Inspection on 20/05/05 for Ashglade Rest Home

This inspection was carried out on 20th May 2005.

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

Ashglade Rest Home 09/12/08

Ashglade Rest Home 09/01/07

Ashglade Rest Home 11/11/05

Ashglade Rest Home 02/11/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Ashglade Rest Home 178 Southborough Road Bickley Bromley BR2 8AL Lead Inspector Lorraine Pumford Unannounced 20 May 2005 10:00 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 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. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashglade Rest Home Address 178 Southborough Road, Bickley, Bromley, Kent, BR2 8AL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01322 868684 01322 860351 Chislehurst Care Limited Mrs Melanie Stewart Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 02/11/04 Brief Description of the Service: Ashglade is an Edwardian, three-storey, detached house, which has been converted to provide care for 15 older people. It is situated on a busy road in a residential area. The accommodation for service users is on the lower two floors. A shaft lift provides access between these floors. There is a garden at the back of the house, which can be accessed by a ramp. There is limited offstreet parking to the front of the house. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector was in the home for approximately three hours. During that time a number of service users were spoken with in the lounge, one service user was spoken with in private; one relative was also spoken with in private. Care staff on duty provided information whilst undertaking their general duties, the nursing director was present for part of the inspection and also provided information. Some policies and procedures were examined and parts of the premises inspected. What the service does well: What has improved since the last inspection? What they could do better: Ensure there is a copy of the home’s Statement of Purpose available in the home. Update the Service User Guide and ensure that each service user or their representative is provided with a copy. Ensure that service users are only admitted to the home following a comprehensive assessment of their needs and after the home acknowledges in writing they will be able to meet the service user’s needs. Develop the service users’ care plans into a user friendly document and involve service users and their representatives in the review of that plan; this must includes risk assessments. Ensure that there are sound policies and procedures in place for the recording, administering and storage of medication. Action is required to ensure, so far as possible, that service users live in a safe environment. Quality Assurance procedures need to be developed further. The companys need to ensure staff informs the CSCI promptly of any death, accident or incident that affects the well being of service users. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 6 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. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 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 standard(s) 1,2,3, Service users have not been given the information required to make an informed decision to live at Ashglade. Service users may be placed in a home where their needs cannot be met due to the lack of a thorough assessment. EVIDENCE: A copy of the Statement of Purpose was not available for inspection. The Service User Guide did not reflect the change of ownership and required updating. The last two service users admitted to the home had been transferred from another care home run by the same company. Assessments have not been completed in relation to their individual needs. A copy of the previous care plan for one service user had been sent over to provide details of the care required, the other service user had returned home for a short period of time before being admitted to Ashglade and a pre-assessment should have been completed in relation to this persons needs. The Nursing Director stated there was a company pre-admission assessment and a blank template of this was seen. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 9 A copy of a service user’s contract was examined. This did not include the details of the room to be occupied. The Nursing Director said that this information was provided in a letter accompanying the contract, which was sent out prior to admission. It was agreed that both the contract and letter would be sent together to enable the prospective service user or their representative to be given all the relevant information at the same time. Ashglade does not provide intermediate care. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9,10,11 The care plan format is not service user-friendly, service users and their representatives should be involved in the review process. The medication systems are not sufficiently robust to ensure safe administration, recording or storage of medication. EVIDENCE: Staff who had completed the initial care plan had identified the needs and aims, however had not included guidance for colleagues on the action required to work towards these aims and objectives for each service user. The care plan format includes areas such as (1) mobility, (2) personalhygiene, (3) nutrition. Daily records for service users consisted of care provided as a numeric list, ie care plan 1,2 and 3, there was no written information regarding service users well being, general demeanour or if they had enjoyed a meal or a particular activity that day. This written information can help staff to work on improving service users quality of life and is an essential part of monitoring the care and service provided. