Inspection on 04/03/08 for Ash Court Care Home

This inspection was carried out on 4th March 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ash Court Care Home 18/05/06

Ash Court Care Home 11/01/06

Ash Court Care Home 27/05/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashcourt Care Home Brookside Avenue Liverpool Merseyside L14 7NB Lead Inspector Julie Garrity Key Unannounced Inspection 4th March 2008 10:00 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 Ashcourt Care Home DS0000063424.V360865.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. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashcourt Care Home Address Brookside Avenue Liverpool Merseyside L14 7NB 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) 0151 259 7522 ashcourt@meridiancare.co.uk Meridian Care Limited Mrs Sarah Ann Molloy Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 40 Date of last inspection 18th May 2006 Brief Description of the Service: Ashcourt is a purpose built home, which was built 7 years ago. It was purchased by Meridian Care Limited in January 2005 There are 40 bedrooms that have en suite facilities. The home has three lounges, a dining room and a conservatory where smoking is allowed. There is also a main foyer that doubles as a seating area for people who live in the home and visitors. Car parking is available at the side of the building. All areas of the building are accessible by the residents and aids to mobility such as ramps and handrails are in place to assist access to the building. The home is located in a residential area of Liverpool and is within easy access to bus routes, churches and local amenities. There is a garden area at the front of the home and a small area to the rear. Ashcourt Care Home DS0000063424.V360865.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 no star. This means the people who use this service experience poor quality outcomes. The inspection was carried out over a period of one day. We (the commission) arrived at the home at 10:00 and left at 18.20. We spoke with 10 residents, 6 visitors, 6 staff members, the acting manager, training officer, peripatetic manager and quality assurance officer. We completed the inspection by a site visit to Ash Court, a review of records available in Ashcourt and offices of the commission, discussions with residents, relatives, visitors, staff and management. Copies of records were submitted to us by the home before the site visit. We followed an inspection plan written before the start of the inspection to ensure that all areas identified in need of review where covered. All of the Key standards were covered in this inspection, these are detailed in the report. Feedback was given to the acting manager during and at the end of the inspection. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. What the service does well: All individuals spoken with thought that the food was of “good quality” and “very tasty”. The chef is enthusiastic and tries to make sure that all special diet such as a diabetic diet can be catered for. The cleaning team try very hard to keep all areas clean and tidy. People who live in the home said that they were particularly happy with their bedrooms, several said bedrooms were “always clean and tidy” and “I really like my room its lovely”. The home has been redecorated within the last 2 years and provides a variety of different communal space for individuals to use. A separate smoking area is available. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A number of the records in the home are incomplete, inaccurate or not up to date. This has resulted in staff not always being aware of the individual needs. Information for people who live in the home states all individuals will have a care plan within 48 hours, however in at least one case this has not occurred. The care plans are unread by the staff, do not involve the individual and in several cases did not detail all the needs of the individual or how to meet them. This means that staff did not have clear instructions to follow. Assessments seen were not complete and the service does not always make sure that they have important information from other professionals such as Social Services. Medications are not safely managed. Seven peoples medications viewed, of these five individuals had not received the correct medication at the correct time placing them at risk. Although training has increased there are a number of staff who have outstanding training needs. Without good training staff will not be able maintain the safety and the care of individuals. Additionally training has not increased staffs ability or competency. This was noted with medications, care plan, dealing with complaints and passing information to the manager. Staffing files viewed showed that not all staff have recieved the proper checks. Without proper training, support and recruitment staff will be unable to meet the needs of people who live in the home. Meridian Care, the owners of Ashcourt have provided additional management support including audits on care aspects. This support has not improved the quality of the service provided. There have been several serious concerns raised about the home, two of which, where noted at this site visit. The staff and the management in the home are not always recognising and dealing appropriately with issues of concern placing individuals at risk. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 7 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. Ashcourt Care Home DS0000063424.V360865.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 Ashcourt Care Home DS0000063424.V360865.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information that would assist people to decide if they want to move into the home is available. Many areas of this are inaccurate and do not provide individuals with a clear understanding of the needs that service can meet. Assessments that are used to help the home decide if the service can meet individual needs do not identify all individual needs. The lack of accurate assessments will mean that individual needs are not recognised or meet. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 10 EVIDENCE: We looked at the information available to people who might wish to move into the service. This information was updated on January 2008. The information did not have the necessary details such as the needs of individuals that the home can meet. Without this information the service may admit individuals whose needs they cannot meet. Copies of the information were not available to the people living in the home. Those spoken with did not recall seeing it. The information did not detail what skills and training staff had received. It is essential that good, accurate and easily readable information is available for anyone wanting to move into the home. Good information helps them to make a choice as to whether the home can meet their needs. Six records of people living in the home were looked at in particular the most recently admitted person. The records for this person showed that an assessment had been done by the manager before the individual moved in. The individual said “I saw someone before I came here”. The assessment did not contain a number of needs specific to the individual and the service had not made sure that they received the assessment from social services. This meant that staff were not aware of relevant needs and were not able to plan how to meet the individual’s needs. Other assessments were viewed and varied in quality some had been reviewed and others were unavailable. All individuals need to be assessed before they move into the home. This is done to make sure that home can meet individual needs. We looked at contracts that are given to people when they move in that explain how their fees are paid for, who has responsibility and what services they can expect to receive. In the most recent admissions none of these had been filled out with a copy given to individuals or their families. The services charges are paid for by three different sources and include a contribution from family members known as a third party top up. The contracts made no mention of this or what it was for. People who live in the home need to be aware of what services they will receive and how it will be paid for. Individuals spoken with said that “the home is very nice”, “I’m glad I moved in” and “I’m happy living here”. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information for staff, such as care plans are not of good quality. The information is out of date, inaccurate or missing. Without a good understanding of how to meet individual needs, staff will be unable to give them the right support. Medications are not well managed, people who live in the home do not receive their medications, as they should. This places people who live in the home at risk. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 12 EVIDENCE: We looked at six care plans, three of these showed they had been written with the residents or their relatives, three others didn’t. People who lived in the home spoken with did not remember seeing a care plan. One relative did remember having seen a care plan. All the care plans were reviewed on a monthly basis however this was not always done accurately. One care plan had been reviewed four times over three months. The review said that the care plan was accurate. The care plan explained that the individual was gaining weight. The records of the individuals weight during those three months showed that they were in fact losing weight and this had not been recognised or the care plan changed. Staff spoken with did not read the plans and relied on the verbal conversations that they had with each other to tell them the different needs of the residents. One individual had been admitted four days before the site visit and did not have a care plan. There were no records explain what care they had received for three days. A risk identified by the manager had not been included in the care plan. Another individual had records that stated that they had been very agitated over night and had not been to bed for a significant amount of time. There was no care plan as to how the staff would support this individual appropriately and the manager was not aware that this was happening. Care plans did not describe how staff were to meet individual needs. Phrases such as “support” were used but no description as to what that “support” was. Without accurate care plans that give clear instructions to staff people who live in the home will not receive care that is consistent and the service may not meet their individual needs. People who live in the home are supported to choose their own doctor or stay with their current doctor. One recently admitted individual had been in the home for four days without the service arranging for a new doctor. This meant that should the individual need to see a doctor during this time the service will not be able to arrange this. Records in general regarding healthcare were brief and did not clearly state the purpose of any professional intervention e.g. district nurses, doctor or chiropody. These records did not explain what actions the staff should take to support the guidance of the professionals. Staff need to have a clear understanding of the guidance given by professionals in order that they can make sure that individual needs can be fully met. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 13 Medications for seven individuals were checked. In five cases the medications have not been given correctly. A newly admitted individual had received medications in the home for four days, five of these medications had been given incorrectly placing the person at risk. Staff have received training in medications and monthly checks from the company have taken place however these actions have not improved the practice of the staff. Not all medications had clear written instructions as to how to give them and information vital such as to given before or with food was not available. Staff spoken with were not aware that this medication had to be given at this time. One individual had not received their painkillers properly for a long time. Although the checks on medications did eventually identify this, the service responded by giving the correct dose without asking the doctor. The medication had been given incorrectly for a long time to change it without talking to the doctor placed the individual’s health and welfare at risk. Staff were observed during the day, in many cases they maintained the dignity of the people who live in the home, however this was not consistent. Some people received support from the staff without the staff member discussing their actions with the individual. It is good practice and maintains individual dignity if staff communicate with the people living in the home whilst they support them. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Choices of meal are available and activities have recently started. There is a lack of information that details what individual choices are and in some cases choices are not offered. Without good information staff will not be able to meet individual choices and preferences. EVIDENCE: Activities have recently started. One relative was very pleased about this explaining previously her relative had been “bored”. There is a new activities co-ordinator who decides on what activities are to take place. As yet there are no records that say what individual personal choices and preferences are daily living activities. The residents spoken with were “happy” and “enjoying” the activities available, one stated “ Could do with being more to keep me busy and active”. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 15 Staff explained that at least three individuals have mental health needs and confusion, there were no activities that were specific to their needs. There was no activities programme available for the people who live or their families to look at. The activities co-ordinator is starting to put a programme in place that will be taken from individual’s preferences. People who live in the home are encouraged to eat in the dining room but are supported to eat in their own rooms if they wish to do so. There were no records available for residents meetings and individuals spoken with could not recall any meetings taking place. Observations over the day showed that staff were not always discussing choices with people who lived in the home. In two cases individuals were given a drink with no communication and they were not asked what biscuits they would like but were given these directly on to a table without a plate to prevent the food being contaminated. The menus detail a choice of meals that residents are asked about that day. The choices also explore the vegetables that they would like. Residents spoken with were generally happy with the food and included comments such as “well cooked”, “ Food is good” and “ quite nice”. One resident said that they would like “more choice”. The cook and the staff did not have a clear understanding of special diets such as diabetic diet or low cholesterol. None of the staff have received training in this area. A care plan for an individual who needs a special diet was not available. There was no evidence that diabetic specialists such as the diabetic nurse or dietician had input into the menus. The cook was aware of who had a diabetic diet, but had not been informed that an individual also needed a low cholesterol diet. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live in the home, relatives and staff know to raise their concerns with the manager. There have been a significant number of serious concerns raised over the last 12 months. Not all of these were recognised or dealt with appropriately by the management team. The majority of staff have received training in recognising and dealing with serious concerns. Not all concerns are reported to the manager by the staff. This places the people who live in the home at risk. EVIDENCE: We looked at how the service deals with complaints. All the people who live in the home we spoke with said that they would “tell a member of staff” or “tell the manager”. One relative explained a number of concerns that she has raised with the manager but these were not written down and did not have any records that they had been investigated. There were records regarding 7 complaints to the home that had been looked at and did have clear records explain what the home had done to resolve the situation. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 17 The home has had several complaints of a serious nature in the last 12 months none of the records for these were available for review and the home had no means to monitor how these were progressing. Two of these concerns were identified at the site visit and had not been recognised by the staff or the acting manager of the home. The lack of action in this area may place both individuals at risk. The manager explained that all staff had received training in protecting vulnerable adults. There were no records to support this such as a training plan, or in staff members file. One member of staff had a good understanding of how complaints of a serious nature another spoken with had not received any training in this area. There is an inconsistency in staff approach and understanding of complaints and concerns. This lack of understanding may lead to concerns not being identified or dealt with. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well decorated and very tidy. People who live in the home are able to make their bedrooms their own and this is appreciated by them. There are areas that need to be looked at such as strong smells and stained and damaged furniture in order that the home is a comfortable and safe place for the people who live there. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 19 EVIDENCE: We spoke with people who live in the home, relatives and staff spoken with said that the home “looked nice”. People who live in the home were happy with their own bedrooms one said, “My room is kept nice and clean”. Staff training records and policies and procedures showed no evidence that staff have been trained or guided in preventing infection. The kitchen and laundry areas where well equipped and maintained. The kitchen had recently been inspected by an external agency and award their top award for cleanliness. Staff are making sure that the kitchen is maintained to good standards. The home has a variety of communal space including a tiled conservatory, two lounges, one activities room, and one dining room. The conservatory is the communal space that can use for smoking. People who live in the home use the quiet upstairs lounge to see their relatives. It is good practice that the home offers a variety of space that can be used to meet the needs of individuals. The furniture in the main lounge near the kitchen was noticed to be damaged and stained. The lounge area and main reception were noted to have an offensive smell. Although the home was well presented, one relative raised concerns regarding maintenance, which in their opinion was not addressed rapidly such as getting a light bulb changed. There is no maintenance plan in place that details when furniture will be renewed or when other areas of the home will be redecorated. Without this information people who live in the home will not be aware of when redecoration or refurbishment will happen. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment processes are not robust enough for the service to make sure that the people who live in the home are always safe. Training is impossible to determine and in some instances even though staff have received training they have not maintained good standards and placed individuals at risk. EVIDENCE: People who live in the home were complimentary about the staff describing them as “kind”, “caring” and “helpful”. One relative said, “Staff are lovely but there are not enough, especially at busy times. Mum often waits to go to the toilet”. Staff spoken with thought there is sufficient staff available most of the time. There is no arrangement in place that looks at the needs of the people who live in the home and supply staff to meet their needs. This means that the manager has no means to monitor that there are sufficient staff available at all times. On the day of the site visit we found it difficult to locate care staff at times and the lounge area was frequently without a staff member near by. The manager explained that it is a large home and that staff can be scattered throughout the building during the day. The size of the home needs to be taken into consideration when deciding how many staff are needed. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 21 Staff training records were unclear and did not reflect the training received by staff, all senior staff have received training in medications and care planning but there were no records of this. Staff members spoken with were unable to recall recent training, in particular moving and handling, fire safety and health and safety. There were no records available either on staffing files or in training records that evidence that staff had received this training. There was no training for the staff that was specific to the needs of individuals such as diabetes, dementia and epilepsy. Several staff named the same three people and said that in their opinion they were unable to meet their needs. Without proper training in health and safety and specific needs of the people of the home staff will not be able to meet individual needs or maintain their safety. Staffing files had not been updated. All staff had evidence of a police check. Induction records showed that all staff had been given a full induction in the home in one day the manager said this was over several weeks and included essential training such as fire safety and moving and handling. There was no evidence that new members of staff had received this training. One member of staff disclosed to us that they had been dismissed from a previous employer. The manager was unaware of this and a review of their file showed that references from either of their previous employers had not been requested. Additionally the member of staff had worked in the home without a police check. In exceptional circumstances staff can be employed before a police check as long as all other checks are in place and the staff member is constantly supervised until the police check is received. There was no evidence available that the employment of this member of staff had been managed sufficiently to safeguard the people living in the home. Although the manager and staff said they had received training in medications and care planning, the manager had not made sure that staff were competent and skilled in these areas. Evidence earlier in this report showed that staff were not demonstrating the ability to undertake these roles in a skilled and safe manner. Without making sure that staff are able to undertake their role the service places the people who live in the home at risk. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are areas of good practice that do have a positive impact on individual lives. The company that owns the home has put in additionally staff and management in order to improve the quality of the service. Despite this commitment the service has not been able to make sustained improvements. Poor practice that does not make sure that individual health, welfare and safety needs met places individuals at risk. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 23 EVIDENCE: The acting manager has been in post for just under twelve months. She is not registered with the commission and has previously been the deputy manager of another residential care homes. People who live in the home and staff were very complimentary comments such as “fantastic”, “lovely” and “very approachable were made”. The registered manager was temporarily allocated to manager another home. Meridian care are reviewing what arrangements will be in place in the near future. Since the site visit a new acting manager has been appointed and will be applying to register with the commission. Due to a serious concern Meridian care committed additional resources to the home such as a support manager, a quality assurance office, a deputy manager and regular checks on the service. Despite this commitment to increasing the quality areas such as medications, care planning, admissions to the home, staff training, development and recruitment of staff are not managed safely. Neither staff or “residents” meetings are held regularly. There were no minutes available that detailed the input of the people who live in the home. A lack of individual input into the home was also seen in the development of menus, activities and care planning. People who live in the home are not supported to have their own personal choices and preferences used to influence the running of the home. A quality assurance system is in place that looks at individual opinions of the home this has been in place for sometime but as yet has not produced a development plan that can be viewed by all the people involved in the home. There are a variety of checks in place including care planning and medications but in this instance these have not identified serious issues or enable the manager to address these issues. The home keeps receipts and good accounts for all people who live in the homes. It is explained to individuals that only small amounts of money are retained on site. People who live in the home had been informed small amounts of money can be easily obtained. Larger amounts needed ordering and this means that the people who live in the home do not have ready access to their own funds. Health and safety training is available to staff as part of their induction. It is unclear from the induction and supervision records as to whether staff have received this training. Staff supervision records were looked it care staff had received regular supervision but other staff had not received supervision in the last two years. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 24 Risk assessments within the home are in need of updating and need to include aspects such as propping open the laundry door, lack of door restrictors in bedrooms and smoking of individual residents in order to maintain safety. A lack of up to date information does not support staff to be fully aware or action health and safety practices and this places individuals at risk. All residents accidents are recorded, although these are not reviewed on a regular basis to determine particular residents or areas at risk. One individual was noted to have received a serious fracture after falling 3 times in 17 days. The service had failed to recognise this risk and had not put a risk assessment in place to manage this risk. Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 25 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 2 1 1 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X 3 3 2 2 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 X 2 2 1 1 Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 4 (1) (a) (b) (c), 5 (1) (a) (b). Timescale for action The information in the home 04/06/08 such as the statement of purpose and service users guide needs to be reviewed. An accurate and up to date description of the home needs to be in place. This needs to support prospective people who live in the home to make an informed choice. Management will need this in order to make sure that they can supply, monitor and develop the services detailed in this information. A copy of this needs to be sent to the Commission whenever it is reviewed and changed. All People who live in the home 04/05/08 need an up to date contract that details what services the fees pay for. Including the amounts and methods of payment from all parties contributing to the fees. Clear information needs to be available in order to make sure that people who live in the home and their supports can make an informed choice and be aware of the services provided. DS0000063424.V360865.R01.S.doc Version 5.2 Page 27 Requirement 2. OP2 5 (1) (b) (c) (3) Ashcourt Care Home 3. OP3 4. OP7 14 (1) (a) All pre-assessments and 04/04/08 (d) (2) (a) assessments undertaken need to (b) be completed by individuals trained to do this. All relevant needs of the individual wishing to move into the home need to identified to make sure that the resident and the management of the home can make an informed choice. Assessments need to be reviewed and changes in individual condition included. 15 (1) (2) Each individual needs a plan of 04/05/08 (a) (b) (c) care that is written in (d) consultation with them or their representatives. The care plans ought to detail how the people who live in the home needs will be met by the staff. This needs to be in sufficient detail for staff to provide consistent support to meet all the needs of people who live in the home. The homes own policy needs to be meet and all care plans drafted on admission and reviewed with 48 hours. 5. OP9 13 (2) 6. OP12 16 (2) (m) (n) Outstanding from 18/05/06 Staff need to give medications 04/04/08 correctly at all times. People who live in the home need to have their medications given as they are prescribed by their doctor. Arrangements need to be made 04/06/08 to determine resident’s personal preferences, choices and equality and diversity needs and daily routines. These should be clearly recorded in order that all staff are aware of them and do not rely on verbal communications to make choices for People who live in the home. DS0000063424.V360865.R01.S.doc Version 5.2 Page 28 Ashcourt Care Home This is particularly relevant for those People who live in the home less able to voice their opinions in order that staff can support them in a consistent manner that meets their needs. 7. OP14 22 (3) (8) Outstanding from 18/05/06 All complaints need to be 04/04/08 recognised and full records kept as to how these are to be dealt with and actioned. Outstanding from 18/05/06 Staff need to be fully aware of 04/04/08 recognising, monitoring and reporting instances of adult abuse. Outstanding from 18/05/06 Staff need to be competent to 04/06/08 undertake the support and care that they give. The management needs to make sure that staff are given the opportunity to develop competency. Staff supervision, reviews and audits of their work and clear descriptions of their role needs to be in place in order to monitor and develop staff competency. All staff must have the proper 04/04/08 checks in place. This needs to include CRB, POVA and references that are valid. Where staff start without a CRB in place a risk assessment needs to be undertaken and supervision that protects the people in the home is in place until all checks are completed. 8. OP16 13 (6) 9. OP28 18 (1) (a) (2) 10. OP29 19 (10 (a) (b) (c) Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 29 11. OP30 18 (1) (a) (c) Staff need to have the skills 04/06/08 necessary for their job role and to be competent in undertaking their role. This includes, writing care plans, monitoring and completing record, managing and dealing with allegations of potential abuse and writing, managing and monitoring risk. A review of staff training skills needs to be undertaken and a plan put into place that identifies training for individual staff, when and how they are to receive this training. A review of previous training needs to be done in order to determine the effectiveness of the training and to determine staff. Staff need to be aware of and deal with their duties in accordance with the homes own policies and procedures Outstanding from 18/05/06 The service must have a 04/06/08 manager in place who is registered with the commission. Risk management plans need to 04/04/08 be in sufficient detail to provide staff with clear instructions as to how to reduce or prevent the identified risk. These need to be reviewed regularly, discussed with the resident and updated as needed. Outstanding from 18/05/06 12. 13. OP31 OP38 9 (1) (2) (a) (b) (c) 13 (4) (b) (c) Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 30 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. Refer to Standard OP1 OP7 Good Practice Recommendations Information in the home needs to be available in different formats that meet the people who live in the homes needs. Staff should be supported to read care plans and not rely on a verbal hand over for information about residents care needs. Resident’s personal preferences should be further explored. These should be made available for all staff including the kitchen staff to be used to form menus and a published activities programme. Further development of staff should be undertaken to make sure that they can give out medications safely, such as training, assessments of competency. The manager should undertake to do her own audits of medications in order to identify any potential issues and those staff that may need additional support. Daily records should be completed in accordance with the homes own policies and clearly reflect the care given to the residents. Staffing levels should be monitored and put into place to meet the identified and assessed needs of residents. 3. OP12 4. 5. OP7 OP27 Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 © 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 Ashcourt Care Home DS0000063424.V360865.R01.S.doc Version 5.2 Page 32 - 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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