Inspection on 13/12/05 for Ashfield Nursing and Residential Home

This inspection was carried out on 13th December 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... 12/07/05

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 Nursing and Residential Home 3 Ashfield Wetherby Yorkshire LS22 7TF Lead Inspector Susan Knox Unannounced Inspection 13th December 2005 09:00 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 Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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 Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashfield Nursing and Residential Home Address 3 Ashfield Wetherby Yorkshire LS22 7TF 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) 01937 584724 01937 584724 Ashfield Nursing Home Limited Mrs Karen Dean Care Home 32 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (32), of places Terminally ill over 65 years of age (4) Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The place for DE(E) is for the named service user only. Date of last inspection 12th July 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 two 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 Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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 and finishing at 2.15 pm. Time was spent talking to service users and observing practice. In addition, the inspector looked at records including duty rotas, service user’s care records and staff training records. The manager was present during the inspection and for the feedback session at the end. The home is well managed and has a stable staff group. What the service does well: What has improved since the last inspection? What they could do better: Fire safety must improve with regular testing of emergency lights and ensuring that fire doors close effectively. Intermediate service users must be given information about the home. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 Page 6 Maintenance concerns such as ineffective fire doors must be dealt with more urgently. 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 Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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 Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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): 1, 2, 6 Good information is available about the home and service users can make an informed decision before moving in. Intermediate care clients would benefit from this information being located in their bedrooms. Service users must be issued with contracts as soon as possible so that they are aware of the terms and conditions of the home. EVIDENCE: The Statement of Purpose and the Service User guide is available. Service users other than intermediate care clients confirmed that they had been given sufficient information about the home. This is provided at the time of assessment so that an informed decision can be made. The manager said that terms and conditions of residency are being reveiwed in line with the recent report about care homes from Trading Standards. These will be available in the New Year. Therefore these have not recently been issued. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 Page 9 The home is registered to take those needing intermediate care. This care is provided in three dedicated bedrooms. Two clients were accommodated at the time of the inspection. Staff confirmed that information such as the Easy Care Plan is faxed to the home about emergency admissions. It was felt that in most cases these service users are not well enough to be given lots of information about the home. The manager was advised that the service user guide should be placed in each bedroom. Discussions were held with one intermediate service user who confirmed that she was very happy with the care provided. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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, 10. Care planning is good and health care needs are met. Service users are treated with respect. EVIDENCE: Two sets of care documentation were reviewed. One contained no pre admission assessment. The manager advised that this had been done and the information must have been filed elsewhere. Care planning was well documented apart from in one where there was an obvious need caused by confusion and aggression. This was not addressed in care planning and should have provided detail about how staff respond in these circumstances and what are the triggers, if any. Monthly evaluation of individual planning takes place. There was some evidence of service user or relative involvement in care plans. Recognised assessment tools are in use and risk assessments were in place. A pressure sore assessment tool is in use and wound care management records described the wound and included information about the type of dressing in use. The tissue viability nurse had been contacted for advice. The registered Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 Page 11 manager confirmed that she had updated her wound care training in the last twelve months. She also keeps up to date by attending conferences and through journals. A profile bed was in use for one service user and this was identified in the care plan. The manager said that this was agreed with a relative but was not recorded in care documentation. This was to be rectified. Health needs were being met this and was confirmed during discussions with service users and staff. Service users nursed in bed appeared well cared for. The manager advised that she was up to date with training in the use of equipment such as syringe drivers. The local PCT would supply this equipment and the manager would provide staff with the training. The manager is proposing a change to daily reports. Instead of being entered in a separate record, care plans will now be updated after each shift. Service users were able to confirm that staff treated them with respect and one confirmed that bathing caused no embarrassment. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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, 14 A varied programme of activities ensures that service users are motivated and in touch with the seasons. Service users are provided with choice in their daily lives. EVIDENCE: A full time activity coordinator is employed and service users benefit from this input. Spring bulbs had been planted and were showing signs of growth. The home was preparing for the festive season with a resident and relatives party being arranged. On the day of the inspection a pantomime was being held later in the day. In addition some service users were enjoying a topical quiz with the ‘Motivator’ who regularly visits the home. A local church has given a Carol service and some service users have been out shopping. Previous events had been a firework display and Halloween party. Service users confirmed in discussions that choice is made available such as bedtimes and at mealtimes. During the main meal it was noted there was a choice and staff asked if anyone wanted more. Staff discussed the forthcoming pantomime so that service users were aware of what was happening later in the day. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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 the following standard(s): 16, 18. The service users and staff are confident that the manager would respond to concerns and complaints. The training of the staff group in abuse ensures that an open forum has been created and staff are aware of procedures. EVIDENCE: The manager said that no complaints were on going. Full records are available of complaint investigations including any action necessary. The complaint procedure was not displayed in the home. This will be replaced. The newsletter included the procedure for making a complaint and gave details about the CSCI. Service users and staff said that the manager is very approachable and they would speak to her about any concerns. Staff confirmed that training had been provided about abuse and were able to describe the procedure they would follow. The staff training matrix showed that the majority of staff have received abuse training only four are left to attend. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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 the following standard(s): 19, 25, 26 Up grading of rooms is ongoing and ensures a better environment for service users. Staff are failing to follow infection control procedures in bathrooms and this puts the service users at risk. Cleanliness in the kitchen has improved and the service given to service users is very good. EVIDENCE: A random inspection of the building including the kitchen was carried out. The manager advised that carpets in some rooms are still to be replaced; measurements of rooms have been made. There are also plans to redecorate the main lounge. Appropriate bedroom door locks are now in place apart from one that had been a problem to fit. In the rooms checked cleanliness and odour control was good. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 Page 15 One bathroom had no lock to ensure the privacy of service users. In addition, bars of soap and soft towels were in one bathroom despite a notice displayed stating this should not happen. If service users prefer to use bars of soap in the bathroom they should be issued with own soap and towels that can be taken back to their rooms after use. The manager advised that individual toilet bags are going to be organised for service users in an attempt to stop this happening. The kitchen and kitchen WC was checked. There had been a significant improvement with cleanliness. Paper towels and liquid soap ensure that staff follow infection control guidelines. Food was stored appropriately and the records for monitoring temperatures of hot foods and cold storage were up to date. The kitchen staff including cooks and domestics provide a twelve-hour service starting at 6.30 to 7.00am. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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 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): 27-30 Staffing levels and training meets the needs of service users within the home. Good recruitment practices ensure that service users are protected. EVIDENCE: The staff rota for the week of the inspection was available. This showed that staffing levels were appropriate for the numbers accommodated The manager is still trying to establish whether the overseas nurses undergoing adaptation can be counted in the numbers of staff having achieved NVQ level 2 or above. One has committed to achieving an NVQ level 3. Approximately half of the staff including adaptation nurses are qualified to NVQ level 2 or above or equivalent. A number of staff are undertaking NVQ level 3. The recruitment files showed that good practices are followed. Three files were checked and these provided evidence of identification checks, work permits, PIN, and two references obtained before staff began to work in the home. The relevant numbers for Criminal Record Bureau (CRB) checks were also recorded. A training officer has been appointed and there was evidence that induction training is on going. This is completed in six weeks and was confirmed in discussions with staff. Foundation training is also on going. Supervision of staff takes place and was confirmed during discussions with staff. The manager said that a new training programme had been devised by the trainer and was Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 Page 17 focusing on statutory training and other courses considered compulsory. Staff confirmed during discussions that all were booked to attend a food hygiene course early in the New Year. Eight staff have attended infection control training, six attended dementia and one Palliative care. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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 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): 33-38 The manager ensures that all interested parties in the home are provided with relevant information about day-to-day routines and activities. The regular supervision of staff means that service users benefit from their development. Health and safety needs to improve particularly fire safety in order to effectively protect service users and staff. EVIDENCE: The manager has held a number of meetings since October. These were a staff and general staff meeting and a relatives meeting. A newsletter is also distributed and refers to the last inspection report. The public liability certificate was up to date. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 Page 19 The administration officer advised that no personal monies are dealt with by the home and no valuables are retained for safekeeping. Staff confirmed that they receive regular supervision. Records were available about fire safety. Training had been held three times in the last twelve months. The names of staff who attended were recorded. The fire alarm was tested weekly but the emergency lights had not been tested for over twelve months. The manager advised that this had been done in a recent emergency but it should occur monthly and a record made. A number of fire doors did not be closed effectively. The last fire report was discussed with the manager who advised that all the issues would be dealt with. Wheelchairs were being used without footrests this was referred to at the last inspection. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 3 3 3 3 2 Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 3 4 Standard OP1 OP2 OP26 OP38 Regulation 5 Requirement Timescale for action 15/01/06 Ensure that intermediate service users are issued with information about the home. 5 Ensure that service users are 15/01/06 issued with terms and conditions as soon as possible. 13, 16 Ensure that staff follow infection 15/01/06 control guidelines. 13, 16, 23 Ensure that footplates are 15/01/06 always in use when transporting service users. Ensure that testing relating to fire safety is carried out regularly. (Both referred to in the last report) Ensure that fire doors close effectively. 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 OP8 Good Practice Recommendations When using equipment that could be considered a restriction ensure that discussions and agreements with DS0000047591.V270917.R01.S.doc Version 5.0 Page 22 Ashfield Nursing and Residential Home interested parties are recorded. Ashfield Nursing and Residential Home DS0000047591.V270917.R01.S.doc Version 5.0 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. 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