Inspection on 27/11/07 for Ashfield Court

This inspection was carried out on 27th November 2007.

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

Ashfield Court 25/11/08

Ashfield Court 12/11/08

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Ashfield Court Great Lime Road Forest Hall Newcastle Upon Tyne NE12 9DH Lead Inspector Janine Smith Key Unannounced Inspection 27th November 2007 10:40 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 Ashfield Court DS0000071023.V354495.R02.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. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashfield Court Address Great Lime Road Forest Hall Newcastle Upon Tyne NE12 9DH 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) 0191 2566344 0191 2566346 Southern Cross BC OpCo Ltd Ms June Bowman Care Home 46 Category(ies) of Dementia (46), Old age, not falling within any registration, with number other category (46) of places Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 46 2. Dementia, Code DE, maximum number of places 46 The maximum number of service users who can be accommodated is: 46 12/12/06 Date of last inspection Brief Description of the Service: Ashfield Court provides care for 46 older people who require residential care. Nursing care is not provided. The home is set over two floors, the first floor being used to accommodate 24 service users who have dementia type illnesses. A security code system is in place on the first floor doors for the safety of service users who may wander. 22 service users, who need care due to general old age, occupy the ground floor. Each service user has a single bedroom with an en-suite toilet and wash-hand basin. The home has been designed to meet the needs of people with physical disabilities and therefore has wide corridors and doorways for easy wheelchair access. There are a number of bathrooms, some of which have baths and showers suitable for use by people with mobility problems. There are attractive lounges and dining areas on each floor. The laundry and staff facilities are on the third floor of the building. There is a garden area to the rear which has gates fitted for added security. Car parking is provided at the side of the home. The home is located on a main road in Forest Hall, which provides good transport links. The local shopping centre is about a mile away. Information about the home, including inspection reports, was readily available in the reception area. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Summary: This is an overview of what the inspector found during the inspection. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 12th December 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives and staff. The Visit: An unannounced visit was made on 27th November 2007. During the visit we: • • • • • Talked with people who use the service, a relative, staff and the manager. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit • • We told the manager what we found. In early November 2007, the ownership of the home was transferred to a new company, Southern Cross BC OpCo Ltd. What the service does well: Potential residents have an opportunity to get to know the home before making a decision to move in. A resident, who had recently moved in, said he was happy with his care and treatment since he come to stay here. Residents said that the home looked after their health care needs very well and they see doctors and other health professionals when they need to. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 6 Relatives who completed surveys were impressed with the quality of care provided. The following comments were made:‘I think the service my father receives from all the staff at Ashfield is first class and he has a better quality of life now than he had living on his own.’ ‘There is all round care that seems to cater for everything. My mother is happy here. We are impressed with the due care and attention mother gets’. ‘From my own point of view, I think the care home is improving all the time’. The atmosphere in the home, particularly the first floor, was relaxed and cheerful. Residents looked happy and greeted each other and the staff. A good variety of social activities are provided, which residents enjoyed. There is good choice and variety of meals. Residents are asked to select their choice when meals are ready to be served, which is good practice. Residents liked the food. One said, ‘meals are freshly cooked and usually very appetising and the kitchen staff very supportive and helpful’. Residents are protected by the home’s complaints, safeguarding and recruitment procedures. It is commendable that 71 of the care staff team have achieved a National Vocational Qualification in care. What has improved since the last inspection? Professional advice has been sought from a dietician regarding the preparation of suitable foodstuffs for people who need a puréed diet. The serving trolley is now used in the first floor corridor at mealtimes, which has provided more space in the dining room to assist residents. Additional carer hours have been provided, which means the manager has more time for managerial tasks. Vetting of new staff has been improved, which safeguards residents. Receipts are obtained for all purchases made on behalf of residents. Checks to make sure the fire extinguishers and emergency lights are in working order were made more frequently, although the latter has lapsed again recently. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 7 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. