Inspection on 01/02/10 for Ashcroft House

This inspection was carried out on 1st February 2010.

CQC 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

Ashcroft House 17/11/09

Ashcroft House 23/06/09

Ashcroft House 25/06/08

Ashcroft House 27/06/07

Ashcroft House 12/06/06

Ashcroft House 23/01/06

Ashcroft House 11/10/05

Ashcroft House 02/08/04

Ashcroft House 14/04/04

Ashcroft House 11/02/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Random inspection report Care homes for older people Name: Address: Ashcroft House Wilderness Hill Fairview Close Cliftonville CT9 2QE zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anne Butts Date: 0 1 0 2 2 0 1 0 Information about the care home Name of care home: Address: Ashcroft House Wilderness Hill Fairview Close Cliftonville CT9 2QE 01843296626 01843571551 Manager.ashcroft@regalcarehomes.com www.regalcarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Regal Care Homes (Margate) Ltd care home 88 Number of places (if applicable): Under 65 Over 65 0 0 dementia old age, not falling within any other category Conditions of registration: 0 0 The maximum number of service users to be accommodated is 88. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Ashcroft House is an exceptionally large detached property, that was previously a hospital, with three floors, which have additional wings, currently the top floor is closed whilst the company considers refurbishment requirements. The Home offers a mixture of care provisions; residential, nursing and dementia. The home is situated within walking distance of local amenities. There is a shaft lift to Care Homes for Older People Page 2 of 13 Brief description of the care home access the upper levels. The home has its own secure garden area. There is limited parking for cars available. There are additional costs for items such as hairdressing, chiropody, newspapers and taxis. Information about fees at this home can be obtained from the registered provider. Care Homes for Older People Page 3 of 13 What we found: This was a random unannounced visit carried out by two inspectors who visited the service on 1 February 2010 and spent 10 hours in the home. The reason for the visit was to check compliance with eight statutory notices only. We (the Care Quality Commission) carried out a key unannounced inspection at Ashcroft House in June 2009. At this visit we identified concerns and made seventeen requirements and rated the home as a 0 star (poor) service. We carried out a second key inspection in November 2009 and found the home had failed to address the requirements and remained a 0 star (poor) service. Following this visit we served 8 statutory notices and our visit on the 1 February 2010 was to check compliance with these. Remaining requirements made in November and not subject to statutory enforcement notices were not checked for compliance at this visit. We looked at a selection of records in relation to the statutory requirement notices. These included 4 care plans, assessments, risk assessments, observational and monitoring records, staff files and training records. We also looked around the building and observed staff interactions and the daily living experiences of people living in the home. We spoke to 4 service users and 6 members of staff during the course of our visit. The manager (who is not registered with us) was available throughout the inspection as well as a senior member of Regal Care Homes (Margate) Ltd. The responsible individual was present for part of the visit. Judgements have been made with regards to each statutory notice, based on records viewed, observations made and verbal responses given by those people who were spoken with. A random inspection does not change the star rating of a service and as such the judgement made in November remains at this time. Previous full inspection reports are available on our website at www.cqc.org.uk . We served an immediate requirement at this visit as we identified the failure of the home to inform us of information as required by regulation. We are not making any more requirements as a result of this visit, but we found that the statutory requirement notices had not been complied with and are now following further enforcement pathways. We looked at each statutory requirement and our findings are as follows: Regulation 12(1)(a)(b) The home was required to ensure that service users nutritional and fluid needs were assessed and monitored and have systems and records in place to support people with these needs and ensure appropriate action was taken. The home was further required to monitor weights in accordance with their identified needs and documented guidance in their care plans and also to have procedures in place for unexplained bruising. Records showed that nutritional assessments were not always completed for individual people and a nutritional assessment which had been completed had not been accurately reflected into the care plan which resulted in incorrect information being given to staff. Care Homes for Older People Page 4 of 13 This has the potential to place people at serious risk as their needs are not correctly identified within their care plans. A nutritional care plan for one person identified that they should be encouraged with a high protein diet, but food and monitoring records for this individual did not evidence that this had happened. The care plan for another person showed that they had lost weight and we asked what action had been taken. We were told that this person should have been weighed weekly and there should be a nutritional care plan in place. The records for this could not be found. We saw evidence that the home had sought professional input from dieticians, however the information and assessment provided was not written into the care plan, which means that care staff do not have accurate guidance on how to support the person. We looked at the fluid charts for 5 people. These records showed that people were not receiving the amount of fluid they had been identified as requiring. The