Inspection on 25/06/08 for Ashcroft House

This inspection was carried out on 25th June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashcroft House 01/02/10

Ashcroft House 17/11/09

Ashcroft House 23/06/09

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Ashcroft House Fairview Close Wilderness Hill Cliftonville CT9 2QE Lead Inspector Anne Butts Unannounced Inspection 25th June 2008 09:30 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 Ashcroft House DS0000040622.V365197.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. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashcroft House Address Fairview Close Wilderness Hill Cliftonville CT9 2QE 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) 01843 296626 01843 571551 jacquibutler2000@yahoo.co.uk Regal Care Homes (Margate) Ltd Jacqueline Ruth Butler Care Home 88 Category(ies) of Dementia - over 65 years of age (49), Old age, registration, with number not falling within any other category (39) of places Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th June 2007 Brief Description of the Service: 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 access the upper levels. The home has it’s own secure garden area. There is limited parking for cars available. There are additional costs for items such as hairdressing, chiropody, newspapers and taxis. Fees at this home range from £312.81 - £660 per week. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a Key Unannounced inspection that took place in accordance with the Inspecting for Better Lives (IBL) process. Key inspections are aimed at making sure that the individual services are meeting the standards and that the outcomes are promoting the best interests of the people living in the home. The IBL process for a Key inspection involves a pre-inspection assessment of service information obtained from a variety of sources including an annual selfassessment and surveys. It is now a legal requirement for services to complete and return an Annual Quality Assurance Assessment (AQAA). This assessment is aimed at looking at how services are performing and achieving outcomes for people. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable The Commission for Social Care Inspection (CSCI) to be able to make an informed decision about each outcome area. Further information can be found on the CSCI website with regards to the IBL process including information on KLORA’s and AQAA’s. The actual site visit to the service was carried out over one day by two inspectors, who were in the home from approximately 09:30 until 6.00. The main focus of the visit was to review any improvements made since the last visit and the well-being of the service users. Time was spent touring the building, talking to people living in the home, talking to staff and reviewing a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. Prior to the site visit the AQAA had been returned and surveys had been sent out to service users and staff to gain further feedback as to their opinion of the service. A number of surveys have been returned. At all times the manager and staff were helpful and demonstrated a pro-active approach to ensuring that service users were being supported to the best of their abilities and resources. This report contains evidence and judgements made from observation, conversation and records. What the service does well: Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 6 Feedback from people living in the home in the returned surveys was positive with comments including: “I never want to leave here – it is a lovely home and I am well looked after”. “I am very happy with the care I get”. Activities are a key focus in the home with people having the opportunity to participate in a variety of pastimes and leisure interests, both therapeutic and recreational that suits their individual needs. Complaints and concerns are listened to and acted upon. Residents receive a good choice of nicely prepared food. Visitors are made welcome and kept informed of any changes to their relatives needs. What has improved since the last inspection? What they could do better: People’s privacy and dignity is not always being promoted. Not all people are being supported appropriately with their healthcare needs including the maintenance of weights and fluid intake. Ensure that all people benefit from the redecoration programme in relation to their individual bedrooms. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 7 Infection control practices are not always being adhered to, therefore putting people at risk of infection. Staffing levels are not always sufficient to meet the needs of the people living in the home. Their care could be compromised where some staff are not fully up to date with mandatory training needs. Outcomes for people in the dementia unit are mainly good with quality of life through their daily living activities and support, but some of the healthcare practices are not supporting people with higher care needs. How the dementia unit is managed on a daily basis needs to be reviewed. 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. Ashcroft House DS0000040622.V365197.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 Ashcroft House DS0000040622.V365197.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): 1, 3, 4 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with the information they need to make an informed choice about moving into the home. People are fully assessed prior to moving into the home to ensure assessed needs can be met. EVIDENCE: The Statement of Purpose and Service Users Guide have been updated and they contain information that informs people about the services that they can expect. We saw that some additional information would further benefit people in relation to meals and mealtimes and have made a recommendation about this. The Annual Quality Assurance Assessment (AQAA) confirms that there is now a pictorial version of the Service Users Guide available. Inspection reports are available at the home. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 10 The AQAA stated that all prospective residents have an assessment prior to moving into the home and two members of staff usually carry this out. We looked at the records for people who had moved into the home and saw that a full assessment of need was carried out. The manager stated that people are only admitted following a full needs assessment and if home is confident that they can meet individual needs. We saw evidence of appropriate information obtained from referring authorities. People are issued with a contract of terms and conditions and people are issued with a letter of admittance once the home has identified that they can meet their needs. People are given the opportunity to visit the home prior to moving. This home does not offer the facility of intermediate care. Intermediate care is a specialised service with dedicated accommodation, facilities, equipment and staff, aimed at maximising residents independence to allow them to return to their own homes Ashcroft House DS0000040622.V365197.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): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have an individual plan that meets their needs, however the further development of the plans in the dementia unit would benefit service users. Peoples individual healthcare needs are mainly well met. Improved healthcare monitoring in the dementia unit will further support people with higher needs. The Home cannot adequately ensure that it always upholds people’s dignity. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: We looked at six care plans, three from the dementia unit and three from the nursing residential unit. A requirement had been made at the last visit in relation to care plans and we saw that they had started to improve. The care Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 12 plans for the people living on the ground floor now reflected actual needs and how to support people. They identified what people could manage for themselves and were reflective of the risk assessments and gave clear guidance. The care plans on the dementia unit, however, were still in progress and these still contained limited information on how to support people. We discussed this with the manager who stated that the dementia unit had been without senior support for a while and this had resulted in the care plans not being developed fully in the dementia unit. We are recommending that the care plans continue to be developed. Daily notes are written and relate to the care plans. They are, however, only written in the early morning and the evening – this means that some information could be missed and we are recommending that the registered provider reviews how daily notes are written. Healthcare support was not always consistent in that people have full access to appropriate healthcare professionals such as GP, District Nurse, dentists, chiropodists etc. Pressure areas are monitored and appropriate action is taken where a need is identified including use of appropriate equipment such as pressure relieving mattresses. However, there were some areas of concern in that weight records in the dementia unit had not been maintained and on the day of our visit we could not find evidence that people were being weighed regularly – we identified this to the manager who stated that this would be resolved immediately. Records we viewed in the dementia unit did not show regular fluid intake. For example one gentleman was bed bound and a fluid chart in the room only showed him as having 325 mls of fluid on one day and 400 mls on another day. Other days showed that he had a larger intake. Another person’s records also showed that there was limited fluid intake on two days. A relative informed us that she felt that her husband was not always given enough drinks at the weekends if she was unable to visit. A requirement is being made with regards to these issues. Outcomes for people are mainly good with people generally being supported in a manner that supports their needs. However, the concerns are that people in the dementia unit, who have higher care needs, are not always being supported appropriately and in accordance with the National Minimum Standards and Regulations for older people. The registered provider must make sure that there is proper provision for the health and welfare of all the people living in the home. The medication administration was assessed by observing the early morning round on the upper floor and by talking to the member of staff who was managing the round. It was evident that this process was taking an exceptionally long time to complete. The staff member stated she started the round at 8 am and it was not finished until 10:30. It was stated that this was the same amount of time that was normally taken. Although the actual administration was done correctly the site of the trolley appeared to be the Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 13 issue. It was left in the middle of the corridor with the member of staff walking to each individual resident in turn. The manager is advised to reassess the procedure used. All of the MAR sheets on the upper floor were viewed and no errors were found. The system used for handling controlled drugs met with the guidelines from the Royal Pharmaceutical Society of Great Britain and the individual drugs audit balanced. Evidence was seen of regular management audits. Staff who administered the drugs have undertaken a one day course, but it is recommended that a more in depth accredited course be undertaken. Regular audits of staff competencies should also be undertaken. We saw that staff generally respected peoples privacy and dignity and treated people with respect. There were some practices, though, that did not support this. When we first arrived we saw that in one area of the home, in the dementia unit people’s dignity had been compromised. We saw that in at least five rooms beds had been stripped leaving the bare mattress exposed and people were still in their nightwear were lying on the beds. We were informed that a member of staff had called in sick on that day and that they were short staffed. We spoke to the manager who was able to show