Inspection on 21/05/08 for Ashfields Care Home

This inspection was carried out on 21st May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Ashfields Care Home 27/11/09

Ashfields Care Home 19/07/09

Ashfields Care Home 23/05/07

Ashfields Care Home 24/05/06

Ashfields Care Home 13/12/05

Ashfields Care Home 16/08/05

Ashfields Care Home 22/02/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Ashfields Care Home Ashfields 129 Prestbury Road Macclesfield Cheshire SK10 3DA Lead Inspector David Jones Unannounced Inspection 21 and 22 May 2008 1:00 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 Ashfields Care Home DS0000062416.V361742.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. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashfields Care Home Address Ashfields 129 Prestbury Road Macclesfield Cheshire SK10 3DA 01625 617288 01625 434753 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) Winnie Care (Macclesfield) Ltd Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 39 service users in the category of OP (old age, not falling within any other category) 23 May 2007 Date of last inspection Brief Description of the Service: Ashfields is a privately owned care home located close to Macclesfield town centre. There are a variety of shops, a church and other facilities nearby. Ashfields is a three-storey building and residents are accommodated on all floors. Access between floors is via a passenger lift or the stairs. Residents’ accommodation currently consists of 39 single rooms, 24 of which have ensuite facilities. Included in these numbers are five flats which are in the grounds of the home; these are linked to the main building via an emergency call system. The people who live in the flats are more independent than those accommodated in the main building. There is a lounge, conservatory and a separate dining room available for the people who live in the home. The current weekly charges for the home are £343.34 to £455 for the flats. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. This key inspection was unannounced. The visit to the home took place over two days and took 11 hours and 15 minutes in total. It started at 1pm on the first day. This visit was just one part of the inspection. Before the visit, the manager was asked to complete a questionnaire to provide detailed information about the home and how it is meeting the needs of the people who live there. CSCI questionnaires were made available for the people who use the service, their families and health and social care professionals, such as nurses and social workers, and their views about the agency have been taken into account. Records for three of the people who live at the home were checked to see the care they receive. Some people were spoken with and their views taken into account. Staff recruitment and training records were examined. Some of the home’s policies and procedures were also checked. What the service does well: Ashfields has a relaxed, friendly and welcoming atmosphere. The people who live at the home have good relationships with staff and enjoy frequent and friendly interactions. There is a good range of activities on offer so people are kept occupied and enjoy a good quality of life. People who are interested in moving to Ashfields are given sufficient information about the facilities and services provided and are invited to visit so they can make an informed choice before moving in. Most of the people who live at the home told us that their needs were always or usually met. One person said that staff are well trained and pay attention to detail, always showing kindness, consideration and respect. Another person told us that the home was well run and their needs were met in the way they would wish. The accommodation is clean, well maintained and comfortably furnished so people feel at home. All people responding to the survey said the home was always clean. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Care management assessments must be obtained for all people who are placed at the home by their local authority before they move in, so managers and staff can be confident that people’s needs have been thoroughly assessed. Each person’s care plan must be kept under review and revised when needed so their needs in respect of their health and welfare are met appropriately. Care plans need to be developed with the involvement of the individual and their representatives and should include their personal preferences regarding care, privacy and dignity, so they always receive care in the way they prefer. Communication with health care professionals must be improved and appropriate arrangements must be made for people to receive treatment and advice from health care professionals as and when they need it, so their health care needs are met. Records of the loose medication received must be made, so managers can make proper checks and people who use the service are protected. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 7 The choice of meals needs to be improved by including all available meals on the menu so people can choose from a range of options. All staff should be provided with training on adult safeguarding so they know what to do if they are made aware of any evidence or suspicion of abuse and vulnerable people are safeguarded. Staff must not begin working in the home on care unless all references have been received so vulnerable people are safeguarded from possible abuse. 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. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 8 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 Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, and 5 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who are interested in moving to Ashfields receive information and can visit so they are able to make an informed choice about the home before they move in. They have their needs assessed so they know the home is suitable to meet their needs. EVIDENCE: People who are thinking of moving to Ashfields are invited to visit the home so they can make an informed choice about moving in. They are given a copy of the home’s statement of purpose, which sets out its aims and objectives, and additional information in the service users guide. The guide provides clear information on the home’s facilities and services including details about activities, food, accommodation and staffing. It is available in large print so it is easy to read. Most of the people who responded to the survey told us that they received enough information to help them with their decision-making. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 10 All people living at the home have been given a contract if they are paying privately or a statement of terms and conditions if their local authority supports them, so they know their rights and responsibilities. Records show that people have their needs assessed before they move in. The manager or other experienced qualified staff from the home had done the assessments. These included identification of people’s health and social care needs, likes, dislikes, some background information and family history. However, none of the case files checked during the inspection visit contained a copy of the local authority’s individual care management assessment. This needs to be obtained for all people who are funded by their local authority before they move in, so managers and staff can be confident that their needs have been assessed thoroughly. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 11 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 and 10 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Arrangements made for health and personal care were based on the needs of the people who lived at the home but poor care planning meant that one person had remained at risk of developing pressure sores. EVIDENCE: The case records of three people who lived at the home were read during the inspection visit to check on the care they were receiving. All people who live at the home had a care plan. Care and support planning arrangements had generally improved since the last inspection. The care files included evidence of good outcomes and improved health care for the people who live at the home. For example, where people were found to be at risk of falls, staff had taken action to protect them from further injury. Risk assessments had been put in place and staff had contacted health care professionals for advice on falls prevention so people were as safe as possible. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 12 However, there was still room for improvement. For example, one of the people who lived at the home was assessed as being at high risk of developing pressure sores. A care plan had been drafted to address this person’s needs but this did not include referring them to the district nursing services for treatment and/or pressure reliving equipment. This meant that this person’s health care needs were not met. One of the three care plans seen had not been reviewed and another had not been kept up to date when the person’s circumstances changed. There was evidence of poor communication between senior staff. For example, senior staff including the manager did not know what progress was being made with the treatment of a person’s pressure sores and they could not get the information needed from the care records. Further enquiries with the district nurse confirmed that the pressure sores had healed and the treatment had stopped. The district nurse had made four visits to treat the person since the last entry in their records but staff had not recorded the outcome of the visits and key staff had not passed this information on to the manager. Health care professionals told us that communication with the home had not always been effective so the health care needs of some of the people who live at the home had not always been met. Staff were aware that each resident had differing needs and expectations regarding personal care but their personal preferences were not recorded in their care plan. Therefore, it was not clear how staff could provide consistent care and make sure that each person’s needs were met in the way they would prefer. Only staff with an NVQ qualification in care are involved in the administration of medication and they have access to a clearly written medication policy. The manager assesses their competence by observation and arrangements are being made to provide refresher training from a local pharmacist. A check of medication records showed that the people who use the service received appropriate levels of support with their medication so their health care needs were met and their independence was promoted. However, it was noted that some stock records of loose medicines where not always made in the appropriate detail. This makes the home’s medication system potentially unsafe and makes audit difficult or almost impossible so the people who use the service are not adequately protected from possible medication errors. Most of the people who live at the home told us that their needs were always or usually met. One person said that staff are well trained and pay attention to detail, always showing kindness, consideration and respect. Another person told us that the home was well run and their needs were met in the way they would wish. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 and 15 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Suitable activities are available and people who live at the home have choice about their daily life so they enjoy a good quality of life that always or usually reflects their needs and expectations. EVIDENCE: Ashfields has a relaxed, friendly and welcoming atmosphere. The people who live at the home have good relationships and enjoy frequent and friendly interactions. All the people who responded to the survey told us that suitable activities are always or usually available. There is an activities co-ordinator who provides a range of activities including beetle drives, bingo, card games, darts, flower arranging, tai chi sessions, movement to music and quizzes. Entertainers are regularly booked to perform in the home. People who live at the home told us there is always something to do and they generally have a lot of fun. The religious needs of the people who live at the home are met. Local clergy visit regularly to give Communion for those who require it and there is a Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 14 monthly service held at