records showed that the target fluid intake for a service user was 1200 mls a day. The completed fluid charts showed that this person had consistently drunk less than this with records showing an intake of 400 mls, 290 mls and 465 mls drunk in a day for example. We looked at the food charts for 5 people and saw that these were not completed in detail and did not always show how much a person had eaten or in some instances had not recorded any consumption of food. During the afternoon of our visit we also looked at the lunch time food records for 5 people in the dementia unit and saw that only 1 of these had been completed and this did not state now much the person had eaten. We were told that they would be completed, however if records are not made at the time this has the potential to result in inaccurate information which does not support in ensuring people can be monitored and supported with their needs in a robust and safe manner. We asked what systems were in place for monitoring the food and fluid charts and what procedures were in place to take any follow up action. We were told that they are looked at on a daily basis any concerns would be reported to the nurse, but there was no evidence in place to show the process for ensuring that low fluid or food intake were reported appropriately and action taken in a timely manner. We looked at records for bruising to people and saw that for 1 person the record only identified a bruise, but offered no explanation as to how this had happened or what the home had done about it. Another record for a person showed that they had completed a full accident form, but not all details had been completed. Regulation 12(3) The home was required to ensure that service users wishes and feelings were taken into consideration as to how their needs were met and have systems in place to ensure that these are clearly documented, respected and supported. We looked at care plans and records for 5 people. Records were seen in place on individual service user files that showed that the home had begun to speak to people about their preferences, likes and dislikes, but at the time of our visit much of this information had not been placed into the actual care plan. There are consent agreement forms in place for peoples permission for bedrails for example, but the agreements in many cases were either not signed or signed by a representative of the service user, with no evidence to show that the person lacked capacity to make their own decisions. We saw that a care plan identified that the service user liked to get up between 8.00 and 9.00 am. On the day of our visit we saw that this person was not assisted to wash and dress until 10.10 am. Observational records in place for this person also identified that they were regularly assisted with washing and dressing after 10.00 am. We spoke to another service user who told us that they liked a strict routine and liked to get up early, but had to wait until staff were ready to assist. The home had carried out a service user satisfaction survey in the middle of January. We were given copies of nine surveys and comments indicated that there was a mixed response from service users about choices of Care Homes for Older People Page 5 of 13 times for getting up, going to bed and when they were able to have a bath. Six of the nine surveys indicated that people could not have a bath when then preferred and half of the surveys said that people felt that they could either not get up or go to bed when they wanted. On our previous visits we had identified that some people on the dementia floor had their liberty restricted as they do not have free access to and from their individual bedrooms into the communal areas and are dependent upon the availability of staff. We asked what had been put in place for people to remove this restriction. We were told that there was information in the individual care plans which identified people who could manage the keypad system and let themselves in and out and also there was a bell, which other people could ring to attract attention should they wish to go through the doors. We looked at the care plans for these people and saw that not all of the care plans identified who could manage the door system. We asked a service user about using the bell and they told us that they did not know how to. Regulation 12(4)(a) The home was required to ensure that service users were treated with dignity and respect. At this visit we observed a female service user sitting in the downstairs lounge area. This service user was not wearing any out lower garments (a skirt for example) and only had a blanket covering one half of her lower body. It was also apparent that she was wearing an incontinence pad as this was clearly on view. There were staff in the lounge area, but nobody attempted to cover her up. Records used to make observations about the service users were left on show in the downstairs lounge. These records had comments included such as wet pad. These records were clearly visible for people to view. The care plan for one person described the use of make up and assisting the person to be presentable, we observed however that her hair had not been brushed on the day of our visit. We did observe that people were now not routinely wearing aprons whilst eating their meals and that there was adapted cutlery for use by those people who required this. Regulation 13 (4)(c) The home was required to ensure that the risks identified in the service users assessments had clear corresponding action plans in place in order to ensure that the risks to the service users are minimised and that they were reviewed at least monthly and updated according to the person changing needs. At our visit we saw that there were risk assessments tools in place for movement and handling, falls, skin integrity, hoists and wheelchairs for example. There were, however, no individual risk assessments in place where it had been identified there was a specific need such as a person displaying challenging behaviour. Completed risk