Inspection on 12/07/06 for Ashdowne Care Centre

This inspection was carried out on 12th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashdowne Care Centre 24/09/07

Ashdowne Care Centre 05/10/05

Ashdowne Care Centre 19/05/05

Ashdowne Care Centre 14/10/04

Ashdowne Care Centre 10/06/04

Ashdowne Care Centre 22/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Ashdowne Care Centre Ashdowne House & Pinnex Moor Orkney Mews Pinnex Moor Road Tiverton Devon EX16 6SJ Lead Inspector Rachel Doyle Unannounced Inspection 10:30 12th July 2006 and 14 August 2006 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 Ashdowne Care Centre DS0000026697.V295464.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. Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashdowne Care Centre Address Ashdowne House & Pinnex Moor Orkney Mews Pinnex Moor Road Tiverton Devon EX16 6SJ 01884 252527 01884 242194 ashdownecare@onetel.com 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) Ashdown Care Limited Mrs Alison Southcott Care Home 60 Category(ies) of Dementia - over 65 years of age (34), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (34), Old age, not falling within any other category (34) Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Registered for 34 - Elderly General Nursing Care Registered for 34 - Elderly Mental Health Care The Home may from time to time admit up to three persons between the ages of 55 and 65 years of age. 5th October 2005 Date of last inspection Brief Description of the Service: Ashdowne is a purpose built nursing home, which opened in 1993. The present owner acquired the property in 2001. It comprises two units under one registration. The units have recently been linked by an enclosed corridor but continue to accommodate service users with distinct types of nursing needs in each separate unit. Pinnex accommodates 26 service users who are elderly with mental health needs. Ashdowne accommodates 34 elderly persons requiring general nursing care. The Home is managed as a whole by the registered manager, Alison Southcott. The Home also makes provision for respite and convalescence care on Ashdowne. The sides and back of the property are garden areas and the front is a car parking area with a portacabin used for administration, training and meetings. The home is situated in a residential area of Tiverton. The kitchen is housed in Ashdowne and the laundry in Pinnex. The average cost of care is £363-640 per week at the time of inspection. Additional costs, not covered in the fees, include hairdressing and personal items such as toiletries, newspapers and magazines and private chiropody and taxis. Current information about the service, including CSCI reports, which are accessible at the Home, is given to prospective residents/their representatives Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector undertook this unannounced inspection over a period of two days, the first day was with another inspector, who focussed on Pinnex Unit. There were 33 residents living on Ashdowne unit and 23 on Pinnex Unit at the times of the inspection. During the inspection the inspectors case-tracked 5 residents, which helps us to understand the experiences of people using the service. A number of other residents were met and spoken with during the course of the day. The inspectors also spent a considerable time observing the care and attention given to residents by staff. Five staff were spoken with during the inspections, including care staff, ancillary staff, and the manager and 2 relatives. Prior to the inspection surveys were sent to relatives to obtain their views of the service provided; 10 were returned. Five resident surveys were returned. Staff were also sent surveys, 14 were returned. Health and social care professionals were also contacted prior to the inspection including GPs, community psychiatric nurses and community care worker. Five were returned. The inspectors toured the premises, including all shared areas and the majority of residents’ accommodation, and a sample number of records were inspected which included care plans, medication records/procedures, staff recruitment files, service and maintenance certificates and fire safety records. The manager had completed a pre-inspection questionnaire and the inspector appreciated the preparation undertaken by the manager to assist with this inspection and found staff very helpful on the day. What the service does well: Residents benefit from having skilled and friendly staff who have a good understanding of residents’ needs. Overall the manager provides clear leadership and guidance to staff to ensure residents’ receive consistent care in a safe environment. The Home’s assessment process is thorough and ensures that the Home is able to meet prospective residents needs prior to admission. Residents’ privacy and dignity are maintained and promoted by the staff and management team at the Home. The health and welfare of residents is well met with evidence of good multidisciplinary working taking place on a regular basis. Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 6 Residents are encouraged to maintain their independence through being given choice and control over their lives at the Home. Meals are nutritious and offer a balanced and varied diet. The standard of the environment is satisfactory providing residents with safe and clean surroundings. Contact with families and friends is flexible and generally promoted well within the Home. Residents are confidant that they are listened to and their requests actioned. There are robust procedures for employing staff that provide safeguards to protect residents living at the Home. Residents’ financial interests are generally safeguarded. What has improved since the last inspection? What they could do better: The numbers of staff are sufficient to meet residents’ needs although this includes work done beyond working hours at times, which could lead to low staff morale. The Home should ensure that staff attend regular staff meetings and formal supervision sessions. Although the Home makes an effort to offer creative and organised activities for residents this does not ensure that all residents social needs are consistently met. Residents are not fully protected from abuse by sound procedures and training. The garden on Pinnex should be geared towards meetings the needs of those residents living with dementia. Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 7 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. Ashdowne Care Centre DS0000026697.V295464.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 Ashdowne Care Centre DS0000026697.V295464.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home’s assessment process is thorough and ensures that the Home is able to meet prospective residents needs prior to admission. EVIDENCE: Pinnex Care files seen contained detailed and relevant pre-admission assessment information including information from Care managers and Hospital discharge information. None of the residents asked were able to speak about their admission and visitors’ relatives had been at the home for over a year. The homes Service User Guide and complaints procedure was seen in a couple of rooms and a staff member said that new residents/families are always given this. Ashdowne The three care files looked at contained comprehensive assessments and there is a clear admission procedure. Staff comment cards stated that they did not Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 10 feel that they were asked to care for any residents outside their expertise. The Satement of Purpose and previous reports are easily accessible in the hall. Ashdowne Care Centre DS0000026697.V295464.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ privacy and dignity are maintained and promoted by the staff and management team at the Home. The health and welfare of residents is well met with evidence of good multidisciplinary working taking place on a regular basis. EVIDENCE: Pinnex Both residents’ records seen contained detailed care plans, which reflected assessments and taking account of physical, psychological and social care needs. This provides a useful picture of residents’ needs and how these should best be met by staff. For example one persons plan gave clear guidance about how staff should respond when the resident becomes anxious/aggressive, stressing the need to be consistant and reassuring. Antoher care plan seen provided clear guidance about how the residents should be supported to mange their diabetes. Care plans showed evidence of regular update and review. Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 12 The health care needs of residents are assessed using professionally recognised tools. Assessments in relation to preventing falls and maintaining skin integrity were seen in use, showing evidence of review and where these tools had identified risks to residents appropriate plans of care had been developed. One relative said that they think staff always involve their GP without delay as required, another relative felt sometimes they have to prompt staff to do this. Care records seen showed evidence of regular GP visits. Relatives and residents able to comment confirmed that clothing is well cared for and always returned from the laundry. Visitors confirmed that their relatives are always dressed in their own clothes. Screens were seen in shared rooms. Throughout the day staff were heard addressing residents respectfully and warmly; visitors confirmed that they also believe staff act respectfully towards residents. Ashdowne The three care plans looked at were comprehensive and clearly recorded actions. Needed and taken. There was evidence of good multidisciplinary working with staff using a communication book and clearly requesting GP visits appropriately. The five comment cards from health professionals all stated that they felt the Home cared for residents very well and they were satisfied overall with the care. Residents all appeared well cared for and the manager and staff spoken to were very knowledgeable about residents’ needs. One staff member explained how staff had been supported to care for a resident with challenging needs. Staff were seen to care for residents in a caring way, maintaining privacy and dignity and facilitating the use of shared rooms sensitively. Three relatives spoken to on the unit were very positive about the care delivered by staff saying ‘its absolutely wonderful care, we are blessed, the manager is wonderful and staff do their utmost’ and that their mother was very happy and there were no worries. Medication was inspected. All records were correct and include relevant additional information and residents photographic identification. The medication storage was appropriate and all creams were clearly named for the resident in their rooms. Prescriptions relating to diabetic care did not have clear instructions about the dose relating to blood sugar levels, which could put residents at risk. This information should be signed by two staff. However, when spoken to staff were aware of the instructions. Ashdowne Care Centre DS0000026697.V295464.