Inspection on 21/08/07 for Ashford House

This inspection was carried out on 21st August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ashford House Long Lane Stanwell Middlesex TW19 7AZ Lead Inspector Sarah MacLennan Unannounced Inspection 21st August 2007 09:45 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 DS0000069300.V345442.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. DS0000069300.V345442.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashford House Address Long Lane Stanwell Middlesex TW19 7AZ 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) 01372 860300 01784 425889 ashfordhouse@barchester.com Barchester Healthcare Homes Ltd Mrs Linda McCarthy Care Home 54 Category(ies) of Dementia (9), Dementia - over 65 years of age registration, with number (45) of places DS0000069300.V345442.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Ashford House is a privately owned care home owned by Barchester Healthcare Homes Limited. Personal care and accommodation is offered for up to 54 service users with dementia. Ashford House is purpose built and is bright spacious and airy. Accommodation is arranged over two floors. single rooms with en-suite facilities. The fees for this service start at £900. Service users have their own DS0000069300.V345442.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit formed part of the key inspection process and took place over 5½ hours commencing at 09:45 and ending at 15:15. Sarah MacLennan, Regulation Inspector, carried out the visit. The registered manager, Mrs Linda McCarthy, was present throughout the inspection. As part of the inspection process a tour of the premises took place. Various written records were examined, including five care plans and service user assessments, seven staff personnel files, samples of staff training records, the complaints record, the medication storage facilities and a sample of the medication administration records. The inspector spoke to a number of service users, relatives and some staff members. Some of the comments made to the inspector are quoted within this report. The inspector would like to thank the staff and service users for their time, assistance, and hospitality during the visit. What the service does well: A comprehensive pre admission assessment is carried on all prospective service users and service users have detailed and comprehensive care plans. Service users and relatives spoken with were complimentary regarding the care that they received in the home. Comments included; ‘mum is doing so very well, I am very pleased with her care’. Service users are encouraged and enabled to live a full life and to participate in age related activities. The home employs two activities assistants and had a structured activities programme in place. Activities included puzzles, art, bingo, reminiscence and current affairs, reading newspapers and magazines, playing cards, singing, listening to the radio and enjoying the garden. Conversation with staff, relatives and service users evidenced that the service users are encouraged to be as independent as possible and to make their own choices, such interactions were observed. Staff were observed to treat the service users with respect and care was provided in an unobtrusive and dignified manner. The home vulnerable with clear allegations has suitable policies and procedures for the safeguarding of adults. The manager has produced a comprehensive flow chart timescales and actions for staff to take in the event of any or suspicions of abuse, copies of this flow chart are clearly DS0000069300.V345442.R01.S.doc Version 5.2 Page 6 displayed throughout the staff areas of the home. Staff spoken to were aware of these policies and procedures and their whistle blowing responsibilities. Service users and relatives spoken with were complementary about the staff at the home. Comments included, ‘nice people’, ‘can talk to them’, ‘the nurses nice, each and every one of them’, the staff are competent and capable’ and ‘I am confident that the staff listen to my mother and me too’. The registered manager, Mrs Linda McCarthy, demonstrated good leadership qualities, she had knowledge and awareness of the service users need. Service users were seen to interact readily with her and an open and inclusive atmosphere was evident within the home. All staff and service users appeared happy, contented and relaxed with the inspection process. The atmosphere within the home during the inspection was lively and cheerful. The home has various quality audit systems were in place to ensure the staff, service users and their relatives had a forum for airing their views. What has improved since the last inspection? 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. DS0000069300.V345442.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 DS0000069300.V345442.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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users had comprehensive assessment prior to admission to the home to ensure that the home can meet the service users identified needs. EVIDENCE: The inspector was advised that a welcome pack that includes the service users guide sent out is sent out to all prospective service users and their relatives. The home encourages relatives and service users, if appropriate, to visit the home prior to admission. The deputy manager and the unit heads carry out a pre-admission assessment on all prospective service users. Five service user care plans were seen and all had comprehensive preadmission needs assessments completed. The assessment was very thorough and covered all elements of physical, mental, and social needs. DS0000069300.V345442.R01.S.doc Version 5.2 Page 9 Service users and relatives spoken to felt they had received enough information prior to moving to the home. Service users were admitted on a month’s trial basis. The inspector was informed that the service users guide and statement of purpose have been recently updated to reflect the new manager of the home; these documents were not seen during the inspection. The home does not offer intermediate care. DS0000069300.V345442.