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of potential residents are assessed before they move in, so that they could be assured they would get the care they need. EVIDENCE: The home has a Service User’s Guide, which was available in the reception area. Six surveys were received from relatives. Four said they ‘always’ received enough information about the care home to help them make decisions and two said they usually did. A person who had recently come to live in Ashfield Court said that his family had chosen the home for him after visiting several. He said he had settled in well and was happy with the care he received. He said that before he moved in, someone from the home had visited him in hospital, to find out about the care he needed. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 10 The care record showed that an assessment of his needs had been obtained from a local authority care manager and a senior person in the home carried out a further assessment before his admission. A plan of care was in place, but this was limited in scope. A senior carer spoken to said she could not recall what particular needs or health problems he had without looking at the care plan. Intermediate care is not provided in this home, so Standard 6 is not relevant. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health care needs are satisfactorily met, however the quality of care provided could be improved if a more individualised and person-centred approach was adopted. Poor practice and lack of adequate recording of medication puts people who use the service at risk. EVIDENCE: Five care records were looked at. These contained a range of assessment tools, which are used to highlight what care needs each resident has. The last inspection identified a need for staff to be given further training in using the assessment tools and drawing up detailed, appropriate care plans. Similar findings have been identified at this inspection. For example, an assessment of the risk of a service user getting pressure sores had been carried out monthly. The service user had been scored as high risk for at least three months, however there was a lack of evidence that any further advice Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 12 had been sought or a plan of care put in place to reduce the risk of a pressure sore developing. There was evidence that staff sought appropriate advice, when they saw physical evidence of skin problems, but proper use of the risk assessment tool, would enable action to be taken much earlier. An assessment tool is also used to assess the risk of residents having falls, but the plans of care put in place followed a standardised format, and did not take into sufficient account the particular problems affecting individuals. For instance, poor vision and/or the effects of some medication, may increase the risk of falls but this had not been considered when drawing up the plan of care. A tool, known as MUST, to assess whether service users are at risk of malnutrition, often had a section uncompleted which affected the score. One had been consistently scored inappropriately month after month and it was evident the scoring system was misunderstood. Some improvement has been made in care plans in that they now contain more information about residents with dementia conditions. An example seen, suggested what staff should do to help reduce the likelihood of aggression from a resident, who was confused and upset sometimes, for example by encouraging her to lay the tables or help make a bed. However, generally the care plans seen were limited in scope, for example, not covering nutrition and poor vision. Carers were frustrated about the amount of time they spent writing the records, which is understandable if they see no value or use in them. However, if used appropriately, they would provide the staff with a more effective information and communication tool and help staff to provide appropriate care. The manager said that, following the change of ownership of the home, a new record system was to be introduced in the near future and that she expected that staff would be given training in this. Residents were being weighed regularly. The cook was kept informed about who was not eating well, so that she could prepare foods that would help them. All of the care records seen showed when residents saw doctors, opticians, dentists and chiropodists. Written notes made by one carer in the care records were difficult to read, which made it difficult to understand what advice a GP had given and the instructions for a medication. Residents spoken to during the inspection said that doctors were contacted if they did not feel well and they had routine check ups from opticians, dentists and chiropodists. Moving and handling assessments were in place on the care records. One said that the resident now requires the assistance of a hoist on occasions, but did not specify the type of sling to be used. A carer said they only had one type of sling available to them. The manager said that they had two slings in the home but that these were not obtained specifically for the use of this resident. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 13 The manager was to attend a three day moving and handling course and hoped that this training would provide her with further skills. Residents made positive comments, such as, ‘everyone here is very nice’, ‘I feel much better now. I don’t know why but I’m a new man’, ‘no-one should grumble, everyone is treated well’. Six surveys were received from relatives. Five said the home ‘always’ meets the needs of their relative/friend and one said it ‘usually’ does. All six said it ‘always’ gives the support or care expected and agreed. One said ‘As soon as my mother needed medical attention, i.e. sore throat, infected eyes, the doctor was called immediately’. Another said, ‘Takes great care of the people they have to look after. I am a regular visitor to this home’. A visitor said they were very happy with the care provided to their relative, who was very happy living in the home. A sample of medication records and the system for storage, handling and administration was looked at on both floors of the home. The medications kept by the staff are stored safely. Records are kept of the prescriptions ordered and when medication is received into the home. The inspector discussed the process for administering medication with two senior carers and observed this being done. Carers were observed to offer medication to the resident and take time to ensure that the resident took the medication. However, one carer did not sign the medication administration records to show she had given the medication. She said she always signed the record before giving the medication, if the resident normally took medication without any problems. This is poor practice. A sample of medication administration records were looked at and it was found some were not accurately recorded. One resident’s record showed that she was prescribed two creams. One had to be applied twice a day, but there was no signature to show that this had been done. Another cream was supposed to be administered three times a day, but the record for one month indicated that it had not been administered at all. The senior carer said she was not sure but she thought the resident, who has dementia, applied this cream herself. The senior carer said it was not normal practice to carry out any formal risk assessment of the resident’s competence and ability to manage their own medications. There was no risk assessment on the care record to show that this resident was able to look after this medication herself. Where residents have regular medication, the pharmacist produces printed medication administration records, which detail each medication and the dosage, quantity and time of medication, which senior care staff then use when giving medication. Several medication administration records had been hand-written by staff. This was done badly with some containing no dates to show which period of time they related to, and one containing conflicting Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 14 dates. The handwritten entries had often not been signed by the person making them. One resident had been prescribed a tranquilliser to be given when required to reduce agitation. The details of the medication were untidily hand-written on one medication administration record and the strength of the medication was difficult to read. There was no detailed guidance to instruct staff when it would be appropriate to give this medication, other than an instruction to give it as required. On another handwritten medication record, the instructions for the same medication had not been recorded accurately. The instruction to give it ‘as required’ was missing. This resulted in the resident being given this medication every day over that month. There was no evidence in his care record to show that he had been agitated every day to justify giving this medication. In June of this year, a medication error occurred when medication was given to the wrong service user. Following this event, staff were given red tabards to wear when giving medication, to show that staff should not be interrupted or distracted. A carer thought that the red tabard tended to attract residents to the carer wearing it. All the senior carers had been previously trained in giving medication, and they have all recently attended refresher training. The supplying pharmacist carried out audits of the medication at intervals and a senior carer carries out a monthly audit. She had identified gaps in the medication records on several audits. Staff were observed being respectful to residents and knocking on bedroom doors before entering the room. The relationship between staff and residents was relaxed and residents who passed comments, said they were treated very well. A resident who completed a survey said, ‘manageress and care staff are courteous and caring and usually understanding of my needs and concerns’. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live their lives as they wish and can choose from a good range of food and activities. EVIDENCE: The manager stated that activities are aimed at physical and mental stimulation. Trips to places of interest occur once per month, although places on the minibus are limited. Outside entertainers come and perform for residents on a regular basis. The home employs an Activities Organiser, who helps the care staff organise and carry out social activities with residents. She described how she is now using a new assessment tool, known as PAL, to help plan activities that suit residents. The Manager had obtained new equipment to provide more variation of activities. Activities are carried out morning, afternoon and evenings. Residents are offered opportunities to attend tea dances organised by the Alzheimers Disease Society. Residents on the first floor were observed thoroughly Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 16 enjoying playing musical instruments and also singing along to songs and hymns they were familiar with. A resident enjoyed being able to keep up his hobby of painting and enjoyed visits by a group who set up film shows for residents. A relative said that plenty of social activities took place, but her relative who lived in the home declined to take part in most but did enjoy the painting activity. A couple of residents on the first floor said they would like to get outside more. Staff said that they do assist residents to go for