Inspection on 03/08/06 for Ashfield House

This inspection was carried out on 3rd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashfield House 03/11/09

Ashfield House 28/05/09

Ashfield House 07/06/07

Ashfield House 07/12/05

Ashfield House 19/07/05

Ashfield House 14/02/05

Ashfield House 03/08/04

Ashfield House 04/02/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Ashfield House Bargates Leominster Herefordshire HR6 8QX Lead Inspector Wendy Barrett Unannounced Inspection 09:45 3 August 2006 rd 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 House DS0000024690.V300049.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. Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashfield House Address Bargates Leominster Herefordshire HR6 8QX 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) 01568 614662 01568 839100 Mrs Margaret Mary Wenlock Mrs Margaret Mary Wenlock Care Home 13 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (13) of places Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 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. The range of fees was £339-00p. to £400-00p. as at 5th May 2006. There are additional fees for hairdressing, chiropody and provision of transport to hospital. Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Provider was away on holiday when this unannounced inspection visit took place. It was not, therefore, possible to cover some areas of the service because junior staff do not have access to the necessary information e.g. staff personal records. During May 2006 five residents and seven relatives’ returned survey forms about their experience of the service. The Provider completed a pre-inspection questionnaire and has also sent the Commission two reports of resident falls, and one report of a chair lift temporarily out of order. All this information has been considered, as well as that gathered during the inspection visit, in writing this report. Staff and residents were met and interviewed during the inspection visit. A relative was also interviewed about her experience of the service. Some records were examined at the home. The Provider was given a verbal feedback when she returned from her holiday and she was able to clarify a few remaining questions arising from the inspection visit. What the service does well: What has improved since the last inspection? Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 6 The way that staff record the work they do in caring for each resident is improving. The information is more comprehensive and there is a clear format to use so that each record is designed in the same way. 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 DS0000024690.V300049.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 Ashfield House DS0000024690.V300049.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are carefully managed so that there is the best opportunity for new residents to settle comfortably into the home. EVIDENCE: A relative described her experience of admitting her mother to the home. She had been able to visit the home to look around, and she was asked for her approval of her mother occupying a shared bedroom. She had received information literature from the home. The staff had also consulted the relative when they wrote an initial care plan. The Statement of Purpose was updated in 2005 and copies of Statements of Terms and Conditions were also seen at this time. These information documents clarified that admissions are always subject to a 4-week trial period. A sample of records relating to pre-admission assessment work and information gathering were seen during the inspection visit. Community Care Assessment reports had been obtained from placing authorities for funded Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 9 residents. These records provided examples of good attention to individual needs and preferences e.g. falls assessment and action plan, resident’s request to have bed a little removed from bedroom wall. There were a few examples of omissions e.g. a record did not contain a photograph of the resident, dietary assessment only partly completed in one case. Ashfield House DS0000024690.V300049.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents’ receive good attention to their health and personal care needs. The written records of this work are improving although the detail is not consistently entered. There should be a review of the current medication procedures because some currently recognised good practices have not yet been adopted. EVIDENCE: During the past six months the Provider has been developing an improved method of recording individual plans of care. The sample records seen during this inspection visit showed that there is a more comprehensive written assessment of needs and preferences as a result of this work with associated risk assessments and care plans. One of the records seen during the inspection visit had not been fully completed although the Provider later explained that there was more information in her office. It would be a good idea to tighten up the process for recording care plans and encouraging staff to Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 11 use them as an everyday working tool. Although the staff clearly have a good awareness of the way they should care for each individual, written records offer clearer information about the way care is planned and provided. A relative was impressed with the way staff responded to her mother’s dementia illness. A resident described eating difficulties and weight loss. The care plan referred to this and the cook was also aware of the situation. The care records included examples of prompt attention to routine and emerging health care needs and a relative commented ‘as soon as anything goes wrong they consult the G.P. or District Nurse’. Medication was securely kept in a purpose designed storage unit. The stock was being kept to a minimum. This is good practice. The Senior on duty at the home during the inspection visit described a number of good practices e.g. medication key kept on the person of the staff member in charge, receipt of medication training from Boots pharmacist, sample staff signatures shown at the front of the administration record file. The medication policy and procedures had not been revised since December 2004. This should now be done as a number of currently recognised good practices were not being followed. Pre-printed instructions should not be altered, allergy boxes should always be completed, and two staff should check and sign transcribed entries to reduce the risk of error. Residents felt that the staff treat them well and it was evident during the inspection visit that residents can choose whether they prefer the privacy of their own bedroom or to spend their days sitting with others in the communal areas. A visiting hairdresser said ‘they give them a choice, they try to let them make their own decisions’. Relative comments on survey forms were also positive. Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to live each day in the way they prefer and the staff provide any support needed for them to do this. The residents receive a satisfactory meals service. EVIDENCE: During the inspection visit residents were observed making choices about the way they spent their day. Some residents were enjoying the privacy of their own bedroom while others were sitting together in communal areas. There are a variety of activities organised – trips out, keep fit musical entertainment. The local vicar was due to conduct a service at the home on the day of the inspection visit. A resident said that the staff shop for her stamps and sewing thread, as she does not have any relatives to do this for her. A care record included details of dietary need. The resident confirmed her difficulty enjoying meals and concerns about her weight. The cook felt that she had adequate supplies and equipment to prepare a healthy selection of foods. Multi-choice breakfasts and teas are always available and the cook showed awareness of individual likes and dislikes in Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 13 relation to main meal choices. Alternatives were being offered and the Provider later confirmed that a record is maintained of lunch alternatives as well as the breakfast and tea choices. A resident survey form stated ‘very good food’. An Environmental Health Officer had inspected the kitchen at the home in January 2006. The Provider confirmed that this was satisfactory with no recommendations arising. Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are confident that their concerns will be taken seriously. The residents are protected from abuse by a staff group who receive training and written guidance to help them recognise and report any related concerns. EVIDENCE: The home has a written complaints procedure that is available to residents and their relatives. There have been no complaints made to the home or to the Commission during the past twelve months. A relative’s survey form included the comment – ‘I have only had to make one complaint and it was dealt with straight away’. Resident survey forms confirmed that they felt able to speak to staff about their concerns – ‘will speak to carer if not happy’, ‘we can speak to the owner or write to her’. An Adult Protection policy is implemented at the home and was reviewed in March 2006. There is also a Whistleblowing policy that guides staff in the way they can raise concerns. This has also recently been revised in December 2005. The Provider has confirmed that staff have received training in the Protection of Vulnerable Adults (POVA) during the past twelve months. Two staff Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 15 mentioned attending this training when they were interviewed at the home during the inspection visit. Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ accommodation is very pleasant and well looked after. Health and safety factors are well managed. EVIDENCE: The premises are well maintained in a way that reflects a homely, caring attitude. The safety of residents is well addressed so that they can move around freely with as little risk as possible e.g. secure garden area. The Provider ensures that professional contractors regularly check essential services and equipment. There was a brief tour of the accommodation during the inspection visit. All areas were clean, tidy, fresh and comfortable. This finding supported the view Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 17 of several relatives –‘cleanliness superb’, ‘mother’s room is sunny, bright and fresh smelling’. A relative survey form referred to some broken furniture in the dining room/conservatory. The relative quite rightly considered this to be a health and safety hazard. The Provider confirmed her awareness of this concern, and no faulty furniture could be identified in the dining room at the time of the inspection visit. The Provider has implemented an Infection Control policy and this had been revised in 2005. Future training programmes for staff include attention to health and safety. A cleaning rota was seen in the kitchen. Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the residents’ needs. The staff receive training to help them work in a safe and professional way. EVIDENCE: There was a satisfactory staffing level when the inspection visit took place. An experienced carer was in charge and the Deputy Manager was due in to work later during the afternoon. Care assistants, a cleaner and a cook were also at work. Arrangements for the rest of the day and the night cover were clarified and were also satisfactory. There is little staff turnover so residents benefit from staff who know them well. Half the care assistants hold an NVQ level 2 qualifications. The pre-inspection questionnaire includes details of an in-house training programme that covers health and safety, dementia care, medication administration. It was not possible to explore the detail of this during the inspection visit because the visit was unannounced and the Provider was away on holiday. Similarly, it was not possible to access any staff personal files. It is reasonable that junior staff should not have access to confidential information about their colleagues. Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Provider manages the home with business competence. The residents feel their interests are well represented by a competent staff group and a Provider who spends a lot of time on site. The management approach works well for the relatively small size of service but recording systems e.g. care planning and medication, need to be more robust to fully meet current standards. Although it is understandable that inhouse training programmes are more suitable for the small number of staff employed, it is important to ensure that the trainer has the necessary qualification to provide the instruction e.g. manual handling. Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 20 EVIDENCE: The Provider has considerable experience and had achieved the required qualifications to fulfil her responsibilities as the Care Manager. Residents and staff benefit from the Provider’s leadership through her active involvement in everyday life at the home. The Provider states ‘ Residents’ families deal with finances and savings, so I have no knowledge of it’. Three residents handle their own financial affairs and three are subject to Power Of Attorney arrangements. This information confirms a flexible approach to meet the wishes and needs of each individual. Relevant policies and procedures have been implemented at the home and these are being reviewed to keep them up to date. There is good attention to health and safety issues. This is evident in the comments from relatives and observations made during the inspection visit. Staff training programmes include health and safety aspects e.g. food hygiene, risk assessment, manual handling. Methods of auditing, consultation etc. as part of quality monitoring were not inspected this time. The Commission are being informed of notifiable events at the home e.g. accidents, essential equipment failures. This complies with regulatory requirements and it demonstrates an open management approach that will strengthen the safety of residents. Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 21 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 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 2 Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 17(1)a Requirement Work must continue so that all residents have comprehensive and up to date care plans in place. (previous timescale mostly met. Some more work required to achieve consistency) The medication policy must be reviewed and procedures updated to fully address current good practice guidance. Develop a quality assurance system and set it up as a working tool. This must include formal consultation with residents, relatives and other stakeholders. (Not reviewed. Carried forward with revised timescale) Timescale for action 31/10/06 2. OP9 13(2) 31/10/06 3. OP33 24 31/12/06 Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 23 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 OP30 Good Practice Recommendations The Provider should satisfy herself that the in-house training programme will achieve National Training Organisation targets. Ashfield House DS0000024690.V300049.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 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. 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