Inspection on 08/07/08 for Asher House

This inspection was carried out on 8th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Asher House 05/07/07

Asher House 02/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Asher House Third Avenue Walton on Naze Essex CO14 8JU Lead Inspector Francesca Halliday Unannounced Inspection 8th July 2008 09:30 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 Asher House DS0000066638.V368086.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. Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Asher House Address Third Avenue Walton on Naze Essex CO14 8JU 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) 01255 676100 01255 852846 Sentimental Care Asher Limited Mrs Vera Francis Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 20 persons) 5th July 2007 Date of last inspection Brief Description of the Service: Asher House is a large detached property situated in a residential area of Walton on the Naze. The home is within walking distance of the seafront and local amenities. Asher House has gardens at the rear of the building, which are only accessible to people living at the home. The home also has a small garden at the front of the building and adequate off road parking. Asher House can accommodate a maximum of 20 people over the age of 65 years who need care due to a physical disability. The home has 12 single rooms, seven of which have en-suite facilities and four double rooms. There was a stair lift for access to the first floor. The fees at the time of inspection in July 2008 were between £367 and £420 each week. The fees were dependant on the type of care package, the needs of the individual resident and also on the size of the room and whether it had en-suite facilities. Additional charges were made for private chiropody, hairdressing, toiletries, sessions at the local day centre, newspapers, private phone installation and phone bills. For up to date information about fees contact the home directly. Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. This key inspection was carried out on 8th July 2008. The term resident is used throughout the report to refer to people who live in the home and the term “we” refers to the Commission for Social Care Inspection. The registered manager was on leave on the day of inspection but the deputy manager was present. We spoke to the manager following the inspection to clarify some of the issues raised during our visit. We spoke with four members of staff, including the deputy manager and we also had a chat with five residents. Four residents and four relatives responded to our survey and their comments have been included within the report where appropriate. We also spoke with a visiting district nurse during the inspection. We carried out a tour of the premises and sampled the records held in the home. At the time of inspection the home was putting in an application to be registered to care for residents with dementia as well as residents with a physical disability. What the service does well: What has improved since the last inspection? The complaints procedure had been made more accessible to residents and their relatives. Window restrictors had been fitted to windows on the first floor Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 4, 5 (standard 6 is not applicable) Quality in this outcome area is good. Prospective residents can be confident that they will receive an assessment of their needs before making a decision about admission to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a range of information for prospective residents and their representatives. This included a statement of purpose and a service user guide. Prospective residents and their relatives were invited to visit the home as many times as they liked for short visits, or for periods of respite before making a decision about admission. A trial period of four weeks was also offered before a decision was made about permanent residency in the home. Three out of the four residents who responded to our survey told us that they had enough information about the home before they moved in and decided it was the right home for them. Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 9 The deputy manager confirmed that a pre-admission assessment was always carried out and that the manager usually undertook the assessments. We sampled three records and they showed that a good assessment had been carried out. A resident had recently been admitted with dementia and this diagnosis had been confirmed following admission. The home was not registered for dementia but the deputy manager said that an application had been made to vary the home’s registration categories to include dementia. An application had not been received at the time of inspection and we are therefore pursuing this matter. The manager said that the majority of staff had received an initial introduction to dementia care and said that further training was being arranged. Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 10 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): Standards 7, 8, 9, 10 Quality in this outcome area is adequate. Residents healthcare needs are generally met but their privacy and dignity are not always upheld. Residents cannot be assured that medicines will be managed in a way that fully ensures their safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three out of four residents who responded to our survey told us that they “usually” received the care they needed and one resident said that they “always” received the care and support they needed. One relative told us that they felt that the home “always” met the needs of the resident they visited and two relatives considered that staff “usually” met their needs. The residents who responded to our survey all told us that staff listened and acted on what they said. The majority of residents we spoke with said that the standards of care in the home were very good. Some residents considered that communication between staff and between staff and residents could be improved. One resident told us that their relatives were not informed that Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 11 they had had a fall, another resident said “things don’t get done when staff say they will”. Two relatives who responded to or survey told us that they were “always” kept up to date with health concerns and one relative told us that they were “usually” kept informed. Residents generally looked well cared for. However two residents needed assistance to clean dirty nails and one needed assistance to clean their teeth. Residents told us that staff generally respected their privacy but one resident said that some staff ignored a notice on their door asking for them not to be disturbed at night or when they wanted a rest during the day. We examined the care documentation for three residents. The care plans were in a standard format that was used for all the residents. Residents told us that they had not been involved in the drawing up of their care plans. The care plans did not generally reflect residents’ current condition, abilities or needs. They also contained limited information on residents’ interests, preferred routines, wishes and preferences. Staff had two versions of the care plans, one of which was held in residents’ rooms and the other in the office; however there were variations between the two sets of care plans that could be confusing for care staff. There was considerable detail about residents’ condition and care needs in the weekly and monthly summaries but this information was not used to create up to date and personalised care plans. This could potentially result in a lack of consistency between care staff in the way that they provided the care. The home had a range of risk assessments, which assessed the risk involved in moving and handling and the risk of the resident developing pressure sores or malnutrition. The risk assessments were updated annually. The majority we sampled had not been updated following changes in residents’ dependency, ability or risk. For example the risk of falls and moving and handling had not been updated following one resident’s fall. Another resident’s risks had not been reassessed following an overall deterioration in their condition. This deterioration was identified in our discussion with both the resident and staff. The home was part of the local falls prevention scheme and completed a monthly falls register. The register included circumstances of the fall, any injury and action taken when appropriate. Staff at the home told us that they were aware of the link between dehydration and falls and said they ensured that residents had regular drinks. The home ran a key worker system and the key workers ensured that the resident had sufficient toiletries, marked their clothing, carried out any repairs and checked whether they had any special needs such as shopping. Staff told us that the home had good support from two local GP practices. A record was made of GP and district nurse visits and changes to residents’ treatment or condition. The district nurse we spoke with during the inspection said that the staff referred residents appropriately to the district nursing team Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 12 and that they had no concerns about standards of care in the home. The majority of residents who responded to our survey told us that they always received the medical support they needed. One resident said that they received “very good attention” from their GP. We saw evidence that residents had access to regular chiropody, and had optical and dental visits when needed and residents confirmed this. One relative told us that they would like home visits from the audiology (hearing aid) department as some elderly and frail residents were not able to visit the department. The medicine administration records (MAR) were generally well completed. One controlled drug (CD) was not being kept in the CD cupboard. It was prescribed as a variable dose and it was not always possible to establish from the records what dose had been administered. This was in part due to the fact that the amount of tablets left over from the previous month had not been recorded as “brought forward”. Other medicines that were not in the monitored dosage system also did not have the amount left over from the previous month recorded. This meant that it was not possible to accurately assess whether residents had received all their prescribed medicines. When the dose of a medicine had been changed this was recorded on the MAR with the GP’s name but the person making the change had not signed the record. The manager confirmed that residents had regular medicines reviews. One resident was prescribed a medicine (a sedative) twice a day but was only receiving it very occasionally. The member of staff we spoke with said that that they would get the prescription changed to “as required” to reflect the resident’s current needs and so that staff could administer the medicine as prescribed. One container of eye drops had no prescription label and no date of opening and an inhaler had no resident’s name on it. There was a potential risk of cross infection and a risk that residents would be given the wrong medicine if they were used without a label on. Medicines with a limited shelf life on opening were not dated on first use. This could result in residents being given the medicines beyond the date that they were safe to use. Staff who administered medicines had received regular training and the manager confirmed that she had observed their practice. Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 Quality in this outcome area is adequate. Residents are offered a nutritious and varied diet but are not always given the assistance to eat that they need. Residents cannot be assured that there are regular social activities and stimulation in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user guide and statement of purpose stated that there were a wide range of activities in the home on a daily basis and that the home understood the importance of social and leisure activities for residents “as they help to maintain … stimulation, interest and social awareness … keep mobile and most importantly take an interest in life”. However, residents told us that there were no activities in the home. They said that there were only occasional outings and entertainments. According to the records there had been some outings and a few residents had been on three or four outings over the past year. These included visits to the Clacton air show, a village fete, a carnival, a garden centre and a local restaurant. A barbeque was due to be held at the home soon after the inspection and families of residents were also invited. One resident said “it’s a very lonely place here, if only we could go out. We Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 14 never even walk down the road to see the sea because of staff shortage”. One relative who responded to our survey told us that the home could do with “more outings and activities”. The home had unrestricted visiting. A relative told us that the staff “all seem very kind and if they can help you in any way they will. They always make you feel very welcome”. Two relatives who responded to our survey told us that staff “always” helped the resident they visited keep in touch with them and one relative considered that staff “usually” helped the resident they visited keep in touch with them. Residents told us that they generally had a choice about when they got up and went to bed and where they spent their day. However, they said that they did not have a choice about when they had a bath and if they missed their bath one week they would not be offered another until the following week. The food was described by one resident as “very good”, by another as “not bad at all”, and another told us the meals were “not brilliant”. One resident who had a large plateful of food in front of them and was not eating their lunch told us that they were put off eating their food because of the large portion they had been given. We did not see the resident being given any encouragement or assistance from staff in the half an hour that we observed them. We observed another resident being given the assistance they needed in an appropriate manner. The menus we looked at showed that a choice was offered at each meal and there was evidence that alternatives were given when residents did not like what was on the menu. The lunch we saw looked nutritious and there was evidence of choices available. Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. Residents can be confident that they will be protected from abuse but cannot be assured that their concerns will be addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure was contained in the home’s statement of purpose and user guide and a copy was on display in the entrance hall. There was a “feedback on concerns” form in a folder in residents’ room. However, the form directed residents or their representatives to complete the form rather than discuss the issues with staff or managers first, which might discourage some residents from raising issues of concern. The deputy manager told us that the home had not received any complaints apart from the one that was also sent to the commission (see below). However, a minority of residents spoken told us that they had raised some concerns and had not always been satisfied that the issues had been addressed. There were no records of any verbal concerns or complaints, or the action taken to address them. All the residents who responded to our survey, or had a chat with us during our visit, knew who to speak to if they had a concern or a complaint. Relatives who were surveyed told us that they knew how to make a complaint and two of the relatives who completed our survey said that staff had responded appropriately when they had raised a concern. One complaint had been sent Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 16 to the commission since the last inspection, concerning poor standards of care in the home, but it was not upheld. The home had a policy on safeguarding adults from abuse. All staff had completed a distance-learning course on safeguarding vulnerable adults. The manager told us that she was hoping to set up some further training in the near future. We spoke to a member of staff about safeguarding issues. They had a good understanding about the different types of abuse that could occur and the actions to take if abuse was suspected. Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21, 26 Quality in this outcome area is adequate. Lack of maintenance in parts of the home detracts from the homely environment. Some hazards in the environment put residents at potential risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The garden was in need of some attention and the front drive had a number of potholes. This did not give a very good first impression of the home. The rear garden was secure and had an area with chairs, tables and parasols for residents’ use. The home was planning to create a sensory garden and to install a greenhouse. The home provided a homely environment, however, some areas in the home were in need of redecoration and refurbishment. One resident told us “the place needs doing up”. A number of the carpets in the home were very badly stained and one of the bathrooms was particularly in need of an upgrade. Some of the armchairs were very stained and in need of Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 18 a clean or replacement. The deputy manager said that they had received a grant to upgrade parts of the home. Work was due to start soon after the inspection to upgrade one of the bathrooms, the kitchen, the hall and to decorate and replace the carpets in corridors and some bedrooms. Residents’ rooms were personalised to their tastes and with their belongings. The majority had a lockable drawer in their rooms for medicines, valuables or money. Window restrictors had been fitted to the windows on the first floor since the last inspection. A cupboard with cleaning fluids and the boiler room were both noted to be open during the inspection. Access to these rooms was a potential hazard for residents, particularly those with short-term memory problems or the resident with dementia in the home. The radiator in one of the bathrooms was not guarded. This could be a potential risk to residents. The manager told us that a radiator guard had been ordered. The home had three bathrooms but no shower. One resident told us that they would like to be able to have a shower. The home was clean and had no unpleasant odours on the day of this unannounced inspection. Two residents who completed our survey told us that the home was “always” fresh and clean and two considered that the home was “usually” fresh and clean. The laundry room had a washing machine with a sluice cycle but staff were not using the dissolvable bags for handling soiled linen. This could put staff and potentially residents at risk of cross infection. The home had a supply of protective equipment such as gloves and aprons. Residents’ bedrooms did not have a supply of liquid soap and paper hand towels. This would mean that staff could not carry out good infection control procedures when they gave personal care. The manager said that hand wash was ordered following the inspection. Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 Quality in this outcome area is adequate. Residents’ well-being and safety are potentially compromised when care staff work excessively long shifts. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One resident told us that the deputy manager was “excellent, very supportive, nothing’s too much trouble for her”. Residents were also very complimentary about some of the support staff. A resident described one carer as “fantastic” and said another was “very thorough, really good and so kind” and said that this carer kept them informed about any delays in attending them. Another resident described some of the carers as “really good”. However, a few residents described a minority of the carers in more negative way, for example one resident said, “everything seems a lot of trouble for them”. One resident told us that they did not like it when foreign staff spoke in their own language. The manager said that staff had been reminded that it was not appropriate to talk in their own language whilst in the home. Residents told us that there were no activities and very few outings “because of staff shortage”. Staff told us that two residents needed two carers to assist them and that the other residents could manage with the assistance of one carer. Staffing at the time of inspection was two carers during the day for twelve residents. Staffing levels had been reduced from the levels of three Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 20 during the day at the last inspection even though resident numbers were the same. One resident who responded to our survey told us that staff were “always” available when they needed them. Two residents felt that staff were “usually” available and one resident felt that staff were “sometimes” available when they needed them. Residents said that at times they had long waits for staff to attend them or answer the call bells when staff were busy. At night there was one carer awake and one asleep. In addition to this from Monday to Friday the manager worked from 09.00 to 17.00. At the weekend either the deputy manager or an additional carer was on duty in the mornings. On one week of the rotas we looked at a carer worked 77 hours. According to the rotas a carer worked a morning shift, had a seven hour break and then worked all night on more than one occasion and one carer worked a period of 24 hours without a break. These hours put staff at risk of becoming overtired and not able to sustain their best working practice for such long periods, putting residents in the home at risk or at a disadvantage. The manager said that these hours had only been worked due to the fact that two night carers had left the home at the same time. She said that the home had advertised for new staff but had not had any response. She said that the period when a carer worked 24 hours had been due to the fact that a carer did not turn up for night duty. However, agency staff were not used to cover staff absences. The home had domestic cover from 09.30 to 13.30 from Monday to Friday. There was a cook from 08.00 to 15.00 from Monday to Friday and a cook at the weekends from 09.00 to 13.30. Care staff carried out some additional cleaning as well as laundry and some kitchen duties. We sampled the recruitment records for three members of staff. They demonstrated that good recruitment procedures were being followed. There was evidence of criminal records bureau and protection of vulnerable adults list checks. Two references had been obtained and evidence of identification was on file. The manager told us that training was given a high priority in the home but that it was occasionally difficult to find suitable training and that on a number of occasions booked training had been cancelled at the last moment. Two care staff had completed National Vocational qualification (NVQ) at level 2. Three carers were undertaking NVQ level 2 and three were undertaking NVQ at level 3. The home used the Skills for Care induction for all new care staff in addition to induction for the home. The manager was booked to undertake training in the Mental Capacity Act and said that she was trying to get further places for other staff. Two residents in the home had Parkinson’s disease. The deputy manager said that they had visits and support from a member of the Parkinson’s Disease Society but none of the staff had received training on the care of older people with Parkinson’s disease. All staff had received fire safety, food hygiene and moving and handling training but some staff needed an update in moving and handling and food Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 21 hygiene. Two staff had not received health and safety and infection control training. Further training in health and safety was booked. The majority of staff had received first aid training and further training was booked. Five staff had received training in pressure area care and five in blood glucose monitoring since the last inspection. Asher House DS0000066638.V368086.