assessments did not always give accurate information. For example we saw that a risk assessment for skin integrity for one service user had failed to identify their age within the score sheet and if this had been included then the risk factor would have changed from a high needs dependency category to a very high needs dependency category. We saw that another risk assessment for a person had 2 versions in place, and both of these gave different information. A falls risk assessment had been reviewed after a month and there was a significant difference in the score. On closer inspection of this document it was identified that the score had been incorrectly added up on one of the review dates - but there was no evidence in the file to identify that the member of staff completing this record had looked to see why there was such a large change in the outcome score. There was no indication in the falls risk assessment as to what the outcome score meant. A hoist risk assessment had been carried out for a service user in October 2000; this had been poorly completed and did not identify the type of hoist or sling to be used. The guidance stated Care Homes for Older People Page 6 of 13 assess resident need and appropriateness to use of machine/hoist, but did not give an assessment. There was no evidence in the records to show that this had been reviewed since this date. A wheelchair risk assessment for this same person had been carried out on in January 2010. This identified that the service user was able to maintain a safe position in the wheelchair at all times. It did not, however, identify as to whether the person needed a lap belt or not. Records showed however that this service user had fallen and a witness had informed staff that she had fallen forward in her wheelchair, 14 days after this assessment. Following this accident there was no updated risk assessment in place for the wheelchair. This has been referred to the safeguarding coordinator. Records for a service user showed that following an incident where the person had been aggressive on one occasion, the advice of a G.P. had been sought and medication had been prescribed. The care plan stated that the person could become agitated. We did not see any evidence in the daily records of this being a regular occurrence for the behaviour or a risk assessment in place. This incident has been referred to the safeguarding coordinator. Regulation 14(1)(a)(b)(c)(d), 2(a)(b) The home was required to ensure that a full assessment of service users needs was completed prior to the person being admitted to the Home and consequently keep the same under review. Since our last visit there have been no new services users admitted into Ashcroft House. The home has introduced a new template for a preadmission assessment tool. This has been implemented in the home to complete assessments on existing service users. The information recorded in assessment does not always correspond to the information and care needs described in the care plan, therefore resulting in conflicting information. Regulation 15(1), (2)(b)(c) The home was required to ensure that there are written care plans provided to staff which gave consistent and clear guidance as to how a service users needs were to be fully met and are up to date and accurate based on assessed needs. We found that the home was in the process of updating care plans and had introduced new formats. Some of the care plans we viewed still contained older care plan formats and in some cases there were 2 versions of the same care plan in place which gave conflicting information and had the potential to misinform staff of the care needs of the individual person. Records showed that not all care plans had been reviewed or updated. We also saw, that many areas of the care plans still did not give clear guidance on how to support individual people and also contradicted associated assessments. For example; a plan for personal care for a person stated to give personal care, but did not identify what this was. An eating care plan for one person who remained in bed did not record the position needed to assist the person to eat their meal. We also saw evidence that changes to individual needs was not reflected into care plans. For example: a mobility care plan for a person written in November 2009 did say that mobility was poor and the person found it difficult to weight bear and that staff should take special care due to delicate and sensitive skin, but it had later been identified that the person suffered with hip pain and the mobility care plan and associated risk assessment had not been updated to take account of this. The records for this person also identified that they were at end of life and required palliative care. There was no end of life care plan in place. Records for another person identified deterioration in their condition and that they now remained in bed. The care plan and associated risk assessments had not been reviewed to reflect this. Care Homes for Older People Page 7 of 13 Regulation 18(1)(c )(i) The home was required to ensure that there are arrangements in place for staff training protect the health, safety and welfare of the service users. At our visit we looked at the records for five members of staff and at the training matrix and spoke with the manager and members of staff and found that the new members of staff had records in place to show that they had completed an induction in line with the Skills for Care. We did not evidence any competency assessments in place to ensure that staff were deemed as competent for the roles they are to perform. The Clinical Lead told us that she would be putting competency assessments in place for nursing staff, but we did not see any evidence of this at the time of our visit. The The action plan presented to us prior to our visit stated that this would be in place by 31 January 2010. The training matrix evidenced that not all staff had completed the appropriate training. For example we found on the day of our visit that movement and handling had not been