Inspection on 13/10/06 for Ashgrove Residential Care Home

This inspection was carried out on 13th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashgrove Residential Care Home 06/09/07

Ashgrove Residential Care Home 13/10/05

Ashgrove Residential Care Home 28/07/05

Ashgrove Residential Care Home 10/03/05

Ashgrove Residential Care Home 15/10/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

St Josephs Rest Home

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

CARE HOMES FOR OLDER PEOPLE Ashgrove Residential Care Home 64-66 Billet Lane Hornchurch Essex RM11 1XA Lead Inspector Mrs Sandra Parnell-Hopkinson Key Unannounced Inspection 13th October 2006 09:00 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 DS0000042148.V314461.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. DS0000042148.V314461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashgrove Residential Care Home Address 64-66 Billet Lane Hornchurch Essex RM11 1XA 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) 01708 458834 01708 472294 care@ashgrovecarehomes.co.uk Mr Pathmanathan Elango Mrs Rajakala Elango Ms Lesley Burkett Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places DS0000042148.V314461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 26 Places to be used flexibly between the two categories. Date of last inspection 13th October 2005 Brief Description of the Service: Ashgrove Residential Home offers 24-hour residential care to 26 people over the age of 65 years. The premises comprise a linked pair of Edwardian houses which have been modernised over the years as far as the building would allow. All rooms are spacious, airy and bright. They all have hand basins, TV points and a call system and some residents have their own telephone. The home has a passenger lift. There are two lounges with disabled access to the rear garden, and a dining room overlooking the garden. There is disabled access to the front of the building, and there are also car parking facilities at the front of the property. The home is located on a busy road in Hornchurch, and is close to local services and facilities, including the Queen’s Theatre. Ashgrove Residential Home is easily accessible by car or by public transport and is situated in close proximity to the M25, A12 and A127. The statement of purpose and the last inspection report were available in the reception area, and a copy of the statement of purpose can be obtained from the home upon request. At the time of the inspection the fees for dementia care are from £525 per week, and £485. per week for the care of frail older people. DS0000042148.V314461.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 key inspection undertaken by the lead inspector, Mrs. Sandra Parnell-Hopkinson on the 13th October, 2006 from 08.00 hours until 15.30 hours. The registered manager was available throughout the time to aid the inspection process, and during the inspection the proprietors were also available to speak to the inspector. During the inspection the inspector was able to talk with and observe service users, staff members, the proprietors, the registered manager, and some ancillary staff. 6 residents’ files were case tracked, together with the viewing of staff rotas, training schedules, activity programmes, medication administration, maintenance records, accidents records, fire safety records, menus, complaints and staff recruitment processes and files and a preinspection questionnaire which was returned by the proprietor. Some health professionals were also contacted by telephone and all said that the care provided at Ashgrove was of a good standard. A tour of the premises, including the laundry and the kitchen, was undertaken and all of the rooms were clean with no offensive odours present anywhere within the home. One bedroom is awaiting the laying of new carpet which has been ordered. The rear garden is secure and was well maintained with disabled access and seating areas for residents. Since the last inspection the home has attained a registration category for the care of older people living with dementia. All staff were observed to treat residents with kindness and respect. Residents appeared well dressed and groomed and happy. Where possible the inspector chatted to some residents, although this was difficult due to the varying levels of dementia, but it was evident from some of these discussions that residents liked the food and the care workers. Also during the inspection the inspector was able to have conversations with some residents about the areas of London in which they grew up. There was some interaction between the staff and residents but this could be improved upon with the now increased staffing levels. The manager has also agreed to pilot an “end of life programme” with a project group organised by representatives of the National Health Service. This is in line with the current initiative published by the Department of Health. Staff were also aware of the need to ensure that an individual resident’s religious, ethnic and social care needs are respected. However, at this inspection all current residents were white British and, therefore, their cultural DS0000042148.V314461.R01.S.doc Version 5.2 Page 6 needs were being met by a staff group who were primarily of the same culture, but they do have different religious/spiritual needs. During the inspection the inspector was able to provide some feedback to both the proprietor and the registered manager, and more feedback was provided to the manager at the end of the inspection. What the service does well: What has improved since the last inspection? Since the last inspection the home has attained registration to care for older people living with dementia, and comprehensive training in dementia care has been provided to the majority of care workers. Also some signage is now in place which will aid residents in finding toilets around the home. The system