Inspection on 28/06/06 for Ashcroft Rest Home

This inspection was carried out on 28th June 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.

Other inspections for this house

Ashcroft Rest Home 29/05/08

Ashcroft Rest Home 01/11/07

Ashcroft Rest Home 24/04/07

Ashcroft Rest Home 24/11/06

Ashcroft Rest Home 23/02/06

Ashcroft Rest Home 12/04/05

Ashcroft Rest Home 07/12/04

Ashcroft Rest Home 02/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Ashcroft Rest Home, 27-29 Chadwick Road Leytonstone London E11 1NE Lead Inspector Sheelagh Doherty Key Unannounced Inspection 28th June 2006 12:05p 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 Rest Home, DS0000007230.V301179.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 Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashcroft Rest Home, Address 27-29 Chadwick Road Leytonstone London E11 1NE 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) 020 8530 6072 Ms Hyacinth Valeska Sandilands Mrs Neva Bernice Gilpin Ms Hyacinth Valeska Sandilands Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 Brief Description of the Service: Ashcroft Rest Home is a care home providing personal care, support and accommodation to up to 15 older people. The home, which is privately owned and operated, is located in a residential area of Leytonstone in East London. There is easy access to local shops and other amenities. The property is two storey with bedrooms situated on both the ground and first floor. There are two double rooms with the remainder for single occupancy. Some bedrooms have a small en-suite providing toilet and hand washing facilities. There is a stair lift available on one set of stairs with a separate staircase for those who are more mobile. Because of the configuration of the building the home would not be suitable for wheelchair users. There is a rear garden available and accessible to residents with support of staff. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place between 12md and 4.30pm on a weekday. The manager was present throughout the inspection. The focus of the inspection was to assess key standards against the National Minimum Standards for Older People and to assess whether the requirements of the last inspection have been met. The home was found to be operating generally in line with National Minimum Standards and residents spoken with, who were able to provide an opinion, were generally happy with the care they received. Lunch was served during the inspection and was a home cooked meal, which looked and smelled appetising and was clearly enjoyed by the residents. The staffing level was adequate to meet care needs of residents, taking into account that one member of staff had been assigned to accompany a resident to see his GP and to remain with him when he was unexpectedly transferred to hospital, even though her shift had ended. The manager and staff are commended for their willingness to support residents in such circumstances. A number of areas for improvement were identified, including provision of activities at both a general and individual level, provision of supervision to staff. One area of concern to the inspector was the fact that the registered manager, who is also one of the proprietors, is overstretched, in that whilst trying to manage the day to day operation of the home she also does the shopping and the cooking [main meal at lunchtime]. A deputy manager, appointed following the last inspection, had left two weeks before this inspection. As a priority, further consideration must be given to the appointment of staff at a senior level to whom the manager can delegate some of her current duties, as well as to the appointment of a cook to be responsible for the main meal of the day. Thanks are extended to the residents, relatives, manager and staff for their assistance throughout the inspection. What the service does well: What has improved since the last inspection? Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 6 There has been a clear improvement in most aspects of medication handling and administration, including in meeting the immediate requirement made at the last inspection in February 2006. Care planning documentation and implementation continues to improve, including evidence of systematic review of care plans. 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 Rest Home, DS0000007230.V301179.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 Rest Home, DS0000007230.V301179.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): 2, 3, 4 [standard 6 is not provided in the home] Two of those standards tested were being met. One was not being met despite there being a requirement made against it at the last inspection. EVIDENCE: A requirement that all residents have a statement of terms and conditions of occupancy had been met. One resident had been admitted since the previous inspection in February 2006. As this was an urgent/ emergency admission following an attack on the resident and the decision that it was not possible for her to return to her own home, no pre-admission assessment had been carried out. There was evidence that the registered manager had obtained the assessment completed by social services and carried out her own assessment whilst developing an initial care plan for the resident. This was done within the required timescale stated in the regulations covering care homes. One requirement made against standard 4 at the last inspection remains outstanding. This has been re-stated at this inspection with a new timescale. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 9 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, 10 All residents have an individual plan of care that identifies their needs and how these will be met. Systematic reviews take place. Since the last inspection medication systems and administration have improved. However, further attention needs to be paid when writing medications on to the MAR chart to ensure that instructions are clear and accurate. EVIDENCE: Those care plans seen were up to date, contained information about the resident’s likes and dislikes as well as how care needs were to be met. The manager said that she tries to involve residents in the development of their care plans and that some are more able than others to participate in this activity. Where this is not possible relatives are able to contribute their views. Health needs are assessed and monitored and appropriate interventions ensure that these needs are met within the home and the local community. Residents are registered with a local GP, who is said to be very helpful and to provide a good service. As previously stated one resident was admitted to hospital via the surgery whilst the inspection was in process. The manager ensured that the relatives were informed of the admission. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 10 Medication systems, including records, have improved since the last inspection. Medications had all been receipted into the home on the MAR chart and all boxes had been signed or had a code entered if the medication had not been given for some reason. One medication that had been handwritten onto the MAR chart was not clearly legible. Care must be taken to ensure that what is written on the chart is exactly the same as that on the prescription label and that it is completely legible. The manager stated that she had requested her dispensing pharmacist to visit the home the following week to carry out a medication systems review. Those residents spoken to felt that the staff were kind and helpful and the inspector observed staff to treat residents with respect when responding to them. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 11 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, 15 Residents are able to maintain relationships with family and friends, who are welcomed into the home when they visit. Opportunities for residents to be involved in stimulating activities remain very limited. A requirement about this remains outstanding and has been re-stated. Although the food likes and dislikes of residents are known and catered for there is no choice of main meals. A requirement about this remains outstanding and has been re-stated. EVIDENCE: Although the manager stated that activities take place regularly there was little evidence of this in care plans. There is an activity tick chart for each resident but there is little indication from this that residents are involved in stimulating activities, either individually or communally. The manager takes one resident out shopping and others occasionally go out with their relatives. The inspection took place on a warm summer day but no residents were sitting outside and the garden was not a readily accessible place for them as there was nowhere to sit and no shade. Following the completion of lunch residents sat in the lounge and the lights were turned off so that they could have a rest period. On the day of inspection this lasted approximately two hours. There were no activities planned for the afternoon or evening and there was no indication that residents actively choose to have a rest period. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 12 The main meal of the day is served at lunch and this looked and smelled appetising and was clearly enjoyed by the residents. There is no choice offered unless it is known that a resident does not like a particular dish or food when that resident is provided with an alternative. One resident stated that there was no choice and that she ate what she was given. The manager continues to be responsible for cooking lunch. Employment of a cook to relieve the manager of this responsibility and allow her to concentrate more on management tasks should be made a priority. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 13 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, 18 The complaints procedure outlines the action to take to make a complaint and residents, relatives and staff were aware of it. Staff have received training in adult protection. EVIDENCE: Residents, a relative spoken to and staff were aware of the complaints procedure and expressed confidence that appropriate action would be taken to resolve complaints. They were also aware of what action to take if they wished to take a complaint further. Since the last inspection staff have received training in adult protection and prevention of abuse. Staff spoken to were able to say what they would do if they witnessed/ suspected abuse and this was appropriate. Accident recording has improved since the last inspection. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 14 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, 20, 26 The home provides clean, hygienic and comfortable accommodation for residents. Due to the constraints of the building the home is not suitable for those who use wheelchairs. EVIDENCE: Since the last inspection a number of repairs and replacements have been carried out and no health and safety issues were identified during this inspection. The garden is small with ramp access from the conservatory. There is a small paved terrace lined with attractive pot plants, which, if properly equipped, would make a nice sitting area. Access to the garden can only be made with supervision of staff and, even though it was a lovely sunny day, there was nowhere ready for residents to sit in shade. Access to sunlight is necessary for the production of vitamin D, which is a vitamin many older people are deficient Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 15 in. Residents who wish to sit outside should have the opportunity to do so and the garden must be made available to them. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 16 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, 30 Staffing levels remain at the minimum level to ensure provision of good, basic care but are not sufficient to allow staff to meet individual social and recreational needs of residents. There are insufficient ancillary staff to undertake all tasks that are neither care nor management responsibilities. Staff receive regular training in topics relevant to the client group. Staff have not received training in management of people with confusion. EVIDENCE: Staff are committed to the home and dedicated to providing good care to the residents. There is a stable staff group. However, there are insufficient staff to provide more than good, basic care. The staffing level does not allow staff to spend time with residents on an individual basis or provide stimulating activities for residents to participate in. The number of ancillary staff does not allow the manager to concentrate on management responsibilities and tasks when she is also responsible for the shopping and the cooking. The registered manager [who is also one of the registered providers] and the other registered provider need to undertake a review of staffing, including skill Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 17 mix and job descriptions, and increase it to a level which allows all staff to concentrate on carrying out their responsibilities. Staff are provided with regular opportunities for training both in-house, from the manager and externally. Most staff had recently undertaken medication update training and adult protection training. No new staff have been appointed since the last inspection, [except the deputy, who had been appointed but had already left]. The manager stated that she is using agency staff to cover gaps on night duty. Although this was not tested at this inspection, the manager is reminded that she is responsible for ensuring that all mandatory checks have been made by the agency for each person the agency send to work at the home. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 18 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, 36, 38 The registered manager has the qualifications, experience and skills to manager the home competently. She also has the best interests of the residents at heart. However, as mentioned in other sections of this report the registered manager is overstretched in trying to carry out her responsibilities for day to day management of the home as registered manager/ registered provider as well as to carry out tasks which should be undertaken by other staff – e.g. cooking and shopping. Priority needs to be given to appointing staff competent to carry out these tasks and free the manager to concentrate on management. Health and safety of residents and staff is promoted and protected. EVIDENCE: The registered manager is a registered nurse with many years experience of caring for older people and managing this home. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 19 Following the last inspection a deputy manager was appointed in order to alleviate some of the workload the manager was dealing with. However, this appointment did not work out and the deputy left two weeks prior to this inspection. In discussion the manager acknowledged that she is overstretched and aware that she is not able to carry out some management tasks in the way she would like – e.g. medication and care plan audits, supervision sessions – these are being held more frequently than before but still do not meet the required standard and are not recorded. Appraisals are undertaken and those are recorded. Since the last inspection accident recording has improved and records generally showed improvement. The manager acknowledged that some of this improvement was due to the fact that she had more time because of the appointment of the deputy. She was also able to delegate some tasks to her deputy, enabling her to concentrate on other aspects of managing the home. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 20 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 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 2 X 3 Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 14 Requirement The manager must confirm in writing to the prospective resident that the home is suitable and able to meet the assessed needs of the prospective service user. Outstanding from the last inspection All hand written entries on MAR sheets must be legible and clear to avoid confusion and potential errors. Residents must be given the opportunity to make decisions about their daily lives and to participate in stimulating activities according to their needs and wishes. Outstanding from the last inspection Residents must be offered choice at meal times so that they can actively decide what they wish to eat. Outstanding from the last inspection The garden must be accessible to residents so that they can make use of this facility if they wish. Timescale for action 31/08/06 2. OP9 13 31/08/06 3. OP14 12 31/08/06 4. OP15 16 31/08/06 5. OP20 23 31/08/06 Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 22 6. OP27 18 7. OP31 18 8. OP36 18 There must always be a sufficient number of staff on duty, including ancillary staff, to meet the health, social and recreational needs of the residents. Outstanding from the last inspection The registered persons must ensure that there are sufficient staff employed to enable the registered manager to fulfil her responsibilities and concentrate on effective management rather than on work that can be undertaken by ancillary staff. All staff must receive supervision as laid out in National Minimum Standards. Records of supervision must be kept. Outstanding from the last inspection 15/08/06 31/08/06 31/08/06 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 Refer to Standard OP12 Good Practice Recommendations It would be of benefit to the residents if an activity coordinator were appointed. Ashcroft Rest Home, DS0000007230.V301179.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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. 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