completed for 6 staff. Adult protection training had not been completed for 13 members of staff. Administrative staff were identified as adult protection training being not applicable. Coshh training is identified as being not applicable for care staff. Nutritional awareness training had not been completed for 28 members of staff. We found that training for the above had been allocated to take place in February or March, but we did not see any evidence of any ongoing planned training. Regulation 19 (1)(a)(b)(c), (5)(a)(b)(c)(d)(i), (9), (10)(a)(b), Schedule 2 The home was required to have a system in place to ensure that the documents specified in Schedule 2 of the Care Homes Regulations 2001 are obtained for all staff before they start working in the Home. At our visit we looked at the recruitment records for five members of staff. We saw that none of the recruitment records contained a photograph. This was identified by a Director of the company through a regulation 26 visit carried out on 14 December 2009, but on the day of our visit had not been addressed. The file for a member of staff showed that there was still not a reference in place which had been obtained by the home. We had previously identified this at our visit in November 2009. We saw that a person had a 5 year gap in employment, which they had identified on their C.V., but there was no evidence in the file to show that this had been verified at interview. The records for one member of staff showed that their Protection of Vulnerable Adults (POVA) check had not been received until the day after their start date. We saw that this member of staff was not in receipt of a clear Criminal Records Bureau (CRB) check and was rostered to work on shift. The rotas identified that this person was to be supervised at all times. However, when this member of staff was on duty, they were not rostered as an additional member of staff supernumerary to allocated staffing levels. The records for another member of staff showed that this person also had a start date prior to the receipt of the POVA check. Rotas showed that following the receipt of the POVA check this person had been allocated to work on night shift duties unsupervised prior to receipt of a clear CRB check. The home has continued to fail to ensure that people are employed within regulations and this has the potential to put service users at serious risk. Overall records we viewed were seen to be poorly completed with inaccurate and conflicting information. We saw evidence that records were not always completed at the times recorded, with staff completing records at a later time than stated. This has the potential to record inaccurate and misleading information which does not support in accurately assessing any changes in need. Care Homes for Older People Page 8 of 13 There is a system in place to record regular checks carried out on people who are in their rooms, but unable to access the call bell. The care plan for a service user said that the person should be checked on an hourly basis during the night, observational records we viewed did not record that these checks were taking place on an hourly basis and in some instances did not record any checks occurring after 7.30 in the evening. Daily records did not fully reflect care plans and identify care and support provided to the individual person. We saw that inappropriate entries had been made in some of the records and we saw that on one occasion the information entered had been about another service user. There was no evidence to show that they were reviewed or checked to identify any change in needs. The lack of robust recording and monitoring of individual changing needs and the failure to ensure that there is consistent and accurate guidance in care plans and assessments had resulted in inconsistent care and support to people. This means that people are not benefiting from care and support which meets their individual needs. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered person shall 31/01/2010 compile in relation to the care home a written statement The Statement of Purpose. In that the current statement of purpose and service users guide are reviewed and give accurate, un-contradictory and factual information about the services which are to be provided. The registered person shall ensure that people living in the home receive proper provision for the health and welfare of service users. In that full records are maintained in respect of pressure sores and the treatment provided. 31/01/2010 2 8 12 (1) Schedule 3 (3)(n) 3 12 16(2)(n) The registered person shall 31/01/2010 having regard to the size of the care home and the number and needs of service users - consult service users about the programme of activities arranged on or behalf of the care home, and provide facilities for recreation including, having regard to the needs of the Page 10 of 13 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action service user, activities in relation to recreation, fitness and training. This is to ensure all service users social needs are met. 4 19 13 (4) (a) The registered provider shall 31/01/2010 ensure that all parts of the home are free from hazards. This is so that people are not subject to any risks. Any person who carried on or 28/02/2010 manages an establishment or agency of any description without being registered under this part in respect of its (as an establishment or, as the case may be, agency of that description) shall be guilty of an offence. Care Standards Act 2000 (11 (1)). In that an application be made for a registered manager by date set. 5 31 8 Care Homes for Older People Page 11 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 38 37 The registered provider must 04/02/2010 formally notify the commission in writing of any event in the Care Home in line with Regulation 37. In that the Commission is formally notified when a service users accommodation with the service is terminated. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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