Inspection on 07/06/07 for Ashfield House

This inspection was carried out on 7th June 2007.

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 03/08/06

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

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

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 Key Unannounced Inspection 7th June 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashfield House DS0000024690.V336221.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.V336221.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 F/P 01568 614662 margaret@wenlock8457.fsnet.co.uk 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.V336221.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd August 2006 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. All existing residents have been given a copy of a service user guide that describes the service provided at the home. There are plans to supply each bedroom with a pack of information literature e.g. service user guide, complaints procedure. Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written with reference to information about the service and held by the Commission, an annual quality assurance assessment (AQAA) completed by the Provider and an unannounced inspection visit to the service. A sample of survey forms was sent out to obtain feedback on the service. One relative response was received. A district nursing team also completed a survey form. What the service does well: What has improved since the last inspection? A new call alarm system has been installed. When residents are admitted to the home there is more consultation with them and/or their families to make sure the introduction to the home is a good experience for them. The records that describe the care provided to each resident have been improved so that they give staff better up to date guidance about individual care needs and residents’ wishes and preferences. Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 6 More staff have achieved a national qualification (NVQ) and there has been more in-house training for them. Some of the most important aspects of the care have been strengthened with the development of up to date policies and procedures to guide staff e.g. medication management, infection control measures. 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 House DS0000024690.V336221.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.V336221.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Proposed admissions are carefully considered and planned to try and make sure that they will be a good experience for the resident and the service. EVIDENCE: Residents are only admitted to the home once the Provider has obtained as much information as she can to help her assess if the home is likely to suit the particular individual’s needs and expectations. This work has been improved over the past year. Relatives are asked to fill in a ‘family form’ to help the staff get to know new residents. The Provider also checks if the admission has been successful from the resident’s viewpoint. She has introduced comment cards for this purpose. Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 9 Potential residents and their families are encouraged to visit the home before deciding if they want to pursue a placement, and all new residents have a trial period as a way of testing if the home will suit them. A recently admitted resident had been well supported by health and social care professionals in choosing Ashfield House as the most appropriate place for her to be cared for. Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The records of care and the way medication is managed have been improved as part of the work to keep residents safe and comfortable. Staff work well with other care professionals in making sure health and personal care needs are met. EVIDENCE: A sample of care records showed that there had been work to make these more detailed since the last inspection. The records also contained examples of the staff attention to residents’ preferences e.g. preferred bathing times. District nurses who visit residents at the home feel the staff work well with them – ‘poorly patients are cared for well with the support of district nurses’. There was also an example of the Care Manager’s work with Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 11 specialist health and social care professionals in planning and providing a care package that required a flexible approach to best meet the needs of the resident. A visiting relative commented how care from staff had helped the resident through several periods of illness since her admission to the home. Medication is carefully managed to keep residents safe. A pharmacist from the Primary Care Team had helped produce a system for safe handling of medication. A folder containing comprehensive records was being maintained e.g. copy prescriptions. A sample of administration records reflected satisfactory practices e.g. double-checking of handwritten instructions. A policy and procedure for safe handling of medication had recently been revised and updated. Staff were observed approaching residents in a respectful manner and those residents who were spoken to expressed confidence in them. Ashfield House DS0000024690.V336221.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. 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 are able to live in the way they prefer but within a safe environment. Relatives are encouraged to visit and join in any activities taking place at the home. Menu dishes are quite traditional because the residents generally prefer foods they are familiar with. Individual dietary needs are taken into account and the staff keep an eye on residents who are finding it difficult to eat a normal diet so they can receive extra support if needed. EVIDENCE: The residents at Ashfield House benefit from a small home that provides a homely sort of atmosphere. There is a programme of social activities and there has been more attention on individual activities during the past year. There are plans to improve access to the garden for disabled residents and staff would also like to increase the number of trips out of the home. Relatives are encouraged top participate in life at the home e.g. visitors were observed sitting with residents who were involved in a painting session. Staff Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 13 respect the right of any resident who prefers to live more privately. One lady spends most of her time in her bedroom and has her meals served there. The menu dishes are quite traditional which reflects the preference of the resident group. The cook was aware of individual preferences e.g. a resident who doesn’t like fish dishes is offered a different choice of main meal. Care records showed how staff assess each resident’s dietary need and preference. Weights are regularly checked and care plans introduced for any resident who experiences difficulty eating a normal diet. Ashfield House DS0000024690.V336221.