the home. Some people go to church on a regular basis. One person said they are a member of a church religious study group and attend meetings several times a week. The service users guide confirms that visitors are welcome at all reasonable times. A visitor told us that they were always made to feel welcome. People who live at the home told us that they are able to please themselves and their choices are respected. One person said, ‘there are no rules we come and go as and when we please’. Care staff were observed to be caring and sensitive in their approach. They told us that they respect people’s wishes regarding rising and retiring and try to promote choice in all aspects of daily living. One person told us they were aware that some staff put people to bed early for their own convenience. They said it happens to those people who would be unable to speak up for themselves. There was no other evidence to support this. However, managers will need to investigate to make sure that people go to bed when they choose and not for the convenience of staff. Spot checks should be made as part of the home’s quality assurance system. Most of the people told us that they always or usually liked the meals on offer. One person said the food was excellent and another that it was good. Some people said they would like more choice especially at teatime. The catering manager said there is more choice than what is shown on the menu because people can always ask for an alternative meal. However, one of the people who lived at the home was refused jam and bread when they asked for it as an alternative to the sandwiches provided at teatime. Menus should be revised so they confirm the full range of meals on offer including alternative meals. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 15 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 and 18. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home has complaints and adult safeguarding procedures so the people who use the service are able to express their concerns, are listened to and are safeguarded from abuse and neglect. EVIDENCE: People who live at the home are able to express their concerns and have access to an effective complaints procedure so they are listened to and their concerns are acted upon. Most people responding to the survey told us that they know how to make a complaint and all said staff listen to and act on what they say. The complaints records confirmed that since the last inspection, senior staff had responded appropriately to concerns raised by four of the people who live at the home. However there was no mention of a complaint that had been made by a relative. The manager said that this complaint had been made to head office so the details were recorded there. A record of all complaints made by people who live at the home or their representatives must be kept in the home at all times available for inspection. The home has procedures for responding to suspicion or evidence of abuse or neglect including whistle blowing inline with the Public Interest Disclosure Act 1998. There have been 2 adult safeguarding referrals since the date of the Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 16 last inspection. In each case managers and staff worked with the social services department so vulnerable people were protected. However, the Commission was not notified of the most recent incident within appropriate timescales. The Commission must be notified of any evidence or suspicion of abuse so the home meets its regulatory responsibilities and vulnerable people are safeguarded. The manager has completed “alerter” training and some staff have received training on implementing adult safeguarding procedures through their NVQ training. However training records provided by the manager indicate that most staff have not received training on adult safeguarding other than basic training during their induction. All staff need training on adult safeguarding so they know what to do if they are made aware of any evidence or suspicion of abuse and vulnerable people are safeguarded. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 17 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 and 26. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who live at the home have well-equipped and well-maintained accommodation, which meets their needs and expectations so they are safe, comfortable and feel at home. EVIDENCE: People who live at the home told us that they are very comfortable. One person said they were happy with everything and another said the home provides a very pleasant environment. All who responded to the survey told us the home is always clean and some made further comments about the high standards of cleanliness and the absence of any unpleasant odours. The home has been awarded a “Gold Award” for food hygiene by the environmental health department. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 18 Since the last inspection a number of bedrooms have been redecorated and refurnished and new carpets have been provided in some of the corridors. There is a business plan for ongoing redecoration and refurbishment. This confirms further replacement of carpets in corridors is to take place. Maintenance records show that electrical and gas installations, hoists and fire prevention equipment are serviced on a regular basis so people are safe. However, it was noted that some bedroom doors were not fitted with intumescent strips or smoke seals and some radiators guards were missing. The area manager told us after the inspection that immediate action had been taken and appropriate smoke seals and radiator guards had been fitted so people are protected from heated surfaces and are safe in the event of a fire. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 19 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): 27, 28, 29 and 30 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. There are enough staff to meet the needs of the people who live at the home but staff recruitment procedures are not always followed so the people who live at the home are not fully safeguarded from the potential for abuse. EVIDENCE: Staff rotas and staff training records show that staffing levels and skill mix are sufficient to meet the needs of the people who live at the home. The staff rota for the week beginning 18 May 2008 confirmed that there were 6 care staff on duty each morning and 4 every afternoon and evening throughout the week. Agency care staff were used in limited numbers to cover vacant posts but they always worked alongside experienced staff so continuity of care was assured. Many staff have worked at the home for a number of years. This provides stability and continuity for the people who live at the home. All of the people who responded to the survey told us that staff are always or usually available when they need them. Staff are encouraged to do nationally recognised qualifications beyond the basic requirements, and managers recognise the benefits of a skilled and trained workforce. All new recruits benefit from comprehensive induction Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 20 training that meets “Skills for Care” criteria and standards. More than 50 of the care staff team either have an NVQ at level 2 or above or are working towards the qualification. This means that the home is on target to meet the National Minimum Standards for numbers of staff with a nationally recognised qualification in care. The staff recruitment files for two new staff members were read and discussed with the manager. It was confirmed that the home has appropriate recruitment procedures but these had not always been followed. One staff member had been employed to work with vulnerable people before all required recruitment checks were in place. Their previous job was in care but a reference had not been received from their previous employer. There was no attempt made to get a verbal reference and the person’s stated reason for leaving their previous job had not been verified with the previous employer. This means that vulnerable people did not receive the protection that the home’s recruitment procedures should have given them. Staff responding to the survey told us that they are confident they have the right support, experience and knowledge to meet the needs of the people who live at the home. They told us that training provided keeps them up to date, helps them to understand and is relevant to their work. Information provided by the manager confirms that a staff-training programme is in place. Staff training records show that staff have received training on various topics in the last 12 months including the principles of care, maintaining safety at work, effective communication, recognising and responding to abuse and neglect, personal development, care planning, dysphagia, fire awareness and moving and handling. This shows us that staff are trained and competent to do their jobs. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 21 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 and 38 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Quality assurance systems in the home have improved and the people who live there are consulted about their views but managers and staff do not always communicate effectively with each other or health care professionals so the well being of the people who live at the home is not always assured. EVIDENCE: There is a new manager who started work at the home in January 2008. She is not yet registered with the Commission for Social Care Inspection but was in the process of making an application for registration. The manager is experienced in the field of social care including four years in management. She has NVQ level 4 in care and the Registered Managers award. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 22 The management structure is suitable for the size and purposes of the home but communication is not always adequate. For example, a senior member of staff was concerned about the quality of care provided but the manager was unaware of their concerns and they had not been acted upon. Visiting health care professionals told us that there had been occasions when people had not had their health care needs met because of poor communication. They said that communication with senior staff had improved in recent weeks but the care records that were checked identified a further example of poor recording and poor communication between senior staff and health care professionals. There is a quality monitoring system, which seeks to involve people who live at the home in measuring quality and making a positive contribution to home’s development. Since the last inspection residents’ and relatives’ meetings have been held and quality survey questionnaires have been handed out. In addition senior managers from the company make regular monthly visits to the home to satisfy themselves as to the quality of care, facilities and services provided. The people who live at the home are consulted during this process and their views are acted upon. This shows that managers and staff are working with the people who live at the home to implement appropriate arrangements for measuring and improving the quality of care, facilities and services provided. However, a report on the review of quality of care and facilities and services provided by the home must be produced to complete the process. The report should bring together all aspects of the home’s quality review and be made available to the people who live at the home so they know what has been done to address the issues they raise. Consideration should be given to widening the scope of the home’s quality assurance system to include checks on the quality of assessments, risk assessments, care plans and outcomes for the people who use the services. This will help managers to address some of the care management issues identified during this inspection. People who live at the home may deposit small sums of money for safekeeping. A check on the arrangements for handling money found all transactions to be recorded correctly, with receipts for items purchased on each individual’s behalf. One staff member said that they have had an appraisal this year and they were aware that supervision meetings were to be arranged. However other staff said that they had not had supervision since 2006. The manager aims to provide all staff with structured one-to-one supervision meetings at least four times each year. This will ensure that all staff receive the guidance and