of care plans is good and all care plans are reviewed monthly, or more frequently if necessary. DS0000042148.V314461.R01.S.doc Version 5.2 Page 7 The quality assurance procedures continue to be developed and the services of a health and safety consultant have been employed. This has meant a total re-evaluation of all aspect of health and safety, with key members of staff being responsible for completing health and safety audits on a regular basis. Another company has undertaken a fire risk assessment to ensure that the home complies with the requirements of the new fire regulations that came into effect at the beginning of October, 2006. What they could do better: The needs of those residents who do not have dementia must continue to be of importance, especially in the area of daily activities. It may be that the manager needs to give consideration to some activities for this group of residents to be provided away from those who have dementia. This will give “space” for both groups of residents to continue to live in harmony. Activities need to be more focused on residents living with dementia, in enabling them to retain daily living functions such as washing, dressing and undertaking any household functions such as helping to clear tables, dusting, keeping rooms tidy and conversing. The retention of these skills takes a lot of time, and the most important thing to give residents living with dementia is “time.” Rushing and hurrying them is upsetting and confusing, which is why it is essential that staffing levels be kept constantly under review. The manager is continuing to work on the production of menus and other information in a pictorial format which, again, can be useful to all residents. If more relevant pictures for display around the home could be obtained, these would be more meaningful for people living with dementia, and also for those without dementia. Such pictures can also used as a point of reminiscence/discussion in activities with staff and residents. Life histories for each resident should be developed, but these can only be done with the involvement of the resident, their relatives and friends. It is extremely important for people living with dementia to have family photographs and other mementoes with them as these play an important part in their reminiscence activities. The more that staff know about each resident the better able they are to relate to him/her as an equal in the journey through dementia. DS0000042148.V314461.R01.S.doc Version 5.2 Page 8 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. DS0000042148.V314461.R01.S.doc Version 5.2 Page 9 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 DS0000042148.V314461.R01.S.doc Version 5.2 Page 10 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. (6 does not apply as intermediate care is not provided) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective service users and their relatives have the information required to enable them to make an informed choice about where to live, and do not move into the home without having had a comprehensive assessment of need undertaken, and been assured that these will be met. Both service users and their relatives have an opportunity to visit and assess the quality, facilities and suitability of the home before making a decision to move in. EVIDENCE: The statement of purpose and service users guide include detailed information about the service provided and this is available to all prospective residents and relatives. A comprehensive assessment is also undertaken and, wherever, possible the prospective resident is invited to visit Ashgrove. However, work could be undertaken to produce a more simplified service user guide, which could be more beneficial to those prospective residents living with dementia. DS0000042148.V314461.R01.S.doc Version 5.2 Page 11 Relatives and friends are told that their support and involvement in the continued care of the person living with dementia is important, and that they can bring in familiar objects that have real meaning to the person with dementia. Care staff at Ashgrove Residential Home have undertaken training in caring for people living with dementia, and are fully able to understand the constantly changing needs of these residents. On admission a key worker is allocated to the new resident, and that worker is responsible for ensuring that the care plan is followed and any changes are recorded and put into practice. Intermediate care is not provided at Ashgrove Residential Home. The Care Homes Regulations 2001 have been amended with effect from the 1st September 2006 for new residents, and for existing residents with effect from the 1st October, 2006 so that more comprehensive information is to be included in the service users’ guide. Details of information to be included are contained with the amended regulations which can be obtained from the Commission’s website www.csci.org.uk DS0000042148.V314461.R01.S.doc Version 5.2 Page 12 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, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The health, personal and social care needs of each service user are set out in an individual care plan. They can be assured that their health care needs are fully met, that they are protected by the home’s policies and procedures for the administration of medication, and that they will be treated with respect and their right to privacy upheld. Service users are also assured that at the end of life they and their family will be treated with care, sensitivity and respect. EVIDENCE: The files of six residents were inspected, some of whom did not have dementia and some who did have dementia. All had a comprehensive assessment from which had been produced a comprehensive care plan which was regularly reviewed on a monthly basis, or more frequently if necessary, and had been updated to reflect changing needs and current objectives for health and personal