Inspection on 11/05/07 for Ashgrove House

This inspection was carried out on 11th May 2007.

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

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

CARE HOMES FOR OLDER PEOPLE Ashgrove House 116 Manygates Lane Sandal Wakefield West Yorkshire WF2 7DP Lead Inspector Gillian Walsh Key Unannounced Inspection 11th May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashgrove House DS0000068472.V333417.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. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashgrove House Address 116 Manygates Lane Sandal Wakefield West Yorkshire WF2 7DP 01924 255540 01924 253660 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) Warmest Welcome Ltd Elaine Tucker Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (30), Physical disability over 65 years of age (30) Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection New Service Brief Description of the Service: Ashgrove House is a care home offering personal care and accommodation to 30 older persons, a high percentage of whom have dementia or mental health problems. The accommodation is an adapted detached Georgian property, which operates over four floors. Twenty-four of the rooms are for single occupancy and three for double occupancy. There is one large and one smaller lounge area, which are open plan to each other and a separate dining area. A separate small lounge is available for residents who wish to smoke. The floors are connected by a passenger lift and there is a stair lift between the first and second floors. There is a car park to the front of the property and a garden to the rear. The accommodation is sited at a main road junction in the residential area of Sandal on the outskirts of Wakefield. The home has recently been newly registered to Warmest Welcome Ltd and the new owners have plans to refurbish throughout. The manager informed the Commission that the charge for living at the home, as of March 2007, is £359 per week with extra charges made for hairdressing, newspapers and private chiropody. Information about the home is available within the Statement of Purpose and the Service User Guide, which are given to everybody who lives at the home and people enquiring about moving into the home. Details of the Commission for Social Care Inspection are included within the Service User Guide Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first full inspection made of the home since it was newly registered as part of Warmest Welcome Ltd. The inspection process included a visit to the home on 11 May 2007 lasting from 10am until 4pm. During the visit time was spent speaking with people who live at the home, staff and the home manager, looking at documentation and looking at the general environment. In order to gain the views of people involved with the home, the Commission for Social Care Inspection sent out surveys to eight people who live at the home and their next of kin and eleven professional people such as district nurses, GP’s and social workers who are involved in the care of the eight people surveyed. Response to the surveys was limited. One person who lives at the home responded but the manager explained that others were unable to do so due to them suffering from dementia. Three relatives responses were received and indicated a general satisfaction with the home. Two GP’s also responded, one indicated general satisfaction but one felt that staff at the home needed to give more input to preventing people who live at the home from feeling lonely. In writing this report, information and evidence was not only obtained by way of visiting the home but also from notifications and information obtained by CSCI. Information was also obtained from the home manager within the Pre inspection questionnaire, a document which is sent to the home from the Commission prior to an inspection taking place. In gathering evidence, CSCI undertook case tracking, reviewed documentation, sought feedback from residents and their families, staff, the home’s manager and other relevant stakeholders, and undertook relevant observations and discussions appropriate to needs of the service users, taking into account their needs and communication abilities. The inspector would like to thank residents and their relatives and staff for their time and assistance during this inspection. What the service does well: People who live at the home enjoy homely and clean surroundings and are supported by a well-trained team of kind and friendly staff who are respectful of their privacy and of their individual needs. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 6 All of the people spoken with said that the meals are very good and they are given lots of choice. Care planning is generally good and aids staff in understanding peoples’ needs and how they should be met. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. (Standard 6 is not applicable as the home does not provide intermediate care) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are not admitted without being assured, through assessment, that their needs can be met at the home. EVIDENCE: All of the four care plan files seen during the visit contained pre-admission assessments, completed by staff from the home prior to the person concerned being offered a place at the home. Also in the files, where relevant, were copies of assessments completed by social workers or nursing staff prior to the person being admitted to the home. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. People who use the service experience Poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live at the home benefit from good care planning and delivery of care from staff who treat them respect. However people could be placed at risk due to poor practices in relation to medication. EVIDENCE: Four care plan files were examined during the visit to the home, one of these was for a person admitted only a few days prior to the visit. Three of the files contained a sheet entitled ‘Daily Care Needs’ which covered details of the individuals needs in relation to most of their activities of daily living. This also included detail of peoples choices and preferences within their Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 10 daily lives such as when they like to get up, how they prefer to bathe, abilities and preferences regarding eating and drinking and what time they like to go to bed. Further information is then given for what are assessed as ‘priority care needs’ and ‘social activities’. Further care plans are developed for short-term needs such as infections or illnesses for which specific treatments or care interventions are being given. A separate care plan is also developed for individuals needs during the night. All of the care plans had been reviewed on a monthly basis. The detail