Inspection on 02/02/06 for Ashgrove House

This inspection was carried out on 2nd February 2006.

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

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

Other inspections for this house

Ashgrove House 23/11/06

Ashgrove House 11/10/05

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 2nd February 2006 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.V278126.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 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 Vacant 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.V278126.R01.S.doc Version 5.1 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 3 service users with a terminal illness over the age of 30 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 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 11th October 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. Ashgrove House also employs staff for other key tasks, such as catering, cleaning, laundry, maintenance, and administration. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 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. Two CSCI inspectors carried out this unannounced inspection between 9.30am and 4.30 pm. There were 31 residents in the home. The findings 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. The findings were discussed with Mr Trowbridge, the registered provider and Mrs Knight, the deputy matron, at the end of the inspection. At the time of the inspection the home did not have a manager registered with the CSCI, however Mrs Kim Mark, a registered nurse with previous experience in care home management had been appointed and her registration has since been approved by the Commission. What the service does well: What has improved since the last inspection? What they could do better: Medication administration and recording practice needs to improve to ensure residents are not put at risk. Staff recruitment practice needs to be more robust, particularly with regard to obtaining references from previous employers. The call bell system needs to be repaired or replaced and some radiators in communal areas need to be covered. Appropriate locks should be fitted to toilets and bathrooms to help maintain residents’ privacy and dignity. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 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.V278126.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None reviewed. EVIDENCE: Standards 1,3,4 and 5 were reviewed at the homes previous inspection held on the 11th October 2005 and found to be met. Standard 6 does not apply to this home. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 The standard of personal and health care delivered was good and care planning has improved. Current medication administration practice puts residents at risk. EVIDENCE: A new care planning system has been introduced since the previous inspection. Care plans appeared to be a good reflection of assessed needs and were regularly reviewed, which is an improvement. Appropriate pressure relief equipment was in use and there were good records of wound care where required. A physiotherapist is employed for three days a week and has reported an improvement in some residents’ mobility. The inspectors noted that some recorded interventions and plans were unnecessary and caused additional paperwork for staff, which impacted on the time available to residents. Residents spoken with were positive about the care they received, comments included “the staff are very kind” and “they get the Dr. for me when I’m not well”. Records indicate prompt response by staff to residents’ health problems. Residents appeared to be having their hygiene needs met and were clean and Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 Page 10 comfortable. Relatives spoken to during the inspection were very positive about the standard and quality of care provided in the home. There had been an improvement in the recording of the administration of medicines, however the inspectors observed that medicines were not being administered individually. Trays were used to carry several residents’ medication to them at the same time. This practice constitutes a risk to residents. It was also noted that nurses did not always witness the resident taking their medication. Where a resident was prescribed creams or ointments, administration was not always recorded; also some prescriptions that had been hand written on medicine administration sheets did not specify the area that the cream or ointment needed to be applied to. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 15. The home ensures residents are supported to maintain contact with people who are important to them and that they are provided with stimulating activities and a varied and nutritious diet. EVIDENCE: The home employs an activities coordinator to ensure opportunities are provided to enable residents to pursue their hobbies and interest. One commented they were going on a shopping trip the next day and another stated, “there is always something to do”. The cook was observed offering residents a choice of the main meal of the day. Residents spoken to commented favourably on the quality of meals provided. Discussion with the cook confirmed that residents’ likes and dislikes are known and recorded and any special diets are catered for. The inspectors observed part of the lunchtime meal. Residents who required assistance with their meals were provided with support from staff in a discreet and sensitive manner. Discussion with the relatives of three residents confirmed they are able to visit the home at anytime. A payphone is also available at the home for residents use. In addition a number have also installed a private telephone in their bedroom. The family of one residents stated the home provides them with transport to enable them to visit their relative twice a week. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 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, residents are protected from possible abuse, although recruitment practice still 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. No complaints had been received since the previous inspection. 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. As found at the previous inspection, 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 and a written policy has been produced. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 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, 20, 21, 22, 23, 24, 25 and 26 The home provides residents with a good standard of accommodation that is clean and well maintained and improvements to the décor have taken place. The provision of suitable locks on bedroom and bathrooms doors need to be made to ensure residents dignity and respect is upheld. EVIDENCE: The inspectors viewed all communal living areas and all bedrooms. The home was clean, tidy, well maintained and free from any offensive odour. Residents were generally satisfied with the standard of accommodation provided at the home. One stated they “had everything they need” and another that they had brought some of their own furniture to the home. There is a maintenance programme in place, which ensures minor repairs are quickly responded to. Outstanding requirements from the fire officer’s report have now been complied with. The communal living space is split into both small and large areas to offer more choice to residents. Furnishings in these areas were of a good standard. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 Page 14 There is a separate dining room, which is in need of decoration. This was identified at the previous inspection and the time scale for compliance had not yet expired. Discussion with the maintenance person indicated the required improvements would be completed by the given timescale. Toilets and bathing facilities are situated close to communal and bedroom areas. However the inspectors found several bathrooms and toilets had no locks fitted to ensure residents dignity and privacy is respected when using these facilities. In addition, some toilets and bathrooms were being used to store wheelchairs making access difficult for residents and staff. Residents are offered a choice of a single or double bedroom with the majority of rooms offering single occupancy. Bedrooms are located on two floors, which can be accessed by staircases or passenger lift. Residents can choose to spend time in their rooms or in one of the communal areas. The inspectors found four rooms had keys hanging outside their bedrooms. These locks would not allow access to staff in the event of an emergency and if residents wish to lock their rooms then a more suitable lock must be installed to ensure their safety. Two residents commented to the inspectors that on occasions, staff did not answer the emergency call bell in a prompt manner. The inspectors tested the call bell system and found that it took thirteen minutes to respond to the alarm. This was brought to the attention of the registered provider who has subsequently investigated the matter and found a fault with the call bell system, which the manager reports has now been repaired. Bedrooms have been fitted with radiator covers or low surface temperatures to reduce the risk of scalding to residents. However, radiators in communal areas have no radiator covers and risk assessments to support this practice were not available during the inspection. Copies have since been sent to the Commission, which indicate that covers are required. The laundry is situated on the first floor well away from any food preparation areas. In addition there is a small laundry area on the ground floor, which is used for infected laundry to reduce the risk of cross infection. Discussion with residents confirmed they were happy with the laundry arrangements. One commented, “washing is returned promptly”. The home employs two staff in the laundry who provide cover over the whole week. It is recommended that laundry staff receive formal training in infection control. Disposable aprons and gloves are supplied to reduce the risk of infection however care needs to be taken to ensure that used gloves are disposed of in the correct receptacles. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 Page 15 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 and 29 The number and skill mix of staff meets residents’ needs. Recruitment procedures need to be more robust in order to offer residents more protection. EVIDENCE: Staffing levels appeared appropriate to meet the residents needs and were often above the homes minimum staffing notice. There were three registered nurses and seven care assistants on duty the morning of this inspection to care for 31 residents. Residents’ spoken to were happy with the number of staff available both during the day and at night. A review of staff recruitment documents indicated that some staff had commenced work at Ashgrove House before two references had been obtained. These were staff who had previously worked with vulnerable people, but the reason why they left their previous employment had not been recorded. In some cases only one reference had been obtained or references were incomplete. This constitutes a risk to residents. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 Page 16 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 and 38 A new manager had been recently recruited. Fire safety arrangements were satisfactory. EVIDENCE: At the time of the inspection the home did not have a manager registered with the CSCI, however Mrs Kim Mark, a registered nurse with previous experience in care home management had been appointed and has since been approved by the Commission. Mrs Mark was not available during this inspection. Mrs Mark will need to complete the Registered Managers award, or equivalent, in 2006. Although standard 38 was not fully reviewed during this inspection, examination of the fire logbook demonstrated fire safety checks were being completed at the required intervals. The last recorded fire safety drill took place on the 6th January 2006 and records show these are taking place every three months. Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 2 3 3 2 2 STAFFING Standard No Score 27 3 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 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 OP9 Regulation 13 (2) Requirement The registered manager is required to ensure that medications are administered individually to service users, and that nurses witness service users taking medications. The registered manager is required to ensure that persons administering prescribed creams and ointments, sign as having done so, or enter the appropriate code for non-administration. The registered person is required to ensure the corridor adjacent to rooms 18 to 21 are redecorated. The registered person must ensure all toilets and bathroom doors are fitted with a suitable lock to ensure service users privacy and allow access to staff in the event of an emergency. The registered person must take action to ensure the emergency call bell system is repaired or replaced. The registered person is required to ensure that radiator covers, or DS0000015886.V278126.R01.S.doc Timescale for action 02/02/06 2 OP9 17(1,a) Sch.3(k) 02/02/06 3 OP19 15(2,b,c) 01/04/06 4 OP21 12(4,a) 01/04/06 5 OP22 13(4,c) 01/04/06 6 OP25 13 (4,a,c) 01/06/06 Ashgrove House Version 5.1 Page 19 7 8 OP26 OP29 13 (3) 18 (1,c,i) 7,9,19. Sch 2 (5) 9 OP29 19(1,a,b,c )Sch2(3,4 ) 10 OP31 9 (1,2,6,i) low surface temperature radiators are fitted in communal areas, where indicated by risk assessment. The registered manager must ensure laundry staff receive training in infection control. The registered manager is required to ensure that two written references are obtained when employing new staff, before they commence employment. Unmet requirement from inspection held 11/10/05 The registered manager is required to ensure that where a person has previously worked in a position involving contact with vulnerable adults, then a reference is obtained along with written verification of why they ceased to work in that position, unless it is not reasonably practical to do so. The registered manager is required to obtain a Registered Managers Award, or equivalent. 01/06/06 02/02/06 02/03/06 31/12/06 Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 Page 20 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 OP21 OP24 Good Practice Recommendations The registered person should review the practice of using service users toilets and bathrooms for storing wheelchairs and linen trolleys. The registered person should consult with service users regarding the fitting of locks on their bedroom doors and where service users wish a lock on their door then one should be provided that provides privacy to service users and access to staff in the event of an emergency. It is recommended that the laundry staff receive infection control training. 3 OP26 Ashgrove House DS0000015886.V278126.R01.S.doc Version 5.1 Page 21 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.V278126.R01.S.doc Version 5.1 Page 22 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!