care. However, where a resident has a “challenging” behaviour the manager must ensure that the care plan shows the required strategies necessary for staff to implement to minimise such behaviours. DS0000042148.V314461.R01.S.doc Version 5.2 Page 13 It was evident that, as far as is possible, residents are involved in the drawing up and reviewing of their care plan. Care plans are reviewed monthly and are updated to reflect changing needs. Service users are encouraged to remain as independent as is possible and are therefore assisted in undertaking personal and oral hygiene on a daily basis. This can be very time consuming for the care workers and those residents living with dementia, which is why it is essential that there is always sufficient staff time allocated to this. Staff must be more aware of the importance of listening to what the resident is saying, and getting to know the meaning of words and phrases used by an individual resident. From observation it was not always apparent that staff recognised the importance of maintaining eye contact and being on the same level, not hurrying or interrupting. However, staff did ensure that residents had any aids they needed such as hearing aids, glasses and dentures. As with the production of menus in pictorial format, so the manager may wish to give consideration to producing daily living tasks in a pictorial format, as this may assist in the continued independence of the person living with dementia. There was some evidence that continence programmes were included in the care plan, but staff must be more aware of the importance of ensuring that such programmes are implemented consistently. One resident’s plan showed that she had had a pressure sore, but that this had now healed. Where necessary the district nurses visit and are involved in the care programme for treating pressure sores. The manager has a close working relationship with the health professionals at the local NHS dementia resource centre, and residents can access professional advice as necessary. All residents are registered with a GP, and also have the services of an optician, dentist and chiropodist. All aids such as spectacles, hearing aids and dentures are marked with the name or initials of the owner. Nutritional screening is undertaken on admission but on a more frequent basis if the health needs of the resident indicate this. Appropriate action is taken if necessary with the involvement of the GP, nutritionist or dietician. All residents are weighed monthly and any increase/decrease in weight is monitored, together with the actual daily diet of each resident. Residents are never sent to hospital or to attend appointments outside of the home without being accompanied. Wherever possible family and friends are encouraged to support these appointments, but where this is not possible then a member of staff will accompany the resident. DS0000042148.V314461.R01.S.doc Version 5.2 Page 14 In discussions with the manager she demonstrated an awareness that some behaviours in residents living with dementia, such as refusing food, quiet rocking, or really challenging behaviour, could be due to an individual experiencing pain. Therefore, she was very well aware of the need to exclude this when trying to understand what residents are trying to express through their behaviour. All senior staff have completed training in the administration of medication and during the inspection all records in this area were found to be in good order. Staff monitor the condition of service users on medication and if there are any concerns, they would call in the GP. Currently there are no service users who are able to self-medicate. All of the care plans viewed had a medication profile of the drugs being administered to the individual. However, there were some concerns over the actual medicine trolley being used, and also the manager requested more guidance on the use and storage of different drugs now being used for those people living with dementia. In view of this, and with the agreement of the manager, an inspection by the Commission’s specialist pharmacy inspector is being requested. Staff were observed to knock on a bedroom door before entering, and obviously had a good knowledge and understanding of the needs of residents with regards to what they preferred to be called. Staff were seen to treat residents with respect, understanding and kindness. During discussions with some staff it was very evident that they enjoyed working with people living with dementia, although some said that this could also be very stressful. From viewing the care plans and talking to the manager and some staff, the inspector was satisfied that residents who may be dying, are treated with care and dignity, and the necessary religious rites observed where appropriate. However, more detailed end of life care needs, in line with the Department of Health guidance, were discussed with the manager and she informed the inspector that she has agreed to pilot a project being organised by representatives of the National Health Service. End of life care planning is not just about the actual wishes after death, but the desired plan of care leading up to the process of dying and death. Staff may benefit from some additional training in this area and the registered manager is directed to the guidance currently given by the Department of Health and the Commission for Social Care Inspection, both of which can be found on the respective web sites. In discussions with the registered manager it was evident that any resident wishing to remain at Ashgrove Residential Home rather than being transferred to hospital would be enabled to do so with the appropriate services being provided. Support is also given to the families and friends of residents who may be dying. The manager was also very aware of the need to increase staffing levels at such times, to ensure that the needs of all residents could still be met without putting additional pressure on the staff. DS0000042148.V314461.R01.S.doc Version 5.2 Page 15 The accident records were also inspected and these were well documented with details of the necessary action taken recorded. DS0000042148.V314461.