CARE HOMES FOR OLDER PEOPLE
Ashfield House Bargates, Leominster, Hereford, HR6 8QX Lead Inspector
Wendy Barrett Announced 19 July 2005 09.30 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 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 House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ashfield House Address Bargates, Leominster, Herefordshire, HR6 8QX 01568 614662 01568 880242 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs M Wenlock Mrs M Wenlock Care Home 13 Category(ies) of Dementia over 65 years - 13 registration, with number Old Age - 13 of places Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 14th February 2005 Brief Description of the Service: Ashfield House is a Victorian three-storey detached house, set in large, mature gardens and situated on a main road through Leominster. There is a large dining room and conservatory that overlook the gardens. There is also a separate lounge and library. Two bedrooms are also on the ground floor. One of these has an en-suite facility. Seven single bedrooms and two double bedrooms are upstairs. A stair lift is installed to enable residents to access this accommodation. Three of the upstairs bedrooms have en-suite facilities. There is a ground floor shower room with wheelchair access and two bathrooms on the first floor. The baths are of a specialist design to assist access for people with mobility difficulties. The garden has a secured area so that residents can safely spend time outside. The front door is fitted with a coded lock and staff have a pager system, including direct link to the sleeping in room, so that they can respond to the residents call bell. The service is registered to accommodate 13 older people, male or female, who may have needs arising from the normal ageing process or from dementia related conditions. The Statement of Purpose confirms that the home cannot accommodate residents who may have behaviours that significantly impact on other residents in a negative way. Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection that was undertaken between the hours of 9.30am and 4.15pm. The Provider was present at the home to assist with the inspection. The Commission sent feedback questionnaires to the home in May 2005 and the Provider was asked to distribute these to residents, relatives and staff in order to obtain a wider view of the service. Five staff, three relatives and one resident responded to this request. This is not a large enough response to form any firm conclusion but this report includes reference to those responses that were submitted. Four residents were interviewed. Others were met during a tour of the premises. A Senior Care Assistant and a Care Assistant were also interviewed. Documentation was referenced as part of the inspection process. This included the Provider’s response to the last inspection report, information on the Commission’s file, and records required by regulation that are maintained at the home. What the service does well: What has improved since the last inspection?
The written records kept at the home are being developed so that they show more detail of how staff go about their care work with each individual resident. The Provider has improved the way she checks that potential new staff are suitable to work closely with vulnerable adults. Staff training programmes are now arranged so that they are in line with national specifications for staff employed in care homes. Staff receive health and safety training and they are also offered training to help them cope with the particular needs of the residents who live at the home.
Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 6 The way that medicines are managed has been reviewed with attention to the advice of a professional pharmacist. This means there is a safer system of dealing with the drugs at the home. There is now a secured garden area so that residents can spend time outside without the risk that they may wander away from the home and get lost. 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. Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 3. There is information literature available at the home to help prospective residents decide whether the home will suit them. There is a commitment to pre-admission assessment work. EVIDENCE: The Provider has updated a Statement of Purpose to include all the required information. There is a Statement of Terms and Conditions of Residence. This refers to a four week trial period to allow the resident and staff at the home to assess the suitability of the placement. Residents were unable to confirm their awareness of the above information literature as they had relied on relatives to arrange their admission. There has been a new care planning system introduced at the home. This includes the facility to record needs assessments. The effectiveness of this system in addressing pre-admission assessments will be inspected at a later date when there has been an opportunity to apply it more fully. Residents were unable to recall the type of contact they had with senior staff at the home prior to their admission.
Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 There is still work to be done to produce written individual plans of care for each resident although residents feel their care needs are being met. Staff know the care needs of the residents. They treat the residents respectfully. Medication is safely managed. EVIDENCE: A care assistant well described the care needs of an individual resident. Residents and relatives expressed confidence in the care provided e.g. ‘overall, we are extremely happy with Mum’s care’. A hoist was seen in the bedroom of a resident who has mobility problems. There were no residents with pressure sores. The Provider has recently purchased a care planning recording format and some work had been done to start using this. There have been previous inspection requirements regarding the introduction of comprehensive care planning systems and so there will now need to be early attention to achieve full implementation. The records of work done to date include evidence of assessment work. The care planning sections had not yet all been completed. There was an example of consultation with relatives as part of a risk assessment. This work had been properly recorded and signed by those
Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 10 involved. The care-planning format is comprehensive and includes attention to areas such as diet and feeding, skin care. There is also reference to evaluation and review. The Provider will need to monitor how effective the new format is when fully utilised. The use of tick boxes and the limited space for entering additional information may create difficulty in showing how the plan is a working tool that will regularly need amending in response to emerging needs. There should be evidence of the competence of Staff to undertake particular types of assessment e.g. manual handling. Day and night reports are well written. In order to comply with relevant legislation re: access to records, night staff should use separate recording sheets for each resident. The Provider has complied with previous requirements made by the Commission’s pharmacy inspector e.g. the stock cupboard has been fixed securely to a wall, receipt, administration and disposal records are fully completed. Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 14 Residents can choose how they live at the home and are offered a variety of activities. They are able to maintain contact with their relatives and go out into the local community if they wish. There will need to be further development of activities that are particularly suited to people with dementia related conditions. EVIDENCE: Part of the garden has recently been secured so that confused residents can walk outside without risk of them wandering away from the premises. A relative feedback commented that her mother could not always sit outside due to another resident who was at risk of wandering. The introduction of a secured garden area should solve this problem in the future. Residents were observed pursuing a variety of activities e.g. puzzle book, sewing, listening to classical music. A relative mentioned weekly exercise sessions. One resident described continuing opportunity for religious worship e.g. visits from a Minister, communion at the home every month. Regular art sessions take place. Residents referred to contact with relatives e.g. one resident uses a mobile phone supplied by the home to speak to her son in the privacy of her bedroom. The Provider is purchasing professional literature about dementia care although no specific examples were identified to indicate how this information is being applied at the home.
Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 12 The care records included reference to residents having choices e.g. refusal to accept a bath. There had been consultation with a resident and her relatives about potential risks associated with unescorted walks into the town centre. It had been agreed that the activity should continue. All who were involved had signed a record of the risk assessment. Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents and relatives are able to approach the staff with any concerns, and that they will be taken seriously. Staff have the information they need to protect residents from abuse. EVIDENCE: The Statement of Purpose includes appropriate information about the method of raising complaints at the home. There is also a Complaints Notice to advertise the procedure at the home. The relatives who sent back feedback questionnaires had made no complaints to the Provider, and the Commission has received none. The relatives indicated their awareness of the home’s complaints procedure. A resident felt that she could talk to the Provider and staff if she had a problem. The Provider has consulted an advocacy group with a view to bringing in an advocate for any resident who is unable to express concerns and has no involved relative to represent them. The staff were informed about procedures relating to the protection of vulnerable adults at a staff meeting in September 2004. A care assistant explained that she had received written information about abuse awareness from the Provider. She had also learnt about this subject as part of her N.V.Q. award and was able to describe the correct way of raising any related concern to her employer or to outside agencies. Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 The residents live in a safe, comfortable and well maintained environment. EVIDENCE: The Commission has received a ‘Programme of Refurbishment’ undertaken between April 2002 and November 2004. This reflects a considerable amount of redecoration and refurbishment achieved in this period. There were examples of more recent work e.g. covering of heating radiators that present a risk of scalding, new fridge, dishwasher and range cooker. New worktops have been fitted in the kitchen, and a new fly screen is in place. The home was clean, tidy and odour free at the time of this inspection. Furnishings and décor are of a good but homely quality. One bedroom was in need of redecoration but the delay was understandable due to the resident’s reluctance to vacate the bedroom. The grounds are well maintained. Water temperatures are thermostatically controlled and electrical appliances are routinely inspected. There is a premises fire risk assessment in place. Staff have a maintenance
Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 15 book for alerting the provider to any repair or safety work identified as they go about their work. Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The residents needs are being met by staff although the staff group should be consulted about any difficulties experienced in maintaining this at all times. The residents are protected by the recruitment practice at the home and staff are trained to enable them to do their job competently. EVIDENCE: There was a satisfactory level of staff for the twelve residents accommodated at the home on the day of inspection. The Care Manager, a Senior care assistant and a care assistant were on duty. A separate cook and a cleaner were supporting them. Four of the five staff feedback questionnaires indicated that there were not always enough staff on duty for either the cleaning or for spending social time with residents. Staff interviewed at the home did not express concern. One of the staff felt that the Provider was offering more training and support to make the task easier. The purchase of a hoist and prompt attention to repairs were examples given of improved working conditions. The discrepancy in staff views about staffing levels should be discussed at future staff meetings. Two staff records included Criminal Records Bureau disclosures. A completed application form and written reference from the last employer was also seen in the file of a recently appointed employee. The Provider has introduced an induction programme for new staff that meets the nationally recognised specifications. Both staff on duty at the home had achieved N.V.Q awards. The Senior Care
Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 17 Assistant had considerable previous experience at a senior level before being employed at the home. Her personal file contained copies of certificates for relevant training previously undertaken. There was good evidence of health and safety related training identified at the home and within staff questionnaire responses e.g. manual handling instruction had been received within the previous twelve months. There were a few examples of staff who had not attended a fire drill at the recommended frequency i.e. at least one per year. Professional practice training was being provided e.g. infection control and dementia care. Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36 and 38 The home is small enough to allow the Provider to lead the care practice through regular, direct contact with each resident and the staff group. The Provider will need to review the reason for some staff feeling less supported than others. There is evidence of ongoing attention to promote the health and safety of residents and staff. EVIDENCE: Ashfield House is a comparatively small home where the Provider maintains regular oversight of staff, and the care provided to each resident. There is work underway to introduce a formal system of supervision and appraisal. This should be pursued as staff feedback questionnaires contained conflicting information about the level of support from the Provider. However, most staff felt they were given the information they need to do their job well. A Health and Safety poster is displayed at the home and the Commission has
Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 19 received a copy of a health and safety policy implemented at the home. Eleven staff had received fire safety instruction on 6th July 2005. The fire log contained records of checks of fire safety equipment at the required frequency. The last fire drill was recorded in June 2004. All staff should participate in a fire drill at least once a year. The accident book complied with Data Protection requirements. There is further evidence of attention to health and safety factors recorded under the ‘Environment’ section of this report. Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x 2 x 2 Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? 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 33 Regulation 24 Requirement Develop a quality assurance system and set it up as a working tool. This is a repeated requirement. There is evidence of work underway to fully comply and so the requirement timescale has been put forward to allow the Provider to complete the work. Written records about each residents care must be kept and stored separately to maintain confidentiality. Work must continue so that all residents have comprehensive and up to date care plans in place. The activity programme must include opportunities designed to suit residents who have dementia related conditions Staff must be consulted about their views, particularly in respect of staffing levels and support and supervision. Timescale for action 30th September 2005 2. 7 17 31st August 2005 31st`Augus t 2005 30th September 2005 30th September 2005 3. 7 17(1)a 4. 12 16(2)n 5. 27 and 36 21(2) Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 22 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 38 Good Practice Recommendations It would be advisable to review the management of fire drills to ensure that all staff participate in a drill at least once a year. Ashfield House E52-E02 S24690 Ashfield Hse V230545 190705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street, Hereford, HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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