CARE HOMES FOR OLDER PEOPLE
Ashfield Rest Home 18 Windsor Square Exmouth Devon EX8 1JX Lead Inspector
Caroline Rowland-Lapwood Unannounced Inspection 10:00 21 January 2008
st 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 Rest Home DS0000069112.V357191.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 Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ashfield Rest Home Address 18 Windsor Square Exmouth Devon EX8 1JX 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) 01395 264503 01395 275652 South West Residential Homes Ltd Post Vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16 October 2007 Brief Description of the Service: Ashfield is a residential home providing personal care for up to 25 older people who may have dementia or physical disability. It is situated in a quiet residential area of Exmouth approximately half a mile from the town centre. Accommodation is over 3 floors, with a stair lift between the ground and upper floors. All rooms are single occupancy. There is a central courtyard area and small front garden. Steps lead up to the front door but there is a level access through a side door. Information received from the home in June 2007 indicates that the current fees are £300-£375 weekly. Services not included in this fee are hairdressing, chiropody, papers and magazines and incontinence pads. CSCI Inspection reports are available upon request. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means the people that use this service experience adequate quality outcomes.
This inspection was unannounced and took place on Monday 21st January 2008. The quality manager for the company was present throughout the inspection. There is currently no permanent manager. Before the inspection we also sent out questionnaires to the people living in the home, their families and their health care professionals. We received four questionnaires from people who use the service and one questionnaire from a relative. All this information gives us a picture of what it may be like at the inspection and helps focus the inspection on what matters to the people who use the service. On the day of inspection we “case tracked” three people who use the service. This means the inspector spoke with staff about individual care, read the persons records and either spoke with the person or made observations if the person was unable to speak with us. We spoke with staff that were on duty. We also looked around the building and inspected other records. These included, accident records, staff files, medicine records, complaint records, care plans and maintenance records. What the service does well:
People have the information they need to make an informed choice about their admission to this home. The home has a written statement of purpose; this document sets out the aims and objectives of the home and provides information about the service. The admissions process is safe; an assessment of care needs of people takes place prior to admission to the home. Documents provided evidence that staff use a standard pre admission assessment form; this is used to assess peoples’ ability to undertake their activities of daily living. Other records seen included copies of assessments carried out through care management arrangements and hospital/community health care teams where applicable Care Plans at the home generally have enough information to identify each person’s basic needs and highlight any health care needs. Staff have a reasonable knowledge and understanding of the needs of people who use the
Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 6 service. Personal care is provided in a caring way. Verbal and informal communication is very good at the home, which means that information about people in the home is passed on to all staff. Also access to a full range of health care is maintained at the home and the medication systems are managed well. People who use the service are encouraged to maintain links with their friends and family. There are activities available on most days which people that are able to can take part in if they so wish. Meals are good at the home with balanced and varied meals being provided. Discreet help and specialist equipment are provided where required to promote independence. Complaints received from relatives are dealt with efficiently and the owner views this system positively as a way of improving the quality of the services provided. People are protected from abuse through the training of staff in safeguarding vulnerable adults. The home has good systems in place to safeguard peoples’ cash and valuables. People are protected by the home’s recruitment practice, which is good. The environment is clean for people to live and work. The management of fire safety and specialist equipment is managed well at the home. What has improved since the last inspection?