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users can be assured that the lifestyle experienced in the home generally matches their expectations and preferences with regard to social, cultural, religious and recreational interests and needs. All service users are helped to exercise choice and control over their lives and to maintain contact with family and friends and the local community as they wish. They can be assured that they will receive a wholesome appealing balanced diet in congenial surroundings, and at times convenient to them. EVIDENCE: There is a general programme of activities available for all residents, and these include singalongs, board games, bingo, drawing, quizzes and visiting entertainers. Day trips are also organised but these are less frequent because of the need to have 1 carer to 1 resident in view of the dementia suffered by some of the residents. It was possible to speak to one visiting relative who spoke very highly of the care given to her mother. She said “the staff and manager are angels. I know that my mother can be very difficult but they are always kind and caring.” DS0000042148.V314461.R01.S.doc Version 5.2 Page 17 A volunteer helps with craft activities on a Wednesday morning, and the more able residents enjoy participating in this. Some of the residents at Ashgrove have a diagnosis of dementia, and therefore, their concentration span is very short and this does make the organising of activities very difficult. All residents have had an activity profile completed and this is providing guidance on the appropriate level of activity for each individual. Staff do give great consideration and time to the retention of an individual’s daily living skills, and the task of assisting a resident living with dementia in washing and dressing can be very time consuming. Some residents like to dust, help clear the tables, and fold napkins and they are encouraged to do this. Others may wish to help in the garden with planting plants or bulbs into tubs or raised flower beds, and staff should actively pursue this especially during the warmer weather. The manager now ensures that staff are given the time to sit and talk to residents on a small group or individual basis, and the further development of the life histories will help in this area. The inspector was able to observe that residents felt able to speak to staff, and that staff did not ignore them. Activity resources are available, and it is recommended that these be left out during the day so that residents can “dip in and dip out” as they wish, as the organising of a designated time can prove to be very difficult for those residents with dementia. The purchase of items for a “memory box” such as various types of material, items of home equipment which may have been used by the residents in their younger days and old photographs of the 1920’s onwards could also be used as discussion points in reminiscence sessions with individual residents or small groups. These items could also be used in quizzes for all residents. In discussions with the manager she said that she was also considering “themed evenings”, and on this point was busy organising events for a “Halloween” evening on the 31st October, 2006. There are regular visits by local clergy and if any resident wishes to attend a religious service outside of the home then this would be arranged. Other annual festivals are celebrated and these include the birthdays of residents. Although there are set mealtimes, residents can exercise choice in relation to these as these are made flexible and varied to suit an individual’s preferences and capacities. Four meals per day are served and these are: • • • 7.0 a.m. and 10 a.m. Lunch – between 12.45 and 1.45p.m. Tea – between 4.45 p.m. and 5.45 p.m. DS0000042148.V314461.R01.S.doc Version 5.2 Page 18 • Supper – from about 7.30p.m. Drinks and snacks are freely available between these times, and during the night. Lunch was observed being served, and the meals were nicely presented and served and residents were not being hurried. Sufficient staff were on hand to give assistance where required. Menus were viewed and these give a choice for residents, but there are also other choices available if neither of the main dishes are liked. Menus are being produced in pictorial format to aid choice, and another method of enabling choice is by the use of other senses such as smell, sight and touch of the actual meal. A choice of the two meals on offer could be put onto small plates which are then shown to the resident, so that he/she can make a choice at that moment by using the senses of smell, sight and touch. On the day of the inspection the cook was off sick, but staff assisting in the kitchen were well aware of the recorded dietary and cultural needs of each resident. However, during discussions with some of the staff it was evident that the menu still contains some foods that residents do not like, such as ravioli. It is essential that residents’ likes and dislikes are listened to, and adjustments and changes made where necessary. The manager and care staff were also very aware of the importance of providing “finger” foods where residents are experiencing difficulty in using cutlery. It was apparent from talking to some residents and staff, and from observation, that residents can choose when to get up and go to bed. Contact with family and friends, and the local community, are encouraged and periodic residents/relatives meetings are held. From discussions with one lady it was evident that she has been able to continue membership of a community group to which she belonged prior to moving into Ashgrove. Another resident has a telephone in her bedroom, and is able to keep in touch with her family who currently are unable to visit as frequently. It was obvious during the inspection that the manager and her staff are very aware that Ashgrove is the home of the residents and they try to make this as appealing as is possible. The manager and staff were also very aware of the need to minimise any reduction in the freedom of residents to walk about the home, and realistic risk assessments are in place that balances safety with the individual’s right to be as free and in charge of their actions as possible. The manager also ensures that the rights of all residents are recognised and addressed and balances the needs of all with the needs of individuals. Appropriate signage and décor is in place to aid the orientation of residents living with dementia. DS0000042148.V314461.R01.S.doc Version 5.2 Page 19 DS0000042148.V314461.