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to maintain their independence through being given choice and control over their lives at the Home. Meals are nutritious and offer a balanced and varied diet. Although the Home makes an effort to offer creative and organised activities for residents this does not ensure that all residents social needs are consistently met. Contact with families and friends is flexible and generally promoted well within the Home. EVIDENCE: Pinnex Resident records seen ontained well constructed risk assessments completed regarding them going on outings & trips from the home; they helped to identify possible difficulties that could be encountered and described what staff should do to minimise these difficulties. Neither of these residents could recall going on outings from the home and activity records seen did not contradict Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 14 this. Activity records looked at for the previous month did not mention any trips out for any of the residents. Staff confirmed that only one residents of the 23 regularly goes out beyond the grounds of the home. Residents spoken with indicated they would like to visit the local town, one person who said they had always worked with animals and would like the opportunity to see animals and described feeling like a caged rat ,unable to get out, walking up and down corridors all day with nothing else to do. Care staff reported that activites workers are in the home for a couple of hours, on average most days. Activity records showed that these workers spend time talking with individuals, playing games and doing activites such as making fruit milk shakes. One activity worker was seen on the morning of the inspection using a bubble machine which several residents took great delight in. This worker related warmly with residents, some of whom clearly enjoyed laughing and joking with her. However, records did not indicate that all residents’ social and leisure needs were being met on a regular basis although activity workers were doing their best with the time provided, which is 30 hours a week for 60 residents. The inspector ate with residents on the ground floor. The meal was hot and tasty, residents were served individually, given a choice of vegatables and a resident who did not like the dish of the day was given a hot alternative she clearly enjoyed. Residents were given a choice of drinks and care staff were seen sitting with residents who needed help to eat, patiently and attentivly. When sweet was being served the inspector sat in the upper lounge where the atmosphere was calm and residents were enjoying their meals at their own pace with appropriate help from staff and two visitors. Residents spoken with said they like the food. Two residents said that they find the food very good. Relatives spoken to on Pinnex confirmed that they can visit without appointment and that they felt welcome. Ashdowne Four residents said that they were happy living at the Home. They got on well and had all they needed around them and sometimes play games. Some had been out for a coffee morning. Two residents had communication difficulties but staff were aware of their preferences and choices, which were recorded in their social history records. Residents felt that they could chat to staff and had a good rapport with them. Residents knew what was for lunch and those who commented said that the food was lovely and that they could choose anything. During the inspection residents were having coffee, some with relatives and listening to music.Carers were making an occasion of one residents’ birthday. The activity worker showed the inspector excellent records relating to residents’ social needs and they had made good use of the time allocated although some residents had some days or more between activities, especially those with limited communication meaning that a resident could go for long periods with no real effective stimulation. The activity worker said that the Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 15 time does not enable them to consistently meet social needs for all residents but they said that carers also have input but do not record time spent with residents, including relatives’ visits. The inspector ate with residents upstairs on Ashdowne. The food was well presented and carers offered choice including where residents would like to sit. Staff should be reminded to offer condiments in the upstairs lounge. The kitchen was well organised and clean. The kitchen staff have undertaken relevant training and one commented ‘I love working here’ and had taken pride in making home-made cakes for the residents’ tea. Most residents felt that their relatives could visit at any time although one relative felt that they had to go at the same time each week with another commenting that there are no private areas to visit on Ashdowne other than residents’ rooms. Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are not fully protected from abuse by sound procedures and training. Residents are confidant that they are listened to and their requests actioned. EVIDENCE: The complaints procedure was clearly posted in the entrace lobby of the home and seen in files in some residents rooms. Relatives spoken to felt that they were consulted if there were any concerns about a resident and residents felt that they knew who to complain to and that they would be listened to. There have been no documented complaints recently but the manager said that they would ensure that any concerns are recorded in future. One of three staff spoken with had watched a video about how to recognise and report abuse of vulnerable adults. The Alerters’ Guide is available in the staff office. Two staff said they had received no teaching about abuse though both said they had been clearly told that they must report any concerns they may have to senior staff. The homes protection policy provides relevant and appropriate advice, though could be presented in a clearer fashion. Staff training records showed that few staff have attended Protection of Vulnerable Adults training. Ashdowne Care Centre DS0000026697.V295464.