Random inspection report
Care homes for older people
Name: Address: Asheborough House Asheborough House St Stephens Saltash Cornwall PL12 4AP zero star poor service 21/05/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gail Richardson Date: 0 2 0 8 2 0 1 0 Information about the care home
Name of care home: Address: Asheborough House Asheborough House St Stephens Saltash Cornwall PL12 4AP 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sheval Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 31 Number of places (if applicable): Under 65 Over 65 0 0 31 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 31 31 0 The maximum number of service users who can be accommodated is 31. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Mental disorder, excluding learning disability or dementia (Code MD) Date of last inspection 2 1 0 5 2 0 1 0 Care Homes for Older People Page 2 of 14 Brief description of the care home Asheborough House (previously called Beech House) is a detached property set in its own grounds with a lawned area to the side and rear. Car parking is available in the grounds of the home. Saltash is approximately five minutes away by car and has all the usual facilities of a small town. Accommodation and care to include nursing is offered at the home in the category of dementia or mental disorder. The home is entered via secured garden gates into an entrance with communal areas off to include a lounge and a dining room. A shaft lift is available to all the bedrooms in the home on the first and second floor. The laundry and kitchen are on the lower ground floor area of the home. Fees range from £550.00 to £700.00 per week (Fees correct as to the time of this report ). An additional charge is made for dry cleaning, visits from a hairdresser and chiropody. The Statement of Purpose and Service User Guide (available in an easy read format) are available on request. Care Homes for Older People Page 3 of 14 What we found:
This was an unannounced inspection, which took place over two hours on the 12th July 2010 by Compliance Inspector Gail Richardson. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. There are currently 27 people using the service. On the day of inspection on duty was the Manager Designate, a Registered General Nurse and six care staff. There were a further two staff doing breakfast service and administration staff, cooks and cleaning staff. The responsible individual was available for a short period of time. The last key inspection took place on the 21st May 2010 and had an 0 star rating. This inspection is to follow up on some of the requirements made at that time relating to staff recruitment, induction, training and supervision. We looked at staff records for three staff recently recruited to the home. We found that none of the statutory requirements relating to these areas had been fully addressed or met within the timescale stated. What the care home does well: What they could do better:
We looked at the recruitment files for three staff members. The files identified that each person had an application form and a signed declaration of the Rehabilitation of Offenders Act. We noted that one person had identified on their application form a gap in employment history. All gaps must be explored and documented prior to staff starting work at the home. This is required to ensure that people remain safe. Two people had only received one reference. One person had one written and one verbal reference. We were told that a verbal reference had been received but this was not documented or recorded. The registered person must ensure that all staff have recruitment checks in place which includes two references, this is to include one from the most recent employer or the reason why this is not possible. This is required to ensure the protection of people using the service. Two files had POVA (Protection of Vulnerable adults) and CRB (Criminal record Bureau ) checks in place. One person had a recent CRB check from a previous employer. When this is the case, the registered person must undertake a risk assessment and appropriate checks to ensure that in the interim before a new CRB is received, the employer can establish that people using the service are safe. All three staff had started work after the POVA was received and prior to the CRB being received. The manager designate told us that staff in this position are supervised at all times. This is written on the board in the staff office. It is recommended that this record be made permanently so that it can be referenced if needed in the future.
Care Homes for Older People Page 4 of 14 We are told that all staff starting work at the home have a three month induction period. The induction is undertaken with a senior member of staff. We were unable to speak with any new members of staff to review if this is a successful arrangement and will review this area at the next inspection. We looked at staff training. We were told by the manager designate that staff training had been booked for moving and handling and that two staff had undertaken dementia care training. The manager designate has begun to re organise staff training and has issued all staff with an audit sheet to establish what training is needed. It is recommended that the manager designate undertake a staff training matrix to establish training needs to enable this training to be provided. This will promote and develop staff skills to meet the needs of people using the service. Further development of staff training for dementia is needed. The homes improvement plan told us that the induction is to include dementia care and outside and internal training is to be sourced and provided. Further staff training in all mandatory areas must be undertaken to ensure that all staff have the skills needed to meet peoples needs. The manager designate told us that staffing levels are assessed using the level of dependency of people using the service. No evidence was available of how this was calculated. This is required to ensure that there are always sufficient staff available to meet the current needs of people using the service. One staff member told us that they felt staff were available in sufficient numbers. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 1 3 The registered person must ensure that information supplied to prospective people using the service is an accurate reflection of the services provided. This will enable people to make an informed decision about the services and facilities available. 24/06/2010 2 2 14 The registered person must 24/06/2010 ensure that a pre admission assessment is undertaken for all new admission to the home. The pre admission assessment must be made available to staff prior to admission. This is required to ensure that the home is suitable for the purpose of meeting the needs of thep prospective person using the service. 3 7 15 The registered person must 24/06/2010 ensure that risk assessments and appropriate plans of care are put in place for each persons areas of assessed needs. These care plans need to be reviewed and updated to reflect any changes in care need.