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Service users and their relatives can be confident that their complaints will be listened to, taken seriously and acted upon and that they will be protected from abuse. EVIDENCE: As part of the inspection process the complaints log was viewed and this was found to be comprehensive in that complaints are recorded together with the action taken to resolve them. There have been very few formal complaints, but where these have been received they have been responded to in writing. The complaints policy and procedures are available within the home to residents and relatives. In discussions with some of the residents they said that they felt able to tell staff if they were not happy, but generally they had nothing to complain of. Because of the difficulty of residents living with dementia to express verbally concerns or complaints, staff need to be more observant to the changing behaviours of residents in case they are unhappy. Complaints and concerns made to the manager are always taken seriously, acted upon and viewed in a positive way. Where an incident needs external input from other agencies such as the Commission, local adult protection, then DS0000042148.V314461.R01.S.doc Version 5.2 Page 21 advice is sought in order to clarify difficult judgements. Where necessary for the benefit of residents, the manager will liaise with Age Concern’s advocacy service. Training records viewed and staff spoken to confirmed that all staff had received training in adult protection and recognising and reporting any adult abuse. This is especially important in the care of people living with dementia, since abuse is more likely to go unrecognised because of the inability of such residents to verbally express themselves. In discussions with the manager and some staff, it was also apparent that they are vigilant to the possible abuse between resident and resident/s. The manager does not act as appointee, nor does she hold any personal expense monies for any resident. Any purchases made on behalf of a resident are paid for from petty cash, and an invoice is sent to the relatives for the reclaiming of any monies. The manager is very proactive on acquiring information and knowledge on new legislation, and was very informed on the new Mental Capacity Act which comes into effect in 2007. The promotion of the rights of the individual are paramount to the manager and staff at Ashgrove, and this was evidenced during the inspection process by staff attitudes towards residents, and the policies and procedures of the home. DS0000042148.V314461.R01.S.doc Version 5.2 Page 22 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, 22, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users live in a safe, generally well-maintained environment with sufficient and suitable lavatories and washing facilities. Any specialist equipment required by a resident is provided, and their bedrooms reflect their own choices with their own possessions around them. The home is clean, pleasant and hygienic. EVIDENCE: A tour of the premises was undertaken and the home was found to be well-lit, clean, pleasant and hygienic with no offensive odours anywhere in the home. Specialist equipment such as hoists and handrails were evident, and any other equipment would be provided to enable a resident to maintain independence. There are currently 14 single bedrooms, 4 of which have an en suite and 6 double bedrooms, 2 of which have an en suite. At the present time 3 of the double bedrooms are being used as single bedrooms. The present occupants DS0000042148.V314461.R01.S.doc Version 5.2 Page 23 of the 3 double bedrooms have shared for sometime and made a positive choice to share. All of the bedrooms have been fitted with an emergency alarm which is within easy reach of each resident’s bed. There is a mixture of suitable baths and showers which gives a resident choice. Toilet seats which are a different colour to the rest of the fittings in that room have been ordered to help with identification, and the toilet door-frames have been painted in a different colour with appropriate signage to aid orientation for people living with dementia. All of the toilets were equipped with toilet paper, towels and soap, and hot water was plentiful. The manager and staff are proactive around infection control and staff have undertaken training in this important area. The proprietor and the manager are looking to put appropriate pictures and photographs in the corridors and sitting areas to provide points of interest for residents. Work is also in hand to identify individual bedrooms with signage which is familiar to the occupier. Bedrooms have been personalised by the individual, and fixtures and fittings are of a good standard, but one bedroom is still waiting to be recarpeted. Residents are encouraged to bring in some of their own furniture. The lounges and dining room are well furnished and carpets are not highly patterned as this prevents visual disturbance. There are also several other areas around the home