walks outdoors, when they have time to do this and in good weather. The manager has obtained a grant which she is going to use to improve the garden. Five of the seven residents who completed a survey, said there were ‘usually’ activities they could take part in and one said there ‘sometimes’ were. One said the art activities were interesting and other activities enjoyable and appreciated what was done. A relative said she was always welcomed into the home, when she visited. A resident also said that their relative could visit daily with no restrictions and he could see her in private. A resident, who needed help with her mobility, said that staff always gave her help when she needed it ‘at the press of her bell’ and that she could get up and go to bed at the time she wanted. A resident who completed a questionnaire said the staff assisted her to have baths when she wanted. Residents’ bedrooms were personalised with belongings. The home offer choices at all mealtimes, following a menu plan. One service user has a mainly vegetarian diet. There was no separate menu plan for this and a record of the meals prepared is not always kept, so it was not possible to see whether the food provided was varied and nutritious. The cook did describe the variety of main meals she makes for this person. The cook was kept informed about any residents who were not eating well, so that she could prepare fortified foods that would help them. A problem was identified at the last inspection where the dining room on the first floor was crowded making it difficult for staff to assist residents who needed help. The serving trolley is now kept outside of the room, which has created more space. On the first day of inspection, a choice of lunch was offered of bacon chops, with butter beans and roast potatoes or lamb curry with rice. This was followed by bread and butter pudding or banana and custard. The choices were offered at the meal-time, which is good practice. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 17 A resident told the inspector without any prompting, that he had ‘thoroughly enjoyed’ his lunch. Another said the food was ok, there was always a choice and enough to eat. A relative said the food provided was good, and if her relative did not want the main meal offered, she asks for a boiled egg which is provided. Four of the seven residents who completed a survey, said they ‘always’ liked the meals, and two said they usually did. (One did not reply to this question). One added that the meals are ‘freshly cooked and usually very appetising and the kitchen staff very supportive and helpful’. A comment was made that puddings are not always enjoyable if saccarin is used as a sweetener. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and other interested parties knew how to make complaints. These are listened to and acted upon. The Manager and staff know about adult protection issues, which helps to protect service users from abuse. EVIDENCE: The home had a satisfactory complaints procedure. Residents spoken with said they did not have anything to complain about but if they did, they would readily tell the manager or staff. Since the last inspection, the home has received two complaints and there was a record showing they had been investigated and action taken to deal with the issues raised. Of the people completing surveys, five said they knew how to make a complaint, one said they did not. Five said the home ‘always’ responded appropriately if they had raised concerns about the care provided and one said they ’usually’ did. The home had procedures for protecting residents from abuse. Staff records confirmed staff had had training about safeguarding vulnerable adults. The company, who have recently taken over running the home, plan to provide update training to all staff in this area. Staff said they knew of the procedures to follow if they suspected abuse of a resident. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 19 Where residents may be at risk of harming themselves or others, the manager was aware of the need to seek professional advice and monitor residents to try and establish the causes underlying difficult behaviour. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 20 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, 21, 23, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and well-maintained environment, which was kept clean and smelled pleasant. EVIDENCE: The building was toured and a number of bedrooms seen. Residents have single bedrooms, each with an en-suite toilet. Accommodation is provided over two floors. The third floor is used for laundry and staff facilities. Bedrooms were personalised, clean and well maintained. There are lounge and dining areas on the ground and first floors, as well as smaller sitting areas in foyer areas, so residents have a choice of places to spend their time. There is a secure garden area at the rear of the home and a separate car parking area. There are plans to improve the garden area so it is more attractive for Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 21 residents to use. There are also plans to improve the bathing facilities, so that they better suit the needs of residents. There is an under floor heating system, which means radiators are not required. The home was very warm. Lighting levels were appropriate. The passenger lift was in working order and records showed that it is serviced and maintained. New window opening restrictors have been fitted on the first floor, to protect residents. Privacy locks were in place on bathroom and toilet doors. The home has a hoist, which is used to help transfer residents who have difficulties with mobility. Two slings are