The care planning process has improved, each person now has a plan of care that identifies most individual needs and some offer instruction to staff on how these needs should be met. Care plans were reviewed regularly although some improvement is still needed. The laundry facilities were improved from the last inspection with the laundry areas looking clean and tidy. A tour of the building showed that some areas of the building have been decorated since the last inspection. The provider has compiled a building and maintenance programme to ensure continual improvements are made. The rear garden has been tidied since the last inspection and the pile of rubbish has been removed. There is still work needed to ensure the service users will have access to a pleasant garden in the summer months. The registered provider has consulted with service users about their social interests and some arrangements have been made to dedicate activities staff twice a week and to purchase more meaningful activity equipment. The registered provider takes his responsibilities seriously. Extensive fire precautionary work has been undertaken throughout the home. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 7 What they could do better:
Care plans must be consistent, providing enough specific information for staff for them to properly meet peoples needs. Care plans are being reviewed regularly but no changes are being recorded in detail to show how different needs will be met. The activities at the home are adequate, however particular consideration should be given to stimulating and meaningful activities for people with dementia to ensure that individual preferences can be met. To ensure people have ample recreational stimulation their plans of care, which provide the basis for the care to be delivered, need to provide more detail about their social needs and how these will be met. To ensure a pleasant, clean smelling and comfortable environment is available for all people, work to improve the environment needs to continue as per plan. Particular improvements are needed with regard to infection control procedures. The home currently does not have a permanent manager, during this time of transition and change the home must do more to reassure people, ensuring they are satisfied with their care and keep this under constant review. A person delegated by the owner visits the home unannounced on a monthly basis in order to help make a judgment as to the quality of care and services offered to the people who live here. She does not send this report to the commission after each visit. We are now requiring this to happen so that we can see that an opinion has been formed about the standard of care provided and can see what actions have been taken where this is appropriate. Policies in place in the home should be followed so that people living there are protected from poor practice. This relates to the giving of money as gifts to staff. Two aspects of Health & safety were identified, as needing urgent attention; these were three windows on the first floor which had no restrictors on and could be a risk for people falling and a radiator with no cover which was extremely hot and could burn someone. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 9 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 Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 3&6 This judgement has been made using available evidence including a visit to this service. People have enough information about the home before they move in which helps them make an informed choice about whether the service is right for them. The personalised needs assessment means that people’s needs are identified and planned for before they move into the home. The home does not provide intermediate care EVIDENCE: People have the information they need to make an informed choice about their admission to this home. The home gives each new person that enquires about
Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 11 living at the home an information pack. A copy of the last inspection report is also included if required. The surveys received from people living at the home showed that they had received enough information about the home before moving in so they could decide if it was the right place for them. The home had obtained comprehensive assessments completed by a health or social care professional, such as community psychiatric nurse, or care manager. The manager will visit people at home or in hospital in order to complete assessments. Two pre-admission assessments we saw were generally comprehensive apart from having little information about people’s social history, past lifestyle and routines, interests, etc. All staff said they were not asked to care for people with needs outside of their experience. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been improvement to the care planning process and further development of these plans and other care records will ensure that all health and personal care needs continue to be met. Health care needs are generally well met by good monitoring and close working with other professionals. Medication is managed well Privacy & dignity is well maintained. EVIDENCE: Those people that were able to said they receive a good level of care. Personal records held on behalf of 3 people were examined in detail; there were documented assessments which provided information about skin integrity,
Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 13 moving and handling, safety - including risk of falls and some had included social needs. The information in the assessments had been used to form the plans of care and provided the basis from which the care was to be delivered. For instance one care plan showed an individual who had particular needs with regard to diabetes, clear guidance was written on how to care for this person effectively. However this approach was not always consistent. Another care plan had no instruction on how when or why to use oxygen even though the person uses it regularly, it did not describe how this was managed nor identify any associated risks. Care staff said they referred to the care plans, and seemed to know people well. Reviews were recorded monthly. Most reviews were usefully detailed, but some entries gave little information to show the success or otherwise of planned care and how the person had been. Risk assessments were carried out for some potential physical problems (such as falling). Some care plans contained personal histories have been developed by the staff and with the relatives that contain important information about the persons’ past life and occupation, which gives a sense of who this person is. Personal histories are particularly important for people