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Inspection on 30/08/06 for Ashcroft Nursing Home

Also see our care home review for Ashcroft Nursing Home for more information

This inspection was carried out on 30th August 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents and their relatives were pleased with the standards of care at the home. There were positive comments, such as "a happy atmosphere", "the manager and all the staff most helpful and welcoming", "a nice and friendly place". Residents` needs were met by a competent staff team. Staff spoken with were knowledgeable about the needs and preferences of residents.

What has improved since the last inspection?

Some of the requirements and recommendations made at the last inspection had been met, resulting in improvements to residents` care records, the medication system and to the environment of the home. An activities coordinator had been employed working for 30 hours per week and a good range of activities was being developed for residents.

What the care home could do better:

The care plans should include evidence of the involvement of residents and / or their representatives in the care planning and review process. Although improved, there was still an odour problem on the Lea View unit as noted in previous inspections.

CARE HOMES FOR OLDER PEOPLE Ashcroft Nursing Home 18 Lee Road Hady Chesterfield Derbyshire S41 0BT Lead Inspector Rose Veale Unannounced Inspection 30th August 2006 10:30 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 Nursing Home DS0000002038.V310142.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 Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashcroft Nursing Home Address 18 Lee Road Hady Chesterfield Derbyshire S41 0BT 01246 204956 01246 555524 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) www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Lynda Hodgkinson Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (20) of places Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Ashcroft Care Home can admit persons within the following categories :Dementia - over 65 years of age DE(E) 2. 3. Old Age not falling within any other category OP The maximum number of persons to be accommodated within Ashcroft Care Home is 42 To be able to admit into Ashcroft Care Home the named person of category dementia over 65 years of age named in the variation application dated 20th June 2006. 7th October 2005 Date of last inspection Brief Description of the Service: Ashcroft care home provides nursing and personal care for up to 42 people aged 65 years and over, 22 with dementia and 20 not falling within any other category. The home is purpose built and is located on the outskirts of Chesterfield close to a main bus route. The home comprises two units on two floors. Willow View unit is on the ground floor and Lea View unit is on the first floor. Stairs and a passenger lift access the floors. Each unit has it’s own staff group. The kitchen and laundry facilities are shared. Residents have access to a garden. Fees at the home range from £409.40 to £478.30 per week. The fees do not include hairdressing, chiropody, toiletries and newspapers. This information was provided by the manager in the pre-inspection questionnaire dated 14th July 2006. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 6 hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 35 residents accommodated in the home on the day of the inspection visit. Residents, visitors and staff were spoken with during the visit. Most residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. A questionnaire and surveys had been completed and returned prior to the inspection and the information received has been included in the body of this report. The manager was not available on the day of the inspection visit due to annual leave. The administrator and the nurses in charge of each unit assisted with the inspection and were very helpful. What the service does well: What has improved since the last inspection? Some of the requirements and recommendations made at the last inspection had been met, resulting in improvements to residents’ care records, the medication system and to the environment of the home. An activities coordinator had been employed working for 30 hours per week and a good range of activities was being developed for residents. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 6 What they could do better: 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 Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 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 the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There was a good range of detailed assessment information so that residents/ their representatives were confident that residents’ needs could be met at the home. EVIDENCE: The care records for 4 residents were examined, 2 from each unit. All the records seen included assessment information. There was a pre-admission assessment completed for each resident, plus assessment information from social workers, care managers and hospital staff. Copies were seen of the letter sent to residents/their representatives to confirm that the home was able to meet the needs of the resident. Each record seen had assessment information compiled following the resident’s admission to the home. All the records seen had assessments of the moving and handling, nutritional, and continence needs of the resident. All the records seen had a ‘well being’ assessment of the mental health of the resident and an Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 9 assessment of the resident’s dependency. The records of residents on Lea View unit also included an assessment of their oral health. This was an example of good practice and should include all the residents in the home. All the records seen included a general risk assessment, a falls risk assessment, and an assessment of the risk of developing pressure sores. All the records seen included information about the resident’s family and social history with details of preferences regarding daily routines. Relatives spoken with were satisfied that the needs of the residents were met at the home. Examples were given, such as soft food being provided for a resident with swallowing problems, and the changing needs of a resident being reflected in the care provided. Standard 6 did not apply to this service. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ health and personal care needs were well met and their dignity and privacy respected. EVIDENCE: Each of the 4 care records seen included a care plan. 3 out of the 4 care plans covered all of the assessed needs of the resident. 1 care plan did not include some of the resident’s assessed needs, such as the help needed with personal hygiene and eating and drinking. 3 out of the 4 care plans had been reviewed at least monthly, 1 had been reviewed twice so far in 2006. It was explained that this was because the resident had been in hospital. Staff said that residents/ their representatives were involved in the planning and review of care – this was evidenced in 1 of the care records seen by the signature of the resident’s relative. One relative spoken with during the inspection visit said they had been consulted and involved in reviews of the care plan. Staff spoken with were knowledgeable about the care needs of residents and were familiar with the care plans. It was observed during the inspection visit Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 11 that care needs detailed on the care plans were being met, for example, a resident needing frequent change of position to prevent the development of pressure sores. Records were seen of the visits and input of other healthcare professionals, such as GP, chiropodist, optician, and consultant psychiatrist. Discussion with relatives and the records seen showed that GPs were promptly contacted when needed. Maintaining the privacy and dignity of residents was referred to in the care plans seen. Relatives spoken with said that residents’ privacy and dignity were maintained giving examples such as residents always dressed suitably and in their own clothes, and staff speaking to residents in an appropriate way. Staff spoken with were aware of the need to protect residents’ privacy and dignity and demonstrated this, for example by knocking on doors before entering bedrooms and bathrooms, and by addressing residents by their preferred names. Medication for both units was stored in the treatment room on Willow View. At the last inspection it was found that creams and ointments were not securely stored on Lea View unit and a requirement was made for the home to address this problem. Since the last inspection a suitable, locked storage cupboard had been provided and the requirement had been met. Also since the last inspection a new drugs fridge had been provided. The temperature of the fridge was checked daily and records kept, but the maximum and minimum temperatures were not recorded as recommended at the last inspection. This recommendation has been repeated in this report as good practice to ensure medication is always kept at the correct temperature. The medication administration records, (MAR), for 4 residents were seen and were correctly completed by staff administering the medication. 1 MAR did not have a record of medication received into the home on the admission of the resident from hospital. Otherwise, the receipt and disposal records were satisfactory. Since the last inspection, a new system had been put into place for the disposal of medication to comply with a requirement made and with new legislation. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. 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 the service. A range of activities was being developed to meet the social and recreational needs of residents. Visitors were made to feel welcome so that important contacts for residents were maintained. A varied menu and pleasant dining areas were provided so that residents enjoyed their meals. EVIDENCE: Since the last inspection, a new activities coordinator had been appointed working for 30 hours per week. Records were seen of activities carried out with residents, including dominoes, hand and foot massage, music, art and crafts, walks out to the local park, entertainers, and use of the home’s ‘Snoezelen’ room. The activities coordinator was enthusiastic about the role and had received training about dementia and suitable activities for people with dementia. With the support of relatives, the home had developed a ‘story board’ for each resident displayed outside their bedroom. This gave details of the resident’s family and social history, interests and lifestyle before coming into the home. Relatives spoken with liked the ‘story boards’ and staff said they were good for finding out about the resident’s past life. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 13 Discussions with relatives and staff and observations during the inspection visit showed that residents were encouraged to exercise control and choice over their lives where possible. For example, some residents preferred to spend most of the day in their bedroom and staff respected this; the bedrooms seen were personalised with residents’ own belongings. Visitors spoken with said they were always made welcome. One visitor was pleased that they were greeted by name by the staff and always offered refreshments. Another visitor was pleased to be involved in social and fundraising events at the home. Details of family and friends were in the residents’ care records. The surveys sent out prior to the inspection had mixed comments about the food at the home, ranging from “monotonous” and “lacking in variety” to “OK”, “plentiful” and “a good variety”. The menus seen appeared varied and balanced and choice of meals was given. The lunchtime meal on the day of the inspection visit looked appetising and residents appeared to enjoy the food. Residents were encouraged to eat independently where possible and were assisted in an appropriate way by staff when they needed help. Residents’ food and drink preferences were included in the care records. The dining areas were bright and pleasant. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. 