CARE HOMES FOR OLDER PEOPLE
Ashdale Lodge 2 Wheeler Street Anlaby Road Hull East Yorkshire HU3 5QE Lead Inspector
Simon Morley Unannounced Inspection 09:30 15 March 2007
th 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.V324409.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. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 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 Lynne Buxton 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.V324409.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To admit one named person under the age of 65, for this condition to expire when the person reaches the age of 65 or moves out of the home. 14th December 2005 Date of last inspection Brief Description of the Service: Sanctuary Care Ltd owns 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.V324409.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector arrived at the home at 9.30 in the morning and left at 4.30 in the afternoon. He had a look around the home, and chatted with four of the residents staying at the home. He also talked to four staff, the manager and looked at what staff write down about the residents they look after. The inspector looked at other records in relation to the management and maintenance of a care home. Questionnaires about the home were sent out to relatives and other health and social care professionals involved in the care of 10 of the residents. Five staff working at the home were also sent a questionnaire. Questionnaires were returned from one member of staff, two relatives and one social care professional. What was said in the questionnaires and what people said during the inspection has been included in this report and used with other information to say how well the home is doing. 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 are able and 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. They treated residents with respect. And residents were able to exercise their own choice and control over how they spend their time. There was a good admissions process that made sure the home only took in people that would be looked after well. There are good standards of care and a high number of staff have achieved the required ‘care qualification’. Residents are provided with a healthy diet and they said they thought the food was good and were happy with mealtime arrangements. Special diets e.g. food allergies, diabetic diets, are catered for. The home was clean and tidy and there were no malodours.
Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 6 Staff are supervised and receive training to be competent at their jobs. The new manager knows the strengths and weaknesses of the home and has some good plans for improving the service. Residents’ views about the home are taken seriously and the manager will try to make sure they get what they need. The home was safe and well maintained. What has improved since the last inspection? What they could do better:
Statements of terms and conditions agreed with residents must clearly detail who is responsible for paying any ‘top-up’ fees and what these are charged for. This is to help prospective residents decide if they want to choose Ashdale Lodge as their new home. Care plans must include people’s social, cultural, religious and psychological needs and the support they need from staff. This is to make sure residents get all the care and support they need. The number of hours per week that care staff work must meet the recommended guidance so that residents are able to have all their care needs including social care needs met. Risk assessments must be completed to help ensure that residents would not be out at risk if they were to slip or fall on laminate flooring that has been put in bedrooms.
Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 7 The manager should carry on with her action plan to improve the quality of social care for the residents. The manager should review cleaning practices in the home before bedroom carpets are removed and replaced with laminate flooring. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3, standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were good arrangements to help people choose Ashdale Lodge House as their home and to ensure they will get good care once they have moved in. 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. Before residents move into the home the manager visits them and completes a good assessment of their care needs. This is to make sure that the care staff will be able to look after them well once they have moved in. The manager also gets copies of other assessment information from health and social care services to help this process. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 10 This assessment information is then used to write a care or support plan describing what staff need to do to look after each person. These records were available to be seen as part of the inspection. The quality of assessment records had improved since the last inspection. A written contract / statement of terms and conditions is agreed with residents when they move in. This is part of the service user guide, which gives people looking for a care home a good range of information to help them choose. The terms and conditions did not have clear information about who is responsible for paying any ‘top-ups,’ which are an additional charge. The home charges this as fees paid by the local authority for some one’s care are not enough. The reason for this ‘extra’ and who is responsible for paying it must be made clear. Residents and their families who cannot afford this are not charged the extra. There were other ‘extras’ not included in the fees e.g. hairdressing, toiletries, newspapers and private chiropody. The home does not provide intermediate care, which is a specialist service aimed at maximising people’s independence and return home after a hospital admission. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for making sure all a residents’ care needs were met needed some improvements. EVIDENCE: Residents were very complimentary about their care, spoke highly of the staff and manager, and felt they were treated with respect and dignity. They gave some examples of this: staff always knock before they come in our rooms, we get our own post to open and staff are very polite in how they talk to us. It was clear from observation that staff were polite, respectful and patient with the residents. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 12 Each resident has a written support plan, which gave detailed descriptions of individual care needs and what staff needed to do for each person. There is good communication about residents needs between staff as well. And staff were knowledgeable about people’s individual care needs. Individual care plans and care given to residents is mainly focussed on health and personal care tasks e.g. medication, bathing, dressing and toileting. Other areas of care e.g. social, cultural, psychological and spiritual are not so well planned for. This is especially so for people who suffer from dementia and have associated memory loss and confusion. The new manager has some good plans to improve the quality of care for these people. Residents said they were looked after if they were poorly and got to see the necessary health care professionals e.g. GPs and District Nurses. Care records also showed regular visits to the dentist and optician for those that needed them. Referrals are made to other specialists e.g. dieticians and consultants when there were particular health issues. These referrals are important so that residents who need particular health care support get it when they need it to help keep them fit and healthy. There was safe storage of medication and good procedures to make sure residents get the right medication at the right time. Staff responsible for dealing with medication receive the necessary training. Residents were happy with the arrangements for getting their medication. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new manager has started to make mealtimes and social activities better for everyone. This work must continue to make sure residents are able to have a good quality of daily life. EVIDENCE: The home has an activities co-ordinator who is popular with the residents and he arranges group and individual activities for residents. The home also arranges a number of trips out and indoor social events throughout the year. During the inspection care staff on duty were busy with care tasks e.g. helping residents with personal care, providing drinks and snacks, helping 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 are lower than the recommended guidance. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 14 Feedback from residents about this was mixed, some were happy with what the home arranged but others thought the home could do more. The new manager is well aware of this issue. She has plans to improve the range of activities on offer and to make sure these are also appropriate for residents with dementia 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 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. 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. Since the last inspection the new manager has made some changes in consultation with residents. Tea is now served in the dining room as well and there are more choices on the menu. Menu choices include more food for people with dementia and staff are receiving more training in dietary needs for people with dementia. More attention is being given to ensuring residents get to use adapted cutlery when needed. There are four lounges and residents have the opportunity to make their own drinks in these areas. Staff also come round regularly offering tea and biscuits. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements to make sure that residents are listened to and kept safe from harm. EVIDENCE: Residents had no complaints but said they knew how to complain if they felt it necessary. The complaints records showed that residents and their relatives can complain and their complaints are taken seriously. There were 4 recorded complaints since the last inspection all about carpets / floor coverings. Due to some residents’ problems with continence, their relatives had asked for bedrooms not to be carpeted and to have some form of laminate flooring. This would help to help keep their rooms clean and fresh. It was recommended that the manager look into how these rooms are cleaned and odours tackled before carpets are removed. The manager must also make sure that any risks to residents (e.g. from falls) are not increased from having hard flooring. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 16 The manager and care staff have been trained in recognising abuse and what to do if they witness any abuse so that they can protect the residents from harm. Staff were knowledgeable about the procedures for reporting any abusive practice. There had been one allegation of abuse since the last inspection and this had been properly looked into to make sure residents are safe. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well maintained, safe comfortable and homely environment. 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. 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 the case at the last
Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 18 two inspections. A new call system is soon to be installed but there was no information to say how this will make things better. The new manager has plans to improve the physical environment of the home to make it more user-friendly to people with dementia. This should people who are confused to find there way around the home. The home was well maintained and the majority of maintenance certificates were available. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There must be more staff on duty to improve the quality of care that residents get. EVIDENCE: The number of care hours staff work on the rota added up to 575 a week, the recommended guidance says there must be almost 700. That’s 125 more care hours needed each week to meet the guidance. This was an issue at the last two inspections as well. There are three care staff on duty throughout the day a senior carer and the manager. The senior mainly works in the office as does the manager. Included in the staffing figures above is an activity co-ordinator who works 25 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. During the inspection residents received very little in the way of social stimulation, leisure and recreational activities. This was partly due to the Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 20 absence of the activities co-ordinator but also due to the home’s general care staffing levels. 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. So did visiting relatives. The new manager is aware of this issue but is unable to increase staffing. This is the responsibility of Sanctuary Care the company who own the home. Staff undertake a range of training to help them be able to care well for the residents they look after. Specific training about looking after people with dementia has been planned for staff for this year to improve the care these people get. The target set by government for 50 of care staff to have the NVQ 2 Care qualification has already been met. The required checks are made on new staff to make sure they are suitable to work in the home and are not likely to harm anyone. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good management arrangements to make sure residents benefit from a home that is well run and has their interests at heart. EVIDENCE: There is a new manager in post. She is registered with the Commission and has almost achieved the required qualifications. She has a good understanding of the home’s strengths and weaknesses and has plans in place for improvements – some of these have started already e.g. improved menus and mealtime arrangements. Residents are able to make their views known about the service in several ways. There are regular residents’ and relatives’ meetings, and residents are
Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 22 also given satisfaction surveys to complete. The manager is approachable and residents quite often make their views known directly to her. Minutes of recent meetings and results of surveys are on display in the home for people to see. A recent check has been carried out paying specific attention to the quality of life for people with dementia. The manager has plans in place to improve this part of the service. A senior manager from Sanctuary Care visits monthly to also check the quality of care. These visits are recorded and also highlight any issues that need sorting out. Reports of these visits were detailed and informative and are a good way of monitoring the management of the home. The home looks after some of the residents’ finances and there were accurate and up to date records kept. Residents spoken to were all happy that they received their full personal allowance or were happy for their relatives to look after their money. One safety issue was seen and that was the replacement of bedroom carpets with laminate flooring which made the floor surface much harder. The manager was asked to complete a risk assessment to ensure that residents would not be out at risk if they were to slip or fall on such a surface. Otherwise the home was physically safe and well maintained and maintenance certificates were available for inspection. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 23 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 3 X X X 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 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 3 X 3 X 3 X X 2 Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 Requirement Statements of terms and conditions agreed with residents must clearly detail who is responsible for paying any ‘topup’ fees and what these are charged for. This is to help prospective residents decide if they want to choose Ashdale Lodge as their new home. Care plans must include people’s social, cultural, religious and psychological needs and the support they need from staff. This is to make sure residents get all the care and support they need. The number of hours per week that care staff work must meet the recommended guidance so that residents are able to have all their care needs including social care needs met. Risk assessments must be completed to help ensure that residents would not be out at risk if they were to slip or fall on laminate flooring that has been put in bedrooms. Timescale for action 30/06/07 2. OP7 15 30/06/07 3. OP27 18 30/06/07 4. OP38 13 30/04/07 Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 25 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 OP12 OP24 Good Practice Recommendations The manager should carry on with her action plan to improve the quality of social care for the residents. The manager should review cleaning practices in the home before bedroom carpets are removed and replaced with laminate flooring. Ashdale Lodge DS0000000833.V324409.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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