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 11 Service users had signed to say they had participated in or seen their care plan. There was no evidence to indicate that ongoing reviews had involved service users, relatives, care managers or any other relevant parties. Lists of staff signatures indicated that that they were being reviewed on a regular basis, although some areas signed as being reviewed were not relevant to the service users group accommodated, i.e. staff had signed to say they had reviewed service users numeracy skills. Although bed safety rails were seen in place for two service users there was no evidence to indicate the parties who had made this decision and no risk assessment had been completed in relation to this practice. Medication is stored in a locked trolley in the office. Medication to be returned to the pharmacist was in open boxes on the office floor and there was no record being maintained of medication returned to the pharmacist for safe disposal. There were instances of additional handwritten entries to the medication record that had not been signed and dated. Although there was a code to be used to explain why medication had not been given this had not been used by staff. There were some unexplained gaps on the medication record, in one instance the medication record indicated a tablet had been given when it was still found to be in the dossette box. During the tour of the home a tablet was found left on a service user’s bedside cabinet. There was no record indicating staff members’ names and the signature used by them when signing the medication record. All staff administering medication are required to receive training from an appropriately qualified person, who provides written evidence when staff are assessed as being competent to administer medication. A relative and service users spoken with stated that they are always treated respectfully by members of care staff, evidence was seen that service users are addressed by their preferred name and staff afford service users privacy when assisting with their personal care. Service users wishes in respect of action to be taken following death are included in their care plans. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Social activities are varied creative and provide daily variation and interest for people living in the home. Service users would benefit from a greater choice of meals on the menu. EVIDENCE: Service users spoken with stated that pre-arranged activities are arranged at least three mornings a week. These include quizzes, physical exercise, reminiscence therapy, bingo and sing-alongs. On the afternoon of the inspection service users were listening to a VE commemorative audiotape, the majority of service users in the lounge were singing or dancing along to the music and seen to be enjoying themselves. A service user said that the hairdresser attended the home fortnightly. One service user said that she missed being able to attend the church she had attended when living at home. The Nursing Director said she would discuss options regarding this with the service user in more detail after the inspection. A relative spoken with stated he was able to visit his mother at any time and was always made to feel welcome and offered refreshments. There is a small room available to enable service users to meet with visitors in private. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 13 The menu was examined. There is a set menu. Service users stated the meals they have are well cooked and alternative meals are provided if they do not like the meal being cooked on that day. Service users stated that they would like to have a choice of more than one meal on the menu. Records indicated that one service user requires a vegetarian diet and one service user is currently receiving fluids only. There was no record kept regarding the meals these residents are receiving therefore no evidence to indicate if they were receiving a varied nutritious diet. One service user is receiving prescribed meal supplements; this had not been recorded on her medication record. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service users and their representatives can be confident that any concerns they have will be listened to taken seriously and acted upon. EVIDENCE: A copy of the home’s complaints procedure, including the contact address for the Commission for Social Care Inspection, is displayed on a notice board in the front porch. The Nursing Director stated that an updated complaints procedure will be included in the home’s amended Service User Guide. A relative spoken with stated that when he had felt it necessary to complain his concerns had been taken seriously and the company had responded promptly and in a courteous manner. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 15 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 standard(s) 19,20,21,24,25 The lounge, dining room and conservatory are clean, comfortable, appropriately furnished and provide a home-like environment. Some action is required to ensure people live in a safe environment. EVIDENCE: The home benefits from an attractive conservatory which looks out over a wellmaintained garden which is accessible to service users. There are nine single bedrooms and three double bedrooms. None of the bedrooms have ensuite facilities. The number of bathrooms and toilets meet with the current National Minimum Standards. The water to the ground floor bath was too hot to touch; this is potentially hazardous to service users. There is a passenger lift to the first floor. There is an emergency call system in all areas of the home used by service users. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 16 A number of service users were storing suitcases on top of their wardrobes, this is potentially hazardous and they need to be appropriately stored to reduce the risk of accidents. Service users’ bedrooms were attractively personalised and service users spoken with stated that they had been able to bring in personal mementos, pictures, photos and small items of furniture, when they moved into the home. A smell of urine pervaded some bedrooms. The carpet in one-bedroom was particularly stained and in need of replacement. Although generally all communal areas were clean, dust was apparent on a number of bedroom ceiling lampshades, tops of wardrobes etc. These areas need to be cleaned more frequently. The Nursing Director stated that new laundry equipment had been purchased since the last inspection.There are now operational soap dispensers in the laundry, bathrooms and toilets. New freezers have also been purchased since the last inspection. The Nursing Director stated that bedside cabinets identified as being substandard were due to be replaced imminently. Each service user has a bedside table with a lockable drawer, which enables them to store papers and small personal items securely. