Inspection on 04/07/05 for Ashcroft

This inspection was carried out on 4th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Ashcroft 21/11/06

Ashcroft 17/01/06

Ashcroft 22/02/05

Ashcroft 10/10/04

Ashcroft 05/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Ashcroft 48 - 50 London Lane Bromley Kent BR1 4HE Lead Inspector Wendy Owen Announced 4th & 5thJuly 2005 10:00am 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. Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashcroft Address 48 - 50 London Lane Bromley Kent BR1 4HE 020 8460 0424 0208 402 5460 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) Care Providers (UK) Ltd Stella Barnes CRH 22 Category(ies) of OP 22 registration, with number of places Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: staffing notice issued 21st July 1999 Date of last inspection 22nd February 2005 Brief Description of the Service: Ashcroft is a residential care home registered to provide nursing care to 22 residents, male and female. It is is a small, family run business, situated on the outskirts of Bromley town centre, conveniently placed for public transport. The service users’ private accommodation is on three floors, accessed by stairs and a lift. Some of the bedroom accommodation is in shared rooms. The communal area comprises a lounge and dining room on the ground floor. There are proposals to extend this area to provide more spacious accommodation. The home is set back from the road and there is a well-tended secluded garden and patio at the rear. Twenty-four hour care is provided by a Registered Manager, with registered nurses on each shift and care staff. Ancillary staff are employed to undertake domestic and kitchen tasks. Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over five and a half hours (over two days) The inspector spoke to three relatives and received written feedback from six relatives; one health professional and one GP. The inspection included a tour of the communal and private accommodation; viewing of a number of records and observation of the lunch-time meal. What the service does well: What has improved since the last inspection? What they could do better: Whilst the home produces a number of risk assessments, those for the use of bed-rails require more information on the decision-making process, acknowledging any risks involved. The standard of food provided is adequate. Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 6 However, attention to individual requirements would benefit residents, whilst ensuring a relaxed environment in which to take meals is fully promoted. The care plans and related risk assessments were satisfactory, although more detail in the equipment used to promote improvement of pressure sores is good practice, agreed by the PCT. Medication procedures were generally good but requires a little improvement, such as ensuring two staff record receipt of medication into the home and recording full details of the reasons why medication is not administered to a resident. Recruitment procedures whilst adequate must be improved in that two written references are received, including that of the last employer. 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. Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.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 Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.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) 2,3,4 &5 The admissions procedures are adequate with visiting prior to admission encouraged and viewed as an important part of the decision-making process. Assessment procedures are satisfactory although full completion of the home’s assessment would alleviate the potential risk of staff not being fully aware of all the individual’s needs. The home provides good information on the terms and conditions of the residents stay at the home enabling residents and relatives to make decisions on whether the home is suitable for their needs. EVIDENCE: Contracts are in place for residents and their format was discussed with one relative who stated they found the terms and conditions easy to read and understand. The visitor also told the inspector that they visited the home prior to their relative’s admission in order to decide on its suitability. Assessments are completed by the home, although one viewed had not been signed or dated and not fully completed. (See recommendation 1) The assessment obtained from the health professional, included a summary assessment and very basic care plan. The home writes to service users or Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 9 their relatives to confirm that they are able to meet the individuals’ needs. (Recommendation 1) Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.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 Care plans identify and reflect individual needs to ensure staff are provided with the information required to support and provide the appropriate care to residents. Residents’ health is promoted through regular access to health services. However, the use of bed-rails for individual residents require further detail to ensure the decision –making process and risk assessment accurately reflects the potential risks and promotes the safety of residents. Medication procedures adequately promote the safety of residents but could be further improved by ensuring all medications and toiletries are kept safe. EVIDENCE: The care plans are reviewed regularly. Two care plans were viewed in detail and one briefly. They contained some very good information, covering all aspects of care. It was pleasing to note that, one recorded information on the individual’s morning routine eg: not to be got up before 8.00am and to be given a cup of tea in bed. However, in another the information was not quite as informative or up to date. Residents are registered with a local GP and feedback indicates a positive relationship with the GP stating the home provides a “High standard of care” with “Good communication between the surgery and staff.” Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 11 Risk assessments are in place regarding nutrition, pressure care and falls and appropriate record of the actions the home is taking to minimise the risks. The “pressure care plan” identifies pressure care and wound care treatment and there are records of the actions taken by staff to improve the wounds. However, where residents have developed pressure sores good practice recommends that full details of the pressure care equipment used, is recorded on the care plan. This was in place for some, but not all residents. (See recommendation 2) The daily records and wound monitoring chart show good records of the wound and its improvement or otherwise. The feedback received shows that generally the home keeps relatives or residents’ representatives up to date with any changes in health, including accidents and that their health needs are met. Some of the feedback indicated that the knowledge and understanding of some staff could be improved upon. Permanent staff provide good knowledge of practices and procedures yet those working in the home as adaptation nurses, do not always have the required knowledge or understanding. One particular area of concern for one relative was the use of hoists on residents and apparent lack of competency in this area. There were good hygiene and infection control procedures in place, especially for those with MRSA. The procedures and recording relating to use of restraint equipment, such as bedrails require further detailing, to ensure their use, is in the best interests of the resident and that the risk associated with using them are clearly identified. (See requirement 1) The medication records showed no residents prescribed controlled drugs and very few prescribed medication to help them sleep. The medication records were comprehensive with the required details, including photographs. One record viewed showed a resident not given medication for three days. Although the code was provided as “not given” the home should clarify the reasons why the medication had not been given on those occasions. The inspector also clarified the need to discontinue the use of labels stuck onto medication records and where medication has been hand transcribed, the home should ensure two signatures record the medication coming into the home. (See recommendation 3). The requirements from the last inspection have been implemented with staff training taking place on the administration of creams and risk assessments completed on medication/creams/toiletries kept unlocked in residents’ rooms. Many risk assessments identified no risks to residents, however, one risk assessment highlighted a resident with dementia and mobile, therefore presenting a possible risk. When the service user’s room was viewed, toiletries were left in an unlocked wardrobe, in the shared room. However, the inspector has been informed that the risk to the service user is low. A homely remedies procedure has been produced and although the home did not have a procedure to record the medication coming into the home or the Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 12 administration of such medication on the first day, this was produced for the inspector, on the second day of the inspection. Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 13 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) 13 & 15 The home encourages family and friends to visit their relatives, encouraging the continuing of previous relationships. However, there is some limitation to privacy, due to the lack of a visiting room. The standard of meals provided is adequate although there are areas, which could be improved upon to ensure all residents receive a diet suitable to their individual needs and in an environment, which is relaxed and comfortable. EVIDENCE: The home encourages residents to maintain contact with family and friends. Feedback showed that the amount of contact varies but that visitors are warmly welcomed in by staff. Some feedback from relatives did, however, indicate the lack of space available to meet their family members in private. The lounge and dining areas are open- planned and there is no other room available, except the residents’ own room, suggesting this is not always a satisfactory arrangement. Of the eight relatives who feedback, four made specific comments regarding the meals provided. One relative stated the “food is barely satisfactory, although some meals are good”. One relative said the quality of food appeared to be good whilst two relatives commented on a lack of green vegetables with meals, Other feedback stated the home was not always proactive in providing alternatives, if a resident was poorly. For example: providing soup for a resident who is being cared for in bed and having a poor appetite whilst Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 14 another relative said that they think staff do not “understand that Y would like small tasty meals rather than a plateful of food which Y cannot face”. The inspector observed the lunch-time routine and noted that crockery and cutlery were available appropriate to the resident’s needs and that residents were being assisted to eat, either by staff or relatives. However, one relative commented that staff often “stand around residents waiting to take their plates away” causing anxiety for some residents. This reflected the observations of the inspector on the day. (See recommendation 4) Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home provides an open and inclusive environment, which enables residents or their relatives to raise concerns or complaints and ensure appropriate action is taken to resolve them. EVIDENCE: The home has a complaints procedure with eight of the nine feedback from relatives stating they were aware of the complaints procedure. Most of the feedback suggested the home listens to any issues raised and tries to resolve the problems. There have been three complaints since the last inspection, which have been investigated by the manager. One relative stated that although they have raised concerns about a particular aspect of practice the same practice continues and they have to “keep telling” staff about this. This is highlighted in a previous standar regarding the correct use of hoists. There is evidence that staff have received training in the protection of residents from abuse and the home has adequate procedures in place. Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 16 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) 19,21,22,23,24,25,26. The standard of private accommodation provides residents with a safe, homely, clean and tidy environment, which is equipped to ensure residents’ needs are being met. EVIDENCE: The environment remains as the previous report in January 2005. The home is clean and well-maintained and in a satisfactory state of repair and decoration. Some relatives commented on the small size and poor layout of the lounge/diner. This does, however meet the environmental standards. The provider plans to extend these areas, which will provide more space and include a visiting room. The bedroom areas viewed were all clean, homely and well decorated and furnished with personal possessions and mementoes. One resident spoken to, appeared to be very happy with their bedroom and one other relative told the inspector their relative’s room was kept clean and tidy and adequate for their needs. There was an adequate amount of storage space to store clothes and other belongings. A number of rooms are shared and Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 17 contained the necessary screening to ensure that the privacy and dignity of residents is maintained. Aprons and gloves were available throughout the home and staff were observed wearing appropriate protective clothing when undertaking various tasks. Infection control procedures were in place, appropriate to resident’s individual needs. Bathrooms and WCS were appropriate with adequate hand-rails, bath hoists and shower facilities. Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 18 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 Staffing within the home meets the previous staffing levels and mix, required by the previous health registration authority. Recruitment procedures require a little improvement to ensure the home meets the current regulations to ensure the safety and well-being of residents. EVIDENCE: Residents’ care is provided by qualified RGNs and care staff, supported by the management team and ancillary staff. The staff roster shows staffing levels meet the staffing notice issued by the previous health regulator. Feedback regarding staffing raised issues, not about the lack of staff, but the number of adaptation nurses in the home. One relative stated this situation makes the home “overcrowded” and adds to the level of activity in the home, having a negative impact. Of the eight relatives feedback three specifically mentioned this concern. It is likely that the restricted space, commented on previously, adds to this perception. Comments received from relatives identified a lack of continuity in the home due to the constant changes. However, the Registered Manager has recognised this and will be implementing changes to reduce the number of adaptation nurses they train and provide off-site training facilities. The feedback from relatives showed that the care provided by the trained staff ie nurses and care staff is good with one relative stating they found the staff “to be very competent,” but later states that the adaptation staff are unqualified and uncertain about what they are doing. You cannot gain the confidence you have with qualified staff.” Another relative stated that the “trained nurses/carers are excellent but adaptation nurses do not always reach Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 19 the same standard. The manager is currently reviewing the above number of adaptation nurses and should consider these views during the course of the review. There has been one new member of staff recruited since the last inspection. The recruitment procedures were adequate. Although verbal references had been received, there was no indication of the referees’ person’s job role and there was no other written reference. All other documents were in place. (See requirement 2) Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 20 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) 38 The manager promotes the health, safety and welfare of residents by ensuring the equipment used in the home is regularly serviced and staff attend training in a number of areas relating to health and safety. EVIDENCE: A number of service contracts were viewed and found to be in order, including fire systems, gas equipment and hoists. Risk assessments have also been developed for a number of areas and accidents recorded appropriately. Previous comments have detailed infection control procedures in place, moving and handling instruction is provided by trained staff and staff are trained in food hygiene, where appropriate. Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 x 3 3 3 3 3 3 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 x 3 x x x x x x x 3 Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 22 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 8 Regulation 13 Requirement Timescale for action 01/09/05 2. 29 18 The Registered Person must ensure that risk assessment are fully completed on the use of bedrails for individual residents. The assessment must detail the decsion-making process for the use of bed-rails. The Registered Person must 01/09/05 ensure that recruitment procedures promote the safety of residents. Specifically, written references must be obtained. 3. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 1 8 9 Good Practice Recommendations The Registered Person should ensure that all assessments completed by the home should be fully completed, signed and dated. The Registered Person should record the details of the pressure relieving equipment used in the treatment of pressure sores. The Registered Person should record the reasons for nonadministration of medication and ensure where medication G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 23 Ashcroft 4. 15 is recorded by hand, two signatures record the information. The Registered Person should ensure that the individual nutritional and dietary needs of residents are fully met. Accurate records of meals provided, including special diets prepared for individual service users. Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection Riverhouse 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashcroft G51G01s10126Ashcroftv225641.4.7.05stage4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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