Key inspection report CARE HOMES FOR OLDER PEOPLE
Ashfields Care Home Ashfields 129 Prestbury Road Macclesfield Cheshire SK10 3DA Lead Inspector
David Jones Key Unannounced Inspection 10:24 27th November and 1 December 2009
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DS0000062416.V378552.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ashfields Care Home DS0000062416.V378552.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.V378552.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 39. 19th July 2009 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 £460.00 to £499 for the flats. Ashfields Care Home DS0000062416.V378552.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 one star. This means that people who use this agency experience adequate quality outcomes.
This visit was unannounced. It took place over two days, taking fifteen hours in total, and was done by one inspector. This report will say we when referring to our activities and findings, as it is written on behalf of the Care Quality Commission. Our visit was just one part of the inspection. Before the visit took place we asked the manager to complete a questionnaire that we call an annual quality assurance assessment or AQAA for short. It gives us information about how the service is meeting the needs of the people who use it and includes plans for future development. We made survey questionnaires available for the people who live at the home, their relatives and staff. Replies we received have been taken into account in the report. We also looked at the information that we already had about the home and this, with the information from the AQAA, helped us to form our inspection plan. We checked the records of four people who lived at the home to see what care they receive. We spoke with them and the staff who support and care for them and their views were taken into account. We looked at the communal areas of the home, including lounges, bathrooms and toilets to see at how the home was decorated, maintained and furnished. We also looked at some policies and procedures to check that these were up to date and provided suitable guidance for staff. What the service does well:
The people who live at Ashfields Care Home and those who are thinking of moving in are given good information to help them make decisions about the home. The information about the home, what it does and who it is for, is clearly written and available in large print so people are helped to understand the information and know what the home provides. People who had recently moved in told us that the information they were given was very good. They were invited to visit the home before they moved in so they could make sure it was suitable for them. This showed us that managers and staff understand the importance of providing people who wish to live at
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DS0000062416.V378552.R01.S.doc Version 5.2 Page 6 the home with the information they need to help them choose a home that is suitable for them. The home has a relaxed, friendly and welcoming atmosphere. We could see that people were supported to follow personal interests and activities and enjoyed good relationships with the staff. We could see that people are able to please themselves and their choices are respected. Staff respect people’s wishes regarding rising and retiring and they try to promote choice in all aspects of daily living. The home is well maintained so it provides clean and comfortable accommodation that meets people’s needs and expectations. Care staff were seen to be caring and sensitive in their approach. We could see that the staff are trained and have gone through thorough recruitment processes so they are suitable and have the right qualities and skills to meet the needs of the people who live at the home. All the people we spoke with during our inspection told us that they are happy with the standard of care and spoke highly of the care staff team. For example one of the people who returned our survey questionnaire told us “We are looked after very well. The staff are very friendly”. They also said “there isn’t anything that could be done better I am very pleased”. Another comment was “They do everything well for me, whatever I have asked for they have given me, so I am very pleased and I am happy and settled”. Relatives of the people who live at the home made positive comments about the standard of care provided. One comment was “Since moving to Ashfields Mum has received first class care and support from the staff and Mum’s health and well being has improved significantly, we feel reassured by the fact that she is being well looked after”. This shows us that the home is managed in a way which respects the dignity of people who live there. What has improved since the last inspection?
At our last inspection of Ashfields we were concerned to find that some of the people who lived at the home were not always treated with respect. The home was not being managed properly. Assessments were not always carried out so new people could not be confident that the home was suitable for them. Concerns and allegations of abuse were not always acted upon so vulnerable people were not always safeguarded. Staff recruitment and staff training procedures were not thorough so there were doubts about whether some of the staff had the right qualities and skills to work with the people who lived at the home. We found that managers had responded to the requirements we made to improve the service and we could see from our observations and discussions with staff and the people who live at the home that the requirements we made had been met.