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 the service. The home had a robust complaints procedure in place and good staff awareness and attitudes regarding safeguarding adults ensured residents felt safe and were well protected. EVIDENCE: The complaints procedure for the home was displayed in the main entrance area. Relatives spoken with said they had received a copy of the complaints procedure. Relatives said they were confident that any complaints raised would be properly dealt with. A relatives meeting was held at the home every 3 to 4 months to give relatives the chance to raise any concerns. No complaints about the home had been received by CSCI since the last inspection. The home had satisfactory policies and procedures in place for safeguarding adults, including a whistle-blowing policy to support staff. Staff training records showed that staff had received training in safeguarding adults. Staff spoken with were aware of safeguarding adult procedures. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The standard of the environment within the home was good, providing residents with a safe, pleasant and comfortable place to live. EVIDENCE: A tour of both units was carried out, including some of the bedrooms. Since the last inspection there had been redecoration of all the communal areas and some bedrooms. The lounge/dining rooms were bright and comfortably furnished. The bedrooms seen were pleasant and comfortable. The home was suitably equipped with handrails in the corridors and toilets and with moving and handling equipment. It was noted that there was only one stand aid hoist in the home to share between both units. Consideration should be given to providing another stand aid so that there could be one available on each unit. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 16 At the previous inspection it was found that there was a problem with odour on the Lea View unit and this was also commented on in 2 of the pre-inspection surveys returned. There was a noticeable odour on entering Lea View, despite a special air freshening unit in use. Staff said that a new carpet was to be provided soon in the lounge/dining area and it was hoped that this would address the odour problem. There was no odour noticed in any of the bedrooms seen on Lea View. Visitors said that the home was always clean and that the odour problem had improved. The home appeared clean throughout on the day of the inspection visit. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There were staff in sufficient numbers and with appropriate training to meet the needs of the residents. EVIDENCE: The staff rotas for the home showed that there was always a registered nurse plus 2 or 3 care assistants on duty for each unit during the day. At night there were 2 staff on duty for each unit. Relatives and staff spoken with said that staffing levels were generally sufficient to meet residents’ needs, although there were times when staff were very busy, such as mealtimes when many residents needed help with eating and drinking. Since the last inspection there had been a significant turnover of staff with 8 care assistants leaving and a number of new staff employed. There were comments on the pre-inspection surveys returned that some of the new staff did not have the experience and skills of the staff they had replaced. There were also comments on the surveys and from visitors and staff spoken with during the inspection visit that there could be communication difficulties as some of the new staff did not speak English as their first language. It was noted that some of the new staff were to attend an English class to improve their spoken language. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 18 Individual staff training records, discussion with staff, and the information provided on the pre-inspection questionnaire showed that staff had received appropriate training. The induction training record for a new member of staff was seen and was satisfactory. In addition to the required training, such as fire safety, moving and handling and safeguarding adults, staff had received training appropriate to the needs of residents, such as dementia awareness and oral health. The manager and 2 staff had recently attended a course about dementia care mapping. Staff spoken with were pleased with the training programme at the home and said that training was a high priority. Of 22 care assistants at the home, 6 had already achieved National Vocational Qualification (NVQ) in care and 7 were about to start working towards the qualification. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home was well managed and run with the best interests of residents in mind. EVIDENCE: The manager of the home was away on annual leave on the day of the inspection. The manager had been in post for several years and was suitably qualified and experienced. Staff spoken with said the manager was approachable and the home was well organised. There was a quality assurance system in place with annual satisfaction surveys of residents / their representatives. Relatives spoken with were satisfied with the home and said they would recommend it to others looking for a similar care service. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 20 The records were seen of personal money held for residents. The records were well kept and up to date. The money was kept in a safe. The manager and the administrator dealt with personal money. There was a system of audit checks by the company. Health and safety records were seen, including the fire log book, maintenance and servicing records. All the records seen were well kept and up to date. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP9 OP26 Regulation 13 16 Requirement All medication received into the home must be recorded. The home must be kept free from offensive odours. (Previous timescale 24/11/2005) Timescale for action 30/09/06 30/11/06 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. 4. 5. Refer to Standard OP7 OP7 OP7 OP9 OP38 Good Practice Recommendations All residents should have an assessment of their oral health and related care needs. There should be evidence of the involvement of residents and / or their representatives in the planning and review of care. All care plans should be reviewed at least monthly. The maximum and minimum temperature of the medicines fridge should be monitored daily and recorded. A stand aid hoist should be provided for each unit as funding permits. Ashcroft Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Nursing Home DS0000002038.V310142.R01.S.doc Version 5.2 Page 24 - 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!