Inspection on 11/10/05 for Ashcott Lawns

This inspection was carried out on 11th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashcott Lawns 01/05/09

Ashcott Lawns 29/04/09

Ashcott Lawns 28/01/09

Ashcott Lawns 25/01/08

Ashcott Lawns 12/09/07

Ashcott Lawns 14/11/06

Ashcott Lawns 17/05/05

Ashcott Lawns 19/10/04

Ashcott Lawns 21/05/04

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

CARE HOMES FOR OLDER PEOPLE Ashcott Lawns Chapel Hill Ashcott Bridgwater Somerset TA7 9PJ Lead Inspector Judith Roper Announced 11 October 2005 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. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ashcott Lawns Address Chapel Hill, Ashcott, Bridgwater, Somerset, TA7 9PJ 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) 01458 210149 01458 210932 Mrs Monica Diana Corbett Mrs Monica Diana Corbett Personal Care Home Only 17 Category(ies) of Old Age (17) registration, with number of places Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17th May 2005 Brief Description of the Service: Ashcott Lawns provides residential care for up to 17 older people. The home is owned and managed by Mrs. Corbett, who lives on the premises. The accommodation is an attractive Grade 2 listed house, which were originally two cottages. It has been adapted as far as possible to meet the needs of older people, however, some service users need to be ambulant as there are a further steps to most first floor bedrooms. This period house is full of character and furnishings and fittings are in keeping with this. The home is located in the village of Ashcott where there are some amenities and village activities. Attractive gardens surround the home and there is ample parking. Some day care provision is offered at the home, for one person, usually five days a week. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out by one inspector and took place over one day between the hours of 10.00 am – 1.00 pm. 7 residents were at the home on the day of the inspection. There are vacancies at the home. The inspector was able to see and talk with all 7 residents and 1 day care client. There were no visitors to the home during the inspection that requested to speak with the inspector. Staff on duty were able to give time to speak with the inspector. The proprietor and manager Mrs. Corbett was available for comment during the inspection. The inspector would like to thank the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and friendly. Staff went about their duties in an unhurried manner, giving time to attend to resident’s needs. This CSCI inspection focused on outcome statements for National Minimum Standards that were not met or not inspected at the previous inspection in May 2005. The inspector also wanted to gain comments on the service from all residents willing to give their opinion and from professional sources. 2 G.P. comment cards were forwarded to the CSCI prior to the inspection. The comment cards both gave positive feedback on their professional workings with the home and the home’s care of its residents. Records examined during the inspection were 2 resident care and support plans, resident risk assessments, medication records, a sample resident contract, policies and procedures of the home, staff training records, bath temperature records and staff induction programme. Mrs. Corbett also completed a pre-inspection questionnaire requested by the CSCI on her service, prior to the inspection for examination by the inspector. What the service does well: Comments from residents and the regular day care client to the home were unanimously positive regarding the dedication of staff at Ashcott Lawns to the care of its residents. Staff were described as kind and caring and attentive. One lady described the home as ‘wonderful’. Routines at the home provide flexibility for residents to plan their day at their own pace. Residents said that the staff and the proprietor are approachable and listen and act on personal concerns raised. Residents said that they are treated with respect and that there are sufficient opportunities for activities and socialising at the home. Meals were rated highly by residents. The home is clean and attractive with a homely feel. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 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. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 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 standard(s) 1,2,3,5. Standard 6 is not applicable. The home provides suitable pre-admission information about the home for prospective residents and their families so those new admissions to the home are able to make an informed decision to the suitability of placement. The home assesses prospective admissions robustly in order to determine whether the home can meet the resident’s needs. Resident contracts provide clear information about the service and expectations of both consenting contracting parties. A trial period is offered at the home to determine whether the placement remains suitable. EVIDENCE: The proprietor completed a Statement of Purpose for the home in 2005 and a copy is held at the Taunton CSCI office. Revised contracts had been sent to residents recently and the information in these contracts was examined at the inspection. The contracts give clear information about the cost of services at the home and responsibilities of both parties. Admission processes were inspected for the one resident admission to the home since the last inspection. Admission procedures were also discussed with the proprietor and staff on duty. The home was able to demonstrate that Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 9 procedures are followed to ensure that the placement is suitable and that the home can meet the needs of prospective residents. The recent admission was able to confirm that visits to the home are offered to residents and family members prior to admission and that there is a trail period offered after admission. A trial period is recorded in the home’s Statement of Purpose and resident individual contract. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 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. Care plans inspected were good. They gave a holistic picture of current resident needs thus providing staff administering care an accurate plan to follow to ensure that residents are receiving good care. Residents said that they are well cared for at the home. There are no residents with pressure sores in the home but the home needs to develop a policy on pressure area relief that reflects current best practice. Medicines are competently managed at the home. Medicines are administered by staff; advisory comments were made to the proprietor regarding medicine management in order to further improve the safe system of medicine record management at the home. EVIDENCE: 2 resident care plans were inspected. The information in these care plans was detailed, holistic and gave good instructions to how the care needs of the individual resident’s would be met by staff. There was evidence of a monthly review of care plans and daily reports of care given by staff were maintained. There was also good record keeping of community health care professionals contacted, their visits and advisory comments to the home. No residents have pressure sores and the home consults with district nurses for advice on pressure areas relief and for assessing or obtaining pressure Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 11 relief equipment. The home does not have a policy on pressure areas relief and this was made a requirement. Medication records were inspected and a discussion regarding medication management was held with the proprietor and one staff member. The home has good policies on medication management but ought to follow the guidance from the Royal Pharmaceutical Society on the taking of verbal instructions on medication management or medication changes from a G.P over the phone in order to protect the staff member receiving the instruction. Two staff members therefore should receive verbal instructions, or a written instruction should be given to the home from the G.P, (for example by fax if in person is not possible). Medication administration records (MARs) were maintained well. Advice was given to ensuring that variable dose recording is always completed as this will help to establish which dose is most effective for the resident. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 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) 15. The quality of home cooked meals at the home was rated highly by residents in terms of choice, quantity, variety and taste. Meal times are relaxed social occasions with residents conversing and catching up with news around the dining table, making meal times focal points of the day. EVIDENCE: Meals are home cooked at Ashcott Lawns. Residents are encouraged to take meals in the dining room so that meal times become a social gathering. Residents can choose to take their meals in their rooms though if they desire. Choice of main meals is offered and residents spoke highly of the quality of the food at Ashcott Lawns. The kitchen premises were not inspected at this inspection. The Environmental Health last inspected the home in 2004. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 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) 16,18. The home has not received any complaints since the last inspection and residents said that they would be happy to raise issues with the staff or proprietor should the need arise. The home holds local policy guidance on the protection of vulnerable adults but needs to supplement this with an in-house policy that staff are aware of in order to demonstrate how staff would proceed should an allegation of resident abuse arise in the home. EVIDENCE: The home has a complaints procedure and there have been no complaints made to the home since the last inspection. Residents spoken with said that the proprietor and staff are approachable and that their relationships with the proprietor and staff are open and friendly. The home has a Whistle Blowing policy, which is displayed in the staff area. Staff spoke to were aware of this policy and the concept of Whistle Blowing in protecting residents’ interests. The home has a copy of the Somerset multiagency local policy on the protection of vulnerable adults. However, the home does not have its own in-house policy on protecting vulnerable adults and abuse detection awareness. This is required. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 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) 19,25,26. The home’s environment is attractive and pleasant giving residents an agreeable place to live. The home is maintained well and provides attractive garden spaces. EVIDENCE: With considerable investment by the proprietor into an upgrade of the fire detection system in 2005, the home now meets the requirements of the local fire service. Since the last inspection the proprietor has continued to conduct routine redecoration of the home both inside and out. Replacement windows are due to be installed next week throughout the home in order to further upgrade the house. Furniture, fixtures and fittings in the home are maintained well and are homely and in keeping with the character of the premises. The home is clean and free from malodour. The home suits residents with good mobility or requiring minimal staff assistance for moving and handling as adaptations, equipment and the layout of first floor rooms for residents with higher mobility needs is limited. There is a stair lift to the first floor but there are additional steps along the corridor of the first floor to several rooms. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 15 Since the last inspection toiletry baskets have been purchased for residents so that staff can take individual toiletries into bathrooms for the resident and then return the toiletries to the room. This system has been implemented to act as an aide memoir for staff to ensure that resident’s toiletries could not be shared thus compromising cross infection principles. Staff on duty reported that this system is working well. As the weather is becoming colder with the onset of autumn, the daily temperature in the home is starting to vary. 2 residents reported being cold and the proprietor arranged for the central heating to be turned on. Residents have radiators in their bedrooms and thus the heating in rooms can be adjusted to suit their needs when it is on. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 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) 27,28,29,30. The staff employed at the home know residents well and can meet their care needs. There are sufficient staff on duty to offer attentive care. Staff receive good support and in-house training but the number of staff holding or willing to achieve the NVQ care award is low. This affects the ability of the home to achieve the Quality Rated status awarded to care homes by Somerset County Council. EVIDENCE: There are good staffing levels at the home to the number of current residents with 3 staff for a morning shift, 2 in the afternoon and 1 waking night worker. The proprietor also lives on site and provides additional managerial support during the day and is on-call at night. There is a small staff team at the home, most of whom have worked at the home for a number of years. There is one care worker who holds an NVQ qualification in care. Other staff have said that they do not wish to study toward this qualification, which is a pity as the staff have the skills and knowledge and experience to achieve the awards. The proprietor keeps individual records of staff training undertaken. Statutory training for staff is maintained but without staff undertaking NVQ training the home struggles to demonstrate a professionalized care team and remains unable to achieve the Quality Rating award from Somerset County Council. Newly appointed staff undertake in-house induction training. This training is not yet linked to the Skills Council recommended format for staff inductions into care work. The proprietor was advised that she should take this into Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 17 consideration by 2006, when the revised Skills Council induction guidelines will be published for managers. Staff recruitment practices are satisfactory. CRBs have been applied for all staff and one is awaiting return. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 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) 33,34,35,36,38. Quality assurance and staff supervision processes are sufficient in keeping with the size and occupancy of the home. Health and safety issues are performed appropriately although the home needs to have a policy on moving and handling that staff understand and agree to adhere to in order to supplement staff moving and handling training. This is to ensure that good moving and handling practices are sustained in order to support and protect residents and staff alike. EVIDENCE: The home uses informal quality assurance processes including daily consultation with residents by the proprietor. Staff receive an annual appraisal and are supervised by working alongside the proprietor. The home does not enter into managing any financial affairs of residents and invoices families directly for toiletries etc in order not to handle cash for residents. The proprietor is planning to increase resident numbers as occupancy is considerably below registered available bed numbers. It had been a deliberate Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 19 strategy of the proprietor to keep numbers lower for a time in order for the staff team to concentrate on meeting existing resident needs. Health and safety records examined were maintained appropriately and the home has a policy for health and safety. The home does not have a policy for moving and handling and this is required. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 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 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 1 29 3 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 3 3 3 x 2 Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 21 No 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. 2. 3. Standard OP8 OP18 OP38 Regulation Requirement Timescale for action 11/02/06 11/02/06 11/02/06 13 (4) (c.) The home needs to devise a policy on pressure area relief. 13 (6) The home needs to devise a policy on the protection of vulnerable adults. 13 (5) The home needs to devise a policy on safe moving and handling. 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. Refer to Standard OP9 Good Practice Recommendations It is recommended that the home follows a more robust protocol in the accepting of verbal medicine prescriptions instruction from G. Ps, in order to protect staff in the home. Current guidance from the Royal Pharmaceutical Society ought to be encouraged for staff to follow. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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 Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V247159 111005 Stage 4.doc Version 1.40 Page 23 - 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. 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