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DS0000062416.V378552.R01.S.doc Version 5.2 Page 7 Managers have improved communication and working relationships with the social services department. Where there had been any suspicion or evidence of abuse they had made contact with the social service department and had worked in partnership with them to make sure that people were safeguarded from harm and abuse. The way new people are introduced to the home has been improved so they can be confident that the home is suitable for them. They benefit from an accurate assessment of their needs which is done with them, or someone close to them, so they know that when they move in their needs will be met in the way they want and prefer. Staff recruitment procedures have been improved. Managers make sure that all checks and references are in place before the person is allowed to start work so they can be confident that new staff are suitable and have the right qualities and skills to work with the people who live at the home. The home has a comprehensive staff training programme and managers are making sure that staff get the right type of training so staff have the skills and knowledge they need to work with the people who live at the home. All new staff complete induction training so they have the skills they need to carry out their jobs effectively and competently. Five of the homes sixteen care workers have now achieved a nationally recognised qualification in care and most others are working towards an approriate qualification. This shows us that people can be confident that their care will be provided by qualified and competent staff. What they could do better:
The manager has been in post for over a year but is not yet registered with the Care Quality Commission. It is an offence under the Care Standards Act 2000 for a person to manage a home without being registered with the Care Quality Commission, so it is important that the manager makes an application for registration without delay. Care plans and risk assessments must be updated when the person’s needs change so staff will always know what to do to meet the person’s health and social care needs and make sure that they are as safe as possible. Where there is any doubt about a person’s capacity to make important decisions about their life or the way they receive care and support managers and staff must make and record an assessment of the person’s capacity to make the decision. The purpose of the assessment is to identify the level of assistance or support the person needs to make the decision or who should be asked to help them with their decision making. This will make sure that peoples’ rights are respected and that they get the support they need to make decisions in their best interests.
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DS0000062416.V378552.R01.S.doc Version 5.2 Page 8 The home’s arrangements for getting peoples’ views need to be put into practice fully so people will know that their views are taken seriously and acted upon. This will help managers to make sure that peoples’ opinions are central to how the home develops and reviews practice so it is always managed in their best interests. All care staff should be offered one to one supervision at least six times a year because it will help to make sure that they are appropriately supervised and supported. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 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 Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking of moving to Ashfields are given clear information and are invited to visit so they can make an informed choice about the home’s suitability for them. They have their needs assessed so they can be confident that their needs will be met when they move in. EVIDENCE: At our last inspection we found that they needed to improve the way new people were introduced to the home so they had their needs assessed and could be confident that the home was suitable for them before they moved in. We checked the records for a person who had moved in recently and we spoke with them to see if they were satisfied with the home and the care provided.
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DS0000062416.V378552.R01.S.doc Version 5.3 Page 11 We could see that they had their needs assessed before they moved in so they knew that the home could support them and meet their needs. Their assessment had been done with them so they received care and support in the way they wanted and preferred. Following the assessment they received a letter from the home which explained the purpose of the assessment and gave them assurances that the home was suitable to meet their needs. They told us that their move to the home had gone very well, they said they had settled in and were quite content with the standard of care and facilities and services provided. The information about what the home provides, how it works and who it is for was written in large print and plain and clear language so people were helped to understand what the home had to offer. Most of the people who lived at the home told us that the information they were given about the home was good. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need to be updated and revised when the person’s needs change so the health and personal care given is based on and meets their individual needs. EVIDENCE: We could see that managers and staff continue to make improvements to the way care is planned for because every person who lives at the home has a care plan that has been written and agreed by them or someone close to them. Their care plans include information about their likes, dislikes and personal preferences so staff know what to do and how the person wants and prefers their care and support done for them. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 13 Visiting health care professionals who responded to our survey told us that the staff usually seek and act on advice to ensure that each person’s social and health care needs are met. Records show that each person’s health care needs were being monitored but we could see that more attention needs be given to the changing needs of the people who live at the home. All the care plans we looked at had been reviewed monthly but we found that some had not been changed when the person’s needs had changed. For example one person’s care plan had not been updated when they had been prescribed medicated cream to treat a particular condition. A senior care assistant was not able to say whether the person was able to administer the medication themselves or whether they need assistance to do this safely. This was because an assessment of the person’s ability to use the medication had not been made or recorded and details of the medication and how it was to be managed were not entered in the home’s medication records. Another person’s care plan and risk assessment had been reviewed by senior staff but the review had not taken account of a change in their circumstances or the number of falls they had in the last few weeks. We could see that this person was at risk of serious injury because the staff had not taken approriate action to make sure the risk of falls was managed and limited as far as possible. This shows us that the home’s risk assessment and care planning procedures need to be improved so the people who live at the home are safe, their needs are met and their health and wellbeing is assured. We checked the medication records and saw that people receive their medicines as their doctor prescribed them. Improvements have been made to the way stocks of medicines are recorded so managers and staff can make effective stock checks of all medicines kept in the home. However, staff need to make sure that all medicines received into the home including medicated creams are recorded in the home’s medication records. Staff training records showed that all senior staff had received training in the administration, recording and safe storage of medicines in the last 12 months. We could see that the managers and care staff have good relationships with the people who live at the home. All the people we spoke with during our inspection told us that they were happy with the standard of care and spoke highly of the care staff team. For example one of the people who returned our survey questionnaire told us “We are looked after very well. The staff are very friendly”. They also said “there isn’t anything that could be done better I am very pleased”. Another comment was “They do everything well for me, whatever I have asked for they have given me, so I am very pleased and I am happy and settled”. Relatives of the people who live at the home made positive comments about the standard of care provided. One comment was “Since moving to Ashfields Mum has received first class care and support from the staff and her health and well being has improved significantly, we feel reassured by the fact that she is being well looked after”. This shows us that Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 14 the home is managed in a way which respects the dignity of people who live there. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Ashfields are able to make choices about their lifestyle and social activities so they have control over their lives. A varied and nutritious diet is on offer but some people living at the home find there is a lack of choice with the evening meal. EVIDENCE: The home has a relaxed, friendly and welcoming atmosphere. We could see from the home’s records that activities including bingo, indoor skittles, and painting were offered most afternoons. Seasonal occasions are celebrated and entertainers visit the home regularly. People told us that they were looking forward to a film show that was being put on in the afternoon of the day of our visit. We could see that people were supported with their individual hobbies and interests and others were able to get out and about themselves. Occasionally staff take people shopping or go out with small groups to local attractions. Most of the people who responded to our survey questionnaire told
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DS0000062416.V378552.R01.S.doc Version 5.3 Page 16 us that suitable activities were always or usually available but some people told us they were bored because they were not interested in the activities on offer. They told us that there had been no residents’ meetings since our last visit and they had not been asked about the quality of care and facilities and services provided. Managers and staff need to address this through the home’s care planning and quality assurance procedures. We could see that people were able to please themselves and their choices were respected. Care staff were observed to be caring and sensitive in their approach. We could see that they respected peoples’ wishes regarding rising and retiring and they tried to promote choice in all aspects of daily living. One of the people who lived at the commented: “There are no rules we are own boss” They told us that smoking inside the home was not allowed but they agreed with that rule. The manager told us that there were no other restrictions on any person’s freedom of movement or power to make decisions. Some people do not have capacity to make some decisions and in such cases managers and staff ask the person’s relatives or other advocates to help them with their decision making. This is good practice but managers and staff need to make sure that an assessment of the person’s capacity is made and kept on their individual care records. The purpose of the capacity assessment is to identify the level of support the person needs to make the decision in their best interest. This will help to make sure that the person’s rights to make their own decisions are respected and promoted. Meal times were enjoyable social occasions. Some people told us that they were happy with the meals served in the home but others said there was a lack of choice with the main meal of the day and a lack of variation at teatime because it was always soup and sandwiches. We could see that an alternative meal was offered at tea time but people told us that the option was usually something on toast so there was no real choice. The manager told us that this would be addressed through consultation with the people who live at the home and meeting with the cooks was arranged to explore how the menu could be improved to offer more choice. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Ashfields are safeguarded from abuse and have their rights protected. EVIDENCE: Ashfields Care Home has a complaints procedure that provides clear guidance on how to make a complaint and it is available in large print so it is easier to read. The complaints records showed that the home had received one complaint since our last inspection. This complaint had been recorded and acted upon appropriately. Some of the people we spoke with told us that they know how to make a complaint but most people did not and were unaware of the home’s complaints procedure. Managers and staff need to make sure that the complaints procedure is promoted so they or someone close to them know what to do to make a complaint, if they want to. Ashfields Care Home has polices and procedures for responding to suspicion or evidence of abuse or neglect including a “whistle blowing policy”. We could see from our discussions with staff, staff meeting minutes and staff training records that action had been taken to make sure that staff know that they can
