Inspection on 22/01/06 for Ashgate House Nursing and Residential Home

This inspection was carried out on 22nd January 2006.

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

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

Other inspections for this house

Ashgate House Nursing and... 10/05/07

Ashgate House Nursing and... 05/09/06

Ashgate House Nursing and... 19/04/06

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

CARE HOMES FOR OLDER PEOPLE Ashgate House Nursing and Residential Home Ashgate Road Chesterfield Derbyshire S427JE Lead Inspector Stuart Hannay Unannounced Inspection 22nd February 2006 09:40 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 Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 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. Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashgate House Nursing and Residential Home Address Ashgate Road Chesterfield Derbyshire S427JE 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) 01246 566958 01246 566216 Community Care Ashgate Ltd Vacant Care Home 34 Category(ies) of Dementia (29), Dementia - over 65 years of age registration, with number (29), Mental disorder, excluding learning of places disability or dementia (5), Old age, not falling within any other category (29) Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration of the MD category is to Room 18 - Single Room, Room 19 - Double Room, Room 20 - Double Room. A total of 5 places. Date of last inspection Brief Description of the Service: Ashgate House is situated on the western outskirts of Chesterfield, within the area of Ashgate. It is a large converted building, rather than purpose built. It is a 35 bedded home for older persons with dementia, registered to provide accommodation, personal and nursing care. The bedrooms are of various sizes and situated on the ground and first floor. The lounges and dining room are located on the ground floor. Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection lasted for four and a half hours, during which a range of records were examined, an inspection of the premises was made and interviews took place with a number of residents, staff members and one visiting relative. What the service does well: What has improved since the last inspection? What they could do better: The home does not have sufficient staffing hours available to be able to provide meaningful activities and stimulation for the service users. Most require assistance with most aspects of personal care, dressing, toileting, bathing and feeding. Whilst the staff appear to be able to meet these needs, this leaves them little time to spend talking or engaging in activities or providing stimulation which is essential for the well-being of people with dementia. One relative interviewed said that the range of activities had Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 6 declined – the person in charge said that the home was still trying to recruit an activities co-ordinator. Some areas of the home, notably the bedrooms had not been cleaned and were in need of vacuuming and dusting. In some rooms there were rubber gloves, plastic aprons and the packaging for dressings which needed to be cleared away. Pads were stored openly in most of the rooms seen. One bath seen was dirty – the person in charge said that this had probably been used by a service user without a member of staff present. The person in charge felt that there were sufficient cleaning hours but that the inspection coincided with the annual leave of one cleaner and that the cleaner working on the day may not have been sure of his duties. Creams and sprays for dressings were stored in boxes in some bedrooms – these may need to be securely stored for health and safety reasons as bedrooms are not locked. Some fire doors which were labelled ‘Keep Locked Shut’ were unlocked and one was propped open. The person in charge closed these on the day of the inspection. 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. Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 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 Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 Assessments are made of the service users needs’ prior to them coming to the home. Their progress is reviewed shortly after their admission and at regular periods after that. EVIDENCE: Two care plans were seen of recently admitted service users. Both of these contained assessments about the full range of needs of the people admitted to the home. There were details of medical and nursing needs in the plans seen and evidence of consultation with other professionals and service users’ families. Many of the service users find it difficult to retain or understand information and the home had consulted relatives wherever possible. Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 The care plans contain information that guide staff on what assistance the service users need to meet their health and personal care. EVIDENCE: Two service users’ plans were checked. All areas of need had been covered and there was guidance in place for staff as to how to meet these needs. The care plans seen had been reviewed on a regular basis by the manager and key workers. Health care needs had been identified, as was all contact or prescribed care from other health care professionals. Seven of the service users were spoken with. Due to their illness it was difficult to obtain clear information from them. They all looked clean and well dressed in ageappropriate clothing. One relative interviewed felt that his mother was treated with respect and kindness by the staff. The medication system was not fully checked but all medication was securely stored. The home’s medication system is reviewed regularly by its supplying pharmacist. Staff interviewed were aware of the varying needs of the service users and how these would be met. They had received training on understanding the needs of service users with dementia. The plans seen included information about the service users’ social Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 10 and emotional needs but staff interviewed acknowledged that there was little time to spend talking with service users or doing activities with them due to the demands of addressing personal care needs. Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 The home does not have a structured activities programme and there does not seem to be sufficient staff time to include these as part of the daily routine. EVIDENCE: Staff were busy on the day of the inspection ensuring that the personal care needs of the service users were met, this appeared to leave them little time to engage in proper conversations or do activities with service users. Staff interviewed confirmed that they did not have sufficient time to provide stimulation for service users, as most of the service users required physical help or at the very least, prompting and supervision to ensure that their personal care needs could be met. This included regular toileting, bathing, washing and feeding for 22 service users. One relative interviewed said that the range of activities had declined – the person in charge said that the home was still trying to recruit an activities co-ordinator. One relative said that he was able to visit at any reasonable time and staff were very welcoming. The food was not checked on the day of the inspection but the staff said they felt it was of a good standard. Whilst it is obvious that the needs of the service users would mitigate against having fully laid tables, the dining-tables appeared very spartan, with no table mats or any other decoration. Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 12 Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has a complaints system which informs service users and relatives of how to complain to the home or the Commission for Social Care Inspection. EVIDENCE: The home had a complaints procedure which had timescales for resolution. It contains the current address of the Commission for Social Care Inspection and informs the complainants that they are able to contact the Commission at any stage of the complaint if they wished to do so. The person in charge said that the staff are due to attend training on Adult Protection in the near future. Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The communal areas of the home were clean but some of the bedrooms and bathrooms seen required further cleaning. Redecoration has occurred in various areas throughout the home but further work is needed. EVIDENCE: The communal areas of the home were clean, tidy and pleasantly decorated. The person in charge said that the carpets had recently been replaced. Seven bedrooms were checked on the first floor. In three of the rooms checked, there were plastic gloves left out. These appear to have been used when doing skin dressings. There were also used plastic aprons left out in some rooms and in most of the rooms checked, there were packets of incontinence pads left out which could have been stored more discreetly. One bedroom contained a roll of disposable plastic aprons. Three of the bedrooms seen were untidy, one of the rooms upstairs needed to be vacuumed and dusted. This did not appear to have been cleaned for some days. One bedroom downstairs needed to be vacuumed. In three of the bedrooms checked, creams, dressings and a spray used for the healing of wounds were left out, either in a box, or loose on the Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 15 service use’s bedside tables. Whilst it is generally acknowledged that service users do not use their bedrooms during the day, these items need to be more securely stored, particularly as many of the service users are confused. Risk assessments need to be completed for the storage of these items in service users’ room and lockable facilities must be made available if necessary. The chair bath in one bathroom checked was dirty – the person in charge said that one of the service users may used this bath on their own. There was a disposable razor left by the side of this bath. These areas were checked halfway through the inspection and at around 1.45pm when the inspector toured the building with the person in charge. The person in charge said that the cleaner on duty finished at 2.00pm – it was therefore unlikely that all the areas seen were due to be cleaned on the day. The person in charge felt that there were sufficient cleaning hours but that the inspection coincided with the annual leave of one cleaner and that the cleaner working on the day may not have been sure of his duties. Work has taken place to upgrade a number of bedrooms but some areas still require redecoration. Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 There are always qualified staff on duty and staffing levels are maintained at the home which enable staff to provide personal care to the service users. Extra hours are required to ensure that activities and stimulation can be provided for service users. EVIDENCE: There were currently 1 qualified nurse and 3 care assistants on duty during the day shifts from 8 a.m. – 8 p.m. This was for 22 service users. At night, there was 1 qualified nurse and 2 care assistants. The person in charge and the staff interviewed said that these levels were usually maintained. Staff interviewed felt that it was hard work meeting the personal care needs of the service users with the numbers of staff available but that it was possible. However, they did not feel that they often had the opportunity to do activities or sit and talk with service users. Many of the service users need more than one carer to assist them with certain tasks and the home needs to be sure that it can provide the safe supervision of service users at all times. Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 36 38 Staff were able to report concerns to senior staff, the manager or the owners. Regular staff supervision and appraisal would enhance communication. Staff must check fire doors are properly closed and ensure that potentially hazardous items are locked away. EVIDENCE: Staff interviewed felt that there were people in the senior team with whom they could raise any concerns about service users. They were also aware that they could contact the owner or other agencies if they had serious concerns. They confirmed that staff meetings are held. Some staff felt that the communication between the senior staff and the care assistants could be improved and hoped that this would be helped by the establishment of regular supervision and appraisal. As noted above, risk assessments need to be completed around leaving creams, sprays, dressings, gloves and aprons out in service users’ rooms. It was noted in the previous report that “Some rooms did not have lockable storage. The managers were of the opinion that the lockable Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 18 storage available was not used, however accepted that they would not have the facility in some rooms if a service user was capable or requested the facility. The acting manager identified that as there was only a few needed, the handyman would fit the outstanding locks.“ During the inspection it was noted that some fire doors which were labelled ‘Keep Locked Shut’ were unlocked and one was propped open. The person in charge closed these on the day of the inspection. She said that one fire door was regularly propped open by a service user. Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 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 3 X X 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 1 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X 2 X 2 Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP12 OP26 Regulation 16 (2) (m) 23 (2) (d) Requirement Activities and stimulation must be provided for service users. All parts of the home must be cleaned when necessary. The home must review the amount of cleaning hours and how they are deployed. The registered person must ensure that there are sufficient staff employed. All staff must receive regular supervision and appraisal. The registered person must ensure that the home is maintained to an adequate standard, with repairs and redecoration, and reduces the possible risk of infection. Fire doors must be kept shut or appropriate closures fitted. Fire doors labelled ‘Keep Locked Shut’ must be locked when not in use. Items such as razors must be stored securely. The home must provide written risk assessments for any creams, dressings, sprays, disposable gloves and aprons left DS0000066966.V283265.R01.S.doc Timescale for action 30/06/06 30/04/06 3 4 5 OP27 OP36 OP19etc 18 18 (2) 13 & 23 30/04/06 30/06/06 30/06/06 6 23 (4) (a) 38 15/03/06 7 8 13 (2) 38 30/03/06 30/03/06 13 (2) & 13 38 (4) (c) Ashgate House Nursing and Residential Home Version 5.1 Page 21 unattended and not locked away in service users’ rooms. 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 Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 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 Ashgate House Nursing and Residential Home DS0000066966.V283265.R01.S.doc Version 5.1 Page 23 - 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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