CARE HOMES FOR OLDER PEOPLE
Ashcott Lawns Chapel Hill Ashcott Bridgwater Somerset TA7 9PJ Lead Inspector
Judith Roper Unannounced 17th May 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 V222802 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ashcott Lawns Address Chapel Hill Ashcott Bridgwater Somerset TA7 9PJ 01458 210149 01458 210932 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) 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 V222802 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 19th October 2004 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 V222802 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day between the hours of 10.30 am – 1.15 pm. 7 residents were at the home on the day of the inspection. The inspector was able to speak with all permanently residing residents and was able to gain the opinion of one person receiving day care at the home. Day care is subject to inspection by the CSCI only in terms of ensuring sufficient staffing levels at the home, adequate space for shared communal space and impact upon permanent residents. There were two staff members on duty at the time of the inspection. Both spent time with the inspector and the owner, Mrs. Corbett was also available for comment during the inspection. The inspector would like to thank the proprietor Mrs. Corbett and her staff for their time and hospitality shown to the inspector during her visit. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff and any visiting relatives. Requirements and recommendations made at the previous additional inspection visit in February 2005 were also followed up. Records examined were care plans, service user contracts, the home’s Statement of Purpose, daily monitoring sheets of hot water and fridge/freezer temperatures, fire records and Medication Administration Records (MAR charts). Other records will be examined at subsequent inspection visits. What the service does well:
Ashcott Lawns is currently providing good personalised care free from institutionalised practices. Residents were emphatic that their choices for daily routines were encouraged and respected. Residents valued this greatly. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 Page 6 The home is presented to a high domestic standard. It is clean and welcoming. All residents made positive comments regarding the choice of menu and quality of home cooking. 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 V222802 170505 Stage 4.doc Version 1.30 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 V222802 170505 Stage 4.doc Version 1.30 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) 1.2.4. With the completion of the Statement of Purpose and revised contracts for private fee paying residents, these documents will allow a transparency of information about the home’s facilities, services, staffing and fee arrangements. This will enable residents and their families/representatives who wish to be admitted to the home to make an informed choice about moving to the home. The current number of residents and their needs suit the current staff team in terms of staff numbers and skill mix well. This allows residents personalised attentive care. EVIDENCE: The proprietor has completed a Statement of Purpose. The inspector had the opportunity to read this document. A copy has been sent to the CSCI office in Taunton. New admissions can now be accepted as the document is published and available for new enquiries to the home.
Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 Page 9 The home also has revised its contracts between private clients and this will be sent to private residents in the immediately coming weeks. The home also has a brochure detailing in a brief guide the home’s facilities and services. There have been no new admission to the home for approximately 12 months and this has been the proprietor’s decision not to accept new admissions. Residents may well be accepted now if enquiries are made and persons would be accepted if the home could meet their needs and the new admission was a good mix with existing residents. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 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) 7.8.9.10.11. Care plans are now personalised to individual’s need and a monthly summary commenting on needs over the months and anticipated changes for the coming month give a good guide to staff in predicting future goal setting on a month by month basis. This contributes to ensuring staff can continue to meet the needs of individual residents. Medication management for residents is safe. Systems are in place and working to ensure residents receive prescribed medications at appropriate times by appropriately trained and supervised staff. The privacy and dignity of residents is respected giving rise to trust and open relaxed relationships between residents and staff. EVIDENCE: 6 out of the 7 resident’s care plans were inspected. The proprietor told the inspector that 1 other care plan was in use. Care planning had improved since previous inspection visits. Plans of care are personalised and give a brief description of intervention required or anticipated by staff in the home or from
Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 Page 11 visiting community professionals. For each plan of care is a (generally) monthly summary of personal care, progress and anticipated needs in the coming month. This has worked in practice in identifying residents who may need reassessment for nursing care or for planning of palliative residential care to be given at the home. Medication storage and medication records were inspected. The inspector was pleased at the continued progress that the home has made in improving its systems of medication management. The inspector gave some advice to the staff and proprietor regarding when to record on the medication chart that a medication had been administered, as in discussion some staff were unclear what their signature on the chart was recording witness to. All residents at the home spoke with the inspector either in their private rooms or in lounge/dining setting. There were unanimous and positive responses to the inspector that their individual privacy and dignity is respected at the home by the staff team and the management ethos. The inspector observed and heard staff interacting with residents. Their relationships with residents seemed relaxed, natural, open and professional. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 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) 12.13.14.15. Residents appeared relaxed and busy with their social lives. The home facilitates enough activities for residents to partake of if they rely on the home for providing social activities. No resident said that there was a lack of stimulation at the home. Visitors are welcomed and the routines of the home promote individual choice. This creates an atmosphere at the home where residents are empowered and remain assertive in expressing their views and wants. EVIDENCE: All residents spoke to the inspector of the relaxed ethos at the home and encouragement for social activities of choice for each person. The home does not offer a schedule of organised in-house activities, residents are all able to suggest things to do or see and are happy in their own or other’s company, socialising either within or outside of the home. There were no visitors at the home during the time of the inspection visit, but residents said that any visitors they receive are made welcomed and offered drinks or sustenance by the staff. Residents were clear that there are not restrictions at the home for choices such as in times or rising and retiring. Lunch was observed at the home being prepared and taken. The dining room is pleasing and residents sit where this suits them. All said that they enjoyed
Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 Page 13 the meals cooked at the home and that choice is offered and respected regards menu. The kitchen needs some attention with regard to replacement flooring and two new drawer covers, but there are plans to alter the kitchen arrangements and these issues are built into these re-build plans. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 Page 14 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) 16.17. Residents feel confident that should they raise a concern/complaint in the home that this will be acted upon in a manner that they would find acceptable and proportionate to the concern. Resident’s views are sought and respected at the home. EVIDENCE: One complaint was made directly to the CSCI in 2005 regarding the home. This was investigated with the cooperation of the home’s proprietor and the CSCI did not uphold the complaint. The home has not received any complaints addressed to them. Residents said that they happy to raise issues with the staff or proprietor should the need arise. In the recent General Election residents who chose to vote, did so using the postal voting method. Some residents confirmed inclusion in the voting process. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 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 standard(s) 19.20.21.22.23.24.25.26. The home’s environment is attractive and pleasant giving residents an agreeable place to live. The fire detection system at the home has been improved in order to make residents and staff safer in the event of a fire. EVIDENCE: The home’s environment is homely, clean and warm. The home suits residents with good mobility or requiring minimal staff assistance as adaptations and equipment in the home for residents with higher mobility needs is limited. Individual rooms are personalised and uniquely reflect the personality of the resident therein. There has been substantive investment into improving the fire detection system at the home in recent months as required by the fire brigade and CSCI. The fire office had been booked for the day after the CSCI inspection to carry out his own inspection of the fire detection system improvements made to the
Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 Page 16 home. I have requested a copy of the fire officer’s report to the home as the fire officer’s previous report indicated that the home had not yet fully reached compliance with expected standards of fire risk assessment and safety systems. The proprietor was confident that she had now met the requirements made by the fire officer in February of this year. There is only one of the shared bathrooms at the home that is generally used. The staff and proprietor were reminded during the inspection to ensure that personal toiletries for residents were returned to rooms following bathing in order to ensure that personal toiletries are not mixed up or inadvertently shared as this could have implications for cross infection as well as annoyance for the resident. The garden at the front of the house is used the most, as this is the more accessible of the home’s gardens. There is attractive garden furniture provided for residents on the front lawn. There is a mezzanine floor on the first floor leading to two bedrooms, of which one is currently occupied. The steps on this floor remain highlighted by bold warning tape. It has been highlighted in previous inspection reports that this tape is far from ideal as it could present a trip hazard, however, the proprietor is mindful of this and to ensure that the tape, if continued to be used, remains in good repair. Any person admitted to the rooms on the mezzanine floor must have fully independent mobility. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 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 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) 27.29. 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. Recruitment practices in relation to ensuring police checks are carried out for staff have improved over the last two inspections but the home’s systems for staff recruitment has not met National Minimum Standards in order to protect vulnerable adults. EVIDENCE: There is a small staff team at the home, most of whom have worked at the home for a number of years. Staff work in established teams and know the skills of one another. Staffing levels are adequate to meet the current needs of service users. Residents and staff confirmed this. The proprietor is mindful that staffing levels may require increasing should resident needs rise or if additional residents are admitted to the home. There is one outstanding Criminal Records Bureau (CRB) check required for a staff member. The proprietor vowed to telephone the staff member following the inspection to request that their CRB form is brought to the home. The proprietor said that she would confirm to the CSCI in writing that this outstanding check had been completed. In the meantime the staff member is supervised on-shift as part of the small staff team, where the proprietor performs hands-on duties. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 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) 31.32.37.38. The management at the home is stable and sensitive to residents’ needs and of providing staffing levels required to meet such residents’ needs. The manager therefore acts professionally in monitoring her service provision so that residents receive a good service that is personalised. EVIDENCE: The proprietor also manages the home and she is aware of the residents’ in the home’s needs well, as of her own capabilities and limitations and those of her staff team. As a short-term measure the home is currently and deliberately running at a much lower capacity than it is registered for, but those at the home are receiving good care from experienced staff. The atmosphere at the home is welcoming and relaxed. The home’s ethos actively promotes choice and self-determination for residents. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 Page 19 Records inspected were kept stored securely in line with Data Protection Principles. Some records were examined in relation to health and safety and the monitoring of the environment at the home. These records were maintained in good order. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 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 2 2 N/A 3 N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 3 x x x x 3 3 Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 Page 21 Yes 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 OP 29 Regulation 19 (b) (i) Requirement All care staff employed must have a completed enhanced Criminal Records Bureau disclosure applied for by the home. Timescale for action 17/06/05. (Previous timescale of 21/02/05 not met). 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 Good Practice Recommendations No recommendations identified at this visit. Ashcott Lawns D53 - D02 S15999 Ashcott Lawns V222802 170505 Stage 4.doc Version 1.30 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
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