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is satisfactory providing residents with safe and clean surroundings. EVIDENCE: Pinnex On walking the building mid morning all areas were generally clean, 2 of 10 rooms visited had mild lingering offensive odours. Rooms are generally basically furnished and rather institutionalised although most were personalised with some photos. Residents able to comment said they were happy with general cleanliness and maintainance as did one visitor. Another visitor said they feel that the home is not as clean as it should be with insufficient attention to detail e.g. windows not cleaned and that curtains never seem to be cleaned. The garden is neat, level and safe, though no special consideration of the needs of people with dementia is apparent in its design. The manager said that Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 18 there were plans to address this in the near future and described their ideas, which sound good. Ashdowne All areas of the unit were inspected. Rooms were well personalised and clean. There were no negative comments relating to hygiene or tidiness, other than four residents who thought the curtains were tired. One armchair in the upstairs lounge was not fit for purpose and needs replacing. Rooms had locakable storage available and call bells although residents in the communal lounge did not always have access to a call bell, one resident saying that they call out and staff come. All staff and residents praised the new maintenance man saying that nothing was too much trouble and that issues were done quickly. Staff felt that there were adequate supplies of equipment enabling them to practice safely such as hand gel and paper towels. There have been improvements in various parts of the Home including kitchen re-decoration, bird bath and table and upgrades to the central heating and electrics. Ashdowne Care Centre DS0000026697.V295464.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are robust procedures for employing staff that provide safeguards to protect residents living at the Home. Residents benefit from having skilled and friendly staff who have a good understanding of residents’ needs. The numbers of staff are sufficient to meet residents’ needs although this includes work done beyond working hours at times, which could lead to low staff morale. EVIDENCE: Six recuitment files were seen and contained satisfactory pre-employment checks. Residents and visitors spoke positively about staff, one resident described them as very obliging and intelligent and a visitor said they are all patient and kind singling some individuals out for particular praise. Residents able to comment all indicated that there are always staff around if you need them, visitors generally agreed though one visitor said that sometimes they feel there is a lack of supervision of residents in lounge areas on Pinnex. The inspector sat in both Pinnex lounges for periods throughout the inspection during which time staff were not absent for more than a minute. This was also the case on Ashdowne. Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 20 Care staff comfirmed that there is usually one Registered General Nurse and 4 carers all day and that this mostly allows them time to provide care in an unrushed mananer. One inspector was told that two training sesions about Dementia and Challenging behaviour had been run in the past seven months to which all care staff were required to attend. Two of the three spoken with had attended and reported that this training had been well delivered and useful. Staff confirmed that they have received mandatory training but felt that it was difficult to attend any other specialised training as there were no staff to cover them. An induction programme was seen which required staff demonstrate a basic understanding of a variety of competancies about care, administration and health and safety. One member of staff recently employed confirmed that they had been asked to work through this induction and that they had to ‘shadow’ colleagues when first at the home, another confirmed they had been well supported and had shadowed colleagues. An overseas member of staff spoken with had good basic english skills, confirming that colleagues had been very supportive and helped her improve. One person conmmented that clients still struggle to understand some overseas staff due to strong accents but it is noted that staff are helped to attend English classes by the Home and that there are always staff on duty who can assist if there is an issue. Three relatives commented that there was not enough staff especially at lunch times and weekends. It was noted that 11 residents require assistance with feeding on Ashdowne but staff were seen to work quickly to achieve this with little delay. However, there was a general feeling amongst staff that they have little time to keep documents up to date as they are so busy prioritising care so they are working beyond their shift hours to do paperwork. Staff felt that residents’ dependency levels have increased although the Home do not keep records of these to enable them to monitor staff hours related to residents’ needs. Staff said that 29 of the 33 residents on Ashdowne need two staff to help them get up. The manager said that the home now has a more stable staff team and two new carers were starting their induction on the day of the inspection. On some occasions there have been lower staffing levels but the manager assured the inspector that every effort is made to obtain staff, usually asking existing staff who know the residents. Agency staff are used only ‘in an emergency’ and by going through the operations manager, which staff said can take time. The manager said that they would record details of these efforts in future and CSCI have been informed if the staff levels have been particularly low on rare occasions due to holidays and/or sickness. Relatives comments about staff attitudes were positive such as ‘residents are looked after extremely well’, ‘staff are genuinely caring and cope with patience and humour’, ‘staff help me take the resident out and they are always happy to return’ Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 21 Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from having skilled and friendly staff who have a good understanding of residents’ needs. The numbers of staff are sufficient to meet residents’ needs although this includes work done beyond working hours at times, which could lead to low staff morale. Residents’ financial interests are generally safeguarded. Overall the manager provides clear leadership and guidance to staff to ensure residents’ receive consistent care in a safe environment. EVIDENCE: Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 23 Fire