us evidence of staff meetings where this issue had been raised. This practice, however, is still occurring and needs to be addressed. We saw that clothes were laundered and ironed nicely whilst in the laundry but evidence was seen when returned to the rooms some clothes were screwed up and crumpled in the drawers. A questionnaire returned from a relative had previously identified this and it had also been raised at staff meetings. This is another practice that is still happening. We are making requirements in relation to peoples privacy and dignity. People are supported with end of life plans and they have been put into place to support the individual. We spoke to relatives who were very complimentary of the care provided with comments including “Cannot fault the care and could not ask for better staff” “We have no problems with the care and we are always kept informed of any changes”. Ashcroft House DS0000040622.V365197.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): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are well organised, creative and provide stimulation and interest for people living in the home. People are able to maintain contact with family and friends as they wish. People benefit from home cooked meals that cater for special diets. EVIDENCE: There is a leisure therapist employed for each floor and their role is to arrange activities and support people with their social needs. This is a key focus within the home and they actively support people with a wide range of leisure and therapeutic activities. Different pastimes include group activities such as bingo, sing-a-longs, playing games, ball activities, film shows and arts and crafts sessions. Support is also given to people on an individual basis and time is spent colouring, doing jigsaws, reading and talking to people. Outside entertainers also visit the Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 15 home on a regular basis and people have the opportunity to go out either on an organised trip or for a walk to the local community. Garden parties are arranged and special occasions such as birthday parties and festivals are celebrated. We saw photographs of events, where people were enjoying themselves. There is a range of books, DVD’s and music available and the home subscribes to the ‘Red Box’ service, where they can access reminiscence material from different eras such as the 1960’s for example. There are different therapeutic techniques used and on the top floor (which is the dementia unit) ‘doll therapy’ has been introduced and this has given some of the people with a diagnosis of dementia an added interest in life. The routines and activities for people are person centred, and time is spent doing reminiscence so that people’s varied interests can be catered for. Staff overall related well to people and observations showed that they talked to people in a friendly relaxed manner and treated people as equals. Comments received in returned surveys included “There are lots of things to do each day and I can choose what I want to do” “I like the different things we do here and I really liked making the Easter bonnets”. “I especially like going out and we recently went to see a show – it was really good”. “There’s lots to do but if I don’t want to join in I don’t have to – I like spending time in my room watching television”. Family and friends are welcome to visit at any time and one relative said, “The staff are always very friendly to me – I always feel welcome”. People are given choice in their daily lives and where care plans have been updated they are reflecting peoples daily living choices such as preferences for getting up and going to bed and how they want to be assisted with personal care. People are supported with their individual religious and cultural preferences with members of the church visiting the home and people sometimes being escorted to church, where possible. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 16 There is a varied menu in place with two choices offered at each meal and people are able to choose which they prefer. We spoke to the chef who confirmed that meals are home cooked and that people tended to prefer ‘traditional’ menus. They do on occasions introduce a variety of foods to cater for different tastes. Different diets are catered for and the chef was aware of the needs of people with diabetes and those who needed their meals of a different consistency. People were mainly supported sensitively with their meals, although we did see that there were occasions when staff were standing over people to cut up their food, which can be uncomfortable for the person sitting at the table. At out last visit we identified that meals were not evenly spread out and the evening meal was served at 16.30 – 17.00. We spoke to the Registered Manager who stated that they were aware of this and although they had tried to change the meal times, people in the home did not want this. They make sure that there are always snacks available. The Statement of Purpose does not make this clear, however, and in accordance with the National Minimum Standards we are recommending that when the Statement of Purpose is next reviewed it contains this information. We received comments in the returned surveys about people’s opinion of the meals and they were mainly positive with comments such as: “I eat all my favourite foods here” and “the meals are always nicely cooked”. One person, however, felt that meals “lacked imagination” and another “would like to see more variety on the menu”. The home may want to consider exploring this through their quality assurance processes. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and adult protection procedures within the home serve to safeguard service users. People can be confident that their concerns will be listened to and acted upon. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated that there had been ten complaints received in the last twelve months. The AQAA identified that six of these had been upheld; this demonstrates that the home takes an objective view of complaints and that issues are fully investigated. We looked at the complaints book in the home and this showed clear pathways of action taken with responses made to the complainants. All complaints were dealt with in the timescales stated. There is a complaints procedure in place and the manager confirmed that following a requirement at the last visit the complaints procedure was now available in a pictorial format. People we spoke to, and returned surveys, all confirmed that they felt confident about voicing any concerns and felt that they would be dealt with appropriately. The majority of staff are trained in adult protection and safeguarding vulnerable people, although some of the ancillary staff have not benefited from Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 18 this. Staff we spoke to all showed an awareness of adult protection issues. There has been one safeguarding adults referral in the last year, this was investigated by the appropriate authorities and was unfounded – this is now closed. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the majority of residents benefit from living in a safe, clean and comfortable environment, there are parts of the home which were not odour free and are in need of refurbishment. Improved infection control practices will further protect people living in the home. EVIDENCE: The home is currently undergoing a period of refurbishment and there is an ongoing programme, which is addressing this. The top floor is being completely redeveloped and this is currently not in use. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 20 At the moment accommodation is set out over two floors, with two wings on each floor. The top floor is for people who have a diagnosis of dementia and the ground floor is for people who need nursing or residential care. There are communal areas on both floors and the lounge areas were spacious and homely. Individual bedrooms were of different standards, in that those that had benefited from the refurbishment programme were homely, clean and welcoming. Other rooms that had not yet been redecorated, particularly those on right wing of the top floor were in need of attention. People can bring in their own items and many of the rooms were personalised. There are still areas of the home that are in need of attention and refurbishment, but this is planned. The AQAA states that improvements for the next year include the replacement of windows and external doors, the ongoing redecoration and refurbishment of all areas of the home and the redecoration of bathrooms. There was suitable equipment in place including hoists, airflow mattresses, wheelchairs and stair lifts. The AQAA confirmed that regular checks are carried out on equipment. Where people have cot sides, there are agreements in place. The laundry has three industrial washing machines and three industrial tumble dryers. There is a ‘circular’ route for washing which means that dirty and clean laundry does not come into contact with each other. There are dedicated members of staff for the laundry and this is staffed seven days a week. The AQAA and training matrix confirmed that the majority of staff have benefited from infection control training. On the day of our visit we saw, however, different levels of cleanliness and staff confirmed that good practice was not always adhered to. For example commodes had not been cleaned properly and areas of the home also did not smell clean and fresh. Returned surveys from people living in the home mainly supported that they felt that their rooms were kept clean and tidy. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The deployment and number of staff available at different times of the day is not sufficient to meet the needs of the residents. People benefit from being cared for by staff who have a good understanding of their needs. Their care could be compromised where staff are not fully up to date with mandatory training needs. EVIDENCE: At the last visit it was identified that at times staffing levels were at a minimum in order to meet peoples needs. At this visit we found that staffing levels still did not always meet the needs of the people living in the home. As stated earlier in this report we had concerns about how some of the people in the dementia unit were being supported with their morning routine as this evidenced that there were not enough staff on duty at the time. Returned surveys also confirmed that people did not always feel that there was enough staff available with comments including: “They are short of staff day and night” and “Sometimes I have to wait, I know they are busy and are trying their best” and “sometimes you have to wait but Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 22 they get things done”. Out of the thirteen surveys returned nine said that there was only “usually” or “sometimes” enough staff on duty. Staff surveys also confirmed that there were times when there was not enough staff available with all surveys stating that there was more staff needed. We looked at staff rotas and spoke to the manager, she stated the dependency levels of the people living in the home were regularly assessed and the rotas were changed accordingly. We advised that we had concerns about the amount of carers on the dementia unit and we are making a requirement in relation to staffing levels. We looked at five staff files, and we saw that each file contained the appropriate documentation in line with the National Minimum Standards and associated Regulations for Older People. This included application forms, references and proof of identification. We spoke to members of staff and they all confirmed that they had attended an interview prior to being employed. All staff have a Provision of Vulnerable Adults (POVA) first check and a Criminal Records Bureau (CRB) check and staff do not work unsupervised until a satisfactory check is in place. The Annual Quality Assurance Assessment (AQAA) stated that that 47 of staff either have a National Vocational Qualification (NVQ) in care or are working towards this. At the last inspection a requirement was made that 50 of staff had achieved this award. We have, however, deemed