CARE HOMES FOR OLDER PEOPLE
Ashcott Lawns Chapel Hill Ashcott Bridgwater Somerset TA7 9PJ Lead Inspector
Shelagh Laver Unannounced Inspection 25th January 2008 14:00 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 Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 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. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 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 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) MRS MONICA DIANA CORBETT MRS MONICA DIANA CORBETT Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17/09/07 Brief Description of the Service: Ashcott Lawns is registered with the Commission for Social Care Inspection to provide personal care only for up to 17 people over the age of 65 years. The home is not registered to provide nursing care. The registered provider/manager is Mrs M. Corbett. Mrs Corbett lives on the premises. The home has been converted from a Grade II house to provide a homely environment for service users. It has been adapted as far as possible to meet the needs of older people however, service users need to be ambulant as there are further steps to most first floor bedrooms and assisted bathing facilities are limited at this time. 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. The current fee range is £430 to £530 per week. Additional charges include; hairdressing, chiropody, personal items and some staff escorts to appointments. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. Concerns raised by a random inspection in July 2007 were followed up by a key inspection in September 2007. Whilst people in the home were well cared for several requirements were made to enable the home to comply with regulations that related to recruitment practice, health and safety and staff training. This second key inspection was carried out by one inspector over three hours. The registered manager has addressed a large number of the requirements and there are further developments in progress. Currently the home has a low occupancy enabling a high standard of individual care to be provided in an informal and homely manner. Some aspects of care provision still need attention in order to comply fully with the National Minimum Standards and regulations. All people who lived in the home and the staff on duty were spoken with. In preparation for the inspection comment cards were sent to people who lived in the home, their relatives and staff. Four cards were returned from people who lived in the home. All said that they “always” received the care and support needed. They felt that staff listened to them and were available when needed. One person wrote “I can always talk to staff but I am always happy.” Another wrote “It is very good here and I am quite satisfied.” Two comment cards were returned by relatives. Comments were “friendly atmosphere” and “look after people very well.” Five cards were returned from staff. Staff felt that they had had an adequate induction when they started at the home. All knew the home had policies and procedures and felt they were regularly supervised and prepared for the situations they met in the home. A tour of the home was undertaken and records were observed. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
Currently there is no hoist available in the home although the manager said there was one on the premises. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 7 We discussed the need to provide a safe manual handling system for people in the event of a fall and in the event of a short- term illness. It is not acceptable to rely on other agencies to lift people from the floor unless they are injured. The absence of a suitable working hoist could mean that care workers are lifting inappropriately and putting themselves at risk of injury. The brochure for the home states that “A resident would be encouraged to return to Ashcott Lawns at the earliest opportunity should a stay in hospital be necessary.” It also states that “loving terminal care” is offered. It is likely that for this level of a care a hoist may be required. One person who returned a comment card said that there was “usually” an activity in the home to take part in. Two people said “sometimes” there was activity to take part in. One relative said “more stimulation “ would be appreciated. There are plans underway to provide a new bathroom facility including a bath hoist. This will improve the comfort of people in the home and the safety of staff. The registered person is required to notify the Commission without delay of the occurrence of a range of occurrences in the home (regulation 37 notifications.) These include the death of any service user, including the circumstances. The registered manager has been required to submit notices however none have been forthcoming. At the inspection it became clear that again someone had died recently and no notification had been received. 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. The summary of this inspection report can be made available in other formats on request. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 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 Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 6Quality in this outcome area is good. People are assessed before coming to live in the home. The registered manager is clear about which needs can and cannot be met in the home. The home provides accommodation to people who are mobile and independent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection there had been one person admitted to the home. The person had come for day care initially and had later decided to become resident in the home. The manager stated that she would always visit someone before they came to the home either in hospital or in their own home. People are encouraged to visit the home. A brochure is available. People who returned a comment card prior to inspection said they had received enough information prior to moving into the home.
Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. People in the home receive a standard of personal care that meets their needs. The home liases with other healthcare professionals to meet healthcare needs. There are systems in place for the safe administration of medication. People are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two personal files were seen. There was an assessment and a clear plan for personal care. It was clear that the community nurses were attending to do dressings and that people had visits from doctors when needed. One person is currently receiving support from the Community Psychiatric Nurse and it was clear that assessments had been undertaken. In the other care plan there was detailed guidance for the care of someone discharged from hospital. All staff who returned comment cards stated that they were clear about peoples’ needs. People who returned a comment card felt that they “always” received the medical support that they needed. The home works with the community nursing team and GPs to meet peoples’ needs.
Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 11 There was evidence of good care at the home. Some areas of care do need to be formally recorded. People are weighed after their bath each week. There must be a clear written plan if someone is losing weight. The manager said they would always “contact the doctor or nurse” but there is much that can be done in the home to ensure peoples’ weight is maintained. There were no people with pressure damage in the home but again any action to prevent pressure damage should be recorded in the plans. When a person nears the end of their life the home ensures that the doctor and nurse give support and that extra staff are available to ensure people are not alone. The people in the home at the present time receive good care. There must however be sufficiently robust systems in place so that whatever the number of people in the home there are records that ensure all health needs are met. Medication systems were reviewed and seen to be safe. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. People can chose how they spend their days. Visitors are welcome in the home. The home does not have a formal programme of activities. The home provides a wholesome menu. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken to were pleased with daily life at Ashcott Lawns. Four people were seen in the sitting room. A Flexercise video had been purchased and people were joining in. One person in their room explained that they liked to spend time reading and had regular visitors. Visitors are welcomed and people go out with their families when possible. No menus are displayed but there is discussion about the meals to be served and people were happy with the meals. The manager agreed that serving from vegetable dishes would promote choice and will give try this method of serving. One person who returned a comment card said that there was “usually” an activity in the home to take part in. Two people said “sometimes” there was activity to take part in. One relative said “more stimulation “ would be appreciated. At the time of the inspection people felt that the activities in the
Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 13 home suited them. In the past when there had been more people in the home a more organised approach had been taken to activities. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. The home has a satisfactory complaints procedure in place. Staff recruitment provides protection for people in the home. The home must ensure there is local guidance available for the protection of people in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure now contains an appropriate time scale and contact numbers for CSCI and is displayed in the home. The home’s policy for the protection of vulnerable adults was seen. It is important that the home has a copy of the local guidance Protecting Adults in Somerset so that all staff know who to contact if they have any concerns. The manager confirmed on 26/02/08 that this had been obtained. Staff have received Safeguarding Adults training. This was confirmed by the five staff who sent in comment cards. Following recent improvements in recruitment practice people are now protected at the home. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is adequate. People live in a safe, comfortable and well maintained environment. The home is pleasant and hygienic. There is a need to fully implement the improvements in bathing and manual handling facilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home showed it to be clean and comfortable. Communal rooms and bedrooms are pleasant and reflect the age and style of the house. There was evidence that decoration had been taking place. Bedrooms and ensuites were very clean and well finished. The home is set in pleasant gardens that can be accessed by people who live there. There is refurbishment taking place of bathrooms and shower rooms. This work is not complete so that at the time of the inspection people continued to use
Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 16 the Bath Knight as the only assisted bath. The standard of current bathing facilities is not commensurate with the standard of communal and bedroom accommodation and people coming to live in the home in the future may well expect additional facilities. While the current arrangements were seen to be adequate by the manager for the people in the home at the present time the Bath Knight is designed for domestic use and the plans to purchase additional bathing equipment when the spacious bathroom is completed will be reviewed at the next inspection. The laundry contains sufficient modern equipment. Currently the floor is concrete. This can be treated to ensure it is not permeable. There are plans under consideration to develop this area and the laundry will be reviewed at the next inspection. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. Staffing levels appear sufficient for the current needs of the people in the home. A training programme has commenced at the home. Staff recruitment procedures have received attention to ensure they protect people in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a small stable team of eight and does not need to use agency staff. Recruitment records were seen at the last key inspection and no new staff had been recruited. At the last inspection recruitment procedures had improved and offered protection for people who lived in the home. References and CRB and POVA checks had been provided for all staff. The home has the Skills for Care induction programme available for future inductions. Staffing levels at the home had not changed and with the current low occupancy were sufficient. Staff spoken to were happy working at the home. Since the last key inspection a training programme has commenced to enable staff to gain NVQ qualifications. The progress and success of the programme will be reviewed at the next inspection. A training plan for the coming year should be developed and displayed to include the up-dating of food hygiene and first aid certificates.
Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 18 Five comment cards were received from staff. Staff felt that there was “always” a senior member of staff to confer with and that they were well supervised. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is adequate. The home is run in the best interests of people who live in the home. The home does not have formal systems in place to review quality in the home. There are no formal systems for reviewing and supervising staff. There have been improvements in the arrangements for health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Corbett has run the home for 19 years and lives adjoining the premises. She is available on a daily basis. She has now arranged to undertake additional training and to receive regular up-dates from a business organisation. She has very clear ideas about how the home should be run and the people who will enjoy living there.
Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 20 Staff are currently supervised informally as there is a small team who meet together regularly. This will be reviewed at the next inspection. A questionnaire template is available but formal evaluation of the service is not made. There was feed back from the CSCI questionnaires that indicated people were satisfied with the care provided at Ashcott Lawns. There was evidence that health and safety issues had been addressed since the last inspection. The Gas Safety certificate was seen. Appliances had current PAT testing certificates. The stair lift had been tested. Fire alarms and emergency lighting are tested. Fire training is given but is not formally recorded. There were no records of recent fire drills. This is an old house with a complex lay out. The registered provider must take all action to ensure that all staff in the care home are aware of the procedures to be followed in the case of fire including the procedure for saving life. During the inspection concern was expressed about a persons bed next to an uncovered radiator. The bed has been moved and a radiator cover has been ordered. Regulation 37 requires that significant events at the home should be reported to CSCI without delay. A review of records of the home indicates that Regulation 37 notifications are not sent to Commission. Discussion with the manager revealed that a person had died recently but we are still awaiting a notification. Reporting requirements had been discussed at the previous inspection. Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 2 2 3 2 2 2 STAFFING Standard No Score 27 3 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 1 X 2 Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(4) Requirement The registered person must devise a policy for staff relating to safe moving and handling. Previous timescales of 11/02/06, 14/02/07 & 10/09/07 15/10/07 not met. Timescale for action 15/03/08 2. OP38 13(4) 15/03/08 Staff must receive appropriate training in moving and handling with at least annual updates. - All staff involved in the preparation or serving of food must receive appropriate training in food hygiene. - Suitable arrangements must be made for the training of staff in first aid. - All staff must receive regular training in fire safety. Previous timescale of 10/10/07 not met. 3. OP38 37 The registered person is required to notify the Commission without delay of the occurrence of: (a) the death of any service
DS0000015999.V357274.R01.S.doc 15/03/08 Ashcott Lawns Version 5.2 Page 23 user, including the circumstances (b) the outbreak of any infectious disease (c) any serious injury to a service user (d) serious illness of a service user (e) any event in the care home (f) any theft, burglary or accident (g) any allegation of misconduct. You are required to forward any outstanding notifications to the Commission by the given date and submit any future notifications as they occur. Previous timescale of 06/08/07 26/09/07 not met. 4. OP7 13(4)(c) The registered person must devise appropriate assessments for service users relating to moving & handling, risk of falls and reducing the risk of pressure sores. Previous timescale 26/10/07 not met. 5. OP33 24 The registered person must establish and maintain an effective quality assurance system which will seek the views of service users, their representatives and any other interested stakeholders. Previous timescale 28/12/07 not met After consultation with the fire authority, the registered person must devise a satisfactory fire risk assessment which meets with current requirements. 15/04/08 15/04/08 6. OP38 13(4) & 23(4)(a) 15/04/08 Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 24 Previous timescale 01/10/06 and 22/10/07 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 OP12 Good Practice Recommendations The registered person should regularly seek the views of service users relating to activities. Records should be maintained. It is strongly recommended that the registered person reviews the home’s provision of assisted bathing/shower facilities to ensure that they are accessible to all current service users. The registered person should provide lockable space for service users in each bedroom. The registered person should develop a documented system to ensure that staff receive formal supervision at least 6 times a year. To reduce the risk of the spread of infection, the registered person should take action to ensure that the laundry floor is impermeable and that walls can be easily cleaned. 2. OP22 3. 4. 5. OP24 OP36 OP26 Ashcott Lawns DS0000015999.V357274.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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