extinguishers looked at had been serviced with in the past year. Upper floor windows seen had opening restrictors. All hot surfaces seen were appropriately guarded or risk assessed. Residents’ monies were inspected. Out of 4 records, 3 were correct. This was due to small errors in recording and handling. The administrator said that they had been very busy as working 50 hours a week over two homes and said that it was unusual for there to be such silly mistakes. Relatives are invoiced monthly and few residents keep cash at the Home as the Home ensure that they have all they need and use petty cash if necessary. Receipts were all correct. The Home has a good quality assurance system and the collated results of the annual surveys sent to relatives, residents and health professionals were seen including actions to be taken from the comments received. One of three staff said that they had received one to one supervison in the past year and the manager is aware that this needs following up as there are other gaps in supervision records. The Home’s supervison policy states that all staff should have formal recorded supervison six times a year. Currently this tends to happen informally. Some staff said that staff meetings do not happen and that morale had been low lately although the manager said that it has been difficult to encourage staff to attend meetings. She has also not been well recently but ensured the inspector that the lack of meetings would be addressed. The manager has also worked excessive hours on the ‘floor’ rather than supernumary over the summer although they felt that it had been good to work with the staff. All staff spoken with on Pinnex said they believe they have a good staff team who are supportive of each other and that senior staff and the unit manager are approachable and supportive. Fourteen staff returned comment cards to CSCI. Some staff felt that there had been changes without consultantion with staff. One staff member felt that the manager was ‘an excellent role model for staff’. Another felt that they had good job satisfaction. One staff member felt that they did not get support from management and another would like the staff to work more as a team. The majority of comments were positive stating that staff felt well supported by management. Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x 3 x 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x 3 x 2 x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 2 2 x 3 Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 25 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 OP18 Regulation 13 (6) Requirement You must make suitable arrangements by training staff or by other measures to prevent residents from being harmed or suffering abuse or being placed at risk of harm or abuse. Timescale for action 14/10/06 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 OP9 Good Practice Recommendations It is recommended that instructions relating to prescriptions are clearly written and signed by two staff to ensure safe administration in the correct dose. (This refers to diabetic medication.) It is recommended that activity records show if residents have been encouraged to participate but have chosen not to and all residents, regardless of capacity, should be given regular opportunities for stimulation and recreational activities in and outside the Home and this monitored to ensure that residents social needs are met on a regular basis. It is recommended that relatives are reassured that they DS0000026697.V295464.R01.S.doc Version 5.2 Page 26 2. OP12 3. OP13 Ashdowne Care Centre 4. OP19 may visit the Home at any time and offer a private area for visiting other than a residents’ bedroom if possible. The garden should be designed to stimulate residents with dementia i.e. through smell, colours, choice of places to sit and a circular path to encourage physical activity. This may mean seeking expert advice, visiting homes with welldesigned gardens or looking at research in this area of design. (This refers to Pinnex unit and it is noted that there are plans to address this recommendation, which is carried over from the previous inspection). It is recommended that the Home ensures that the curtains are well maintained and regularly cleaned and that the armchair on Ashdowne is replaced as discussed. It is recommended that staff ensure that residents have access to call bells in communal areas. (This refers to the upstairs lounge on Ashdowne.) It is recommended that the Home facilitate making residents’ rooms on Pinnex as homely and personalised as possible. It is recommended that appropriate ventilation be provided in one particular resident’s room and/or that a discussion about the ventilation currently provided be included within the new resident assessments when admitting to this room. (This is carried over from the last inspection as no records relating to this were seen.) It is recommended that the Home monitors residents’ dependency levels and staff hours to ensure that there are enough staff to meet residents’ needs without staff working excessively hard or over their paid hours. It is recommended that staff are facilitated to attend at least 3 paid study days per year especially in relevant specialised areas. It is recommended that there are regular staff meetings and that staff are encouraged to attend and put forward their views. Quality Assurance survey results should be collated in enough detail to clearly outline the action taken relating to comments or how many residents or relatives replied. It is recommended that the Home ensures that all residents’ monies are recorded and kept correctly. (This refers to minor discrepancies in three residents’ records.) It is recommended that staff attend formal one to one supervision sessions at least 6 times a year. 5. 6. 7. OP22 OP24 OP25 8. OP27 9. 10. 11. 12. 13. OP30 OP32 OP33 OP35 OP36 Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashdowne Care Centre DS0000026697.V295464.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!