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 38 Quality in this outcome area is adequate. Residents generally live in a well managed home but potential risks to their health, safety and wellbeing are not always identified and addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager had a background in nursing; she had considerable management experience and had completed the NVQ assessors’ award. Residents were generally very happy with the management of the home. A minority of residents considered that they did not see the manager on a regular basis. The manager told us that she saw the residents every day and was always available if residents had any concerns. One member of staff said Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 23 that they found the management team supportive. The deputy manager was undertaking the NVQ at level 4 in care and management. The home had a system for quality assurance but it needed to provide more evidence that individual audits were carried out at regular intervals and that there were action plans to remedy any deficiencies identified. This inspection identified shortfalls in medicines management, infection control, social activities, staffing and the safety of the environment. Residents and relatives were surveyed on an annual basis. The last survey demonstrated a good level of satisfaction with care and services in the home. A small amount of personal money was held for residents. Receipts were available for all transactions. We checked the balances for two residents and they were correct, however, two signatures were not available for all transactions. This would improve the safety of all transactions. There were systems for staff supervision in place and this included direct supervision of staff competence. We saw evidence of systems in place for the maintenance and servicing of equipment in the home. The temperatures in water outlets used by residents were monitored on a regular basis and were within the safe limits of 43c. The manager confirmed that the water outlets that were not in use were regularly flushed through to reduce the risk of Legionnaire’s disease. The fire risk assessment had been updated in November 2007. Asher House DS0000066638.V368086.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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 X X X X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 3 X 3 Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement Residents must have up to date care plans that reflect their current needs and abilities and give clear guidance for staff on how their care should be delivered. Residents must be involved in drawing up the care plans, wherever possible, so that the plans reflect their individual wishes, interests, preferences and priorities. This requirement had a previous timescale of 14/09/07 that was not met. Timescale for action 01/09/08 2. OP8 14 Risk assessments must be 01/09/08 reviewed when residents’ condition changes and must demonstrate the management action taken to reduce the risk to individual residents. This requirement had a previous timescale of 14/09/07 that was not met. Staff must ensure that controlled drugs (CDs) are stored in a CD cupboard. Staff must keep clear records of all medicines in order that DS0000066638.V368086.R01.S.doc 3. OP9 13(2) 08/07/08 Asher House Version 5.2 Page 26 checks can be made on whether residents have received all their prescribed medicines. Staff must ensure that medicines without a prescription label are not used in order that the risk of cross infection and residents being given the wrong medicine are minimised. Staff must ensure that medicines with a limited shelf life are dated on first use in order that they are not administered to residents beyond the date that they are safe to use. 4. OP10 12(4)(a) Staff must ensure that they respect residents’ privacy and dignity. This particularly refers to assisting residents with care that they cannot do for themselves and respecting residents’ wishes in relation to their not being disturbed in their room. Staff must ensure that residents’ individual social care needs are met and that their independence, quality of life and self worth is promoted. This requirement had a previous timescale of 14/09/07 that was not met. Staff must ensure that residents verbal concerns and complaints are recorded along with the action taken to address the issues that they have raised. The home must be kept in good decorative order to create a good environment for residents. This particularly refers to the condition of the carpets and bathrooms. This requirement had a DS0000066638.V368086.R01.S.doc 08/07/08 5. OP12 16(2)(m) (n) 01/09/08 6. OP16 22 08/07/08 7. OP19 23 01/12/08 Asher House Version 5.2 Page 27 previous timescale of 31/10/07 that was not met. 8. OP19 13(4) Staff must ensure that the door to the cleaning fluids and the boiler room are kept locked at all times to reduce the potential risk to residents. The manager must ensure that staff have the appropriate equipment to enable them to carry out good infection control procedures and reduce the risk of cross infection. This refers to the use of dissolvable bags for soiled laundry and the supply of liquid soap and paper hand towels in all areas that staff carry out personal care. There must be sufficient numbers of people available to work in the home to avoid staff doing day and night shifts, without sleep, as this compromises the wellbeing and safety of people they are supporting as well as their own health and safety. 08/07/08 9. OP26 13(3) 01/09/08 10. OP27 18(1)(a) 01/09/08 11. OP33 24 The manager must ensure that 01/12/08 there is an effective audit system within the home and action plans to address any improvements needed to address issues identified. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 28 No. 1. 2. Refer to Standard OP14 OP15 Good Practice Recommendations Staff should ensure that residents have a genuine choice about when and how frequently they have a bath. Staff should ensure that residents are given meals in a portion size that is suitable to their appetite and condition and assistance should be provided when needed. The home should consider installing a shower in order to give residents a choice about the type of bathing they wish to use. A double signature audit system should be in place in order to improve the safety of residents’ monies. 3. OP21 4. OP35 Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Asher House DS0000066638.V368086.R01.S.doc Version 5.2 Page 30 - 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. 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