Inspection on 11/10/05 for Ashgrove House

This inspection was carried out on 11th October 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

Ashgrove House 23/11/06

Ashgrove House 02/02/06

Ashgrove House 10/03/05

Ashgrove House 02/12/04

Ashgrove House 19/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Ashgrove House 63 Station Road Purton Wiltshire SN5 4AJ Lead Inspector Steve Cousins Unannounced Inspection 11th October 2005 09:30 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 DS0000015886.V256855.R01.S.doc Version 5.0 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 DS0000015886.V256855.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashgrove House Address 63 Station Road Purton Wiltshire SN5 4AJ 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) 01793 771449 01793 772286 Mr Keith Paul Trowbridge Mrs Mary ColletteTrowbridge Diane Joy Coxhead Care Home 34 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (34), of places Physical disability (10), Terminally ill (3), Terminally ill over 65 years of age (3) Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. No more than 10 persons with a physical disability between the ages of 30 and 64 years may be accommodated at any one time No more than 5 service users with dementia aged 65 and over may be accommodated at any one time No more than 3 service users with a terminal illness over the age of 30 years may be accommodated at any one time The maximum number of service users who may be accommodated in the home at any one time is 34 No more than 3 persons may be in receipt of day care at any one time The staffing levels agreed with Wiltshire Health Authority and set out in the Notice of Staffing dated 11 January 2000 must be met at all times 10th March 2005 Date of last inspection Brief Description of the Service: Ashgrove House provides care with nursing, and accommodation, for up to 34 people mostly over the age of 65. This includes up to 5 older people with dementia, and up to 3 who are terminally ill. The home is also registered to care for some younger adults and is registered to take up to 10 with physical disability, and up to 3 with a terminal illness. The service is privately owned and is situated in the large village of Purton, which offers a range of local amenities. The town of Swindon is only a few miles away. Ashgrove House is an old property, which has been substantially extended since becoming a nursing home. Accommodation for service users is provided on two floors. There is a lift between these. There are 22 single bedrooms, 6 of which are shared. They all offer some en-suite facilities. There are also 4 bathrooms for general use. Suitable adaptations and equipment are available for less mobile people. Because the home provides nursing care, qualified nurses are on duty at all times supported by carers. This includes waking cover overnight.. Ashgrove House also employs staff for other key tasks, such as catering, cleaning, laundry, maintenance, and administration. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Service users are known as residents in this home and will be referred to as such throughout this report. This unannounced inspection took place between 9.30am and 5.00pm. There were 33 residents in the home. The findings from this inspection are based on a tour of the premises, speaking to residents, staff and relatives; and visiting frail residents. A number of records were inspected, including care plans and staff files. There were a number of frail residents in the home, some of who were unable to communicate with the inspector. The findings were discussed with Mrs Coxhead, the registered manager, at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Care plans need to be regularly reviewed and medication administration recording improved. Recruitment procedures, although generally satisfactory need to be more robust with regard to staff references and all new staff need to undertake induction training. Some areas of the home require redecoration and health and safety arrangements, particularly fire safety need to improve. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 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. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 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 DS0000015886.V256855.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Standard 6 does not apply. Residents/relatives have the information and opportunity to make an informed choice about the home and residents are assessed before admission. The home has the capacity to meet residents’ needs. EVIDENCE: The previous CSCI inspection report was on display. A service user guide was available. Potential residents are able to visit the home prior to admission although one stated that there relative had done this on their behalf. One had attended for day care prior to moving in permanently. Pre admission assessments are carried out either by the manager or a registered nurse. Care plans included pre admission assessment documents and other information from relevant parties. The residents and staff comments and the inspector’s observations indicated that residents’ needs were being met. Eight comment cards indicated that residents felt well cared for, were well treated and liked living in the home. Residents’ comments during the inspection reflected these opinions. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The standard of personal and health care delivered was good and residents privacy respected. Care plans need to be reviewed regularly. The systems for the handling of medication protect residents but administration recording needs to be improved. EVIDENCE: Care plans and assessments, such as those for the risk of pressure damage, were not all being reviewed on a monthly basis and one resident’s plan had not been reviewed since their admission. Not all documents were being dated and signed by the person completing them. Care plans indicated a prompt response by staff to any changes in health and a G.P. was visiting a sick resident in response to a request from staff that morning. Residents confirmed that they were able to see their G.P. when required. A visiting nutrition team were reviewing residents and stated that they were happy with how the staff managed those who were nutritionally at risk and had ‘no problems’ with the home. Diabetics were having their blood sugar levels monitored routinely. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 10 A review of frail residents indicated that appropriate care was being carried out and pressure relief equipment in place. Two residents confirmed that staff were using the correct manual handling equipment when assisting them. There were no residents with pressure sores. The arrangements regarding medication were generally satisfactory; however there were numerous gaps on medical administration records and not all handwritten amendments had two signatures. It was recommended that Midazolam be stored and recorded as a controlled drug and any wastage witnessed by two staff. Staff knocked on doors before entering rooms and personal care was delivered in private. The personal hygiene needs of those who required assistance appeared to be met. Residents stated that staff responded quickly when the call bell was activated and indicated that staff treated them respectfully. Eight comment cards from residents indicated overall satisfaction with the support received and that they felt that their privacy was respected. Two relatives spoken to by the inspector were happy with the level of care and support provided in the home and these views were also reflected in a comment card received from another relative. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Residents’ nutritional and social needs are met and they are able to maintain contact with family, friends and the community. EVIDENCE: Activities and outings are available and an activity co-ordinator employed. A hairdresser visited the home 2-3 times a week. Residents comments indicated that they were happy with the activities provided. A choir entertained the residents in the afternoon. There are no visiting restrictions, unless at the residents request. Visiting can take place in private or in a communal area. Residents are also supported to maintain links with their local community by attending activities outside the home. Vehicles are available and include a wheelchair accessible minibus. Residents indicated that they were able to have a say in how they spent their time and that staff assisted them in doing so. They were very positive about the home and it’s staff. The cook visits residents to make them aware of the menu and a choice is offered. Two residents confirmed this. The men appeared nutritionally balanced and varied and there were positive comments from the residents about the food provided. Meals are available in the dining room or in the residents’ own room if preferred. The PCT nutrition team reviews those nutritionally at risk. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 12 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 and 18 Complaints are listened to and action is taken to resolve them. As far as possible, service users are protected from possible abuse, although recruitment practice needs to improve with regard to obtaining references. EVIDENCE: A complaints procedure is available and on display. The comments of the residents indicated that they were aware of whom to complain to if necessary, although none reported that they had needed to. One anonymous complaint had been received by CSCI and satisfactorily investigated by the provider. Comments received indicated that residents’ felt that they were well treated by staff and abuse awareness was included in staff induction training. A policy was available that referred to local guidelines for the reporting of suspected abuse. CRB/POVA checks were obtained for all staff and they did not commence employment before POVA checks had been obtained. Recruitment procedure needs to be more robust with regard to obtaining references. Findings are detailed in the ‘Staffing’ section of this report and there is a statutory requirement. Systems are in place to ensure the safekeeping and monitoring of residents’ money/finances however the manager reported that a written policy still needed to be produced. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 13 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): 19,21, and 26 The home is generally well maintained and improvements have been made with regard to bathrooms however some areas need redecorating. Cleanliness and hygiene measures are satisfactory EVIDENCE: Since the previous inspection bathrooms have been refurbished to a good standard and useful shower room installed on the ground floor. A double room has been converted into two single rooms with en suite facilities. Some new carpets have been provided and some rooms redecorated. The dining room is in need of redecoration, as is the external area around rooms 18 to 21 on the top floor. The passenger lift was out of order during the inspection and residents and a relative’s comments indicated that this was a recurring problem. The manager reported that this issue was being discussed. The kitchen was clean and food hygiene measures were in place. The home was generally clean and free from unpleasant odours. Infection control procedures were in place. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 14 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): 27,28,29 and 30 There are enough staff to meet residents needs and they are generally trained and competent, although induction training needs to be completed by all new staff. In some instances, recruitment procedures do not fully protect service users. EVIDENCE: There were two registered nurses and eight care assistants on duty at the time of the inspection. Review of staff rosters indicated that the staffing levels during the day are often above the minimum staffing notice. Residents’ spoken to were happy with the number of staff available. Staff undertake induction training although in one case this had been limited to a session on manual handling and not the usual three day training. Records indicate that 14 of the 30 care staff employed have an NVQ or equivalent and that two more are currently undertaking an NVQ. The arrangements regarding staff recruitment were generally satisfactory however in one case only one unsatisfactory reference had been obtained for a staff member who had already begun employment and another had a CRB check that had been obtained from a previous employer. The inspector informed the administrator that CRB checks were no longer transferable from one employer to another. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 15 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, 33,and 38. A new manager was soon to be appointed. Quality auditing could be improved by seeking residents’ opinion more often. In some instances, health and safety arrangements do not fully protect residents and staff. EVIDENCE: The current registered manager, Diane Coxhead has left her post since this inspection and a replacement manager was due to be appointed. Mr Trowbridge, the homes registered provider, is involved in the day-to-day running of the home. The last residents meeting had been held in February. Mrs Coxhead stated that one was due to take place in June but had been cancelled. Satisfaction questionnaires were due to be circulated in November. All policies and procedures have been recently updated. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 16 Following the previous inspection the registered provider was required to ensure that the recommendations contained in the fire safety officer report, dated 21st January 2005, be carried out by the 1st May 2005. Not all of the recommendations had been carried out and an Immediate Requirement Notice was issued. The registered manager has since confirmed that the required work has been completed. Fire safety checks are carried out apart from monthly checks of extinguishers and means of escape. The fire risk assessment required reviewing. Fire training is undertaken but there were no records of fire drills this year. Records of staff manual handling training were available. Radiator covers are fitted and hot water temperatures are controlled. Routine checks of water temperatures are not being carried out and the need for this was discussed with the maintenance person. Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 17 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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 2 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 2 Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 18 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 OP7 Regulation 15(2,b,c) Requirement The registered manager is required to ensure that residents’ care plans and assessments are reviewed on a monthly basis. The registered manager is required to ensure that persons administering medicines sign as having done so, or enter the appropriate code for nonadministration. The registered provider is required to produce a written policy and procedure regarding the handling of service users money and finances. The registered person is required to ensure the dining room and the corridor adjacent to rooms 18 to 21 are redecorated. The registered person is required to ensure that two written references are obtained when employing new staff. The registered person is required to ensure that all members of staff receive induction training to NTO specification within 6 weeks of appointment. DS0000015886.V256855.R01.S.doc Timescale for action 11/10/05 2 OP9 17(1,a) Sch 3(k) 11/10/05 3 OP18 12(1,a) 11/11/05 4 OP19 23(2,b,d) 11/02/06 5 OP29 7,9,19 Sch 2 (5) 12(1)18 (1)13 (4,c) 11/10/05 6 OP30 11/10/05 Ashgrove House Version 5.0 Page 19 7 OP38 13(4,a,c) 23(4) 8 OP38 13(4,a,c) 23(4) 9 10 11 OP38 OP38 OP38 13(4,a,c) 23(4) 13(4,a,c) 23(4) 13(4,a,c) The registered provider is required to ensure that the recommendations of the fire safety officers report, dated 21.01.05 are carried out. Unmet requirement from 10/03/05. Immediate requirement notice issued. The registered person is required to ensure that a visual check of fire extinguishers and fire escape routes is undertaken on a monthly basis and recorded. The registered person is required to ensure that fire drills are undertaken 3 monthly. The registered person is required to ensure that the homes fire risk assessment is updated. The registered person is required to ensure that monthly temperature checks are undertaken of hot water outlets accessible to service users. 11/11/05 18/10/05 18/10/05 11/11/05 18/10/05 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 Refer to Standard OP7 OP9 Good Practice Recommendations It is recommended that dates and signatures be added when completing residents’ assessment documentation. It is recommended that two signatures be obtained for any handwritten additions or amendments to MAR sheets. Where MAR sheets are wholly handwritten then two staff may sign once at the bottom of each sheet. It is recommended that Midazolam be stored as a controlled drug and that two people witness its administration and disposal. It is recommended that residents/relatives meetings be held more frequently. DS0000015886.V256855.R01.S.doc Version 5.0 Page 20 3 4 OP9 OP33 Ashgrove House Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Ashgrove House DS0000015886.V256855.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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