CARE HOMES FOR OLDER PEOPLE
Ashfield House - North Yorkshire County Council Carleton Road Skipton North Yorkshire BD23 2BE Lead Inspector
Caroline Long Key Unannounced Inspection 1st August 2006 11:00 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 - North Yorkshire County Council DS0000034620.V306880.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 - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ashfield House - North Yorkshire County Council Address Carleton Road Skipton North Yorkshire BD23 2BE 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) 01756 792 881 01756 795519 North Yorkshire County Council Mrs Alison Lockyer Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st January 2006 Brief Description of the Service: Ashfield House is a care home registered to provide a service for thirty-three older people of either gender aged over 65 years who do not have any specialist requirements. The home was purpose-built approximately 35 years ago. It is located within a short drive of the centre of Skipton. All bedrooms with 2 exceptions are intended for single occupancy. There are bedrooms on the upper floor, which can be accessed by vertical passenger lift. The home is set in large grounds and there are 2 enclosed gardens. There is a day-centre attached to the home, which offers up to 10 places per day. It is line-managed by the registered manager but has its own dedicated staff team. On the 21st June 2006 the cost care is £368.90 per week. Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • • A review of the information held on the homes file held at the Commission for Social Care Inspection. An unannounced site visit, lasting over 7 hours, by one Regulation Inspector, which included a tour of the premises, talking to service users, staff and the Acting Manager. Observing staff working with Service users and the examination of records. Four Service users care was looked at in detail. Letter surveys were sent to ten Service users of the home and six relatives, and four care managers and four General Practitioners. Six service users, one relative, one care manager and three General Practitioners responded. What the service does well: What has improved since the last inspection?
The acting manager and locality manager are aware of the improvements, which need to be made to the home to improve the quality of life for service users. Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 6 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 - North Yorkshire County Council DS0000034620.V306880.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 - North Yorkshire County Council DS0000034620.V306880.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): 3 Quality in this outcome area is adequate. Prospective service users and their representatives cannot always be assured they will receive enough information to make an informed choice about the home. This judgement has been made using available evidence from a visit to the service, examination of records, and discussion with service users and relatives, also surveys received from service users. EVIDENCE: During the site visit the Manager returned from Airedale Hospital where she had been carrying out assessments on two potential service users. These assessments provided enough information for the home to be able to assess whether the home would be able to meet the needs of the service users. Two service user files were examined, where they had been recently admitted to the home, although both had copies of the Care Managers care plan both did not have evidence of any assessments carried out prior to admission.
Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 9 This information does not single-handedly give a true reflection of the needs of the prospective service users. One of the service users whose care was tracked had been informed about the home by a friend, was visited by a member of staff and provided with information prior to admission. Another service user who had been transferred from another home was unable to recall any information provided to them. A relative said she had found the home to be supportive when they had made a decision about the choice of home. Three-service user surveys returned said they did and two said they didn’t receive enough information before they moved into the home. Written comments were ‘did not know he was coming here’, ‘sent from hospital’. Ashfield House - North Yorkshire County Council DS0000034620.V306880.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. Although the health and personal care, which a service user receives is based on their individual needs and the principles of respect, dignity and privacy are put into practice, inconsistent record keeping compromises this. This judgement has been made using available evidence from a visit to the service, examination of records, discussion with service users and surveys received from service users, health professionals and General Practitioners. EVIDENCE: Case tracking confirmed there was a general inconsistency in the standard and detail of the information recorded. One of the four service user files examined, did not have an outcome based care plan completed, another had a very detailed plan, and the two others were inconsistent in the amount of information they held. All had been reviewed regularly and risk assessments had been carried out but the reviews were not agreed with the service user, and any information from the review was not always incorporated in the care plan.
Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 11 Staff confirmed if they are the key worker for the service user, they are involved in the care planning process. For other service users they are aware of individual needs from the handovers and experience. Service users spoken to were unaware of the care plans but aware of the key worker system. The daily records evidenced visits from chiropodists, GP’s, opticians, district nurses etc. Two service users confirmed they have a choice of GP. Service users spoken to said they ‘were happy with the care provided’, ‘staff always respected their privacy’ and ‘staff always said what they are going to do before they do it’. Staff also encouraged them to be as independent as possible when carrying out personal care to ensure their dignity. A service user who was partially sighted said the staff were very good at helping pick out their clothes and explaining the menu. A relative spoken to said their relative ‘receives good care’. Comments on service user surveys returned were; ’very happy with care’, ‘staff always ready to help and assist’. A comment received from a general practitioner was ‘high quality service’. The manager explained the home is in the process of reviewing the documentation and hoped to ensure all the outcome based care plans contained enough detail to ensure service user receive health and personal care based on the their individual needs. Medication had not been recorded as given on some of the medication recording sheets examined and the manager confirmed the home did not at present operate a monitoring system to ensure any errors in recording were quickly recognised and resolved. Medication was observed being dispensed during meal times, the manager explained the sheet were kept in dining table order, the home did not use photographs as a means of ensuring the correct identity of service users when dispensing medication. To prevent the maladministration of medication, the home needs to ensure the medication is recorded correctly and monitored. To promote good practice the standard collation of the sheets and the use of photographs to enable staff to easily identify service users could be used. Ashfield House - North Yorkshire County Council DS0000034620.V306880.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 adequate. Social, cultural and recreational activities are not meeting all the service users expectations. Service users receive a healthy varied diet according to their choice. This judgement has been made using available evidence from a visit to the service, examination of records, observation of practice, discussion with and surveys received from service users and relatives. EVIDENCE: Observation during the site visit, service users, relatives and staff spoken to and surveys returned all confirmed in general the home does not have sufficient staff resources to allow time for activities and stimulation. The manager confirmed a social activities organiser visits the home twice a week and due to lack of resources she was trying to involve relatives and the local community more with the home to improve the daily lives of the service users. Service users confirmed they are able and encouraged to maintain contact with family and friends as they wish.
Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 13 One service user said they were able to exercise choice about their daily lives another described the home as ‘regimented’. A relative confirmed service users do have a choice about the time they go to bed. Service users said they were able to have their breakfast in their rooms; other meals were generally taken in the dining room at set times. During the site visit although the meal appeared nourishing, service users appeared rushed in the dining room. Service user meal times should be treated as an occasion, and something for the service users to look forward to. Staff should be sensitive to the needs of those service users who find it difficult to eat and make them feel comfortable and unhurried. The chef confirmed service users receive a menu the day before which gives them a choice of food for the next day. Menus were discussed at the service user meetings and were changed to incorporate any requests made. The Chef explained to save costs they had recently been part of a trial by North Yorkshire County Council, where the menu plans had been stipulated by the Council. Service users in general said the food was good. Ashfield House - North Yorkshire County Council DS0000034620.V306880.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. Service users have access to an effective complaints procedure and are protected from abuse This judgement has been made using available evidence from a visit to the service, examination of records, discussion with service users and staff and surveys received from service users. EVIDENCE: The home has an accessible simple and clear complaints policy, two service users and relatives said they were aware of the procedure and felt able to complain. Six service users surveys returned answered they knew who to speak to if they were unhappy. The home has received two complaints since January, both about waiting for a service. The manager had resolved both. The Manager explained the home followed the North Yorkshire procedure for protection of vulnerable adults. Two members of staff confirmed they were aware of what actions to take to protect service users from abuse. Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 15 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. The staff at the home ensures the service users live in a safe, clean environment. This judgement has been made using available evidence from a visit to the service, discussion with service users and staff and surveys received from service users. EVIDENCE: Three of the service user surveys returned stated the home is always fresh and clean, two other said it usually was. During the site visit with their permission two service user rooms were visited, both said their rooms were kept clean. Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 16 The main lounge where the service user mainly sit has three television in, two service users commented it was difficult to hear because often the televisions were on different stations, the Manager explained she had identified this as a issue for the service users and was looking at ways of solving the problem. A tour of the communal areas evidence the home had was generally clean and appeared well maintained. The service users had access to gardens and the home had recently purchased new garden equipment to enable them to sit outdoors. Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 17 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): 27,28,29,30 Quality in this outcome area is adequate Service users are supported and protected by the homes recruitment practices and by appropriately trained staff, but the home needs to ensure it has sufficient numbers of staff to ensure service users lifestyle needs are fully met. This judgement has been made using available evidence from a visit to the service, examination of records, discussion with service users and surveys from service users and relatives. EVIDENCE: Comments in the surveys suggested the staff were generally unable to meet all the needs of the service users. This was discussed with service users, relatives and staff at the site visit all said staff were very busy and did not have the time to talk with service users. Examples of comments by service users were ‘sometimes busy unable to listen’, ‘when asking for the toilet do not get it straight away’, ‘not enough staff’, ‘staff don’t come quickly’ ‘staff work really hard, not enough of them’. Staff themselves felt they were very busy, and could not spend as much time with service users as they would like. On the evening of the site visit there was the Manager and two resource workers on duty for twenty-one service users, with varying levels of dependency. This meant that although service users’ basic needs are met, there are still areas that can be improved upon to ensure that individual needs are being met.
Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 18 The rota showed generally four resource workers in a morning and three on a evening, this includes the acting manager, information from the acting manager stated over a eight week period fifty nine shifts had been covered by bank staff. Information from the acting manager stated 85 of staff have NVQ level 2 or above in care. Although the two members of staff when discussing their training confirmed induction and other mandatory and specialist training such as health and safety, first aid, protection of vulnerable adult took place; it was difficult to this evidence fully due to poor record keeping. Staff were clear about their role and understood the needs of the service users. Four files staff files were examined all contained an application form, criminal records bureau check, two references and were robust enough to protect the service user. Ashfield House - North Yorkshire County Council DS0000034620.V306880.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, 35,37 & 38. Quality in this outcome is adequate Although management need to improve the outcomes for service users, they are aware of the improvements and actions they need to make to improve the quality of the service provided. This judgement has been made using available evidence from a visit to the service, examination of records, discussion with the acting manager, service users and staff EVIDENCE: The acting manager was committed to promoting equality and diversity in the service and meeting service users individual needs, this was evidenced through discussion where the manager highlighted the diverse needs of service users Ashfield House - North Yorkshire County Council DS0000034620.V306880.R01.S.doc Version 5.2 Page 20 The acting manager explained she will be applying to the Commission to be the Registered Manager, she has commenced her NVQ Level Four and Registered Managers Award. She explained is in the process of reviewing all the practices and procedures and she is aware of the areas where the home needs to make improvements and has made plans for undertaking this work. The acting manager explained the home follows the official quality assurance procedure of North Yorkshire County Council and carries out Regulation 26 visits to monitor the quality of the service provided. The acting manager explained when a service user chooses they will administer some of the service users’ money; the system in place was checked and appeared to be in order. Two members of staff were spoken to one said she had the received necessary supervision; the other said recently she had not. Although the manager explained regular supervision was held for staff this was difficult to evidence due to poor record keeping. The acting manager was unaware of her team managers’ supervisions where the records were kept and how often it took place, she kept her own records of staff supervision at home to protect confidentiality. This is not best practice and does not follow Data Protection guidance. The files examined evidenced the home needs to improve upon its record keeping to ensure the protection of service users, all records should be kept in the home to ensure data protection. A sample of health and safety documentation was inspected; accidents were recorded but had not been reported to the Commission. The gas and electrical certificates were both out of date. Ashfield House - North Yorkshire County Council DS0000034620.V306880.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 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 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 1 2 Ashfield House - North Yorkshire County Council DS0000034620.V306880.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 OP3 Regulation 14 Requirement Timescale for action 20/08/06 2. OP7 15 3 OP9 13 All prospective service users must be fully assessed. The assessment should include in detail emotional, social, spiritual, occupational and physical needs of the service user. The assessment should involve the service users, and their representatives and relevant professionals. A copy of this assessment should be kept on the service users file. The manager must ensure that all service users have a care plan in place. Previous time scale not met 31/01/06. Also the care plan is used as the 20/08/06 foundation to provide care by all staff, reviewed regularly alongside the risk assessments and agreed with the service user or their representative. 20/08/06 • The medication record should be collated to ensure the correct medication is given. • Medication administered to service users must be signed for at the time of dispensing.
DS0000034620.V306880.R01.S.doc Version 5.2 Ashfield House - North Yorkshire County Council Page 23 4 OP27 18 5 6 OP31 OP37 8 17 (2) 7. OP38 23(2) b A procedure for regularly checking the medication given should be introduced. The manager must ensure that the staffing resources are sufficient to meet the needs of all the service users. Previous time scale 31/01/06 not met The staffing level must take into account the needs of the service users, the competence and experience of the staff and the layout and design of the premises. The home should have a Manager who is registered with the Commission. All records should be of a good standard and routinely completed, and kept in line with The Data Protection Act The manager must provide the Commission with current gas and electrical safety certificates. Previous time scale31/03/06 not met. • 20/08/06 01/10/06 01/10/06 01/09/06 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 OP12 Good Practice Recommendations Efforts should continue to be made to develop a meaningful programme of social activities for the service users and tailored to their needs, wishes and abilities. The service users should be enabled to remain in contact with local community by, for example, being regularly taken out. The manager should keep accurate records of training, which has been undertaken by staff.
DS0000034620.V306880.R01.S.doc Version 5.2 Page 24 2 OP30 Ashfield House - North Yorkshire County Council Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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