CARE HOMES FOR OLDER PEOPLE
Ashdale Lodge 2 Wheeler Street Anlaby Road Kingston upon Hull HU3 5QE Lead Inspector
Simon Morley Unannounced 14 July 2005 @ 9:30 am
th 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 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 J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ashdale Lodge Address 2 Wheeler Street Anlaby Road Kingston upon Hull HU3 5QE 01482 352938 01482 574929 Telephone number Fax number Email 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 OP Old Age (36) registration, with number DE(E) Dementia (36) of places Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd March 2005 Brief Description of the Service: Ashdale Lodge is owned by Sanctuary Care Ltd who own 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 on a major bus route. Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection lasted for 6 hours and no additional visits have been made to the home since it’s last inspection in March 2005. The inspector looked at records about the care of residents; spoke to 5 residents 2 visitors, 5 staff and the manager. We recently received a complaint about the care of a resident. This was looked into as part of the inspection. The complaint was about how the person was admitted to the home and her care. Her care needs were not assessed and she did not get the care she wanted. What the service does well:
Ashdale Lodge is a modern purpose built home designed to meet the needs of dependent elderly people. The home is kept clean and tidy, is light airy and comfortable. There is wheelchair access throughout including the secluded rear garden. For those who want to use them there is a good range of local amenities. Staff spoken to were enthusiastic about their work and liked working at the home. They wanted to ensure that residents receive high standards of care. Residents spoken to said they liked the care staff and thought they worked hard to look after them well. There was a good admissions process that usually made sure the home only took in people that would be looked after well. This was with one exception, which was part of a recent complaint. Apart from this there were good standards of care and a high number of staff have achieved the required ‘care qualification’. The manager strives to maintain the standards and has changed the way people are admitted in an emergency as a result of the complaint. She has recently reviewed procedures in the home with staff who have made a list of suggestions to improve the service. There are good visiting arrangements and visitors said they were made to feel welcome. Residents are provided with a healthy diet and they said they thought the food was good. There is a small range of choices from the menu and special diets e.g. food allergies, diabetic diets, are catered for. The home was clean and tidy and there were no malodours.
Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 6 The required employment checks were made before new staff work in the home to make sure residents are safe from those who are unsuitable. What has improved since the last inspection? 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 J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 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 standard(s) 3. The admissions process usually ensures that residents’ needs were assessed before moving into the home, 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 four residents showed that three of them had had their care needs assessed prior to moving into the home. One had not. As a result family members took this person home, as they were not happy with how she was looked after. An individual plan of care is written for each resident based on the assessment. Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 and 10 The arrangements for ensuring that residents’ health and personal care needs were met are usually good. Residents were treated with respect and dignity. 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. One resident told the inspector how staff had to use special equipment to help her up to avoid her getting bruised as she had delicate skin. Although she felt uncomfortable about using this equipment she did prefer it to the bruises which would occur if staff tried to help her move without it. 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 four sets of records examined three had a detailed plan of care describing what staff need to do for each resident. These were reviewed regularly and any necessary changes made.
Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 10 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 she received. For example one entry read ‘…all care needs have been met’. But this person did not have a written care plan saying what her needs were in the first place, so staff would not have known what care she really needed. The home had good medication procedures, which were also examined. These ensured that residents received their medication safely and on time. Two small issues were noted: The manager was asked that the quality of handwritten medication records be improved; and that any unused and/or old medication is safely disposed of. Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 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 standard(s) 12, 13 and 15. There were good arrangements for visiting and ensuring residents were offered a healthy, nutritious diet. The arrangements for organising social activities did not meet everyone’s expectations. EVIDENCE: The inspector spoke to a number of visitors as well as residents. All said they were happy with the visiting arrangements and support from the home to keep these links. Visitors were made to feel welcome and also said how good they thought the home was. Residents said that they liked the food and there was plenty to eat. Residents can choose their own breakfast, dinner and tea from a range of options. Special diets are catered for and professional medical help is obtained to help residents who are over/underweight. The home employs an activity co-ordinator who is well known and liked by the residents. He organises a range of activities both on a 1 to 1 with individual residents and some group activities. He works part-time and was on leave at the time of inspection. The home also arranges a number of trips out and indoor social events throughout the year. At the time of the inspection: Care staff on duty were busy with care tasks e.g. helping residents with personal care, providing drinks and snacks, helping
Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 12 residents down to the dining room for dinner, putting laundry away. This meant that they did not have much time to support residents to engage in meaningful activity. This was also affected by the fact that staffing levels from 12pm to 4pm were low. Feedback from residents about this was mixed, some were happy with what the home arranged but others thought the home could do more. Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 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 standard(s) 16 and 18. The arrangements for dealing with complaints did not ensure that all residents and relatives felt listened to. The arrangements for keeping residents free from harm were good and ensured residents felt safe. EVIDENCE: There was one recent complaint about the home’s emergency admission process and subsequent quality of care for one individual. The manager investigated this and wrote to the complainant. The complainant was not happy with the response as she felt the letter did not adequately address her complaint or say if anything was going to be done about it. There were no records of the manager’s investigation available at the home. As a result of this inspection and complaint, the manager did agree to make changes to how people were admitted in an emergency. This is to make sure that all staff know an individual’s care needs so that they know what to do for that person. The manager also agreed to write again to the complainant about making this improvement. The manager and staff spoken to were aware of what was poor and abusive practice. All were adamant that they would report any thing of this type to keep residents safe. Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 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 standard(s) 22 and 26. Ashdale Lodge is homely, comfortable, clean and tidy. Specialist equipment is available for people who need it but the internal call system / alarm facility is not accessible to all residents who need to summon assistance. 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. The home smelled fresh and there were no malodours. Staff knew how to work to reduce risks of infection from clinical waste. 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 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. Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 15 When asked about this the manager reported such residents would have to ask another resident to call for them. The inspector considers that this lowers the level of respect, dignity and independence offered to residents. The manager was asked to review the accessibility of the call system but told the inspector that there was not enough money to make changes to it. Some residents spoken to said that the staff take along time to answer the call bells. When the inspector tried the call bell it took nearly 10 minutes before anyone came to see who needed support. Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. The home was not well staffed. The arrangements for recruiting new staff make sure that only suitable staff are employed to work there. EVIDENCE: The number of care hours staff work on the rota added up to 545 a week, the recommended guidance says there must be at least 700. That’s 155 more care hours needed each week to meet the guidance. Although the home is not currently required to meet this guidance the current staffing levels do affect the quality of care provided. The manager reported that there was not enough money to have more care staff on duty. From 12pm to 4.30 pm there were only 2 care staff on duty, there is a senior carer as well but the senior mainly works in the office. For part of the day there was no senior and the manager covered this absence. During the afternoon one of the two carers was going around with the drinks trolley and the other was putting laundry away. Little was seen in the way of time spent with residents. And these staffing levels may also explain the long time taken to answer call bells. Even when the activities co-ordinator is at work his work hours only allow for about 40 minutes of time (on a 1 to 1 basis) for each resident per week. As a result: during the inspection residents received very little in the way of social stimulation, leisure and recreational activities. This was partly due to the absence of the activities co-ordinator but also due to the homes general care staffing levels.
Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 17 The manager reported that at least two staff had been recruited to work in the home since the last inspection. The required recruitment checks were obtained for these staff members to make sure residents are safe from people who should not be working there. Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these outcomes were assessed on this occasion. EVIDENCE: Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION x x x 2 x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x x x x x Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 20 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 3 Regulation 14 & 15 Requirement The emergency admission procedure must adequately ensure that residents get the care they need. Handwritten instructions on MAR charts must be witnessed and signed by two staff. Old and unused medication must be safely disposed of. All residents must be able to enjoy the lifestyle they expect and their religious, cultural and needs must be met. Details of complaints investigations must be available for inspection in the home. The call bell system must be reveiwed and amended so it meets the needs of all residents without compromising their dignity. The numbers of care staff on duty throughout the day must be reveiwed so that it can clearly be shown that residents needs are met in full. Timescale for action 30 September 2005. 30 September 2005. 30 September 2005 31 October 2005 31 October 2005 31 October 2005 2. 3. 4. 9 9 12 13 13 12 5. 6. 16 22 17 23 7. 27 18 31 October 2005 8. Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 21 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 7 27 Good Practice Recommendations The detail of daily care records should be improved to accurately reflect the care provided. The staffing levels should be increased to meet the recommended guidance. Ashdale Lodge J54_S833_Ashdale Lodge_v226679_140705_Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 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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