Inspection on 24/09/07 for Ashdowne Care Centre

This inspection was carried out on 24th September 2007.

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 12/07/06

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 Caroline Rowland-Lapwood Unannounced Inspection 24th September 2007 09:35 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.V345675.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.V345675.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 Vacancy 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.V345675.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. 12th July 2006 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 been linked by an enclosed corridor but continue to accommodate people with distinct types of nursing needs in each separate unit. Pinnex accommodates 26 people who are elderly with mental health needs. Ashdowne accommodates 34 elderly people requiring general nursing care. Kate Ley the acting manager manages the Home as a whole. The Home also makes provision for respite and convalescence care on Ashdowne unit. The sides and back of the property are garden areas and the front is a car park with a porta-cabin 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 £496-670 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 people as required. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. The site visit began at 09:35am and finished at 4.20pm with two inspectors present throughout the day. One inspector focussed on Pinnex unit the other on Ashdown. During that time we spent time talking with the people living at the home, with staff, visitors and the acting manager. Some of the people living at this home have dementia type illnesses and cannot communicate directly therefore some time was also spent looking closely at the care and accommodation offered to these people. Care plans were read and we spoke with staff about how they meet the care and individual needs of the people living there. We toured the premises, including all shared areas and the majority of peoples’ accommodation, and a sample number of other records were inspected which included medication records/procedures, staff recruitment files, service and maintenance certificates and fire safety records. Prior to the site visit surveys, asking for comments and feedback, were sent to 25 people living at the home/relatives and 10 were returned; to 10 members of staff and 7 were returned; to a variety of health and social care professionals and 5 were returned. Their comments and opinions are included in the main body of this report. In addition the manager completed an annual quality assurance assessment (AQAA), which included information on issues such as training, policies and procedures, staffing levels and meals. There were 26 people living on Ashdowne unit and 21 on Pinnex unit at the time of the inspection. What the service does well: People have the information they need to make an informed choice about their admission to this home. The home has a written statement of purpose; this document sets out the aims and objectives of the home and provides information about the service in the form of a booklet. This booklet was available in the entrance of the home; it has recently been reviewed and updated and now contains current information about the staff available in the home. A guide to services in the home was also seen in the bedrooms of some people. The admissions process is safe; an assessment of care needs of people takes place prior to admission to the home. Documents provided evidence that staff use a standard pre- admission assessment form; this is used to assess peoples’ ability to undertake their activities of daily living. Other records seen included copies of assessments carried out through care management arrangements and hospital/community health care teams where applicable. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 6 Each person has a plan of care which they are involved in developing whenever possible. Healthcare needs are well met with evidence of multi-disciplinary working. Comments included ‘the staff are really good’ and ‘ they do everything I need”. All the people who responded in surveys said that they always receive the care, support and medical support they need. Staff work towards maintaining the privacy and dignity of people, ensuring that relationships are respectful, that they receive all personal care in private and ensuring that they wear their own clothes at all times. People spoken with confirmed they receive a good level of care. Staff were seen treating people living at the home with respect and promoting their dignity. They were observed in conversation with them and were heard to be courteous and respectful. People were complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from clients included: ‘the staff are kind and help me when I need them’. The feedback about food was positive - all of the people spoken to said how good it was; people requiring assistance with their meals were given this in an appropriate manner. During a period of observation, everyone appeared to be enjoying their meal and were in a positive mood. Complaints received from relatives are dealt with efficiently and the manager views this system positively as a way of improving the quality of the services provided. People are protected from abuse through the training of staff in safeguarding vulnerable adults. The home has good systems in place to safeguard residents’ cash and valuables. People are protected by the home’s recruitment practice, which is good. People benefit from having skilled, experienced and friendly staff who have a good understanding of their needs. The acting manager is very highly respected by staff and people living at the home. Staff feel well supported and in turn say they want to support her. She has many years experience of working within a nursing background and has an open, inclusive and problem solving style of management. Good systems are in place to ensure the home is run in the best interests of the people living there to promote their wellbeing and safety. What has improved since the last inspection? All staff has now had training in the protection of vulnerable adults, this will ensure people living at the home are well cared for by people suitable to do so. There is now a private room available for visitors to visit their friends or family in private. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 7 There are plans underway to create a sensory garden, plans of this were seen and work is likely to start in the New Year. This will greatly benefit the people living at the home as they will be able to access the garden and move around it safely Efforts have been made to ensure bedrooms are now more personalised and homely. Staffing issues have improved with regular staff meetings and individual supervision sessions being planned for the near future this will benefit staff and enable them to have “a voice” within the home and contribute to good and safe working practices. Quality assurance is now better managed with new systems in place. There are safe systems in place to ensure people’s monies are well managed. What they could do better: Not all people living at the home have their care planned in a way that coordinates their care, promotes choice or which ensures that consistently high standards of care can be delivered. Aspects of the management of medicines must be addressed so that practices are safe and people’s wellbeing is assured. The activities at the home are adequate however; particular consideration should be given to stimulating and meaningful activities for people with dementia to ensure that individual preferences can be met. To ensure a pleasant and comfortable environment is available for all people, work to improve the environment needs to continue as per plan. People still do not have access to call bells either in the lounges and not all in their bedrooms (this recommendation was made at the last inspection). Staffing levels should be kept under review at all times to reflect the changing needs of the people living at the home. More attention to cleanliness of particular areas of the home is required in order to reach a more acceptable standard. The health and safety of service users and staff needs to be consistently protected. Fire doors must not be wedged open. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 8 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. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 9 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.V345675.R01.S.doc Version 5.2 Page 10 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): 1,3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have enough information about the home before they move in which helps them make an informed choice about whether the service is right for them. The personalised needs assessment means that people’s needs are identified and planned for before they move into the home. The home does not provide intermediate care EVIDENCE: Ashdowne People have the information they need to make an informed choice about their admission to this home. The home has a written statement of purpose; this document sets out the aims and objectives of the home and provides information about the service in the form of a booklet. This booklet was Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 11 available in the entrance of the home; it has recently been reviewed and updated and now contains current information about the staff available in the home. All surveys from people living at the home showed that they had received enough information about the home before moving in so they could decide if it was the right place for them. Four peoples’ files were looked at. The home had obtained comprehensive assessments completed by a health or social care professional, such as community psychiatric nurse, or care manager. Good evidence was seen to show that the home liaises with family and representatives during the assessment and care planning process. The manager will visit people at home or in hospital in order to complete assessments. Three assessments looked at were detailed and contained important information about health and personal care needs as well as individual preferences. All staff responding with surveys said they were not asked to care for people with needs outside of their experience. Pinnex An up-to-date Service user guide was seen in bedrooms; this included a quality of care survey for people to complete. The complaints procedure in it did not include CSCI, nor contact details for the provider although it said people could speak to him. Two pre-admission assessments we saw were generally comprehensive apart from having little information about people’s social history, past lifestyle and routines, interests, etc. Care plans from Social Services care managers had been obtained, as well as information from the person’s previous carers. A mental health nurse said they had been involved in pre-admission assessments, helping to ensure the home was suitable for the prospective resident. Care staff said they sometimes had access to information about expected admissions. Admission checklists were completed, showing staff tried to inform people about the home early in their stay. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 12 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, & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangement in place for planning people’s care generally ensures that people get the care they need in a way that suits them. However, this needs to be consistent on both units. Peoples’ health care needs are generally well met by good practice and monitoring, and close working with other professionals. However, all staff must be aware of the individuals needs in order to care for them appropriately. Medication is generally well managed with the exception of one aspect of recording administration. People are treated with dignity and their privacy respected. EVIDENCE: Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 13 Ashdowne Those people that were able to said they receive a good level of care. Personal records held on behalf of 3 people were examined in detail; there were documented assessments which provided information about skin integrity, moving and handling, safety - including risk of falls, nutritional screening and social needs. The information in the assessments had been used to form the plans of care and provided the basis from which the care was to be delivered. For instance one care plan showed an individual who had particular needs with regard to skin condition and pressure area care, clear guidance was written on how to care for this person effectively. Care plans are reviewed monthly and evidence was seen that they involve the person living at the home and/or their relative whenever possible in this process. Nutritional assessments were being performed and people’s weights were being regularly recorded, support and advice had been sought from specialist health personnel such as dieticians if needed. Some people in the home are nursed in bed, all were seen to be comfortable and warm, however none had a call bell close by to call for assistance if needed. Personal histories have been developed by the staff and with the relatives that contain important information about the persons’ past life and occupation, which gives a sense of who this person is. Personal histories are particularly important for people with diminished communication. Records are kept about all visits to the home by social or health care professionals. Records provided evidence that as well as visits from GPs, district and specialist nurses and chiropodists also visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. Surveys were returned from one General Practitioner, one specialist nurse and two social services care workers. Comments about what the service include: ‘ the people always look comfortable and well cared for’ and, ‘ I always see people in their own rooms, privacy is well respected”. Other surveys received from people living at the home said they “ always” or “usually” receive the medical support they need. The medication system is well managed. Medication storage and recording and procedures were inspected and administration practice observed. There is a system for ordering, receiving, storing and returning medicines, which is well understood by staff and followed to ensure safety. Controlled drugs were looked at and stock numbers checked all were in correct. Staff demonstrated a good understanding of how they can help people to maintain dignity and how they can ensure they have privacy. For example all care is given in private and people wear their own clothes at all times. Staff Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 14 were seen knocking on bedroom doors before entering and speaking with people in a friendly yet respectful way. Pinnex Each person had a comprehensive care plan. One person said staff had come to them to discuss their care plan with them, whilst another said their care plan had been discussed with their family, seeming happy with that. Another care plan had evidence that the views of another person’s next-of-kin had been included in a review of their care. Care staff said they referred to the care plans, and seemed to know people well. Some care plans did not always reflect the person’s state of being in a positive way. One person’s care plan said they had a ‘high risk of wandering’, yet their pre-admission assessment said there was no risk of absconding, and a carer said the person only walked about when they were wanting the toilet. We saw the person being assisted to walk, by one member of staff. Care reviews said they had not had any falls for over five months. Another plan included that the person should be allowed to walk around during the night if they were found doing so; however, staff had not completed a prompt elsewhere to find out the person’s preferred night routine to clarify if this was usual for them or if there was a reason they were not sleeping, etc. Information had been added to some but entries were not signed or dated, so it was not clear what care was supposed to have been given at any one point in time, timescales, etc (For example, ‘Waiting for replacement aid’ without any way of knowing if this was a few days old or months old, in which case this matter may need to be followed up]. One care plan usefully informed about triggers for adverse changes in one individual’s behaviour, so staff could act to prevent those triggers. Information on the Mental Capacity Act was seen in the office. One person had had new glasses recently. Specialist nurses were supporting staff in caring for people with sores. The home had ensured people attended hospital appointments. However, there was an inadequate care plan to meet needs due to diabetes, for one person. One care staff spoken with did not know what particular care a person with diabetes might need. Reviews were recorded 2-3 monthly. Most reviews were usefully detailed, but some entries gave little information to show the success or otherwise of planned care and how the person had been. Pre-printed care plans had not always been personalised to properly reflect each individual’s needs and how they should be met. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 15 Two people who had been at the home for over five months had no Social Activity or History entered on the form provided in their care plan. Some related information was elsewhere, in a file kept separately by activities staff. A health professional said the home usually sought advice and acted on it, seeking more advice if necessary including when the patient did not agree with initial advice. They said if staff did not have the necessary skills to support people, they asked for specialist advice. Risk assessments were carried out 2-3 monthly for some potential physical problems (such as malnutrition, or falling). The family of someone relatively new to the home said they had spoken to staff because the person had been losing weight. The home had taken action; the person was eating better now and was being monitored by the home. A nurse told us they had had recent training on nutrition. More than one staff member was involved in ordering medication stocks, which is good practice. Medication received for each person was usually recorded on his or her medication administration sheet (although we saw occasional omissions), and a photo was also available for each person. One person’s care plan included appropriate guidance for staff relating to the person’s reluctance to take prescribed medication. A nurse described appropriate disposal of unwanted medications. One person was prescribed a skin cream, but there were few signatures on the administration sheet to show it was being given as prescribed. Staff said it was kept in the person’s room and carers applied it. The home needs to show staff applying it has been trained in its administration including keeping records of its administration. There was a handwritten alteration made to instructions for one medication (increasing its dose) that was not signed or dated for future reference if necessary. Fridge temperature records showed it was maintained at recommended levels for ensuring efficacy of items stored in it. Two items kept in the controlled drug cupboard were checked. Balances held tallied with records, which were well kept (two signatures, etc.). Two items in this cupboard were awaiting return, having not been used for some time. Staff were aware such items should be returned more promptly and agreed to address this. We also saw that the outer cupboard was used to store purses and alcohol, which is inappropriate. One care staff said they were occasionally asked to give medication to people who were out of sight of the nurse doing the medicine round, which is not good practice. No guidance was seen for staff regarding this practice. A health professional said staff ‘tries to maintain privacy and dignity within a communal home environment’. One person’s care plan included that they preferred female carers for personal care. Another health professional said Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 16 they were able to see people in private. Some double bedrooms had curtains between the bed areas. However, arrangements were not sufficient to ensure the privacy of anyone using the sink. Senior staff said they would address this. Some bedrooms had Yale door locks. People asked said they had a key for their door. One person told us they had their own phone line put in but there was also a payphone in the corridor for others to use. We saw there was no provision for privacy when using this phone, however people are given the choice to use the office phone in private if so required. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 17 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, & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good provision for activities for people at the home and this would be further improved with meaningful care planning to ensure that peoples’ individual preferences, potential and diverse needs are met. The people living at the home benefit from the good relationships the home has developed with their relatives and representatives. Some people are enabled to make some choices and have some control over their lives whilst others who lack the capacity to communicate their wishes do not. The people that live in the home enjoy a balanced diet which takes into account the likes and dislikes of most individuals. EVIDENCE: Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 18 Ashdowne Two people responding to CSCI surveys said there were activities arranged by the home that they could take part in others said there were” sometimes” activities. The home has two dedicated activities organisers, which work differing hours but provide activities Monday to Friday. Group and individual activities are organised. Three surveys received commented that there were “not enough outings”. Two staff members identified activities as an area for improvement. One wrote, “more staff to take residents out on trips would be good”. Peoples’ hobbies and interests had been briefly explored but little detail of how to meet their social needs was described in care plans. For instance in the lounge the radio was tuned to the local radio station, but there was no communication about whether this was the service users choice, it appeared rather that an assumption had been made that people living there would like the radio on. During the inspection people were seen spending varying periods of time unoccupied apart from when receiving care. The home has established good relationships relatives and visitors. Those responding to the CSCI survey confirmed that they were always welcome at the home and that they were always informed and consulted with regards to their relative. One relative wrote, “Staff do a very good job.” Peoples’ preferences regarding daily routines and choices were not consistently recorded to identify what time people like to get up or go to bed or how and where they spend their day. However, staff did confirm that there is no set routine and for those people that are able to state their preferences and that they choose what to do and