available. The manager was advised to ensure that where residents are likely to need to use the hoist, they are assessed to identify what type of sling they need, to reduce the risk of any accidents occurring when the hoist is used. The home was clean and smelled nice. A domestic described the cleaning routines in the home, which are thorough. The laundry assistant described the processes followed in transporting and laundering items, which helps to protect residents and staff from cross infection. Staff confirmed that protective clothing was always available to them. One relative who completed a survey, said ‘Although the home is always very clean and tidy I feel its due for some decoration and furnishings renewed’. A resident who completed a survey said, ‘The cleaning staff are efficient and attentive. Fresh flowers help. The home is always welcoming and smells fresh. My room is usually kept clean. Washing facilities are good. However, the smell of urine is sometimes/often a problem.’ Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and training have not always resulted in person centred care being given, or ensuring that residents are protected from harm. EVIDENCE: There were 45 residents staying in the home at the time of inspection and it was likely that the vacant room would be filled shortly. Examination of the rotas and discussion with the manager and staff showed that the numbers of care staff are as follows:7.30 am to 2 pm 6 or 7 2 pm to 8 pm 6 or 7 8 pm to 7.30 am 3 or 4 The manager said she was trying to ensure higher levels of staff from 2 pm onwards, due to increased needs of people living in the home. Since the last inspection, the manager’s working hours have been reviewed so that she now has more time to spend on managerial duties. The care staffing levels shown above for days and evenings are below that recommended by the Department of Health Residential Forum, which calculates the recommended number of Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 23 care staff for this size of home as being eight. Staff spoken to said that the staffing levels provided were enough to enable them to carry out their duties. However, the problems with medication and the need for more comprehensive care planning, suggest that staff may need more time to do this tasks better. Of the seven residents who completed surveys, four said the staff were ‘always’ available when they needed them and three said they ‘usually’ were. One said they would like more private time to talk to their designated carer, but that staff make time for them when they can. The staff were seen to be caring and attentive to service users throughout the inspection. A relative who completed a survey said, ‘The staff are always very pleasant and helpful’. A resident who completed a survey said, ‘the manageress and care staff are courteous and caring and usually understanding of my needs and concerns’. Staff meetings are held and are used as an opportunity to ensure that staff are aware of the results of internal audits and where improvements are needed. The manager stated that 71 of the care staff team have now completed a National Vocational Qualification (NVQ) at Level 2 or above. Members of staff spoken to confirmed the NVQ training they had done and certificates were seen on a sample of staff files looked at. Some of the staff have also received training about dementia and how this affects people. Senior staff have received training in safe handling of medicines, but are not applying the principles learned. The records of recently recruited staff were looked at, which showed that thorough vetting checks were carried out before they were employed. There is a system in place to provide new staff with induction training, and evidence that this was carried out was seen on two records looked at, but was not in place for another. Of the surveys received from relatives, five said the staff ‘always’ have the right skills and experience to look after people properly and one said they ‘sometimes’ did. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 24 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, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management and administration is carried out reasonably well and staff are given good levels of training, but quality assurance processes are not good enough to ensure that staff operate at the highest standards. EVIDENCE: Mrs June Bowman has managed the home well for some years and is registered by the Commission. She has recently been awarded the NVQ in Management and Care at Level 4. The manager understands the importance of providing person centred care and gave examples of how she tries to develop staff skills in this area, although she has had some difficulties with this. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 25 There is a quality assurance programme in place, although the format for this is likely to change as the new owners will implement their own systems. Surveys are carried out of residents and other interested stakeholders. An Operations Manager makes monthly visits and audits of various systems in the home are carried out regularly. Medication is checked through these audit processes, but our inspection findings would suggest the audits need to be more rigorous so that poor practice is identified and put right as soon as possible. A sample of records were looked at which showed that records are kept of the fees paid by or on behalf of residents. Records were kept showing how personal allowances were dealt with. The system for handling and storing money held on behalf of residents was looked at and found to be appropriate. There was evidence on staff records that staff are supervised by a senior member of staff. Evidence of maintenance and servicing of essential equipment used in the home was seen. There is a system in place to ensure that the staff team are given training in moving and handling skills, fire safety, first aid and infection control. Staff confirmed that training is provided and certificates were seen on the staff files looked at. The fire log book showed that routine checks are made of the fire safety systems, apart from recent lapses in testing the emergency lights. Staff are given fire instruction at regular intervals. A member of staff was observed to transport a resident in a wheelchair with no footplates fitted, which could put the resident at risk of an injury. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 26 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 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 28 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(1) Requirement Each service user’s plan of care must fully describe their needs and the help they require from care staff. It is advisable that all care plans cover the areas outlined in Standard 3.3 of the National Minimum Standards. For instance, recording any difficulties a service user has with their vision and how this affects their day to day life and what help they need from staff; recording each resident’s nutritional status, their preferred or required dietary requirements, what help they need with eating. Staff must be given training as necessary to meet this requirement. Written entries in the care records must be signed and readable, as otherwise important information may be misunderstood. Assessments of risk, including malnutrition, falls, pressure areas, must only be carried out by care staff who are fully trained in the assessment process and able to put an effective plan of action in place, where required. So, for instance, if a resident is assessed at risk of developing DS0000071023.V354495.R02.S.doc Timescale for action 31/03/08 2. OP8 14(2) 31/03/08 Ashfield Court Version 5.2 Page 29 3. OP8 13(5) 4 OP9 13(2) pressure sores, professional advice must be obtained and followed and a care plan put in place which tells the care staff what to do to help prevent pressure sores happening to the person concerned. Where any resident cannot weight bear, an assessment must be made by an appropriately trained person which tells staff what equipment should be used to assist them. This must detail the size and type of sling and hoist suitable for the resident, as using the wrong type could cause injury to the resident. Suitable equipment must be obtained if not already in place. Procedures for giving medicines must be improved, to reduce the risk of mistakes being made which could harm residents. Where a resident wishes to manage some of all of their medication, a risk assessment must be carried out to explore whether the person:o wants to take responsibility for looking after and taking medicines; o knows the medicines they take, what they are for, how and when to take them and what is likely to happen if they omit to take them; o understands how important it is not to leave the medicines lying around where somewhere else may unintentionally take them and be harmed as a result. 31/03/08 31/12/07 Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 30 Where care workers give medicines, the medication administration record must accurately detail all instructions about the medication prescribed, the amount of medication supplied and must be dated accurately. This provides an audit trail. Where information about medications is hand-written by care staff on the medication administration, it must be accurate, legible, signed and dated by the person making the record. Where medications, such as tranquillisers are prescribed ‘as required’, clear advice must be obtained from the prescribing doctor as to when the medication should and should not be given. This advice must be accurately recorded and understood by the staff responsible for giving the medication. This is to ensure that such medications are not given routinely or inappropriately. A record of whether medication is given to or refused by the resident must be made at the time this happens, not before. Trained care workers must apply prescribed creams, when the resident is unable to do this and a record made in the medication administration record at the time this is done. It may be helpful to refer to the guidance, ‘The handling of Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 31 medicines in social care’, issued by the Royal Pharmaceutical Society for advice on the above requirements. Requirements made following the last key inspection about medication have not been met. Draw up a menu plan or keep a 31/12/07 sufficiently detailed record of the food provided for vegetarian service users to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition, variety and choice. Not met original timescale of 28/02/07. Keep a written record of the 31/12/07 induction training provided to new staff, so that it can be shown that staff have received the training they need to do their job well. Footplates must be used when 31/12/07 transporting residents in wheelchairs, to avoid unnecessary injuries. 5. OP15 17(2) Schedule 3 6. OP30 19 Schedule 2 7. OP38 13(5) 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 OP27 Good Practice Recommendations The care staffing levels should be reviewed to ensure that staff have sufficient time to deliver person centred care. Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Ashfield Court DS0000071023.V354495.R02.S.doc Version 5.2 Page 33 - 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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