Inspection on 19/07/06 for Ashgreen House

This inspection was carried out on 19th July 2006.

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

Other inspections for this house

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 Ash Green House Sandbach Place Woolwich London SE18 7EX Lead Inspector Keith Izzard Unannounced Inspection 19th July 2006 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 Ash Green House DS0000067480.V301251.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. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ash Green House Address Sandbach Place Woolwich London SE18 7EX 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) 020 8331 7249 www.sanctuary-care.co.uk Sanctuary Care Ltd Ms Philippa Blackman Care Home 52 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (50) of places Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. The total number of residents in the home will be 52 19 residents will be in the category of nursing care, including 10 in the category of intermediate 3 residents within the category of intermediate care may be between care may be between the ages of 55 and 65 Minimum staffing levels are those set out in correspondence dated 18/03/02, Explanatory notes (staffing at LBG Resource Centres) No more than 4 residents may be admitted for respite/emergency placements 2 places registered for service user category DE(E) for named service users only Date of last inspection Brief Description of the Service: Ash Green House is a registered care home offering 33 residential, 9 nursing and 10 intermediate care placements for 52 frail elderly people in a comfortable modern home that recently opened in the summer of 2004. The home is situated mid way between Woolwich and Plumstead, South London. The home is one of three new Neighbourhood Resource Centres initially operated by Ashley Homes that replaced four homes previously operated by the London Borough of Greenwich for older persons. A day centre is also located on site and both this and the intermediate care units have dedicated areas and facilities within the building as required in the National Minimum Standards. The Intermediate care unit, provides a specialist rehabilitative service prior to final discharge back into the community of 10 service users who, have either been admitted from the community or direct from hospital. The home is well provided for in terms of communal facilities for service users including dining areas, hairdressing facilities and numerous quiet areas and transport for outings. Resident and relatives meetings are held on a regular basis. Responsibility for the service has recently been taken over by Sanctuary Care. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection was completed over a period of 7.5 hours by two Inspectors on 19/07/06. The previous inspection was an unannounced inspection on 27/02/06. The inspection included a complete tour of the premises, inspecting records, talking to seven service users, eleven members of staff and the manager. All areas of the building were seen and were clean and free from unpleasant odour. Service users also voiced their appreciation regarding the cleanliness of their rooms. It was evident that service users had been given the opportunity to bring in personal possessions to personalise their bedrooms. Service users were seen to be comfortable and good interaction was observed between staff and service users. Service users were seen to be appropriately dressed for the very warm weather and well cared for in clean laundered clothing. Drinks were readily available and staff members were observed to be ensuring that residents were encouraged to drink fluids because of the weather. Service users spoken to stated that staff members were caring and helpful. What the service does well: There was a relaxed calm atmosphere on all the units visited. This new home provides a very bright and airy environment throughout and individual en suite accommodation of a good standard for residents. Overall, the home was clean, tidy and safe for residents who were cared for by staff members who were both caring and professional in their relationship with residents. Health and Safety requirements had been attended to satisfactorily. The responses from residents interviewed were generally favourable and positive comments were made about the caring attitude of care staff by many of them. Minor complaints about food were passed on to the manager. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 6 Both the Manager and the numerous care staff interviewed were very positive about the inspection process and all facilitated the inspection in a constructive and helpful way. What has improved since the last inspection? What they could do better: Requirements have been made in respect of the need to update the Statement of Purpose, Service User Guide because of the change of ownership of the home. A requirement was made regarding the need to monitor the temperature of the storage area for medication and for staff to have updated training in managing medication. Several recommendations were also made in relation to medication and these are listed in the report. A requirement was also made to implement training for staff that had been identified by the manager and are listed within the report. A restated requirement was made that the home must further explore the potential for enabling service users to open their bedroom doors more easily, This, had only been partially addressed. The doors are difficult to open because of the fire closure system in use. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 7 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. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 8 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 Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 9 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): 1-6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose, Service user Guide and contracts for service users still need to be updated because of the change of ownership of the home. Service users are assured their needs can be met by the home prior to their moving in. EVIDENCE: Standards 1-2 are still almost met, as the home has changed ownership and therefore amendments are required to this documentation. The manager confirmed that documentation is currently with Sanctuary Care and it is anticipated will be available for publication in the near future. See Requirements 1 & 2. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 10 The home has complied with the requirement to provide written confirmation to service users that the home can meet their care needs including respite care users so Standard 3 is now met. Prospective service users and their relatives or friends are encouraged to visit the home prior to any admission. Service users provided with intermediate care are helped to maximise their independence and return home. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 11 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 -10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs were being met based on assessment of need and with the involvement of the resident. Those care plans seen were well recorded, with one exception. Medicines were not entirely well managed and a number of recommendations were made. Residents were treated with respect and privacy afforded them. EVIDENCE: The initial assessment documents are detailed in the areas they cover i.e. mobility, personal care etc. However ticks are used and there is limited space for staff to record more detailed information. The Inspectors located a “resident/patient assessment form for five of the six people case tracked but Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 12 one was missing from the file on the nursing unit, although the nurse on duty was confident that one had been done. For one resident it was noted that the waterlow score and manual handling score had been completed; however there was no evidence of the service users weight recorded which is necessary to formulate the level of risk. When I discussed this with the person in charge of the unit she gave me the service users MUST Malnutrition Universal Screening Tool that is held in another book in the office. This separation of information could lead to confusion for staff members. A risk assessment had been completed for service users with regard to the need for bed rails, in one instance staff had stated a service user should have bed rails, then went on to say that she had a tendency to climb out of bed and also gets out of bed unassisted, to use bed rails in this instance could not only be potentially hazardous but could be misconstrued as an act of restraint. The manager agreed to discuss this matter with staff and review the service users assessment. See Recommendation 1. There was evidence that the staff keep a daily record regarding service users health activities and general demeanour. One resident’s users daily record indicated that she had recently fallen; the Inspector found that the incident had been appropriately recorded in the home accident book. The system for dealing with medication was examined in respect of Artillery and Winn units. Medication is stored in the lower ground floor clinical room, both trolleys were secured to the wall, so was the oxygen cylinder. The clinical room is of a good size, the room has also been provided with wash hand facilities and appropriate facilities for the disposal of potentially hazardous waste. The lid of the container housing used needles was open and potentially hazardous should the container fall over. See Recommendation 2. There are limited work surfaces for nurses to prepare medication. Staff agreed it would be beneficial to increase the work surfaces. There is space to do this and the manager agreed to look into the possibility. See Recommendation 3. The room felt particularly hot, the thermometer indicated the temperature was in excess of 30°C. Records seen indicated that staff had been recording the temperature of the room for the previous seven days and the room had remained in excess of this temperature for the duration of that period. General discussion took place with the manager regarding this and she was advised that a requirement would be made in relation to the installation of an Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 13 appropriate air cooling system to ensure that medication does not exceed recommended 25°C. See Requirement 3. A number of service users medication records did not have a photograph or the photograph was a small black-and-white picture (photocopy?) which was difficult to see. See Recommendation 4. MAR sheets were generally well maintained for both units with no unexplained gaps seen on Artillery MAR sheets and only a couple on Winn MAR sheets. There is a list of staff signatures relating to staff responsible for administering medication that contributes towards an effective auditing system. Staff had indicated on MAR sheets if service users had allergies or not, and handwritten entries had been signed appropriately by two members of staff. In respect of Winn and Artillery units, each of the units are using a different MAR sheet format the one displaying the home logo states use 0 to indicate medication not given due to vomiting or refused. Discussion took place with the manager regarding the wording as this could lead to confusion, the manager agreed to look into this. See Recommendation 5. It was apparent that action had