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. 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. Complaints are taken seriously and fully investigated to be sure the residents’ rights are protected. Residents are protected by a staff group who understand how to recognise and report any concerns about the residents’ protection. EVIDENCE: The Commission hasn’t received any complaints about the service since the last inspection. A relative commented ‘never had reason to complain’. There is a written complaints procedure and the Provider intends to improve its availability to everyone. The Provider has recently consulted the Commission about a complaint received at the home. The way this issue was investigated showed an open and robust approach in order to protect the resident’s interests. The staff have received training in abuse awareness during the past year and they have also been given related literature. There are plans for more training in the coming year. The home has written guidance about local protocols for Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 15 the protection of vulnerable adults and staff signatures confirmed they had been asked to read this. Ashfield House DS0000024690.V336221.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 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 well maintained home that is furnished and decorated to a high standard. The particular needs of the residents are taken into account so that they will be as safe as possible. EVIDENCE: The Provider maintains the accommodation well and regularly invests resources to continue improving it e.g. a new call system has been installed since the last inspection and there are plans to introduce more en-suite facilities where possible. Access to the garden is also going to be improved so that disabled residents can better enjoy it. Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 17 The home was clean, tidy and warm at the time of the inspection visit. Two residents were seen in their bedroom and both were satisfied with their private space. Although one of these residents was not happy with her armchair her care record confirmed how staff had been working to make sure her armchair would be safe and comfortable. A new infection control policy has been implemented recently and all staff carry hand cleanser. Anti-bacterial liquid soaps and paper towels were seen around the home as part of infection control practices. Ashfield House DS0000024690.V336221.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 and 30 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 care for the residents’ needs and they receive the training they need to work safely with the residents. EVIDENCE: When asked what the care home does well a relative commented that staff ‘treat residents with care and consideration’. There is little staff turnover so the residents benefit from a staff group who know them well. There were two experienced care assistants at work during the inspection visit. A third care assistant would normally have worked between 8am and 11am but was on annual leave and had not been replaced. The Provider was confident the staffing level was adequate for the current resident group and observations supported this assessment. Residents appeared well attended and the home was clean and tidy. When new staff are employed they are introduced to the work through a nationally recognised induction programme. Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 19 There are now more staff who have obtained a National Vocational Qualification at level 2 and plans for some staff to work towards a level 3 qualification during the next year. There has also been more attention to inhouse training in the past year. Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is run by an experienced Provider who understands what is required to offer residents a good service. She is regularly present at the home to oversee everyday life there. Residents benefit from a management approach that recognises the importance of continual development to maintain and improve the quality of the service. EVIDENCE: Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 21 The service is closely monitored by an experienced Provider who is often at work in the home and is, therefore, easily available to residents, staff and visitors. There are already some practices in place to help the Provider monitor the standard of the service e.g. staff and resident meetings, comment cards. Policies and procedures are subject to regular review to be sure they are up to date. A formal quality assurance system was being implemented at the time of this inspection and the Provider has already identified aspects of the service she feels need to be developed further e.g. staff supervision and support programmes. A few relevant policies have not yet been implemented e.g. continence promotion has not yet been covered although many of the residents have related care needs. This may be an area to look at in future planning for the service. Risks to residents’ safety are minimised through regular servicing of essential equipment and services. Assessments of potential hazards are recorded e.g. cleaning materials, resident personal activities and staff receive training to help them work safely e.g food hygiene. Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 22 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 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no 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. Standard Regulation Requirement Timescale for action 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 OP33 Good Practice Recommendations There are a few policies and procedures that are relevant to the service but have not yet been implemented. Ashfield House DS0000024690.V336221.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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