This inspection was carried out on 12th May 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.
CARE HOMES FOR OLDER PEOPLE
Ashfield House Carleton Road Skipton North Yorkshire BD23 2BE Lead Inspector
David Martin Unannounced 12 May 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ashfield House - North Yorkshire County Council Address Carleton Road Skipton North Yorkshire BD23 2BE 01756 792881 01756 795519 ashfield.skipton_nyccss@btinternet.com North Yorkshire County Council Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 27/09/04 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. Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out on 12 May 2005. It was unannounced and took 8 hours to complete. The majority of time was taken up in discussion with the service user in the home at the time of the inspection and with the staff on duty. The line-manager for the home was in the home at the time of the inspection and made a contribution to the inspection. Service user files and other records were examined. The inspector sat in on the full staff meeting that took place. A check was made as to whether the home had complied with requirements and recommendations from the last inspection. Verbal and written feedback was given at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better:
A risk assessment needs to be completed regarding the use of Warfarin . This will assist in the safe administration of medicines and alert staff to potentially harmful side-effects. A risk assessment also needs to be completed in connection with asbestos within the structure of the building. This will enhance the safety of the environment for service users. Where the home is no longer able to meet a resident’s needs arrangements should be made to refer them to an alternative service for appropriate care. To improve staff understanding of falls, the home should liaise with the ‘Falls Prevention’ service. This may help in minimising the number of falls experienced by service users.
Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 6 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 v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N/A None of the standards in this section was inspected. EVIDENCE: Not applicable. Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 - 10 In general, service users’ health and social care needs are met but there are issues relating to the administration of medicines, the prevention of falls and the placement of a service user where improvements could be made. EVIDENCE: Discussion with service users and staff and examination of case files provided evidence that, in general, service users’ health and social care needs are met. The home has well-established links with local General Practices and District Nursing services which ensures that service users’ health care needs can be met promptly. The administration of medicines is managed well and records were up-to-date. Where ‘Warfarin’ has been prescribed it was recommended that a risk assessment is completed to ensure the ongoing well-being of service users. Falls monitoring has been introduced but in order help staff develop their understanding and minimise the risk of falls it was recommended that links are established with the local Falls Prevention service. One service user has care needs associated with dementia and may need to be referred to a more appropriate service. This has been taken up in correspondence separate to this report.
Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 Daily routines and organised activities are arranged to ensure that service users are able to exercise choice and that their right to privacy is upheld. EVIDENCE: Service users are able to make choices about their daily routines and to participate in organised activities to suit themselves. This helps them maintain their individuality and independence. Service users said they were happy with the activities provided. Through observation it was clear that staff were responding to service users in a positive and respectful way. Service users said that the food was good and one commented that ‘it is the best food I’ve ever eaten’. The menu board provided evidence that an alterantive to the main course is available. Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N/A None of the standards in this section was inspected. EVIDENCE: Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The home was clean and well-maintained providing service users with a pleasant and safe environment. EVIDENCE: Since the last inspection windows, fascias and soffits have been replaced throughout. This has improved the appearance of the home considerably and made communal areas, particularly, warmer and less draughty for service users. Service users bedrooms are comfortably furnished and have been personalised. There were no safety issues picked up during this inspection. There are plans for a major restructure of the home with the intention of providing a wider range of services. The home has sealed in asbestos discovered during recent building work and to ensure this remains as safe as possible a risk assessment should be completed. Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N?A None of the standards in this section was inspected. EVIDENCE: Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 & 36 The home is well-run ensuring that day-to-day life in the home is conducted in the best interests of service users. EVIDENCE: Since the last inspection a new manager has been appointed but has yet to take up post. Inspection visits are carried out by the home’s line-manager. These visits are used to highlight areas of good practice and where improvements could be made. Staff members said the home’s management team is approachable which ensures that issues relating to the care of service users can be quickly resolved. Since the last inspection staff have received the required individual supervision. The sessions are used to discuss training and development and are part of the process of ensuring that the care for service users continue to met in their best interests. Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 15 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 1 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x 3 x x 3 x x Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 16 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 9 Regulation 13 Requirement Where a service users care needs can no longer be met by the home arrangements should be made to find a more appropriate service. A risk assessment should be completed for service users who have been prescribed Warfarin. A risk assessment should be completed to ensure that sealed asbestos remains as safe as possible Timescale for action 1 June 2005 2. 3. 9 26 13 23 1 June 2005 1 June 2005 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 8 Good Practice Recommendations The local Falls Prevention service should be consulted Ashfield House v224807 j53_j04_s34620_ashfield house_v224807_120505_stage 4.doc Version 1.30 Page 17 Commission for Social Care Inspection 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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