been taken since the last inspection to formulate procedures for service users who are responsible for administering their own medication. Evidence was seen of an initial assessment completed by staff upon admission, this was signed by the assessor and the service user and included a risk assessment; there was evidence of staff undertaking audits for service users who manage their medication. There was written evidence seen that the companys nursing adviser had undertaken an audit of medication. The manager stated that most staff members need updated training in medication. See Requirement 5. Good interaction was seen between staff and service users. Staff addressed service users by their preferred name, and spoke with them in a respectful manner. A new service user was admitted during the course of the inspection, staff were seen to offer guidance and reassurance and endeavoured to make the service user feel welcome by offering her refreshments and introducing her to existing service users and members of staff. Although generally staff were seen to provide assistance to service users requiring personal care in a manner which respected their privacy and dignity, the manager was asked to address the following practice. A member of staff Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 14 was seen to bring in the weighing scales, she then weighed the service user and continued to undertake basic medical checks and complete the service users plan in the main lounge with other people sitting around. This task should be undertaken in the privacy of the service user’s bedroom. See Recommendation 6. There was a relaxed calm atmosphere on all the units visited. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are well managed but the residents could benefit from more outings and the provision of transport to facilitate this. Overall, the provision of food was well received by residents and attention has been paid to providing pleasant surroundings in the dining areas. There are no restrictions on visiting or for residents wishing to maintain links in the community. Residents are encouraged to exercise choice and control over their life and are encouraged to do so by staff. EVIDENCE: Service users were seen to be participating in a number of activities of their own choice including knitting, reading and completing puzzles. One resident told the Inspector the inspector she had enjoyed the video of the Sound of Music that they had watched that morning. Staff interviewed to stated that service users can also choose, if they wish, to attend the day centre attached to the home. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 16 Relatives spoken with stated they were always made to feel welcome when they visited the home and were offered refreshments. There are no restrictions in relation to visiting times and friends and relatives are actively encouraged to visit at any reasonable time. Records seen indicate that staff ascertain service users’ likes and dislikes at the time of admission and that these are recorded on the care plans along with historical details of their past life, in order that key workers have a social context for the residents in their care. Several service users who were interviewed stated that were assisted and encouraged by staff members to make their own choices over such areas of daily living such as food, what they wear, what activities they take part in and to attend residents meetings if they wish to contribute their own views on the running of the home. Service users spoken to during and after lunch stated that a choice of meals was offered and if they did not like the main choice an alternative would be provided. Service user stated food provided was of a good standard. Fresh water dispensers are provided on each unit and staff members were seen to provide service users with frequent refreshments throughout the day. Meals were observed in two of the dining areas on the residential care units and it was noted that tables had been set appropriately and that staff members discreetly assisted those residents who needed assistance or encouragement to eat. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. 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. The home has a clear complaints procedure and residents are made aware of this facility. The complaints log was well organised and recorded. The home has Adult Protection policies and procedures, easily accessible by care staff members, however, updated training in this area is required for most staff members. EVIDENCE: The homes complaints procedure complies with the Care Homes Regulations. Information about the contact details for the CSCI had been updated and there were timescales for staff to follow when investigating concerns. Guidance was provided about the stages that complainants could follow if they were not satisfied with the response provided by the home. No complaints had been received directly by CSCI and the complaints log retained within the home showed that since the previous inspection five minor complaints had been received, three substantiated, one partially substantiated and one not substantiated. The Inspector was satisfied that all complaints had been dealt with satisfactorily, within the timescale and to the satisfaction of the complainant. The home has comprehensive information on Adult Protection Procedures and all staff members are made aware of these at Induction training. However, the Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 18 manager stated that most staff members now require updated training in this area and this is accordingly the subject of a requirement. See Requirement 4. One adult protection referral was made in respect of an injury sustained by a resident whilst using a hoist. This matter was investigated properly and substantiated as an accident; appropriate retraining was provided for the staff member in respect of moving and handling. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. 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. Service users are provided with a clean, comfortable and environment, suitably equipped and furnished EVIDENCE: A good standard of accommodation is provided for service users who benefit from large single bedrooms with en suite facilities. Bedroom doors are provided with appropriate locks and each service user has a lockable facility in their bedroom. The furnishings and décor are also of good standard. There are secure grounds around the home with appropriate seating provided. There is an appropriately furnished room for service users wishing to meet with relatives in private and a portable payphone is also provided to ensure service users are able to make and receive telephone calls in private. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 20 The home has a designated smoking room. All areas of the home seen were clean and free from unpleasant odour. All foul waste was seen to be appropriately stored. Three domestic staff members interviewed demonstrated their awareness of the procedures to be followed to minimise the risk of infection being spread within the home. Service users residing on the long term care units confirmed they had been given the opportunity to bring in personal possessions to personalise their bedrooms and this was noticed in a large number of rooms seen. The home provides appropriate equipment in toilets and bathrooms to assist service users with a physical frailty. A tub of Zinc and Castor and Sudo cream was found in one of the bathrooms on Winn unit (unnamed) such products should be provided for named individuals only and kept in the service users bedrooms solely for their own use to reduce the risk of any infection being spread. See Recommendation 7. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home recruits skilled and competent nurses and care workers in suitable numbers to meet the needs of the service users. Overall, recruitment practices were found to be well organised and met the Standard. Staff members are competent to do their jobs but a number of areas including mandatory training have been identified that must be provided for staff members. EVIDENCE: The manager stated she was concerned that a high number of staff need to undertake statutory training. For example, a number of staff members need to update their first aid qualification, food hygiene and manual handling. The manager felt the situation had evolved as the previous registered provider had been reluctant to spend money on a resource that they were no longer going to be involved with. A requirement has, accordingly, been made that the staff members identified by the manager in the current training matrix must be provided with the level of training required as soon as possible. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 22 See Requirement 5. The manager stated that she intends to enrol senior care staff on the Moving And Handling Assessors Course to enable regular training to be undertaken inhouse. The manager was reminded of the need to ensure that all courses provided for staff should be competence based and it was no longer acceptable for certificates to be awarded solely on the grounds of attendance. The term whistle blowing was discussed with a number of staff interviewed. Their responses varied, not all staff were aware of the term, one member of staff demonstrated she knew what it meant but could not recollect having received any training in relation to this. This shortfall relates to the training required in adult Protection highlighted in Standard 18. See Requirement 4. Staff members hold a qualification appropriate to the task they perform i.e. RGN in charge of unit providing nursing care and two care assistants spoken with both held an NVQ 2 qualification. The required minimum level of 50 staff holding the level 2 NVQ was met. The home operates a key worker system; staff members interviewed were all able to provide the inspector with a clear picture of the additional responsibilities this entails and the way in which they provide support to service users they are responsible for. In respect of staffing recruitment and procedures a sample of three members of staff were spoken with and their staffing files were examined. Those staff interviewed stated that they had completed application forms at the time of applying for a post and had provided the names of two referees. The staff files seen indicated that references had been taken up on all members of staff employed. Discussion took place with the manager regarding information available regarding staff recruitment. At the time of the inspection it was evident that the files seen did not fully comply with Schedule 2 of The Care Homes Regulations 2001, the manager stated that she was aware of the situation and was currently taking action to address matter and the Inspector was satisfied that this was being addressed. Discussion took place in relation to the frequency of updating staff CRB checks. The manager stated that she had been informed by the company they had decided they would only complete CRB checks once, at the time of a persons initial employment and not thereafter. It is recommended that a mechanism for updating CRB checks is reviewed and clarified in writing, to the CSCI. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 23 See Recommendation 8. All staff spoken with confirmed that they have been provided with a contract of employment detailing their terms and conditions of employment and had also been provided with a job description. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32 33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to monitor and develop the quality of care and the service provided in the home. Service users live in a home run by a manager who is fit for the purpose and who benefit from the leadership and management approach of the home. Service users are safeguarded by the financial and Health and Safety procedures adopted by the home. EVIDENCE: It was evident that both the residents and staff members interviewed felt positively about the manager and all stated that she had made improvements in the way the home was run and that she was very approachable, neither Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 25 residents or staff members would hesitate to speak to her should they have any concerns regarding the running of the home or the welfare of residents. The manager has submitted her application to be come the Registered Manager for the home and is awaiting her interview date with the Commission. The system for dealing with residents’ personal finance was examined and a good audit trail was seen and no errors found in respect of the five cases that were individually examined. Receipts are obtained for service user expenditure and an ongoing ledger records all money credited and debited in respect of individual service users. Individual plastic zip wallets contain the outstanding balance of cash and receipts obtained for any purchases made and the envelopes retained in a locked safe. The system examined was accountable with a good audit trail. The home will be subject to an annual audit by Sanctuary Care and is Visited regularly on a monthly basis and a report complied on the conduct and running of the home as required under Regulation 26. These reports have been made available to the CSCI and copies are retained within the home. The home is also monitored on a regular basis by the contracting unit from the London Borough of Greenwich and the subsequent reports of these visits are made available to CSCI. The home has a good record of compliance in respect of both CSCI reports and those from the London Borough Of Greenwich. A sample of records to do with health and safety and maintenance checks were examined and found to be comprehensive and well documented. Records seen indicated that regular maintenance and safety checks had been carried out and substantiated the dates recorded within the pre inspection questionnaire submitted by the manager. A requirement made previously has been repeated, that the home must further explore the potential for enabling service users to open their bedroom doors more easily. They are currently difficult to open because of the fire closure system in use and a number of service user have complained regarding issues of dignity and freedom of movement being affected. This requirement was partially addressed in that two push closure mechanisms were installed. See Restated Requirement. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 26 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 2 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 2 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 27 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 Standard OP1 Regulation 4 Requirement The Statement of Purpose must be updated to include any amendments necessary from the change of ownership of the home. Restated as previous timescale of 01/06/06 not met. The Service User Guide must be updated similarly to above but in abbreviated form. Restated as previous timescale of 01/06/06 not met. An air-cooling system must be introduced in rooms where medication is stored to ensure that temperatures do not exceed 25c. All staff dealing must receive updated training in adult protection and whistle blowing procedures.. All staff dealing with medication must receive updated training and training must be provided in all areas identified by the manager in the current training matrix. The Registered Person must further explore the potential for DS0000067480.V301251.R01.S.doc Timescale for action 01/11/06 2 OP1 5 01/11/06 3 OP9 13 (2) 01/12/06 4 OP18 13 (6) 01/12/06 5 OP9 OP30 18 (2) 01/12/06 6 OP38 23 01/12/06 Ash Green House Version 5.2 Page 28 enabling service users to open their bedroom doors more easily. They are currently difficult to open because of the fire closure system in use. Restated as previous timescale of 01/06/06 not met. 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 5 6 7 8 Refer to Standard OP7 OP9 OP9 OP9 OP9 OP10 OP19 OP29 Good Practice Recommendations Risk assessments should accurately reflect identified risks and not be contradicted by other care notes. Containers for used needles should be closed effectively to prevent injury and maintain infection control. The work surface space available for medication preparation should be increased. Medication records should have attached a colour photo of at least passport size to adequately identify residents. The manager should ensure that MAR sheets used are of the same format and that the code “o” is recorded in a uniform way through the home. The weighing of residents should be undertaken in the privacy of resident’s own room or medical room. Ointments and creams should be marked for individuals only and retained in their own rooms and not left in bathrooms, in order to reduce the risk of cross infection. It is recommended that a mechanism for updating CRB’s is clarified in writing to the CSCI. Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sidcup Local Office 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 Ash Green House DS0000067480.V301251.R01.S.doc Version 5.2 Page 30 - 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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