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DS0000062416.V378552.R01.S.doc Version 5.3 Page 18 report poor practice. Some staff still need training in safeguarding vulnerable people but we could see that training for this had been arranged to take place early in the New Year. There had been four safeguarding referrals to the local authority since our last inspection of the home. Information provided by the local social services department showed us that managers and staff had worked in partnership with them to address these issues and ensure that vulnerable people were safeguarded. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained so that it provides clean and comfortable accommodation that meets people’s needs and expectations. EVIDENCE: The people who live at Ashfields told us that they were happy with the accommodation and comfortable in their surroundings. They live in a clean, fresh and well maintained home which meets their needs and expectations. The home has a programme to improve fixtures, fittings and internal decoration. In the last 12 months the improvements to the home have
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DS0000062416.V378552.R01.S.doc Version 5.3 Page 20 included; new carpets been laid in the first floor corridors, the outside of the building has been painted, some of the bedrooms have been decorated and refurnished with new wardrobes and new curtains. The carpets in the hall and ground floor corridors also need replacing because they have become worn and discoloured. The manager told us that they were getting quotes for new carpets so the cost of replacing them will be included in next years decorating and maintenance programme. Maintenance records show that electrical and gas installations, hoists and fire prevention equipment are serviced regularly so people are safe. The standard of cleanliness throughout the home was good. There were no noticeable odours and polices and procedures on infection control were in place and followed by staff. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained and have gone through thorough recruitment processes so they are suitable and have the right qualities and skills to meet the needs of the people who live at the home. EVIDENCE: At our last inspection of Ashfields we were concerned to find that some of the people who lived at the home were not always treated with respect. Staff recruitment and staff training procedures were not thorough so there were doubts about whether some of the staff had the right, qualities and skills to work with the people who lived at the home. Managers responded to the requirements we made to improve the service and they sent us their improvement plan. We could see from our observations and discussions with staff and the people who live at the home that the requirements we made had been met. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 22 We observed the staff working and talking with the people who live at the home. They carried out their work in good humour and with sensitivity for each person’s needs so they received care in the way they wanted and preferred. We could see that the staff were experienced in caring for older people. All twelve people who responded to our survey told us that they always or usually receive the care and support they need. Most of them told us that staff were always or usually available and that they listened and acted on what they said. All the people we spoke to during our visit told us that they were happy at the home and many made positive comments about staff describing them as good or excellent. All relatives who responded to our survey made positive comments about the standard of care and the staff. For example one comment was: “The staff are worth their weight in gold, Cannot remember all there names but some are brilliant and the rest well you cannot fault”. Another comment was: “The staff are polite and efficient. I have a good understanding with the staff on the care needs of mother”. This shows us that the people who live at the home are treated with respect and are supported by an effective staff team. Staff rotas show that there are enough staff on duty to meet the needs of the people who live at the home. Staffing rotas take into account the changing needs of people and more staff are employed at times of higher demand. We talked with the area manager, the manager and three of the care staff about training opportunities and we looked at staff training records. We could see that there was a comprehensive staff training and development programme with opportunities for training in a range of relevant topics. All new staff complete the Skills for Care induction programme. This includes the common induction training standards so new staff have the skills they need to carry out their jobs effectively and competently. Five of the homes sixteen care workers had achieved a national vocational qualification (NVQ) in care at level three or above and nine were working towards NVQ level 2 in care. NVQs are nationally recognised qualifications for staff in the care profession. This showed that the home is on track to exceed the target for a minimum of 50 of staff to achieve a nationally recognised qualification in care by a good margin. The home’s staff training records showed us that action was being taken to address all staff training needs on a priority basis. All staff will benefit from an annual appraisal and a personal development training plan. The home has targets for refresher training on important topics so managers can be confident that staff have the skills they need to carry out their jobs safely and effectively. Information provided by the area manager showed that a number of staff needed training on important topics including protection of vulnerable people, and moving and handling. However, arrangements were being made to address these training needs. This showed us that the people who live at the home were safe and have appropriate support because the staff providing their care are qualified and competent. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 23 We checked the staff recruitment files for two people who had been recruited since our last inspection and we discussed recruitment with the manager and some staff. Records show that the home’s recruitment procedures are thorough so managers are confident that new staff are suitable and have the right qualities and skills to work with the people who live at the home. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in record keeping, safeguarding vulnerable people and staff training so people have more confidence in the management of the home. Arrangements for involving the people who live at the home in making sure that things are done right need to be improved so the home is always managed in their best interest. EVIDENCE: Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 25 The manager has more than sixteen years experience working in the field of social care including 12 years working as deputy manager at the home. In her experience she has developed her skills and has acquired NVQ levels 2 and 3 in social care and is undertaking NVQ level 4 and the registered manager’s award. The manager has been in post for over a year but is not yet registered with the Care Quality Commission. It is an offence under the Care Standards Act 2000 for a person to manage a home without being registered with the Care Quality Commission in respect of it, so it is important that the manager makes another application for registration without delay. Information provided by the social services department and comments made by the people who live at the home and their relatives showed us that significant improvement had been made in the way the home is managed. We could see from the checks we carried out that managers and staff have addressed all the requirements we made at our last inspection so the problems we found have been put right. Improvements have been made in record keeping, safeguarding vulnerable people and staff training so people have more confidence in the management of the home. We checked the arrangements made for assisting people with their money and we could see that a new more accountable system had been put into practice. This showed us that people were safeguarded because staff follow clear accounting procedures, keep records appropriately and make sure receipts are kept for all purchases made on their behalf. The home has arrangements for getting peoples’ views about the quality care, facilities and services provided but these had not been put into practice since our last visit. Managers had not given out the home’s “Quality assurance survey questionnaires” and had not arranged a residents’ meeting so people had not been given opportunity to air their views and share their opinions about the quality of care provided. People who live at the home told us that they did not recall being asked about quality issues. Some told us that they had raised concerns about the lack of variety in the evening meal but did not feel that their views had been taken on board. The home’s arrangements for getting peoples’ views need to be put into practice fully so people will know that their views are taken seriously and acted upon. This will help managers to make sure that peoples’ opinions are central to how the home develops and reviews practice so it is always managed in their best interests. All electrical circuits, portable electrical appliances, lift, hoist, fire detection, and fire fighting equipment had been serviced within the approriate timescale so people living and working in the home were safe. All staff were cheerful and helpful and we could see that they had good relationships with the people who live at the home. Staff told us that they were
Ashfields Care Home
DS0000062416.V378552.R01.S.doc Version 5.3 Page 26 well supported but some wanted better communication with the manager. Since our last inspection there had been no general staff meetings held but the manager had met with a number of staff on a one to one basis to address specific performance issues and carry out competence assessments. The manager told us that staff meetings will be held regularly and staff supervision meetings were being improved to cover all aspects of care practice and career and personal development. It is recommended that staff are offered one to one supervision at least six time a year because it will help to make sure that staff are appropriately supervised and supported. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 27 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 3 3 Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must be updated when the person’s needs change so staff always know what to do to meet the person’s health and social care needs. Risk assessments must be updated when the person’s needs change so staff always know what to do to make sure that the person is as safe as possible and any unnecessary risks to their health and safety are identified and as far as possible eliminated. The manager must make application to the Care Quality Commission for registration as manager without delay so her fitness and suitability to manage the home can be assessed. Timescale for action 15/01/10 2 OP7 13 15/01/10 3 OP31 Section 11 of the Care Standards Act 2000 15/02/10 Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 29 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 OP14 Good Practice Recommendations Where there is any doubt about a person’s capacity to make important decisions about their life or the way they receive care and support managers and staff need to make and record an assessment of the person’s capacity to make the decision. The purpose of the assessment is to identify the level of assistance or support the person needs to make the decision or who should be asked to help them with their decision making. This will make sure that peoples’ rights are respected and that they get the support they need to make decisions in their best interests. Mangers and staff need to promote the complaints procedure so the people who live at the home know that they will be listened to and have confidence that concerns and complaints will be acted upon. The home’s arrangements for getting peoples’ views need to be put into practice fully so people will know that their views are taken seriously and acted upon. This will help managers to make sure that peoples’ opinions are central to how the home develops and reviews practice so it is always managed in their best interests. All care staff should be offered one to one supervision at least six times a year because this will help to make sure that they are appropriately supervised and supported. 2. OP16 3. OP33 4. OP36 Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 30 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk
We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Ashfields Care Home DS0000062416.V378552.R01.S.doc Version 5.3 Page 31 - 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!