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive care plans and medication policies, procedures and practices were in place to ensure the service users health care needs are met. Care was seen to be provided in a respectful and sensitive manner. EVIDENCE: The service user care plans and files were randomly sampled; five care plans and daily statements were looked at in detail. The care plans were detailed and comprehensive, with detailed risk assessments being completed. The service users daily statements evidenced that the care plans were followed and provided details of the service users 24hr day. DS0000069300.V345442.R01.S.doc Version 5.2 Page 11 Service users and relatives spoken with were complimentary regarding the care that they received in the home. Comments included; ‘mum is doing so very well, I am very pleased with her care, so is the rest of the family’, ‘It’s quite nice’ and ‘very happy here’. Service users were registered with local GPs and had access to other health care services. The homes storage and recording of medication were seen and found to be in order. The home had a suitable policy for the administration of medication. No service users self-administered their medication. Conversation with staff and service users evidenced that the service users are encouraged to be as independent as possible and to make their own choices, such interactions were observed. When asked if they received the support they required service user comments included ‘I can talk to them’, ‘they listen to me’ and ‘I am confident that the staff listen to my mother’. DS0000069300.V345442.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision of activities and food are suitable for the needs of the service users. EVIDENCE: From examination of the service user records and discussion with staff, relatives and service users it was apparent that service users are encouraged and enabled to live a full life and to participate in age related activities. Of the five service user care plans sampled four had detailed individual activities records and life histories. The home employs two activities assistants and had a structured activities programme in place. Activities included puzzles, art, bingo, reminiscence and current affairs, reading newspapers and magazines, playing cards, singing, listening to the radio and enjoying the garden. The inspector was informed that a new minibus was due to be delivered in October. Daily outings will then be arranged for the service users. DS0000069300.V345442.R01.S.doc Version 5.2 Page 13 Service users spoken stated that the provision of activities was suitable for their needs. One service user stated that they ‘enjoy reading the newspaper’. Other comments from service users included ‘lots of fun’, ‘the staff are all very nice’ and ‘it’s friendly’. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural groups. The home had no restrictions on visiting times and relatives spoken to stated that the staff always welcomed them in the home. All service users and relatives spoken to stated that they were happy with the food provision within the home. Some of the service users were observed to eat lunch during the inspection. Comments from service users included and ‘the food is good’. The menu was on a four weekly rota and alternatives were available. The inspector was informed that the manager is currently reviewing the food provision within the home. The meals are being evaluated to ensure that they are appropriate for the service user group. This review is taking place in conjunction with the service users, their relatives, staff and an external company. Service users particularly enjoy the daily cooked breakfast and the manager is planning to move the main meal to the evening and then to provide a lighter lunch. Conversation with staff, relatives and service users evidenced that the service users are encouraged to be as independent as possible and to make their own choices, such interactions were observed. Staff were observed to treat the service users with respect and care was provided in an unobtrusive and dignified manner. DS0000069300.V345442.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home had a simple and accessible complaints procedure; service users stated that they felt safe at the home. EVIDENCE: The home had a simple and accessible complaints procedure. The complaints procedure is clearly displayed in the hallway and a copy is given to all service users and their relatives in the service users guide. Service users and their visitors had also been a copy of the Mental Capacity Act 2005 Easy Read Summary produced by the Department of Health. Service users and relatives spoken to during the inspection were aware of the complaints procedure, and felt confident about using the process. There had been three complaints since the last inspection all of which had been appropriately investigated and recorded. One service user spoken to said ‘If I was unhappy I’d talk to the person in charge’ all service users spoken to felt that their views were listened to and taken seriously. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The home had suitable protection of vulnerable adults and whistle-blowing policies. The home also had copies of the Surrey Multi-Agency policy 2005, and the Department of Health publications ‘PoVA a Practical Guide’ and ‘No Secrets’. The manager had produced a comprehensive flow chart with clear DS0000069300.V345442.R01.S.doc Version 5.2 Page 15 timescales and actions for staff to take in the event of any allegations or suspicions of abuse, copies of this flow chart are clearly displayed throughout the staff areas of the home. Staff spoken to were aware of these policies and procedures and their whistle blowing responsibilities. Staff had received training in the protection of vulnerable adults. All service users spoken with stated that they felt comfortable and safe at the home. DS0000069300.V345442.