CARE HOMES FOR OLDER PEOPLE
Ashfield House Bargates Leominster Herefordshire HR6 8QX Lead Inspector
Wendy Barrett Unannounced Inspection 7th December 2005 11:15 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.V272400.R01.S.doc Version 5.0 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.V272400.R01.S.doc Version 5.0 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 880242 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.V272400.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th July 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 DS0000024690.V272400.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 11.15am and 2.30pm. The Deputy Manager was in charge of the service and the Provider called into the home during the inspection. There were enough staff on duty to care for the 11 residents. Time was spent with the cook discussing the catering arrangements. A care assistant was interviewed and residents were met during a tour of the premises. A sample of records was inspected. The inspection focused on core National Minimum Standards that were not addressed at the last inspection. What the service does well: What has improved since the last inspection?
The staff have been working hard to improve their written records of the care they give each resident. The Provider has met with the staff and consulted them about the staffing arrangements.
Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 Page 6 There has been more work to look at ways of helping residents with a dementia to enjoy appropriate social activities. 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.V272400.R01.S.doc Version 5.0 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.V272400.R01.S.doc Version 5.0 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): None EVIDENCE: Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 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 the following standard(s): 7 and 8 Residents’ care needs are met through the skill and experience of the staff. Other care professionals are consulted appropriately but junior staff don’t have written guidance (care plan) from management and/or other professionals when they have to deal with emerging needs. EVIDENCE: There has been a considerable amount of work done since the last inspection to develop an improved system for recording plans of care. However, there were indicators that staff do not yet understand how to use the new recording system to best effect. Assessment work is now being well recorded with evidence of evaluation and review. Care needs identified in this work are still not reflected in action plans to instruct staff in the way they should meet the residents’ needs. Day reports for one resident described aggressive, restless episodes although a recent entry following routine evaluation recorded ‘no change’. It is essential that this type of development be subject to recorded risk assessment and action plan that instructs staff how they should deal with these episodes. There was no clear record of a management response to information in the day reports although the records did make brief reference to consultation with a community psychiatric nurse and medication review. Entries are not always being made in the appropriate section of the care
Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 Page 10 planning format and sometimes important entries had been made on loose pieces of paper. The Provider later confirmed over the telephone that social services staff and community psychiatric nurse had been asked for additional support in managing the aggressive behaviour of the resident. A review meeting had been planned for the near future. Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 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 the following standard(s): 15 The residents are offered a healthy diet and meals prepared with attention to hygiene and safety. The individual needs and preferences of the residents are taken into account. EVIDENCE: The Provider’s action plan following the last inspection referred to the purchase of specialist activity equipment for people with dementia related conditions. There was also a proposal to consult Age Concern about relevant training for staff. The situation will be reviewed at a future inspection. The cook had many years catering experience. She had completed food hygiene refresher training within the previous 12 months. A second cook and the interviewed care assistant had also completed this training. The cook felt that she had the equipment she needs. The kitchen was clean and tidy at the time of the inspection. The lunch for the day consisted of freshly cooked gammon, fresh vegetables and home cooked bread and butter pudding. There was written guidance in the kitchen to help staff with their work. A policy on meals referred to National Minimum Standards. Menus and records of alternative choices were being maintained. A kitchen-cleaning rota was displayed. Fridge and freezer temperatures were being checked and recorded
Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 Page 12 although there were a few gaps. It is important this work is continued in the absence of regular kitchen staff. A care record contained details of a feeding assessment and food preferences and staff showed awareness of individual likes/needs in this respect. Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 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 the following standard(s): None EVIDENCE: Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 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 the following standard(s): 26 The residents live in clean, hygienic surroundings. EVIDENCE: There were many examples of attention to general hygiene. The home was clean and tidy and there was no evidence of malodour. Waste bins in residents’ bedrooms had obviously been recently emptied. Commodes were clean. Staff are supplied with disposable gloves and aprons to avoid spread of infection. It would enhance the homely appearance and residents’ dignity if these could be stored out of sight although they do, of course, have to be readily accessible to staff. Liquid soaps and paper towels were also seen around the home. Records of general cleaning rotas and collections of clinical waste are kept. Laundry facilities are satisfactory to meet the needs of the home. The laundry room was clean and tidy. An interviewed care assistant was aware of policies and procedures that offer guidance in areas such as infection control.
Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 Page 15 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 There are enough staff to meet the residents’ needs. EVIDENCE: Following a requirement arising from the last inspection The Provider held a meeting in September to discuss staff views on staffing levels and support and supervision arrangements. The Deputy Manager confirmed that a programme of one to one supervision is due to start at the beginning of 2006 although the staff meeting did not highlight any concerns about staffing arrangements in general. A Care Assistant felt that there were enough staff on duty although there were obviously peak activity times when things were rather busy e.g. meal times. Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 Page 16 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): 33 The home is run in the best interests of residents. The views of residents, relatives and other stakeholders should be formally sought from time to time to make sure they are satisfied with the outcomes of this work. EVIDENCE: Ashfield House is a relatively small service with a Provider who is actively involved in everyday life at the home. Systems of informal communication and consultation tend to work well in this size of home. The Provider proposed to implement a formal system of quality monitoring by the end of October 2005. This should include a method of formal consultation with residents, relatives and other stakeholders to gain their views on the service. The situation will be reviewed at a future inspection when the Provider is present. There are a number of things already in place that contribute to this type of work e.g. a programme of refurbishment, staff meetings, action plans submitted to the Commission in response to inspection requirements and recommendations.
Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 Page 17 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x x x x Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 Page 18 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 of 31/08/05 only partly complied with) The activity programme must include opportunities designed to suit residents who have dementia related conditions. (Not reviewed. Carried forward with revised timescale) Develop a quality assurance system and set it up as a working tool. This must include formal consultation with residents, relatives and other stakeholders. (Previous requirement partly complied with.) Timescale for action 31/03/06 2 OP12 16(2)n 31/03/06 3 OP33 24 31/03/06 Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 Page 19 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 OP26 Good Practice Recommendations Keeping disposable gloves etc. out of view would maintain the homely feel of the building, and also protect residents’ dignity. Ashfield House DS0000024690.V272400.R01.S.doc Version 5.0 Page 20 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
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