this as met as the home has nearly achieved this and are continuing to support staff in accessing NVQ training. The manager stated that the induction-training programme meets with the requirements of the Skills for Care standards and staff confirmed that they had undertaken a period of induction, which also included shadowing senior members of staff. We looked at the training matrix and a requirement had been made at the last visit that staff completed a more advanced dementia-training programme. Staff have now completed further dementia care training. The AQAA also confirms that members of staff have completed further training including care of the dying, nutrition, fire and infection control. The training matrix, however, identifies that not all staff have up to date training in movement and handling, adult protection, health and safety. A requirement is being made in this report with regards to training. Feedback we received from people who live in the home was positive about the members of staff and comments included: “Very pleasant staff and are very welcoming”, “Staff always listen to me” and “The staff are my friends”. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a home where the manager is competent, and experienced with the care of older people. People in the dementia unit would benefit from more stable senior support. Service users benefit from staff who are appropriately supervised by senior members of staff. EVIDENCE: The manager is registered with us (The Commission) and has the appropriate skills and qualification to manage the home. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 24 The manager oversees the running of the whole home and is responsible for the monitoring and quality review of the home. The returned Annual Quality Assurance Assessment (AQAA) was to a satisfactory standard and identified improvements and areas that they felt they could do better in. This is a large home and as reflected earlier in this report we identified that some of the practices in the dementia unit are not fully supporting people with health and personal care needs. The registered provider must make sure that people on this unit are support appropriately with all their needs. The home has improved on its quality assurances systems with regular resident and relatives meetings, staff meetings, questionnaires sent out to staff, residents and relatives, an open comments book which is available for people to write in and regular auditing of the care needs of the people living in the home. We saw evidence that where issues are raised that they are addressed through the quality assurance process including raising the matter at staff meetings and supervision. However, we also saw on the day of our visit that some of the concerns that had been raised were still occurring. We identified these to the manager, who confirmed that she would address these again. Incidents are monitored and reported appropriately with action taken to reduce future risks. There are senior members of staff and a nurse on duty to manage the daily running of the individual units and they send daily reports to the manager. All staff have supervision on a regular basis, including the manager who is supported by the area manager. Staff we spoke confirmed that they felt supported. The AQAA confirmed that all appropriate maintenance checks are carried out and Regulation 26 visits (which are the providers responsibility) are carried out on a regular basis. Ashcroft House DS0000040622.V365197.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 3 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 2 2 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 OP8 Regulation 12 (1) (a) Requirement Timescale for action 30/09/08 2. OP8 12 (1) (b) 3. OP9 13 (2) “The registered person shall ensure that the care home is conducted so as to promote and make proper provision of the health and welfare of service users. In that people are weighed regularly and appropriate records are maintained. 30/09/08 “The registered person shall ensure that the care home is conducted so as to make proper provision for the care, and where appropriate, treatment, education and supervision of service users.” In that people who are unable to manage their own fluid intake must be supported with this. 30/09/08 “The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines into the care home” In that how the medication round is managed should be reviewed so that it does not take such a length of time. DS0000040622.V365197.R01.S.doc Version 5.2 Ashcroft House Page 27 4 OP10 12 (4) (a) 5 OP27 18 (1) (a) “The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users”. In that People should be assisted with their personal care and not left lying on unmade beds. Clothes should be put away so that they are not crumpled and creased. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users - 30/09/08 30/09/08 6 OP30 18 (1) (c)(i) (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; In that there are always sufficient staff on duty to meet the needs of the people living in the home. The registered person shall, 30/11/08 having regard to the size of the care home, the statement of purpose and the number and needs of service users (c) ensure that the persons employed by the registered person to work at the care home receive - (i) training appropriate to the work they are to perform; A training and development plan identifies ongoing staff training. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 28 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 OP7 OP7 OP15 Good Practice Recommendations That the system for writing daily notes is reviewed so that the registered provider can be confident that people needs are monitored effectively. That care plans continue to be developed in particular those relating to people in the dementia unit. That at next review the Statement of Purpose should reflect the availability of snacks outside normal mealtimes. Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Ashcroft House DS0000040622.V365197.R01.S.doc Version 5.2 Page 30 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!