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 At the time of the inspection there were insufficient care staff to meet the needs of all the service users. EVIDENCE: Generally there are two members of care staff on duty between the hours of 8 a.m. and 8 p.m. Additional staff are employed to cook the morning and midday meals and to undertake general cleaning duties. At night there is one member of staff awake and one member of staff sleeps in on duty to provide backup in an emergency. At the time of the inspection two service users had been assessed as needing nursing care; one of these people was being cared for by staff in her bed during the day as well as the night. The Nursing Director stated that two staff were required for moving and handling purposes for this service user and this resulted in the remaining service users having no staff available to provide routine assistance or help in an emergency whilst the two members of staff were providing care to the service user in bed. Afternoon care staff are also responsible for preparing, serving and clearing away after the evening meal. The Nursing Director agreed to provide an additional member of staff throughout the waking day, and to replace the member of staff sleeping in on duty with an additional member of night staff (awake), until an appropriate nursing home place could be found for the service user. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 18 The CSCI received notification two days after the inspection to say that the service user who had been confined to bed had been transferred to a nursing home. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,38 There are some quality assurance procedures in place, however these need to be developed further. Action is required to ensure the safety of service users and staff. EVIDENCE: The registered manager is currently on maternity leave; two members of care staff are undertaking day-to-day supervision of the home, with daily support from the Nursing Director. Residents and visitors spoken with made positive comments about the staff team. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 20 The Nursing Director stated the company arranged for relative meetings to be held in each of the homes they operate; one had recently taken place in Ashglade and had been well attended. Questionnaires are sent out annually to service users and their representatives as well as members of staff and other stakeholders to ascertain their views about the care and service provided. The results of these surveys should be published and made available to current and prospective service users, their representatives and other interested parties, including the CSCI. In order to comply with Care Home Regulation 24, the person in charge of the home on a day-to-day basis is required to undertake a regular audit regarding the quality of care and service provided and review that the home’s policies and procedures are being fully complied with by staff working in the home. This has not been taking place. From discussion with staff it was apparent the CSCI had not been informed of an incident that had occurred which should have been reported in accordance with Care Home Regulation 37. The fire escape exit from the first floor is via a service user’s bedroom. A key has been provided to enable the service user to lock his bedroom door, this could restrict access to the fire escape door in an emergency. The fire authority should be contacted to advise on a safe way of securing the door, which enables the service user to have privacy and other occupants of the home easy access to the fire exit in an emergency. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 3 3 x x 3 2 x 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 Standard No 16 17 18 Score 3 x x 2 x 2 x x x x 2 Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? 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 1.1 Regulation 17(2) Sch 4 6 Requirement A copy of the homes Statement of Purpose should be kept in the home and available for inspection. Review and update the Service User Guide and ensure all service users are provided with a revised copy. Service users are only admitted following a comprehensive assessment of their needs.The registered person confirms in writing to the service user the home is able to meet the service users needs. Involve service users and their representatives in the review process. Ensure appropriate policies and procedures are in place for the safe handling,administration and disposal of medication. Keep a record of all food provided to service users to illustate all service users are receiving a satisfactory nutritious diet. Stained bedroom carpets are replaced to eradicate the smell of urine. Timescale for action 30.06.05 2. 1.2 30.07.05 3. 3.1 14(1)(d) 30.06.05 4. 5. 7 9 15(1)( c) 13(2) 30.06.05 30.06.05 6. 15 Sch 4(13) 30.06.05 7. 19 16(2)(k) 30.07.05 Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 23 8. 25 13(4)(a) 9. 10. 19 33 23(4) 24 11. 38 37 The registered person shall ensure that unnecessary risks to the health and saftey of service users are identified and so far as is possible eliminated, specifically with regard to bath hot water temeratures(previous timescale of 09.11.05 not met) Consult with the fire officer regarding means of escape/privacy of service user The person in charge of the home on a day to day basis undertakes regular audits to develop the quality of care and service provided. The CSCI is informed of any death, accident or serious incident effecting the wellbeing of service users 30.06.05 30.06.05 30.08.05 30.06.05 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. 4. Refer to Standard 7 7.2 15 27 Good Practice Recommendations Care plans should include information about service users daily health, activities and general demeanour. The care plan sets out details of the action to be taken by care staff to meet service users health, personal and social care needs. Menu planning could be developed futher to enable service users a choice of food at meal times. Keep service users needs under review and ensure an adequate number of care staff on duty to meet service users needs. Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup DA14 5RH 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 Ashglade Rest Home G51-G01 s61312 Ashglade UI v224310 200505 Stage4.doc Version 1.30 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. 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. 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