Inspection on 12/07/05 for Ashfield Nursing and Residential Home

This inspection was carried out on 12th July 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashfield Nursing and Residential... 12/09/06

Ashfield Nursing and Residential... 13/12/05

Ashfield Nursing and Residential... 11/01/05

Ashfield Nursing and Residential... 31/08/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ashfield 3 Ashfield Wetherby Yorkshire LS22 7TF Lead Inspector Susan Knox Unannounced 12 July 2005 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 J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ashfield Address 3 Ashfield, Wetherby, Yorkshire LS22 7TF 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) 01937 584724 01937 584724 Ashfield Nursing Home Ltd Ms Karen V Dawson Care home with nursing 32 Category(ies) of Old age (32), Dementia - over 65 (1), registration, with number Terminally ill - over 65 (4) of places Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11 January 2005 Brief Description of the Service: Ashfield Nursing and Residential home was originally registered in 1984 and then re registered as a nursing home in 1991. It provides nursing and personal care and can accommodate thirty-two older people. This home is located in Wetherby; a market town situated approximately twenty miles from Leeds. It is convenient for public transport and a variety of destinations are accessible from the town centre. The building is a detached adapted property that has been extended to provide the current accommodation. There are a number of parking spaces to the front of the house and patio/seating areas are available. The remainder of the garden has borders and paved walkways.Communal areas are three lounges, a dining room and conservatory area. In addition, there are four double bedrooms and twenty-four single. Thirteen bedrooms have en suite facilities. There are a number of communal bathrooms and toilets situated around the home. Specialist equipment is fitted where necessary to assist those service users with mobility problems and other difficulties associated with advancing years. The laundry is sited in an annexe alongside an office/training area. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection starting at 9.00 am. Time was spent talking to service users, staff, and one visiting professional and observing practice. In addition, the inspector looked at records including duty rotas, service user’s care records, staff training records and medication records and storage. The home was asked to distribute a number of CSCI comment cards to service users, relatives and visiting professionals so that their comments about the home could be fed back directly to the CSCI. The manager and providers were not present during the inspection and for the feedback session at the end. Therefore, feedback about the findings was to the trained staff on duty and to the administrator. Feedback to the manager was made by telephone 14 July 2005. Many of the requirements included in the last inspection report dated 11 January 2005 have been dealt with. What the service does well: Staff said that the service users were well looked after by a stable team of nurses and carers. Service users and staff said that the meals were very good and the majority of service users were happy. Service users and staff said that the activities organised are very good. The providers and manager respond quickly to requests for additional disability equipment or environmental adaptations. The staff team worked well under difficult circumstances on the day of the inspection. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 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 J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 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) 3-6 Prospective service user’s needs are assessed before admission to ensure that they can be met. The intermediate care provided in the home meets the service users and professional expectations. EVIDENCE: The manager and deputy visit and assess prospective service users before admission. Assessment documents provide detailed information of the individual’s needs. A recognised nursing assessment tool is in use. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 9 Care staff have attended training related to Death and Dying this ensures they are prepared for caring for those with a terminal illness. There has been some difficulty in identifying courses for qualified nurses in relation to terminal care this has been addressed and training will take place. Training records seen during the inspection and from discussions with staff it was confirmed that they are trained to meet the assessed needs of the individual service users. During discussions with service users it was confirmed that visits to the home prior to admission were encouraged. One also confirmed that the manager and deputy provided information about the home during a visit to the hospital prior to admission. Some service users were aware that the first weeks in the home are on a trial basis. This home is registered to take those requiring intermediate care. This is provided in three dedicated bedrooms. A number of these service users spoke well about the care received during their stay. A professional visiting from the intermediate care team spoke about the good working relations between his team and the home’s staff. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 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 standard(s) 7-11 The care documentation showed that assessed needs were being met and the services offered were based on good practice. Good health care is provided in the home. Some aspects of the environment compromise the service user’s privacy. Respect towards some service users is compromised by the manner in which some staff respond to requests. The home cares for those with terminal illness well and ensures that any last wishes are respected. EVIDENCE: Three sets of care documentation were reviewed. The care planning addressed the individual needs of the service users. Monthly evaluation takes place ensuring that changing needs are identified and appropriate action taken. Care planning was well documented and up to date. Recognised assessment tools are in use and risk assessments were in place. A pressure sore Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 11 assessment tool is in use and wound care management records were well recorded. Health needs were being met this was apparent from the care documentation and observations of those service users nursed in bed. It was apparent that regular monitoring is carried out and recorded in individual charts. The personal care of those confined to bed was good. The home operates medication in line with a Monitored Dosage Record System (MARS). The storage and records of administration of medication were checked. Storage was satisfactory. MARS records were up to date including controlled drugs. The nurse in charge was advised that a more robust book was needed for the recording the administration of one drug. Discussions were held about the disposal of unwanted medicines as the previous contract arranged with pharmacists for this disposal has changed nationally. A care home (nursing) is now required to make arrangements for the collection of waste medication as well as other clinical waste products with a licensed waste disposal company. This is a new requirement for all care homes with nursing. Generally staff were seen to treat residents with respect and carried out personal care tasks in a way that promoted the privacy of the individual. Service users spoke well about staff interactions with them. However, there were occasions during the inspection when one member of staff spoke loudly and sharply in reply to one service user and another spoke sharply to someone else. This shows a lack of respect towards the service users. This was discussed with the nurses on duty and later with the manager as being unacceptable. Service users can use a pay telephone, a mobile or own telephone. This ensures easy access to relatives and friends. The providers have begun the work to fit missing or inappropriate door locks were necessary. This work needs to be completed especially to WC’s as this compromises the service users privacy. There are clear procedures for staff to follow in the event of death. Care documentation was checked where this had happened. It was apparent that staff had actively accessed the expertise of other agencies especially relating to pain control. Staff have attended Palliative training courses and although there has been difficulty in sourcing this for nursing staff, this is being dealt with. The records showed that religious needs and last wishes were met and relatives were present. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 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 standard(s) 12,15 The importance of providing suitable and fulfilling social care for residents, including opportunities for them to go out is recognised within the home. EVIDENCE: The home has recently recruited a part time activity coordinator. This is in addition to regular motivation sessions, hand massages and weekly entertainment. The staff have recently held coffee mornings to raise funds for trips out. It was apparent from discussions with staff that they recognise the benefits to service users of regular activities. Some enjoy the variety of activities available and others prefer to remain in their room. The new activity coordinator intends establishing one to one sessions with those who prefer not to mix with others. Religious representatives visit the home regularly. Service users spoke positively about the meals provided within the home. Breakfast was still ongoing on arrival. The cook said that free choice was provided at breakfast and this was confirmed during discussions with service users. Staff were observed asking about individual preferences before the main meal of the day. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 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 standard(s) None EVIDENCE: Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 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 standard(s) 19-26 The upgrading of decor and re-carpeting has improved the environment for service users. Failure to address the issues of health and safety in sluice rooms puts the service users at risk. Cleanliness in the kitchen and adjacent facility has improved but further work is required in order to safeguard service users and staff. EVIDENCE: The external areas and gardens have been cleared of debris and a new storage facility provided adjacent to the office. The garden areas are flagged and had a number of planters and displays of summer flowers. A pleasant sitting area that was in use by service users on the day. There are bedrooms and specialist equipment in the home specifically for the rehabilitation service user. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 15 A random number of bedrooms and areas of the building were checked. A significant improvement has been made with redecoration and re-carpeting in bedrooms and corridors. In the rooms cleanliness and odour control was good. The home provides two lounges and a dining room. In addition, there is a small conservatory used by those who smoke. Staff now have the sole use of the small room adjacent to the conservatory. This had been a concern at the last inspection when one service user used it. Work to upgrade these last two areas has been started and new carpets are to be laid. There are sufficient bathrooms and WC’s along with en-suite facilities in some bedrooms to meet the needs of the service users accommodated. Work to upgrade these areas has been carried out to good effect and all were clean and odour free. The woodwork around a bath in one bathroom due to be decorated needed attention as discussed. One sluice room has been upgraded with new floor covering but the others need attention urgently. Cupboards located in these areas were unlocked despite containing COSSH products. Doors were open despite notices to keep shut. One door could not be closed due to warping. Urgent attention is required to address these issues that have been referred to at previous inspections. The cleanliness in the kitchen has improved although work is on going to regrout the wall tiles. Improvements could be seen with cleanliness in the kitchen WC but this could be improved further particularly the WC pan and wash hand basin. Unboxed pipes create traps for debris and dirt. Boxing the pipes in the kitchen WC would improve cleanliness. Unhygienic practices and procedures in the kitchen are a potential threat to the well being of service users and staff. Cleaning in these areas needs to be thorough and on going. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 16 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) 27, 30 The staff team work well. Staffing levels meet the needs of service users. Some discussion is needed with staff in relation to skill mixes on some shifts. There is a commitment to providing appropriate trained and supervised staff who can meet the needs of service users. EVIDENCE: The staff team providing care within the home comprises of qualified nurses, senior carers and care assistants. Ancillary staff support this team within the home. The staff rota was available. This showed that staffing levels were appropriate for the numbers accommodated. However, there was some staffing difficulties on the day of inspection due to escort duties, sickness and one staff member not arriving to work the shift allocated. It was apparent from observations that it is a very busy home but service users said that staff were kind and helpful. The staff worked well on the day in spite of difficult circumstances. Staff felt that the skill mix on some shifts could be improved as sometimes all senior/more experienced care staff work together. The manager advised that this is taken into consideration when organising rosters but staff do exchange shifts. This should be discussed at a staff meeting. A training officer has been appointed to ensure that staff receive the training necessary for providing care to older people. Evidence was available that Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 17 induction training is on going. This is completed in six weeks and was confirmed in discussions with staff. Foundation training has been established and is on going. Supervision of staff is also ongoing. The training records showed the courses attended by staff. Staff confirmed their training as NVQ, Moving and Handling, Care of the Dying and currently attending Health and Safety. It was felt that access to training courses was better for care staff rather than qualified nurses. The manager acknowledged that courses were easier to find for untrained staff. However, qualified nurses are to update training for Wound Care and Palliative Care. In addition the McMillan nurses are going to give a talk on Palliative Care. Other talks are booked about Diabetes and Parkinson’s Disease. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 18 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, 32, 38. The registered manager is competent in her role and available to service users and staff for support and advice. Some practices relating to health and safety put both service users and staff at risk of injury. Regular testing of equipment relating to fire safety must take place in order to safeguard service users, staff and visitors to the home. EVIDENCE: The manager has achieved the Registered Manager’s Award. She is a qualified nurse who regularly up dates her training and working practices. During discussions with service users it was apparent that she is known to them and is Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 19 approachable. Staff also confirmed that support in accessing any specialised equipment is available. Staff meetings are held. Wheelchairs were used without footplates. This practice puts service users at risk of injury. This was referred to at the last inspection. Electrical flexes were seen laid across the floor in two areas this puts both service users and staff at risk of injury. Room risk assessments are displayed in each bedroom. The manager was advised to reassess these as some had been last reviewed 2001. The last staff fire drills had been held February 2005 and in December 2004, the record included the names of staff attending. This is good practice. The testing of water temperatures, emergency lights and fire alarms had not been carried out for some time. These tests must be carried out regularly as required. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 20 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 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 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 x x x x x 2 Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 21 yes 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 10 Regulation 12 Requirement The registered manager must address the issues of the way some staff speak inapproriately towards service users. Continue with the work to fit appropriate locks in order to promote the privacy of service users. Timescale for action With immediate effect hold talks with relevant staff. Locks fitted by 31 August 2005. 31 August 2005 2. 26 3. 38 13, 16, 23 Continue with the work to renovate sluice rooms. Upgrade the woodwork to one bath. Continue with the work to improve the cleanliness in the kitchen and kitchen WC. 13, 16, Ensure that COSSH products are 23. locked away. Ensure that sluice room doors are kept shut. Ensure that foot plates are always in use when transporting service users. Ensure that electrical flexes are not a trip hazard. Up date room risk assessments. Ensure that testing relating to health and safety and fire safety is carried out regularly. With immediate effect. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 22 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. 2. Refer to Standard 9 27 Good Practice Recommendations The registered manager must porivide a more robust form of record to record the adminstration of one type of drug. Discuss the issue of sufficient skill mix on shifts at a staff meeting. Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Ashfield J52_S47591_Ashfield_V220620_120705 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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