when. However, for people that lack capacity and have difficulty expressing their wishes clearly agreed routines and preferences would be useful to guide staff. Positive comments were received from people living at the home regarding the meals. From surveys four people said they “always” like the meals and two said they “sometimes” enjoy the meals. One person said if they didn’t like something they were always offered an alternative. Pinnex Care staff told us that two activities staff had been on relevant courses. A list of coming TV sports programmes was on the upstairs lounge doors, staff saying one person particularly liked sports. One person said they were taken out fortnightly (in a wheelchair) by staff, and that other people were also taken out as she was. It was not clear, from staff or records, how often people in the upstairs lounge were offered opportunities to go outside into the garden, which was easily accessed from downstairs. A carer said people had been brought Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 19 downstairs to the garden in the summer, when ice creams were served out there. Records, kept till July 2007, of activities sessions showed activities staff spent ten minutes with each person during these sessions. Records are now kept for each individual so it is easier to see how much attention each person has had over time. One person remaining in their room said they chose not to go to activities provided but did not see activities staff or other such input on a oneto-one basis either. They also said they would like to go out on the grass more often, being able to see a garden from their room; it was not clear how often they were offered such an opportunity, needing assistance with their mobility. The last entry in their activities record was four days prior to our visit (when the record was started), indicating someone had chatted with them (but with no indication of how long for, or what they talked about). Another person also had just one entry, five days prior to our visit, when they discussed the newspapers. A third person had two entries, one of which included going out into the garden. Care notes for September 2007 had little reference to activities or recreation. Visitors we spoke with knew about a new visitors/quiet room; they were in the lounge when we met them, but they said other visitors used it. People may visit at any time. A health professional said staff ‘promotes life choices within a communal home where consideration has to be given to all residents’. One staff said they always offered people a choice of hot drinks even though they knew what they were likely to choose. We heard staff engaging with people with an open, approach. Care records showed some flexibility in daily routines, enabling people to choose in some way how they wanted their day to go. One person said the food was ‘very good indeed, in general’, although they felt it wasn’t such a high standard on Fridays and Saturdays. A staff member when discussing someone’s care included that they often made last minute requests for their favourite foods, which - because the home had noted these and told the kitchen about them – were kept in stock and could be provided at short notice. These items were culturally significant for the person. Homemade cakes, fresh fruit and vegetables were seen in the kitchen. One person, when asked about food provided, said it was good, adding that they were on a diet and were given nice salads. Another said the food was good but said they had to wait for it. We were able to clarify that this applied to mornings, when they were waiting for their breakfast. Staff said breakfast is served from 9am. Senior staff said snacks were available in the evening, in case people needed to eat more before settling. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 20 Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 21 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure and there are systems in place to ensure that investigations are undertaken, which means that people can be confident that their complaints will be listened to. Staff has a good understanding of what to do to protect people from abuse, however additional guidance will protect people further. EVIDENCE: Ashdowne & Pinnex The complaints policy is given to all people living in the home. In surveys respondents say they always know who to speak to if they are not happy and know how to make a complaint. All complaints made to the manager are recorded and once investigated a letter sent to the complainant stating any findings and actions taken, documentary evidence of this was seen. Two people said they felt able to make a complaint, and named people they would or had spoken to about issues. They felt the home would try to resolve matters. Visitors and a health professional also reflected this. Care staff said they would advise people to report concerns or complaints to the nurse in charge, or would pass the concern/complaint on to the nurse themselves. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 22 No complaints have been received by the CSCI since the last inspection in July 2006. All staff responding with CSCI surveys were aware of procedures to protect people from harm, however when speaking with three members of staff not all of them were clear on the alerting processes especially when witnessing verbal abuse, they felt that reprimanding a fellow worker would be enough instead of reporting it to the manager. Other staff spoken with said they had had recent updates on safeguarding. They were able to give appropriate examples of unacceptable practice (such as forcing people to do something, or blocking people into chairs to stop them walking about), and knew they must report this to senior staff. One carer described multidisciplinary working to provide the most appropriate care for someone whose needs were challenging the service. This approach had included the person’s family also. A safeguarding policy was seen and although it did not include any contact numbers it did guide people to Social Services procedures. Training records showed that all staff had undertaken training in relation to adult protection issues. All people living at the home asked said they felt safe at the home. The home’s gift policy was displayed in the office, with staff signing to confirm they had read it. We saw inventories had been completed for individuals’ own property. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 23 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): 19,20,23,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is safe and improvements to some of the décor and fabric have been made, however there is still work to be done to ensure a pleasant, clean and comfortable environment is available for all people. People have homely bedrooms, which suit their needs. Generally the home was heated adequately but some parts of the home were cold. EVIDENCE: Ashdowne Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 24 The home has an open, welcoming reception area from which the corridor links Pinnex unit to Ashdowne. Décor is of a reasonable standard with refurbishment on going, carpets are due to be replaced to ensure the home remains comfortable and homely. On the ground and first floors there is a lounge/dining room bathrooms and bedrooms. The home is well maintained, with pleasant, comfortable communal areas for residents to enjoy. A tour of the building found the home was clean in some areas but not all, many bedrooms had dirty tables. It was free from odour on the day of the inspection; people confirmed that it was ‘always’ or ‘usually’ like this. Both sluicing areas were clean and gloves and alcohol gel were freely available to ensure good infection control. The home deals with clinical waste appropriately. All bedrooms visited had been personalised with items such as pictures, photographs and various pieces of furniture. The front of the property has car parking for staff and visitors. A passenger lift and ensures that all areas of the home are accessible to all people. Pinnex Those asked liked their rooms generally. Bedrooms were personalised, although some had pictures hung quite high on the walls. This meant for one person sitting in their room they could not easily view the pictures. The use of lino in some areas gave a less homely feel than where carpet was used. Light bulbs were 60 watts and one room had a dark inverted lampshade that reduced the light coming from the bulb. People spoken with said lighting was sufficient in the evenings. However, good lighting should be a consideration where people have needs due to dementia. The carpet in the upstairs hall (outside the lounge) and the lounge carpet were showing signs of wear and becoming a tripping hazard in one area. The lift interior also needed some attention. There were raised toilet seats, a level access shower, and baths with fixed hoists to help people get into the bath. A toilet seat upstairs looked very worn and scratched. Dust had accumulated on some pieces of equipment (bath hoists, toilet frames, etc.). The corridors were cold on this day, one person sitting in their room had a blanket wrapped round them, they said they were cold, although the thermometer on the wall said the temperature was 20 degrees C. Many of the windows were open throughout the home suggesting that staff had opened Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 25 them as they became warmer as they worked. The owner agreed to ensure all the radiators were working properly and to check the temperature. The home is secure with key coded entry. This allows residents to freely wander around the home in a safe way. There is an enclosed level garden with a veranda, accessible from the ground floor lounge/diner, which some people took themselves out to during our visit. The garden is to be developed to make it suited to the needs of people who have dementia. One person, whose room overlooked another garden, said that area had been improved from rough ground to a lawned area. They said they liked birds, and we saw a bird table outside their window - which staff said the home had provided. The staff in the laundry described appropriate washing procedures for dealing with soiled and other laundry, in order to ensure it was properly cleaned. There were two washing machines and two tumble driers for the home. The area was orderly, although dust had accumulated in some places and the hand wash facilities were obstructed. Care staff said kitchen staff were responsible for the kitchenette on the lower floor, and monitoring fridge temperatures. This area was not very clean. Staff were seen taking an electric razor from one bedroom, using it for another person, which is not good infection control practice. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 26 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing numbers are generally sufficient to ensure that peoples’ general care needs can be met. People are protected by the home’s recruitment practice, which is good. People benefit from having skilled, experienced and friendly staff that has a good understanding of their needs. EVIDENCE: Ashdowne Three people living at the home responding with surveys said that there was not enough staff available when needed; two felt that staff were “usually” available when needed. Staff said they felt more help was needed especially in the mornings to ensure that they had time to “ do all the extras” not just the bare necessities for the people living at the home. Comments received on surveys returned by staff included ‘in my opinion we are short staffed, there should be more care on per shift so we can give more time to each person instead of always having to rush them”. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 27 During the day staff appeared to be very busy but well organised. People looked well cared for and call bell were answered fairly quickly. People spoken with during the inspection said that staff were “very good and “lovely”. Currently 32 of staff has achieved a nationally recognised qualification in care (NVQ 2 or above), which falls short of the expected standard. Other areas of staff training require consideration and planning in order to continue to meet the changing and challenging needs of the people living there. Staff spoken with had not received specific training in relation to dementia but expressed enthusiasm for training and felt that it would improve their skills. Training records seen showed that most staff had had training in mandatory topics such as First Aid, Moving & handling, Infection control & Protection of Vulnerable Adults. Pinnex In the morning, there were four care assistants and a nurse looking after 21 people on two floors. There was also an activities staff, who spent the morning with individual people – playing a game (dominos, etc.) the person liked or chatting. One staff said they were rostered to come in at 7.30am - a bit earlier than other staff - so there were more staff available at this busier time of day. We were told that initially there are two carers on each floor, but once everyone is up, a carer goes downstairs to where most bedrooms are. This leaves one staff upstairs with seven people, and three care staff downstairs in the area with the larger lounge/diner. In the afternoon there were three care assistants with a nurse on duty; staff said one carer remained on each floor, with the third moving between the two as they were needed. The nurse said they were able to help for periods of time, but had nursing or shift leader duties to attend to. Some visitors said they could usually find a member of staff. We found either a care assistant or an activity staff in the lounges whenever we visited them. However, the staff member was not always engaging with people. Staff said with levels lower in the afternoon, it was harder to provide recreation because they were alone at times, they were maintaining general safety of everyone in the area, and were thus not able to give their time to one person for any length of time. They said the situation was worsened if someone was particularly agitated. However, one person also said the mix of people on any one shift also affected how well they managed with the current staffing levels. Senior staff felt training on engagement, providing fulfilling experiences, etc. was needed, Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 28 rather than higher staffing levels – so staff knew how to use their time to benefit the people they were looking after. A member of staff who had joined the home since the last inspection confirmed the home used appropriate, safe procedures for recruiting staff. They also said they had been given an induction to the job, not having worked in care settings before (although they had relevant some experience through working with the public). Two staff felt they were supervised in their work but had not had formal supervision (when they might discuss training needs, etc.). They had had some training about dementia. One staff said they had a yearly appraisal/progress report, and thought they had had at least two days of training in the last year. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 29 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home, relatives and staff benefit from the friendly and open management at the home. There are arrangements in place to involve people living at the home and their representatives in the running of the home, with evidence that their views are sought. Systems are in place to ensure that peoples’ personal monies are correctly managed. Formal supervision for all staff will improve care practice. Health & safety is well managed. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 30 EVIDENCE: Pinnex & Ashdowne The Registered manager has just left, Kate Ley who was previously the deputy manager is “acting up” as manager until a new Registered manager is appointed. She is a Registered General Nurse and has many years experience in caring for older people and has worked in the home for seven years. She has a ‘hands-on’ approach and staff and relatives felt that the manager was accessible. Three of the seven staff responding to the CSCI survey said they received formal one to one supervision. The Manager indicated that formal supervision was being introduced, which will give staff an opportunity to review targets and training, and access improvements and achievements. Observational supervision will allow the manager to identify where staff may need support. The manager will oversee supervision but had not received training to support this. The manager thought specific training would assist greatly when undertaking this role (Registered managers award). The home is developing systems to ensure the quality of the service is monitored. Questionnaires have been sent to relatives and some people living at the home, these are formally reviewed to assess the satisfaction levels of those who responded. A comments box is also being introduced; this will be in the reception of the home for visitors to use as a way of giving their ideas and comments to again improve quality. People living at the home said they went to monthly meetings on Ashdown, which they found worthwhile. Another remembered completing a survey from the home, but wasn’t sure when. Visitors spoken with felt communication was good. The majority of staff responding with CSCI surveys said staff meetings did not happen on a regular basis, the manager was aware of this and has planned to make