available in all of these plans is good and is supported by the inclusion in the file of assessments in areas including nutrition, skin viability and risk taking. Moving and handling assessments are also in place but some of these are in need of review as they give different information to the care plan. It would also be advantageous to staff and people living at the home for more detailed instruction to be included in the moving and handling plans. Discussion took place with the manager and deputy manager about the importance of the member of staff who has developed the care plan signing it and also that, wherever possible the person concerned, or their representative, signs to evidence that they have been involved in the care planning process. Further discussion took place about the importance of including people’s needs in relation to their mental health, wherever this is appropriate, within the care plans. Daily records are generally good but do not always include information relating to the care plans. An example of this was where a short-term care plan had been developed for a person who had a particular medical problem, but the daily records did not include evidence that the care described as being needed on a daily basis, had been given. The health needs of people who live at the home are met through community services including GP, district nurses, chiropody and dentists. A letter was seen during the visit from a district nursing team, who had recently been to the home to give people general medical assessments, congratulating the staff on their assistance and care of people during the process. Many of the people who live at the home suffer from dementia and were unable to engage in conversation about their opinions about their care. However observations of staff interventions with people were positive. Staff were seen to treat people with respect and to ensure that their dignity and privacy needs were considered during interventions. All of the people who live at the home who were able to express an opinion, said that staff were very good and that they always treated them with respect. During the visit systems for storage and administration were examined. At the beginning of the visit, the manager was administering the morning medications. The process used for doing this was to leave the medication Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 11 trolley in the office and to take medications out to each person individually. It was noticed that, although the medications are given individually, there was more than one person’s medication being prepared at a time. It was also noticed that on one occasion the medication was given to a person by the manager, who then left the room, leaving a care assistant to ensure that the person took their medication. All of the stock balances checked were correct and good processes are being followed for when medication is received into the home. A number of the MAR (Medication Administration Record) sheets had been handwritten but the signature of the person doing this had not been made and neither had a signature been made to show that the handwritten information had been checked. A printed MAR sheet for one person gave the instruction that the prescribed medication should be given twice daily. However signatures showed that the medication had only been given once each day. The manager said that when the person came out of hospital, they had been prescribed the medication once daily but when the MAR sheet had come with the GP’s prescription on it was for twice a day. The manager said they had tried to contact the GP for clarification but had been unable to do so and had therefore decided to continue to give the medication just once a day. This situation had continued for seventeen days. The manager said it was in her diary to try to contact the GP again on the day of the visit. This was done later in the day and the GP confirmed, in writing, that the medication should be administered once each day. The problems identified above regarding medications were discussed after the visit with a CSCI (Commission for Social Care Inspection) pharmacy inspector. The pharmacy inspector felt that leaving the medication trolley in the office during medication rounds and leaving another person to check that the medication had been taken are both examples of poor practice. The situation regarding staff at the home administering only half the amount the GP had prescribed for seventeen days without obtaining clarification of the correct dose, was felt by the pharmacy inspector to be very poor and unsafe practice. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live at the home benefit from being supported to make choices and are generally happy about their lifestyles but would benefit from more activities being made available to prevent them becoming bored. EVIDENCE: The manager said that she is currently in the process of appointing an activities person to work a minimum of twenty hours each week. In the meantime staff try to engage people in activities as time allows. Some of the people spoken with said that they would like more to with their time and were sometimes bored just sitting around with only the television for entertainment. On the day of the visit a physiotherapist was visiting to do chair exercises to music with the people who were able to join in, the manager said that this is a weekly session. The manager also said that a motivation company visits on a Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 13 monthly basis and day trips for people who live at the home are now made easier as the home has access to the new company’ mini bus. The manager said that Anglican Church services are held on a monthly basis in the home and where appropriate the Catholic priest will come to the home to give Communion. None of the people currently living at the home has expressed a wish to go out to Church but the manager should make sure that this is offered in addition to services within the home. Visitors are welcomed to the home and some people said how much they enjoy visits from their families and friends and, whenever possible, going out with them. One GP said in a survey that they felt that more could be done within the home to prevent people from feeling lonely. During the visit staff were observed to ask people about their preferences when serving drinks and food. Two people who live at the home said that they could have anything they wanted to eat and drink and that the food was very nice. The lunchtime meal on the day of the visit looked very appetising and staff were seen to support people with their meals wherever they chose to take them. The majority of people take their meals in the newly developed dining room, which provides a very pleasant environment for people to enjoy their meals. Discussion took place with the manager about the observed poor practice of one member of staff standing between two people and assisting them both to eat at the same time. The manager said that she would speak to staff to ensure that this practice did not continue. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience Poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Systems are not in place to give people confidence that their complaints will be appropriately dealt with or that people who live at the home are fully protected from abuse. EVIDENCE: The home’s complaints procedure is in need of updating to reflect the change of ownership and therefore the registered person for the home. This also needs to include the correct address for the Commission for Social Care Inspection. The complaints book seen at the home was very difficult to follow, as complaints made had not always been documented on the company’s forms and were not kept in date order. It was not possible to determine the outcome of the complaint from the documentation available. One of the relatives who responded to the Commissions survey said that they were not sure how to make a complaint. People who live at the home said that they would speak to the staff if they had any worries or concerns. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 15 There was discussion regarding safeguarding matters and the manager and deputy manager were both unsure about when and how to refer suspicion of abuse appropriately and whether a complaint including safeguarding issues should be referred. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live at the home enjoy a comfortable and clean environment. EVIDENCE: On the day of the visit the home was very clean and tidy and appeared to provide a safe and very comfortable environment for people to live in. People spoken with said that they were comfortable in and happy with their bedrooms. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 17 The manager and the registered person said that a programme of refurbishment had already begun with two bedrooms but a programme is in place to refurbish all of the bedrooms and some of the communal areas. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live at the home are supported by an appropriately recruited and well-trained staff team who are kind and respectful in their approach. EVIDENCE: Observation made during the visit and information from people who live at the home is that staff are available in sufficient number to meet peoples needs. Staff said that they receive regular training and the training matrix showed that all are up to date in mandatory training such as fire and moving and handling. In addition over eighty percent of the care staff have achieved NVQ level two in care and the deputy manager has achieved the registered managers award. The manager said that three staff, including herself are shortly undertaking training which will enable them to train all of the other staff in moving and handling. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 19 Four recruitment files were seen and all contained all of the documentation required to evidence that recruitment processes are in place to protect people who live at the home. People who live at the home said that staff are kind and courteous in their manner and they can rely on them for help in meeting their needs. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service Management and administration of the home are generally good but this judgement is affected by the lack of safety relating to the handling of medication. EVIDENCE: The home’s manager is a registered general nurse with many years’ experience of managing a care home and holds a diploma in management. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 21 People who live at the home and their relatives expressed confidence both verbally and through surveys in the manager. The registered person said that, as part of a quality monitoring process, they plan, within the next few months, to conduct a survey to get the views of people involved in the home. The manager said that the home does not hold any money for people who live at the home. Petty cash is available and can be used should anybody need any money. All expenditure including hairdressing is then included on a monthly sundries bill. Some records relating to maintenance of systems and equipment in the home were checked. The manager also provided information within the pre inspection questionnaire that maintenance checks and appropriate certification of systems within the home are in place and up to date. The home benefits from the services of a full time handyman to attend to all of the day-to-day repairs, maintenance and small decorating jobs to ensure the safety and comfort of the home. Although several systems are in place to protect peoples’ safety and welfare within the home, the issue relating to medication described under the ‘Health and Personal Care’ section of this report has the potential to compromise individuals’ health and safety. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? New Service 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 OP9 OP38 Regulation 13(2) Requirement Medications must be administered as prescribed by the Doctor. Any queries with regard to the Doctors prescription must be made immediately the prescription is received to ensure that people’s health and safety is not compromised by not receiving the correct medication. Immediate action was taken during the visit to comply with this requirement. Any reports of or suspicion of abuse must be referred under local safeguarding procedures to ensure people who live at the home are protected. Timescale for action 11/05/07 2 OP18 13(6) 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 24 1 OP7 Care plans should include mental, as well as physical health needs to ensure that people are receiving the care to meet all of their needs. Daily records should evidence that the care prescribed in the care plan has been given. The manager should consider revising the way medications are dispensed to ensure: • That the person dispensing the medications checks that it has been taken by the right person and signs the MAR sheet. • • That people receive the medication at the time it is prescribed for them. That the person administering medications is not distracted by other duties. 2 OP9 3 4 5 OP12 OP15 OP16 People who live at the home should have access to activities to prevent them from feeling bored. People should be assisted in eating their meals on a one to one basis to ensure their dignity is not compromised. The correct complaints procedure needs to be accessible to people and followed correctly by staff. Ashgrove House DS0000068472.V333417.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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