Page 6 of 14 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action This is required to ensure that people using the service receive the care they needs and staff have a current plan to follow. 4 8 12 The registered person must 24/09/2009 ensure that monitoring and a record of this monitoring is undertaken for people who are nursed in bed and do not have access to summon assistance. This will ensure that people have access to staff when needed. 5 8 12 The registered person must ensure that the facilities for bathing are put inplace and monitored to ensure that peoples bathing needs can be met. This is required to ensure that personla care choices and preferences can be met. 6 9 13 The registered person must 24/06/2010 ensure that all hand transcribed medications are signed by two people. It is further required that any changes in rescriprion on the medication administration record is signed and dated by the person making those changes. This is rerquired to provide a clear audit trail of any changes.
Care Homes for Older People Page 7 of 14 24/06/2010 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 7 9 13 The registered person must ensure that the controlled medication cupboard is correctly sited on a fixed wall. This is required to ensure that it meets with the Royal Pharmaceutical guidelines. 24/06/2010 8 9 13 The registered person must ensure that the mediaction administration records are audited and any gaps investigated and a coded indicator inserted. This is required to ensure that there is evidence of prescribed medications being given or thje resons provided for them when not given 24/06/2010 9 12 16 (2)(m) People must be able 31/01/2009 to engage in local, social and community activities, within their capabilities, and as they wish. Arrangements for this should be part of care planning. So people can live a fulfilled life and are not socially isolated. 10 12 16 The registered person is required to develop a programme of meaningful activity for each person. This actvity should be recorded to further develop activity to support people choices and preferences. 30/09/2009 Care Homes for Older People Page 8 of 14 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 11 16 22 The registered person must 25/06/2010 ensure that complaints are managed in line with the homes complaints procedure. All complaints must be investigated and a record maintained of actions taken. This is required to ensure that there is clear evidence of the management of complaints. 12 18 12 The registered person must ensure that all staff have received training in abuse awareness. This is required to ensure the protection of people using the service. 30/10/2009 13 25 12 The registered person must 25/06/2010 ensure that all hot water outlets are monitored to establish that they do not exceed the health and safety hot water upper limits. This must be undertaken to ensure that there are no risks of burns and scalds to people using the service. 14 27 18 The registered person must ensure that there are sufficient numbers of staff consistently available to meet the needs of people using the service. The means to measure service user dependency 25/06/2010 Care Homes for Older People Page 9 of 14 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action must be taken into consideration when providing staffing levels to ensure that the levels of staff are correct to meet peoples needs. 15 29 19 The registered person must 30/10/2009 ensure that all staff have recruitment checks in place which include two references, this is to include one from the most recent employer or the reason why this is not possible. This is required to ensure the protection of people using the service 16 29 19 The Registered Person must ensure that all appropriate recruitment checks are in place prior to people commencing employment at the service. This must include a full employment history and appropriate police checks. This is to ensure that people using the service are not at risk of harm. 17 30 18 (1)(c) Staff must be trained and competent in all conditions which affect people at the home, especially dementia. So that people receive appropriate and effective care. 18 30 18 The registered person must 25/06/2010
Page 10 of 14 02/03/2010 31/03/2009 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action ensure that all staff complete an induction program within a reasonable timescale before they work unsupervised in the home. This is required to ensure the safety of people using the service and staff members. 19 36 12 The registered person must ensure that all records relating to people using the service are stored confidentially and in line wit the Data Protection Act. This is required to ensure the dignity and confidentiality of people using the service. 20 37 12 The registered person must ensure that accidents are recorded and audited. This audit is then used to promote accident prevention. 21 38 18 The registered person must 19/03/2010 ensure that all staff have the skills both individually and collectively to provide the care to meet peoples needs.This is with reference to moving and handling training. This is required to ensure that staff and people using the service are not placed at risk of injury. 22 38 26 The responsible person must 26/02/2010 forward all Regulation 26
Page 11 of 14 25/06/2010 25/06/2010 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action monitoring visit reports to the lead inspector. This is required to ensure that we can continue to monitor closely the development of the service. Care Homes for Older People Page 12 of 14 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 26 The registered person is recommended to record how staff are supervised in a permanent record. This will enable a clear audit trail of how people were supervised. It is recommended that the manager designate undertake a staff training matrix to establish training needs to enable this training to be provided. This will promote and develop staff skills to meet the needs of people using the service. 2 26 Care Homes for Older People Page 13 of 14 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 14 of 14 - 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!