them more frequent beginning in the near future. One staff felt staff meetings were not useful or positive, besides always being in the evening, which did not suit them; others found them useful or helpful, however. The home encourages family or advocates to assist people to manage their finances. Good systems are in place to ensure that peoples’ monies are managed appropriately. A representative of the company undertakes monthly audit visits and from that produces a report, which is sent to the CSCI. Fire safety appeared to be well managed; records showed that fire equipment is serviced and maintained regularly and that staff receive training. However, Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 31 on a tour of the building it was found that the laundry door was wedged open. We discussed this with senior staff that a more appropriate door-holding device should be fitted for this fire risk area. An environmental health inspection in January 2007 identified work to be undertaken in the kitchen. The kitchen was generally clean and well organised. Regular fridge temperatures are recorded to ensure safe storage. We saw kitchen staff used current good practice guidance. The area looked clean and orderly with hand wash facilities available. Documentation was seen of maintenance of equipment and water, gas and electrical systems. Window restrictors have been fitted to windows where we looked for them this will reduce the risk of falls, and all radiators were covered which reduces the risk of scalding. People we asked said they did not find any problems or hazards in the home. One said staff checked the bath water with a thermometer before the person got in. Bath water records in each bathroom and a thermometer were seen. Staff who were asked felt they had a safe working environment, and sufficient equipment to do the job expected of them. Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 32 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 3 3 X 3 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 33 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 OP8 Regulation 12(1)(a) Requirement Proper provision must be made to ensure that all people have their health care needs met and be recorded in the care plan. All staff must be aware of these needs and how to meet them. A record must be made of all administrations of medicines made to any person living at the home to ensure they are given medicines as prescribed. This includes the application of external products. Fire doors must not be wedged open (laundry) so that all people within the home are kept safe. Risk to people that live at the home must be identified and eliminated or reduced as far as possible. On this occasion this includes 1) The replacement of worn carpets that present a trip hazard. This is to ensure people are kept safe. Timescale for action 31/10/07 2 OP9 13(2) 17(1) 31/10/07 3 4 OP38 OP38 23(4)(a) (c) 13(4)(a) 31/10/07 30/11/07 Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 34 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 OP8 Good Practice Recommendations Care plans need consistency & sufficiency of information in all plans so that the people living at the home get the care they need at all times. It is recommended that staff ensure people have a call bell at all times when left unsupervised so that they can call for assistance at any time. It is recommended that consideration be given to ensuring that complete privacy is given when the sink is being used in a double room. It is recommended that consideration be given to ensuring privacy when using the pay phone. Activities should be meaningful and appropriate to the individuals’ capabilities so that everyone living at the home has a fulfilling life. It is recommended that peoples’ preferences for their daily routine be planned for and that social needs and interests are clearly documented so they can be met appropriately especially for those people who are not able to communicate their wishes very easily. It is recommended that staff ensure choice and autonomy is promoted for less able people. Improvements to the environment need to continue, as are planned, to ensure service users live in a comfortable, well maintained home. Arrangements should be made so that each person has a lockable space for money and valuables. The temperature in the home must be monitored to ensure people are kept warm at all times. The premises should be kept clean and hygienic throughout. It is recommended that staff do not use electric shavers for more than one person to ensure good infection control measures. It is recommended that the Home monitor peoples’ dependency levels and staff hours to ensure that there are enough staff to meet residents’ needs without staff working excessively hard. DS0000026697.V345675.R01.S.doc Version 5.2 Page 35 2 3 4 5 6 OP8 OP10 OP10 OP12 OP12 7 8 9 10 11 12 13 OP14 OP19 OP24 OP25 OP26 OP26 OP27 Ashdowne Care Centre 14 OP28 15 OP30 16 OP32 It is recommended that at least 50 of the staff group be trained to NVQ Level 2 or above so that people living at the home can be assured that they are being well cared for by appropriately trained staff. It is recommended that staff receive training in topics that will beneficial in meeting the needs of people living in the home (for instance activities/engagement with people with dementia, Lewy Body dementia & Diabetes). It is recommended that there are regular staff meetings and that staff be encouraged to attend and put forward their views. It is recommended that staff attend formal one to one supervision sessions at least 6 times a year. 17 OP36 Ashdowne Care Centre DS0000026697.V345675.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 © 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.V345675.R01.S.doc Version 5.2 Page 37 - 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!