CARE HOMES FOR OLDER PEOPLE
Ashfield House - North Yorkshire County Council Carleton Road Skipton North Yorkshire BD23 2BE Lead Inspector
Pauline O`Rourke Unannounced Inspection 31st January 2006 10:15a 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.V275362.R01.S.doc Version 5.1 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.V275362.R01.S.doc Version 5.1 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.V275362.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th May 2005 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 - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection including preparation time took place over 12 hours. A tour of the building was conducted. A number of the service users records, staff records and records about the management of the home were inspected. Service users, and staff on duty were spoken with. What the service does well: What has improved since the last inspection? What they could do better:
The management team should make sure that a record is kept of any assessments they carry out on prospective service users. All the information provided before someone is admitted to the home should be used to develop a plan identifying the help and support each person requires. The manager must also ensure that the staffing levels can meet all the needs of the service users. The manager must provide the commission with a current gas and electrical safety certificate. All staff must ensure the safety of the service users is not compromised by leaving the front door unlocked on an evening. Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 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 - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 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.V275362.R01.S.doc Version 5.1 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 and 6. The service users can be assured their needs will be met. EVIDENCE: The service user files seen contained copies of an assessment by a care manager. The duty manager confirmed that they do visit all prospective service users before their admission. However, they do not keep a record of their assessment. Intermediate care is not provided. Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 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 Service user needs are usually identified in a care plan. EVIDENCE: Several service user files were seen and whilst most of them contained a promotion of independence plan, one did not. The service user was identified to the manager and it was pointed out that they had been resident in the home since September 2005. Where care plans were present, evidence was available to show they are reviewed every month. Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: None of these standards were assessed at this time. Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 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 the following standard(s): 16 and 18. Service users were confident that any complaints or concerns they had could be raised and acted upon. Service users are protected from abuse by thorough recruitment policy and regular staff training. EVIDENCE: North Yorkshire Social Services has a detailed complaints policy. This policy is provided to all the service users and is displayed around the home. There have been no complaints made to the CSCI in the last 12 months. Several complaints have been made to the home. A record of these are maintained with the outcome of the investigation. Service users spoken with all said that if they had any problems there was someone within the home they would go to. A relative spoken with during the inspection said that she had made a complaint to the manager and a meeting had been organised to discuss their concerns. There is an Adult Protection Policy in place. Staff spoken with had received training in Adult Protection issues and they had a good understanding of their responsibilities if they believed any inappropriate behaviour was taking place. Policies are also in place regarding the management of service users money. Staff are also subject to a criminal records bureau disclosure and a protection of vulnerable adults check to ensure that they are suitable to work in a care setting. Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: None of these standards were assessed at this time. Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 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 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 and 30. The service users needs are met by staff that receive regular training and have been properly vetted through the recruitment procedure. EVIDENCE: The staffing levels within the home mean that there are at least 4 carers in the morning, and 3 in the afternoon and evening. There are also 2 night staff. Staff spoken with said that the current care levels in the home were high and whilst care needs were being met the activities available can be curtailed. Service users spoken with commented on how busy the staff were. The manager discussed the dependency levels they have to work with and as at 22.01.06 the proposed dependency points available were 72 and the actual dependency calculated within the home was 78. Any future admissions must be made within the proposed dependency levels available and this level should not be exceeded. The staff are provided with a variety of training covering, food hygiene, back care, first aid, dementia care, medication, infection control and using a hoist. Staff are working towards their National Vocational qualification level 2 in care and the home should achieve their 50 ratio in the near future. Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 Page 14 There has been a low turn over of staff in the last twelve months. The staff files of three staff members employed in that time were inspected and were found to contain all the necessary documentation as required by the Care Homes Regulations 2001. The service users spoken to said that the staff were ‘first class’ and ‘very nice’. They said that the staff were helpful and they appreciated the fact that they try to organise some of the activities whilst being very busy. Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 Page 15 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): 35 and 38. Policies and procedures are in place to ensure the service users financial interests are safeguarded. The health and safety of the service users and staff is promoted. EVIDENCE: The personal allowance for several service users is held in the office and the records were checked and found to tally with the cash held. Receipts are obtained for any purchases made. The staff spoken with during the inspection said that they had received training in, back care, first aid, food hygiene, COSHH, and fire training. Evidence is available to show that the equipment used in the home is usually serviced at the prescribed intervals. However, both the gas and electrical safety certificate were out of date. Health and safety notices were displayed around the building. A relative did say that when she had left the home late
Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 Page 16 one night the front door was unlocked and the home was effectively open to anyone. She felt alarmed that the security of the building was this lax when the service users were all in their rooms and the staffing levels were reduced. Accidents are properly recorded and where necessary reported to the Commission for Social Care Inspection. Information from the accident records is used in the care planning process. All staff can access Induction and Foundation training, this provides them with basic skills required to undertake the role of resource worker. Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 1 Ashfield House - North Yorkshire County Council DS0000034620.V275362.R01.S.doc Version 5.1 Page 18 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. 1. 2. Standard OP7 OP27 Regulation 15 18 Requirement Timescale for action 31/01/06 3. OP38 13(3) 23(2)c The manager must ensure that all service users have a care plan in place. The manager must ensure that 31/01/06 the staffing levels are sufficient to meet the needs of all the service users. The manager must provide the 31/03/06 Commission with current gas and electrical safety certificates. The security of the building must be maintained at all times to ensure the safety of the service users. 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 OP3 Good Practice Recommendations A copy of the pre-admission assessment should be kept in the service users files.
DS0000034620.V275362.R01.S.doc Version 5.1 Page 19 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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