service user/ relative input into care planning would ensure that all parties are fully informed. The outcomes for service users would be improved by more robust follow up/ investigation following incidents and accidents occurring. The outcomes for service users would be improved by ensuring that agency staff receive appropriate instructions regarding their responsibilities on a shift in particular in relation to administration of medication. The outcomes for service users would be improved if staff were to receive adult protection training. The outcomes for service users would be improved if the manager monitored the skill mix on each floor and where required support and further deployment of staff initiated, this is considered vital in view of the level of internationally recruited nurses who have been given senior posts and are responsible for the management of established staff. Outcomes for service users would be improved by the appointment of an internal infection control link nurse who delivers training to staff. 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 C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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 standard(s) 3 A comprehensive assessment of needs is undertaken prior to admission this ensures that needs are appropriately identified and that service users are assured their needs will be met. EVIDENCE: All service users’ case tracked had a comprehensive assessment of needs in their care plan.Care plans inspected were reflective of assessed needs. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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 standard(s) 7.8.9.11 Robust care plans and the involvement of family, and professionals ensures that care needs are met and that service users are assured of dignity at the time of their death, Poor management of medication potentially puts service user at risk of harm. EVIDENCE: All four-service users’ case tracked had a care plan in place. Service users’ health and social care needs were detailed in the care plans. Care plans contained essential risk assessments however evaluation of care plans and risk assessments varied in all four plans inspected. It was noted that one service user was newly admitted. Two out of four service users were able to confirm their involvement in their care plans. Adequate evidence was found to suggest that healthcare needs were being met and records inspected included dialogue with other professionals and family regarding healthcare (infection control) matters raised in the complaint. It was noted in records that appropriate medical attention was sought when required by service users’. All service users are screened for nutritional and tissue viability on admission. Medication issues raised at the last inspection identified the need for additional audit and monitoring of procedures. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 11 Observation of staff during drug rounds identified that in the main they are knowledgeable and have received appropriate training. It was of concern however that a nurse from an agency was commencing a teatime drug round at approximately 4.10pm. This was reported to the deputy manager. It was agreed by the deputy manager that this would be monitored and that agency staff would be suitably inducted into the shift and in particular with regard to the administration of medicines. The case tracking process included a new service user with palliative care needs. Discussion with the person indicated that they were fully informed and supported by the home and by external friends and family. The service user did however state that she was not aware of the content of her care plan. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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 standard(s) 12.13.15 Service users interests are maintained by a programme of internal and external activities this ensures the lifestyle experienced satisfies their individual needs. EVIDENCE: Discussions with the service users tracked and others in the home indicated that an activities programme is in place, which includes both internal and external activities. Service users who are able to communicate are consulted with at residents meetings with regard to the programme. The spiritual needs of service users are met by internal church services facilitated by the local curate. Activities are fully documented and the organiser who works full time was enthusiastic about her role. The home has two registered drivers who are available to drive the community bus on outings Community outings are arranged and where possible residents visit their families at home. Two service users tracked indicated that routines in the home were flexible and met their expectations. Meals and menus were inspected and discussion with service users and staff and observation of the breakfast and lunch time meal indicated that meals were of good quality and nutritious. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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 standard(s) 16 Complaints are managed satisfactorily and responded to within given time scales. Service users are assured their concerns will be dealt with appropriately. EVIDENCE: Complaints records were inspected and it was noted that only one complaint was outstanding a conclusion. Matters raised in the complaint to the CSCI featured in this complaint to the home. Evidence was found in internal records of liaison with relatives involved in discussions with the home, however the matter had not been fully resolved at the time of this inspection. Service users’ tracked indicated that they were fully aware of the complaints process and had seen a copy of the procedure. The procedure is on display in the entrance hall. Information supplied by the manager indicated that 100 of complaints had been dealt with within 28days. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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 standard(s) 19.26 Service users live in a clean, safe and well-maintained environment, which provides them with a homely environment. EVIDENCE: Individual rooms and associated communal areas of service users tracked were inspected and three out of four were found to be clean, pleasantly decorated and have appropriate fixtures and fittings as required in the National Minimum Standards. All areas of the home were well maintained and decorated. A new assisted bath has been purchased since the last inspection, which was due for delivery the week after this inspection. The room of a newly admitted service user was noted to be in the process of being redecorated. The maintenance person stated that normally this was done before admission. This room was found to have a strong smell of urine and despite the homes attempts to eradicate the smell they had not been successful. The service user had accepted the room irrespective of this and it was agreed that the manager would take further steps to permanently eradicate the smell after the inspection or if required remove and replace the carpet. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 15 Concerns raised by relatives regarding infection control issues identified that the organisations policies and procedures do not specifically identify management of scabies, Policies and procedures were noted to be in need of review although the deputy manager has compiled a file of relevant infection control information for staff to read. Appropriate action had been taken to address the matter of scabies with relevant professionals and records inspected confirmed that discussion had taken place with relatives over treatment and follow up care. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.30 Service users needs will only be met by staff who are deployed according to skill mix and competency. Monitoring of staff deployment will ensure service user safety. Adequate adult protection training will ensure that resident’s rights are promoted and that they are protected from harm or abuse. EVIDENCE: Calculation of staff hours over a four-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. Concerns were however noted regarding staff deployment and this had been raised within the complaint to the Commission. Concerns raised by relatives related to the observation of service users on the top floor particularly in relation to their vulnerability. It was noted at this inspection that a member of staff was overseeing this lounge and the deputy manager stated that difficulties with understanding had resulted in service users being left alone whilst staff were otherwise occupied and this resulted in a person falling from their chair. Assurances were given that this had been discussed with staff and instructions given that the lounge must be attended at all times. The deputy manager had put up a notice in the lounge to this effect. Rosters inspected additionally indicated regular agency usage although the deputy manager stated that the home attempt to maintain continuity by using regular staff. Staff raised some concerns over working relationships and this was discussed in detail with the deputy and registered manager. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 17 Staffs training files were not fully completed as the organisation have a new policy regarding the recording of staff training. The files are stored on the computer, which was not accessible to the deputy manager. Staff spoken with confirmed that they received all mandatory training including Fire. Health and safety. Moving and handling and NVQ but no obvious evidence was found to suggest that infection control or adult abuse/protection training had been given to staff. Two new staff discussed in detail their induction programme and what it had involved. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35.36.38 Service users financial interests are protected by a well-managed internal system. The health and safety and welfare of service users would be improved further by regular evaluation of risk assessments and robust investigation of accidents. EVIDENCE: The organisation has policies and procedures for the management of service users money. Several service users were spoken with including those case tracked and most stated that either they or a family member were responsible for financial matters or that money was deposited in the homes internal system. The inspector was unable to look at records due to the administrator not being in the building at the time available. The deputy manager stated that service users are issued with statements regularly to confirm the status of their account. This could only be confirmed with one individual, as two of the service users tracked were unable to answer questions and one dealt with their own personal money. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 19 Evidence was seen of group supervision being held although it was evident from discussion with some Internationally recruited staff that there was a need for individual sessions where staff could express views and concerns. A number of staff indicated that they would welcome more individual sessions. The health and safety of service users is protected by the systems in place. all records relating to health and safety including fire, accident and individual risk assessments were completed appropriately although several accidents recorded did not include an outcome and a number of individual risk assessments had not been evaluated appropriately. Risk assessments were not inspected on this occasion but will be at the next inspection. Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x 3 3 2 3 Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 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. 1. Standard 7 Regulation 13 Requirement risk assessments and care plans must be updated at least monthly and must include the involvement of the service user /or relatives care plans must be updated follwing investigation of any incidents and accidents to reflect outcomes. The registered provider must satisfy themself regarding the competency of agency staff to administer medication appropriately. The registered provider must deliver to all staff adult protection training Appropriate action must be taken to permanently eradicate the odour identified in the bedroom of a service user. All Staff must receive infection control training Accidents and incidents records must be conclusive and evidence any investigations undertaken following such incidents. Timescale for action by November 31st 2005 by November 31st 2005 by November 31st 2005 By 31st December 2005 Immediate 2. 7 15 3. 9 13 4. 5. 18 26 13(6) 16 6. 7. 30 37 18 17 By 31st december 2005 Immediate Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 22 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 9 26 33 Good Practice Recommendations It is recommended that competency checks are carried out on regular agency staff to ensure that they are competent to undertake the task according to BUPA policy. It is recommended that a infection control link nurse is identified and attends community training. It is recommended that informal meetings are held with relatives and service users periodically in order to provide a non formal environment in which to express views and concerns. It is recommended that Internationally recruited nurses/care assistants receive individual supervision along with group supervision. 4. 36 Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 23 Commission for Social Care Inspection The Pavilions 5 Smith Way, Grove Park Enderby, Leicestershire LE19 1SX 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 Ashby Court C51 C01 S1884 Ashby Court V234429 220705 STAGE 4.doc Version 1.40 Page 24 - 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!