with diminished communication. Records are kept about all visits to the home by social or health care professionals. Records provided evidence that as well as visits from GPs, district and specialist nurses and chiropodists also visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. The medication system is well managed. Medication storage and recording and procedures were inspected and administration practice observed. There is a system for ordering, receiving, storing and returning medicines, which is well understood by staff and followed to ensure safety. Controlled drugs were looked at and stock numbers checked all were in correct. Staff demonstrated a good understanding of how they can help people to maintain dignity and how they can ensure they have privacy. For example all care is given in private and people wear their own clothes at all times. Staff were seen knocking on bedroom doors before entering and speaking with people in a friendly yet respectful way. Some comments made by the people living there included “ the staff treat me well” and “ I am well looked after”. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an adequate provision for activities for people at the home and this would be further improved with meaningful care planning to ensure that peoples’ individual preferences, potential and diverse needs are met. The people living at the home benefit from the good relationships the home has developed with their relatives and representatives. People are enabled to make some choices and have some control over their lives. The people that live in the home enjoy a balanced diet which takes into account the likes and dislikes of most individuals. EVIDENCE: Two people responding to CSCI surveys said there were sometimes activities arranged by the home that they could take part in. Group activities are organised. Three surveys received commented that there were “not enough outings” and “nothing going on”. On the day of the inspection the notice on the
Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 15 board in the hallway of the home stated that there would be bingo that day, however no activities took place during the day. On the second day of the inspection an updated list was shown with activities planned for every weekday. Peoples’ hobbies and interests had been briefly explored but little detail of how to meet their social needs was described in care plans. For instance in one care plan it said that this person loved “building models” but nothing had been done to explore this and enable the person to actually do it. When asked staff told me that he had a visitor every day, which kept him occupied; however throughout the morning this person was sat alone in his room alone just staring out the door. In the lounge the television was on and several people were watching it. One person was sat knitting; others were sleeping. During the inspection people were seen spending varying periods of time unoccupied apart from when receiving care. The quality manager of the company informed us that two members of staff are going to be employed solely for activities twice a week. Staff said they are now able to purchase meaningful materials to offer interesting activities and it is planned that activities will improve. Visitors were seen coming and going throughout the day, they were made welcome and seemed comfortable being there. There is a quiet lounge at the home that can be used to spend time with relatives and visitors in a more private way. However on the first the day of the inspection this room was being used by the staff to change in, staff lockers were kept there and the care planning files. Also the hairdresser was using it for several people having their hair done at one time. This was raised with the manager and on the following day the room was clear and free for people living at the home to use. Peoples’ preferences regarding daily routines and choices were not consistently recorded to identify what time people like to get up or go to bed or how and where they spend their day. However, staff did confirm that there is no set routine and for those people that are able to state their preferences and that they choose what to do and when. However, for people that lack capacity and have difficulty expressing their wishes clearly agreed routines and preferences would be useful to guide staff. Positive comments were received from people living at the home regarding the meals. From surveys four people said they “always” like the meals and two said they “sometimes” enjoy the meals. One person said if they didn’t like something they were always offered an alternative. One person said the food was ‘very good indeed, in general’. A staff member was seen asking people what they would like for the following days main meal, choice was given if they did not like the meal on offer. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 16 The kitchen was clean and well ordered. The home employs a cook who undertakes the cooking and most of the tasks in the kitchen; the home does not employ a kitchen assistant but instead uses the domestics to help with washing up and to do the teas and coffees. This should be monitored to ensure that sufficient domestic staff are available throughout the day to keep the home clean at all times. The Environmental Health Department encourages homes to work to the guidance Safe Food Better Business; currently the home does not do this. Fridge temperatures are recorded daily and a cleaning rota is in place, which is good practice. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 7 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure and there are systems in place to ensure that investigations are undertaken, which means that people can be confident that their complaints will be listened to. Staff has a good understanding of what to do to protect people from abuse. People feel safe living at the home. EVIDENCE: The complaints policy is given to all people living in the home. In surveys respondents say they know who to speak to if they are not happy and know how to make a complaint. All complaints made to the manager are recorded and once investigated a letter sent to the complainant stating any findings and actions taken, documentary evidence of this was seen. One complaint has been received by the CSCI since the last inspection in October 2007. It was relating to the poor care of one individual living at the home, this was thoroughly investigated by the owner and was found to be in the main, substantiated. This resulted in disciplinary action for staff and clear instruction given so that a similar occurrence may not happen again. The owner is very open to complaints and investigates them in a fair and professional way.
Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 18 All staff were aware of procedures to protect people from harm. They confirmed they had recent updates on safeguarding; training records supported this. They were able to give appropriate examples of unacceptable practice (such as shouting or blocking people into chairs to stop them walking about), and knew they must report this to senior staff. A safeguarding policy was seen in the office. All people living at the home asked said they felt safe at the home. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is safe and improvements to some of the décor and fabric have been made, however there is still work to be done to ensure a pleasant, clean and comfortable environment is available for all people. The home is clean but some areas were found to be malodorous The laundry facilities are adequate, but some procedures could put people at risk of infection. EVIDENCE: Mr Beale bought the home in January 2007. At that time the decoration and maintenance of all areas of the home were poor. The new owner has started to improve the décor by refurbishing and decorating bedrooms. Most areas throughout the home are looking tired and in need of modernisation. The
Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 20 communal areas are decorated to a satisfactory standard. A programme of refurbishment and redecoration is in place. It is planned that all windows and doors are to be replaced in the near future. A handyman is employed. There is an enclosed level courtyard to the rear of the building, accessible from the first floor. This area is to be developed and improved upon by the end of this year. The care staff described appropriate washing procedures for dealing with soiled and other laundry, in order to ensure it was properly cleaned. There were two washing machines and one tumble drier for the home. The area was orderly, although in need of total refurbishment. Staff described how they sluice and clean commode pans; as there is no sluicing facility at the home this is done is any sink available and if needing “a good wash” this is done outside. This could pose a considerable risk to health and hygiene, therefore we advised the home that we would contact the health protection team and request they visit and advise how to manage and improve this situation so that people living their become better protected from infection. There were raised toilet seats and baths with fixed hoists to help people get into the bath. It is planned that a “wet room” is to be made for people to use that have difficulty bathing and to give everyone living at the home more choice. Generally the home smelt clean however some bedrooms did have offensive odours. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the qualities and skills to provide people with the support and care they need. However support and stability will further enhance staff morale. People are protected by the home’s recruitment practice, which is good. EVIDENCE: On the morning of inspection there were three care staff, a cook, and two domestics to care for sixteen people. The acting manager was present all day. Feedback from people found that staff were “usually” available when needed. During the inspection call bells were answered fairly quickly. On the day of the inspection staff were busy, but seemed well organised. The domestics were busy and the home was clean throughout. Currently the home uses one domestic to help in the kitchen washing up and they also give out the teas and coffees. The people living at the home were complimentary about the staff team confirming their needs were met, some comments received from people included: ‘I am really happy here’, ‘the staff are kind and attentive’, ‘Staff all try very hard’. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 22 Comments received on returned surveys from visitors/relatives included ‘ I fully appreciate that the staff have the skills required, they are very attentive and friendly’, ‘all are willing, some are short of experience and some have problems understanding the English language’. Another comment was “ staff are always leaving”. Observation during the inspection showed staff speaking slowly and clearly to people but some people did have difficulty understanding them. Several people living at the home also said they had difficulty understanding some of the foreign staff. Both people living and working at the home expressed concerns about the high turnover of staff in recent months. This has been discussed with the owner previously and it is hoped that this situation will now stabilise and staff will feel more confident and secure in their jobs. Three staff personnel files were examined, all of these records showed a commitment to safe recruitment practices, the files contained an application form, 2 written references, Criminal Record Bureau check, health checks and main terms and conditions of employment. Individual training records (personal development plans) provided evidence that training is provided and ongoing. Staff spoken to on the day of the site visit confirmed they received sufficient training to enable them to meet the needs of those living in the home. Training is mainly provided by way of DVD training courses and questionnaires. A member of staff who had joined the home since the last inspection confirmed the home used appropriate, safe procedures for recruiting staff. They also said they had been given an induction to the job. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements need to be more clear and consistent to ensure people have confidence in the running of the home. The arrangements in place to involve people living at the home and their representatives in how the home is run is not meaningful and does not ensure people are listened to. Money that is held on the behalf of service users is secure. The health and safety of people living at the home and staff are not consistently protected. EVIDENCE:
Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 24 The previous manager has left since the last inspection. The “quality manager” for the company is currently acting up as manager and is in the home every day. She is experienced, knowledgeable and has demonstrated that she is competent to manage the home whilst a permanent manager is sought. Generally staff said they felt unsettled by the constant movement of care staff and management and would benefit from some stability. All staff said there was no clear sense of leadership and direction and there were not opportunities to raise concerns and issues. People living at the home were also concerned about staff and management changes. There is an adequate quality assurance system in place. This includes people living at the home, friends, relatives and health professionals’ satisfaction surveys. A satisfaction survey will be undertaken within the next six months, the results of which will be analysed and actions taken where issues arise. However, we sent out surveys prior to this inspection, only five responses were received back, most of the surveys sent to the home were left on a table in the hallway with no explanatory note to say who they were for or why. Meetings for people living at the home and relatives take place on a bi monthly basis. In order to ensure that this home is run in the best interests of the people living there the quality assurance systems must ensure that peoples’ views are heard. The person registered with the commission as the person who is legally responsible for this service has delegated monthly visits to the quality manager. Visits by this person include speaking with staff and with the people who live here. We looked at the personal allowances of the three people who live at the home we found there is a clear audit trail of any monies spent on behalf of people. There are accompanying receipts and staff signatures. We checked the amounts of money in relation to the account information and these matched. The acting manager said that access to this money is restricted and it is kept in a locked space. The home has a gift policy, which states that cash cannot be accepted as a gift for staff. However records were seen which showed money is kept for staff which had been given from people living at the home but which had never been divided up and shared out. Whilst no inference of deceit is meant this is poor practice. The acting manager immediately took action to deal with this. Maintenance and associated records provided evidence that the registered provider has a sensible approach towards maintaining the safety of the environment; the fire precautions logbook indicates that the fire alarm is tested weekly and emergency lights monthly. Records and discussion confirmed that the staff have regular training in fire safety. The owner was required by Devon & Somerset Fire & Rescue Service to undertake extensive fire precautionary works to ensure the home is safe and meets fire regulations; Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 25 the home has done all it was required within the timescales given and to a high specification. Two areas regarding health and safety were found which pose a risk to the people living at the home. Windows in three bedrooms on upper floor were not restricted and therefore pose a risk to people who may fall out and a radiator was not covered in one of these rooms and posed a risk of burns. The owner assured us that this would be dealt with immediately. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 26 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 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 3 X 2 X 3 X x 2 Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 27 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. Standard OP7 Regulation 15(1)(2) Requirement Each person living at the care home must have a plan of care that identifies all their individual needs and which offers instructions for staff on how these needs should be met in a consistent way. (timescale of 03/11/07 not met) Each person must have their social needs and interests identified and you must make arrangements to enable these needs to be met. This is particularly important for those people with dementia. This will ensure that people can live a fulfilling life. (Previous timescale of 31/12/07 not met) Timescale for action 01/03/08 2. OP12 16 (2) (m) (n) 01/04/08 3. OP26 13(3) Suitable arrangements must be put into place to prevent infection and the spread of infection at the care home,
DS0000069112.V357191.R01.S.doc 01/04/08 Ashfield Rest Home Version 5.2 Page 28 (This relates to sluicing procedures). This will ensure that people living at the home are kept free from harm. 4 OP33 24(1)(a) (b) In order to ensure that this home is run in he best interests of the people living there the quality assurance systems must ensure that peoples’ views are heard. All parts of the home to which people living there have access must be kept free from hazards to their safety. (This relates to three windows having no restrictors and a radiator that is very hot and has no cover) 01/05/08 5 OP38 13(4)(a) 01/04/08 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 1 Refer to Standard OP37 OP38 Good Practice Recommendations Policies in pace should be followed, as is good practice. This relates to the “gift” policy whereby people living at the home are asked not to give money as gifts to staff. The home should work with Environmental Health guidelines “ Safe Food Better Business”. Ashfield Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Rest Home DS0000069112.V357191.R01.S.doc Version 5.2 Page 30 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
