CARE HOMES FOR OLDER PEOPLE
Ashdale Lodge 2 Wheeler Street Anlaby Road Hull East Yorkshire HU3 5QE Lead Inspector
Simon Morley Unannounced Inspection 14th December 2005 10:00 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 Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 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. Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ashdale Lodge Address 2 Wheeler Street Anlaby Road Hull East Yorkshire HU3 5QE 01482 352938 01482 574929 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) Sanctuary Care Limited Mrs Eileen Ann Harland Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Old age, registration, with number not falling within any other category (36) of places Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th July 2005 Brief Description of the Service: Sanctuary Care Ltd own Ashdale Lodge and a number of other homes across the country. The home is registered to provide accommodation and personal care for up to 36 people over the age of 65, some of who may suffer from dementia. Ashdale Lodge is a purpose built home and has 30 single and 3 double rooms on two floors. There is a passenger lift from the ground to first floor. There is a large dining room and conservatory in the centre of the home overlooking the attractive rear garden. The garden was well kept with raised flowerbeds and there is some car parking space to the front of the home. Ashdale Lodge is about a mile west of Hull City Centre situated just off Anlaby Road. It is close to a range of shops, pubs, post office, indoor bowling alley, churches and is on major bus routes. Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection lasted for nine hours and no additional visits have been made to the home since it’s last inspection in July 2005. The inspector looked at records about the care of residents; spoke to a number of residents, visitors, staff and the manager. The inspection lasted until 7pm to see what the quality of care was like after teatime. What the service does well: What has improved since the last inspection?
Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 6 New staff have been recruited and were about to be added to the rota to give an extra 30 hours per week of care. 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. Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 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 Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 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 and 3. The admission process needs to improve to ensure all residents’ needs are assessed so that they can be assured they will be well looked after. EVIDENCE: Residents spoken to were happy that their care needs were being met. Staff spoken to were aware of individual resident’s needs and what they needed to do for them. Individual care records are kept for each resident. An inspection of the records for three residents showed that two of them had had their care needs assessed prior to moving into the home. One had not. This person had been in the home for nearly two weeks. Without a proper assessment of some one’s needs they are at risk of receiving care that is less than the minimum standard. A written contract / statement of terms and conditions is agreed with residents when they move in. These did not have clear information about who is responsible for paying the weekly fee. The home also charges some of the residents’ relatives an extra ‘top-up’ fee. It is not clear what this is for.
Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 9 An individual plan of care is usually written for each resident based on the assessment. Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 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 and 9. The arrangements for ensuring that residents’ health and personal care needs were met are usually good. EVIDENCE: Residents spoken to were happy with their care and how staff looked after them. They said that they were helped to have regular health checks and any necessary health care. Residents also said that they were happy with how the home took care of their medication. And that staff were polite, friendly and treated them with respect and dignity. This was seen to be the case by the inspector. Of the three sets of records examined two had a detailed plan of care describing what staff need to do for each resident. These were reviewed regularly and any necessary changes made. One resident did not have a care plan – this was the same person who did not have their needs assessed. The records relating to this person’s care were not sufficient in detail to allow an accurate judgement to be made about the quality of care he received. Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 11 Without a proper care plan informing staff what care they need to provide to some one they will be at risk of receiving care that is less than the minimum standard. The home had good medication procedures, which were also examined. These ensured that residents received their medication safely and on time. One issues was noted – two staff were not double-checking handwritten instructions about administering medication. These are usually pre-printed by the pharmacist but occasionally staff have to write them. Double-checking helps prevent mistakes. Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 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): 14 and 15. Residents are able to exercise choice and control over their lives within the confines of living in a care home. EVIDENCE: Residents said they could make their own choices about how they spend their time and what they do. They are encouraged to manage their own finances and there is information in the home telling them and/or their relatives where they can get additional support independent of the home if they want to. Residents can bring their own personal possessions when they move in and are told that they can look at the records kept about them. The front door is locked in such a way that residents can’t use this as an exit. This is designed to keep them from harm if they went out alone. There were no risk assessments explaining why this was necessary. Residents also said they liked the food. Residents can choose whether they eat in the main dining room or their own bedrooms. There is a three-course meal served in the dining room at lunchtime. Residents are regularly asked for their ideas to put on the menu. There are four lounges and tea is served in these or in people’s bedrooms. This is a much lighter meal of sandwiches, salad and buffet type food.
Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 13 If residents want to they can eat tea in the dining room. A large number of residents were spoken to about the mealtime arrangements and were happy with them. They also said they get some supper before bedtime. Residents were also asked about bedtimes and when they liked to get up in the morning. Again they were happy with these arrangements. Those residents dressed for bed before the inspector left were happy to do so. Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 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): The key standards were included in the last inspection report. EVIDENCE: Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 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, 22 and 26 Ashdale Lodge is homely, comfortable, clean and tidy. EVIDENCE: Residents spoken to said how nice the home was to live in. It was clear from a look around how clean and tidy the home was kept. The décor of the home was of good quality. There was a range of adaptations and specialist equipment to support residents to keep their independence. The home has a call system for residents to summon help. The design of the call system is such that in some communal rooms people with poor mobility or poor eyesight could not reach or see where the call button is, especially in communal areas, e.g. the lounges. This was also the case at the last inspection. The home was well maintained and the majority of maintenance certificates were available.
Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 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 and 30. There are good arrangements for staff training but staffing levels do not meet the recommended guidance. EVIDENCE: The number of care hours staff work on the rota added up to 575 a week, the recommended guidance says there must be at least 700. That’s 125 more care hours needed each week to meet the guidance. The staffing has been increased by 30 hours a week since the last inspection, but is still a long way off the recommended guidance. There are now three care staff on duty throughout the day and a senior carer as well but the senior mainly works in the office alongside the manager. Included in the figures above is an activity co-ordinator who works 20 hours a week arranging individual and group activities. Although popular with the residents who join in, his time is limited and stretched between a possible 36 residents. The manager reports that a limited budget prevents increasing the staffing levels to the recommended guidance. Additional staff would improve the service and allow staff to spend more time engaging residents in meaningful activity. Some residents spend a lot of the time alone in their bedrooms or sat quietly in the lounges. Some of the residents spoken to also said they thought the staffing levels should be higher.
Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 17 Staff undertake a range of training to help them be able to care well for the residents they look after. The target set by government for 50 of care staff to have the NVQ 2 Care qualification has already been met. Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 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, 35, 36 and 38. There were good arrangements for the management and administration of the home. EVIDENCE: The manager has completed a level 4 NVQ in care management. She also had a large amount of experience, and undertakes periodic training, which she uses to fulfil her role competently. There is an open door policy for residents and staff. They are also regularly asked their views about the home. This is done through residents meeting and use of satisfaction surveys. Results of these are on display in the home. Residents and /or their families are encouraged to look after their own finances. The home safeguards small amount of monies on behalf of some residents. There were accurate, detailed records kept, and these are audited regularly to make sure there are no mistakes.
Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 19 Staff receive formal supervision from the manager or shift leader and records are kept of this. A representative of the owner also visits the home monthly to check on the quality of the service. The home was well maintained and the majority of required maintenance certificates were available for inspection. Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 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 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5 Requirement Statements of terms and conditions agreed with residents must clearly detail who is responsible for paying the weekly fee, the home’s policy on charging ‘top-ups’ and what the ‘top-ups’ are for. All residents including those staying for respite care must have a detailed assessment of their care needs before moving into the home. All residents including those staying for respite care must have a detailed care plan describing how their care needs will be met. The reasons for keeping the front door locked and not allowing residents out on their own must be clearly recorded as part of each persons care plan. Handwritten instructions on MAR charts must be witnessed and signed by two staff. (Target date of 30/09/05 not met). The call bell system must be reviewed and amended so it meets the needs of all residents
DS0000000833.V263639.R01.S.doc Timescale for action 31/03/06 2 OP3 14 31/03/06 3 OP7 15 31/03/06 4 OP7 15 31/03/06 5 OP9 13 31/03/06 6 OP22 23 31/03/06 Ashdale Lodge Version 5.0 Page 22 7 OP38 23 without compromising their dignity. (Target date of 30/09/05 not met). There must be an up to date maintenance certificate for the fire alarm system and a ‘Corgi’ gas certificate. 31/03/06 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. Refer to Standard OP7 OP27 Good Practice Recommendations The detail of daily care records should be improved to accurately reflect the care provided for all residents. The staffing levels should be increased to meet the recommended guidance. Ashdale Lodge DS0000000833.V263639.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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