CARE HOMES FOR OLDER PEOPLE
Ashfields Care Home Ashfields House 34 Mansfield Road Heanor Derby Derbyshire DE75 7AQ Lead Inspector
Vanessa Davies Key Unannounced Inspection 29th January 2007 10:00 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 DS0000068572.V326951.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 DS0000068572.V326951.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ashfields Care Home Address Ashfields House 34 Mansfield Road Heanor Derby Derbyshire DE75 7AQ 01270 882725 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) Ross Healthcare Limited Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To be able to admit the named person of category MD named in the variation application number V37318 dated 14th December 2006 First inspection since new registration. Date of last inspection Brief Description of the Service: Ashfields is a large old extended building on a busy main road. It has many original features and a number of communal lounges. The home has recently changes owners and a refurbishment programme is in place. There is a large car park for staff and visitors. The home is situated close to all local amenities. Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and the Acting Manager was present for part of the inspection. Information for this report was gathered prior to and during the visit to the home. The inspector spoke with a number of residents and staff. What the service does well: What has improved since the last inspection? Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 6 This is the first inspection of this home since a change of ownership and new registration. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear and detailed assessments of need enable staff to meet the needs of the residents and help them to feel safe and well cared for. EVIDENCE: Three resident’s files were examined during the visit. All of the files examined had an assessment of need in place. At the front of each file there was information relating to the social history of each resident. All residents spoken with confirmed that they were aware of their care file and were able to access it if they requested. Needs highlighted within the assessment of need have a care plan and or an assessment of need in place to address it. The Acting Manager confirmed that as referrals are made she completes a pre-admission assessment prior to making a decision. Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 9 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. Although needs highlighted are addressed with care plans and risk assessments, the lack of information following an incident potentially prevents the health needs of the residents being fully met. EVIDENCE: The resident’s health and social needs are assessed in the assessment of need. As stated earlier within this report the home has information relating to the activities residents enjoyed prior to moving into care. All needs highlighted within the assessment are addressed with a care plan or risk assessment. Two care files examined highlighted a failure to document illnesses appropriately and to follow up on doctors appointments and tests. One file detailed a fall in the bedroom, ‘ paramedics called taken to DRI’ on 8th Dec 2006, however nothing else was recorded following this incident until 18th Dec
Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 10 2006. In another file a urine sample was taken to the hospital on 16th March 2006 but nothing else was recorded in the file regarding this. The home has detailed policies and procedures regarding administration of medication. All staff who administer medication have completed a 12 week distance learning training course and at the end of the 12 weeks. The home keeps a record of medication received and administered by the staff. The home has a fridge to stored medication needing to be kept cool, however the temperatures have not been taken since 27.12.06 as the thermometer is broken. The residents spoken with felt that the staff treated them with respect, they always knocked on doors prior to entering, this was evidenced on the day of the visit. All residents were called by their preferred name as detailed within their file. Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 11 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities, inviting friends and relatives to continue contact and the promotion of choice ensures that the social needs of service users are met. EVIDENCE: Each of the files held detailed information within them regarding social and religious needs of the residents. The home ensures that religious services are offered to residents. All of the residents spoken with felt that the home met with their expectations, ‘there is plenty to do if you want to do it’ was one comment made. The Acting Manager stated that the new provider was in the process of purchasing a new minibus to enable the residents to go out more often. The new providers are also in the process of employing an Activity Coordinator to ensure that activities are offered on a regular basis. All residents spoken with confirmed that relatives and friends are always made to feel welcome and can visit without appointment.
Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 12 Residents went on to confirm that they are offered choices in their lives. The home keeps records of menus and choices offered along with any alterations to the menu. When food needs to be liquidised it is done so to ensure that flavours are kept separate. Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed procedures for Safeguarding Adults, dealing with complaints and recruitment ensure that service users are safe and protected from abuse. EVIDENCE: The home has a detailed complaints procedure in place and all service users and relatives spoken with were aware of it. All those spoken with stated that they had had no cause to complain, however they were confident that if they needed to complain they would do so and it would be dealt with appropriately. The Acting Manager stated that all staff were aware of the need to report any complaint and document it and this was confirmed when speaking with staff. The home has rigorous recruitment procedures and Safeguarding Adults policies and procedures. A cross-section of staff records was examined. All files examined had 2 written references, a Criminal Records Bureau (CRB) check, a completed application form and 2 forms of identity. Staff are not given a start date at the home until their CRB has been returned. Training records evidenced that all staff had completed training in Safeguarding Adults, this had been completed in 2004 for a number of staff, although the Acting Manager stated that she ensures that staff are kept updated internally. Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. A well-maintained environment helps to ensure that service users are not put at any undue risk. EVIDENCE: The home appears to be well maintained and provides a safe environment. It was clean and tidy on the day of inspection and residents stated that it always appeared this way. The Acting Manager stated that the new providers have a refurbishment programme in place with the intention of completely revamping the existing dining room, making it more inviting. They also intend to refurbish bedrooms as they become vacant, prior to a new resident moving in. Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 15 Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Rigorous recruitment procedures and appropriate training courses ensure that staff are trained to meet service users needs and that service users are cared for safely. EVIDENCE: Duty rotas evidence that there appears to be sufficient staff on duty over a 24 hour period. The residents spoken with felt that staff numbers were sufficient. The home has 2 waking nights and a member of staff sleeping in every night. The provider offers a range of training to ensure that residents needs are met. Training includes the mandatory courses and NVQ 2, moving & handling. Care staff spoken with felt that the training met with the needs of the residents. However, as stated earlier within this report the staff do need to complete record keeping training to ensure that documentation is kept up to date. As stated previously within this report the home has a rigorous recruitment procedure to ensure the safety of the service users. Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 17 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): 31,33,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of a Registered Manager and insufficient quality monitoring potentially prevents the service from developing and meeting the changing needs of the residents. EVIDENCE: The Acting Manager has key responsibilities as does the Provider, the Acting Manager stated that the provider was due to advertise for a Registered Manager. The Acting Manager was confident that the new providers were making positive changes and were visiting the home on a regular basis. Although the Acting Manager does undertake some form of monitoring, it does not cover all aspects of care and health and safety, she did state that this
Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 18 would change in the near future. The Acting Manager stated that they intend to send out questionnaires to relatives and residents every three months and one out to all staff annually. Staff have regular supervision as stated within the standards, the Acting Manager completes supervision for the Senior Care Workers and they complete supervision with the Care Staff, however the Senior Care Workers have not had any training to undertake this role. The staff at the home undertake regular fire alarm tests, drills and emergency lighting tests. Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 19 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 X 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 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 3 Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2. 3. Standard OP7 OP33 OP36 Regulation 18.1c 24 18.1c Requirement Staff must receive training in record keeping. A quality monitoring system must be in place. Staff providing supervision must receive training to do so. Timescale for action 30/04/07 30/05/07 30/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3. Refer to Standard OP8 OP9 OP31 Good Practice Recommendations Records for residents should be kept up to date, recording findings from health tests. A new thermometer should be purchased for the medication fridge. The organisation should appoint a Manager and ensure that they apply for Registration. Ashfields Care Home DS0000068572.V326951.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 DS0000068572.V326951.R01.S.doc Version 5.2 Page 22 - 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!