support they need to do their jobs effectively and meet the needs of the people who live at the home. All electrical circuits, portable electrical appliances, lifts, hoist, fire detection equipment and gas appliances have been serviced within the last twelve months so people are safe. The manager ensures that risk assessments are Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 23 carried out to make sure working practices are safe and significant findings are recorded. However some risk assessments were not signed or dated and one relating to the care needs of a person who lives at the home had not been acted upon so the individual remained at risk of harm. Where hazards to health and safety are identified, risk management plans must be developed, and recorded so the people who use the service and staff are safe. They should be signed and dated by the author and where appropriate agreed with the person they relate to so their rights are promoted and they receive care and support in the way they prefer. Winnie Care (Macclesfield) Ltd the company that owns and operates the home is committed to promoting equality and diversity so the differing needs, personal preferences and cultural requirements of all people who may wish to use the home are recognised, respected and met. This was not reflected in the home’s statement of purpose or service users guide. The area manager told us that the statement of purpose and service users guide would be amended to reflect the home’s commitment to equality and diversity. Equality and diversity is promoted in the home by recognising and addressing people’s differing needs through care planning but some staff have not received training on equality and diversity. Arrangements should be made to make sure that all staff have the knowledge and skills they need to acknowledge, understand and cater for each individual’s needs including those relating to their religious and cultural needs, personal preferences, sexuality and sexual orientation. Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 24 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 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 25 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)(b) and (c) Requirement The care plans for each person who lives at the home must be kept under review and where appropriate, and after consultation with the individual or their representatives, be revised to reflect their changing needs so their needs in respect of their health and welfare are confirmed in writing and met. Arrangements must be made for the people who live at the home to receive, where necessary, treatment and advice from health care professionals so their health care needs are met. (This requirement is outstanding from the previous inspection the timescale of 30/06/07 was not met) Staff must not begin providing care in the home until full and satisfactory information is received in respect of them. This must including a written reference form their previous employer where the individual worked in a position with DS0000062416.V361742.R01.S.doc Timescale for action 25/06/08 2 OP8 13(1)(b) 25/06/08 3 OP29 19(10)(b) 25/06/08 Ashfields Care Home Version 5.2 Page 26 vulnerable adults and verification of the reason why they ceased to work in that position. This will make sure that people are safe and safeguarded from abuse. 4 OP31 12(1) Communication between the manager, staff and health care professionals must become more effective so as to promote and make proper provision for the health and welfare of the people who live at the home. 25/06/08 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 Refer to Standard OP3 Good Practice Recommendations Care management assessments should be obtained for all people placed at the home by their local authority before they move in so managers and staff can be confident that their needs have been assessed comprehensively Each individual’s personal preferences regarding the way they wish to receive assistance with personal care should be recorded in their care plan. Wherever possible, people should sign their care plan to show they agree with it so they always receive personal care in the way they prefer Detailed records of the stocks of loose medicines must be kept, including adding the amount of any new stock of a medicine to the existing balance so managers can conduct thorough medicines audits and ensure stocks are maintained at the appropriate levels. This will help to ensure that the people who use the service are protected and receive their medicines in accordance with their needs. All staff involved in administration of medication should receive refresher training so they can maintain their skills DS0000062416.V361742.R01.S.doc Version 5.2 Page 27 2 OP7 3 OP9 4 OP9 Ashfields Care Home and make sure that medicines are administered, stored and recorded appropriately. 5 OP15 Action should be taken to improve the choice of meals on offer by including all alternatives on the menu so people can choose from a range of options. A record of all complaints made by people who live at the home or their representatives must be kept in the home at all times available for inspection so the record can be inspected. The Commission for Social Care Inspection must be notified of any evidence or suspicion of abuse so the home meets its regulatory requirements and vulnerable people are safeguarded. All staff should be provided with training on adult safeguarding so they know what to do if they are made aware of any evidence or suspicion of abuse and vulnerable people are safeguarded. The scope of the home’s quality assurance system should be widened to include checks on the quality of assessments, risk assessments, care plans and outcomes for the people who use the services so their health care needs are met and they receive care in the way they prefer. Risk assessments should be signed and dated by the author and where appropriate agreed with the person they relate to so the individual’s rights, safety and independence are promoted. 6 OP16 7 OP18 8 OP18 9 OP33 10 OP38 Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 Ashfields Care Home DS0000062416.V361742.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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