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was found to be clean, tidy and suitable in layout for its purpose. EVIDENCE: The inspector toured areas of the home. At the time of inspection some of the communal areas of the home were being redecorated and new chairs were delivered. The premises were seen to be well maintained with service users able to access all areas of the home and grounds. The home was suitable for the needs of the service users. The décor was domestic in nature and general standards of maintenance were good. It was seen to be clean, tidy and free from offensive odours. Service users spoken to stated that the home is always clean, other comments from service users included ‘there is a nice courtyard’. DS0000069300.V345442.R01.S.doc Version 5.2 Page 17 The home had recently employed a gardener and a group of relatives were very involved in the care of the garden. DS0000069300.V345442.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staffing arrangements in place on the day of the inspection were sufficient to meet the needs of the service users. EVIDENCE: Discussion with staff, service users and relatives demonstrated that the staffing numbers and skill mix were appropriate to meet the assessed needs of the service users living in the home. The inspector was informed that the home maintains staffing number of three trained nurses and nine carers during the day and two trained nurses and five carers at night. The home had adequate ancillary staff on duty at the time of the inspection. Seven staff files were seen during the visit and found to contain the required information and documents specified in paragraphs 1 – 9 of Schedule 2 of The Care Homes Regulations 2001 (as amended by The Care Standards Act 2000(Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004). The staff training records were randomly sampled, they were well organised and evidenced that staff had received mandatory training in infection control, basic food hygiene, manual handling, fire safety, medication, protection of vulnerable adults and CoSHH. Staff had also received service user specific DS0000069300.V345442.R01.S.doc Version 5.2 Page 19 training which included, challenging behaviour, yesterday today and tomorrow in dementia care, communication skills, nutrition and falls prevention in older persons, continent promotion and pressure area care and wound management. Staff had also received training in managing ethnicity and diversity. A comprehensive induction programme was also in place. The deputy manager was responsible for staff training. Six members of staff have just completed NVQ level 2 in care and six have just enrolled on the course. The home is due to start a programme of NVQ level 3 in dementia care. This course will be primarily aimed at overseas nurses who have already been accredited with an NVQ in care by the Home Office. The home has three NVQ assessors, one of whom specialises in dementia. Service users and relatives spoken with were complementary about the staff at the home. Comments included, ‘nice people’, ‘can talk to them’, ‘the nurses nice, each and every one of them’, the staff are competent and capable’ and ‘I am confident that the staff listen to my mother and me too’. All interactions observed between the staff and service users were caring and respectful. DS0000069300.V345442.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from the management approach at the home, which provided an open, positive and inclusive atmosphere. EVIDENCE: The registered manager, Mrs Linda McCarthy, demonstrated good leadership qualities, she had knowledge and awareness of the service users need. Service users were seen to interact readily with her and an open and inclusive atmosphere was evident within the home. During the inspection the manager presented a clear understanding of the homes purpose and a grasp of the management challenges. Mrs Linda McCarthy is a registered nurse who has achieved her registered managers award. DS0000069300.V345442.R01.S.doc Version 5.2 Page 21 She has untaken various service user specific training including leadership skills in dementia care and dementia awareness train the trainer. All service users and relatives spoken to spoke very highly of her. All staff and service users appeared happy, contented and relaxed with the inspection process. The atmosphere within the home during the inspection was lively and cheerful. The registered manager stated that various quality audit systems were in place to ensure the staff, service users and their relatives had a forum for airing their views. These included staff, service user and relatives meetings. As well as a meeting for all staff, separate meetings took place for trained nurses, senior care staff, night staff, health and safety meetings and meetings were due to start for the dining committee, who were looking at ways to improve the dining experience. A list of actions and updates from the meetings was circulated to service users and their relatives. All service users spoken to felt that their views were listened to and taken seriously. The home had recently introduced an ‘employee of the month’ and was using this as a motivational tool to improve standards within the home. The forthcoming employee of the month will go to the staff member who has discovered something new about a service user and found a way to use the information to improve their quality of life. The registered manager was aware of the need to maintain a safe environment for service users and staff. The homes accident records were randomly sampled and found to be satisfactory. A monthly report is sent to the head office where their analysis took place. The manager then received a graph clear showing any trends. Required policies, procedures and safety checks were in place; samples of which were seen. Staff were observed to be following appropriate health and safety practices as they went about their work. DS0000069300.V345442.R01.S.doc Version 5.2 Page 22 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 DS0000069300.V345442.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000069300.V345442.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 DS0000069300.V345442.R01.S.doc Version 5.2 Page 25 - 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. 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