where residents and relatives can meet quietly if they wish. Residents were able to walk around the home freely without being told to “sit down” by care staff. The rear garden area is laid to paving and lawn and has sitting areas for residents, and has disabled access from the two lounges. The kitchen area was inspected and this was found to be clean with foods being stored and labelled appropriately. The laundry area was also visited and again this was found to be clean with the laundress being aware of the need to take precautions where necessary. One dryer was out of use as a spare part had been ordered, but this was still awaited. It is essential that high importance is given to the repair/replacement of necessary equipment, since this can have a major impact on the delivery of appropriate care. There is an ongoing programme of redecoration and refurbishment. DS0000042148.V314461.R01.S.doc Version 5.2 Page 24 DS0000042148.V314461.R01.S.doc Version 5.2 Page 25 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 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Generally service users’ needs are being met by the numbers and skill mix of staff, but these could be better met to the benefit of both service users and staff with increased interaction between staff and residents around activities, and those for daily living. Service users are protected by the home’s recruitment policy and practices and the training provided to all new and current staff. EVIDENCE: The files of two new staff were inspected and these were found to be in good order and contained the necessary references and criminal records bureau disclosures. The retention of the criminal records bureau disclosures was discussed with the manager who was advised that new disclosures should be retained until the next inspection. Then having been inspected by the Commission’s inspector they should be destroyed in accordance with the Data Protection Act and the Criminal Records Bureau’s code of conduct. The inspector understands that staff may be recruited overseas. If staff are recruited overseas, then the registered persons are reminded that recruitment must be in accordance with the Care Home Regulations 2001, and the home’s recruitment policy and procedures. Also that all new staff must undertake DS0000042148.V314461.R01.S.doc Version 5.2 Page 26 induction training in accordance with the requirements of the regulations and the Skills for Care. Generally staff are receiving training in various areas such as dementia awareness, medication, moving & handling, fire safety, health and safety, adult protection and infection control. It is essential that the manager ensures that staff put into practice skills learned during the training because during the inspection there were times when staff were observed not to be interacting with residents. More than 50 of the current staff have achieved NVQ level 2 and above at the date of this inspection. The inspector was also pleased to note that staff spoken to who had been on the dementia training said “it was really good and has changed the way that I look at dementia.” The inspector was pleased to note that the registered manager, who has day to day control of the home, is now able to increase/decrease staffing levels according to the changing needs of residents. Where a care home is registered to care for people living with dementia, it is essential that staffing levels be kept under review. With sufficient staff on duty, in all areas such as care and ancillary work, residents will receive a service suited to their needs and staff will be under less pressure and stress. Staff spoken to were well aware of the procedures for reporting any suspected adult abuse, and were also conversant with the home’s whistleblowing policy. DS0000042148.V314461.R01.S.doc Version 5.2 Page 27 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, 35, 36 and 38. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users and their families can be assured that the home is managed by a person competent to do so, and that the home is operated in their best interests. Generally staff are appropriately supervised but there is some room for improvement in this area. The health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The registered manager is experienced and qualified and has been employed at Ashgrove for many years. She does have an NVQ level 4 in both care and management and, therefore, there is no requirement for her to undertake the Registered Manager’s Award. DS0000042148.V314461.R01.S.doc Version 5.2 Page 28 From observation and during discussions with some staff, residents and a relative it was apparent that the home is run in the best interests of residents, and that their needs are paramount. A visiting relative said “I am always kept informed and I know that my mother is well cared for. The manager is really approachable, as are most of the staff.” Generally staff are receiving adequate and appropriate supervision, but the manager must ensure that senior carers also benefit from appropriate and sufficient supervision, as there was evidence that this does not happen as often as it should. This evidence was gained from viewing records and in discussions with staff. Residents are encouraged to manage their own finances with assistance from their families or representatives, and where necessary the services of an advocacy service are engaged or the local authority is involved. The manager does not hold any monies for residents and does not act as an appointee. Cleaning liquids and other items required to be securely locked under the COSHH, Control of Substances Hazardous to Health, regulations are now kept locked in a cupboard near to the laundry area. Maintenance records such as those for gas, electric, water, lift maintenance, fire alarms and insurance were inspected and found to be in good order. The registered proprietor has now engaged the services of a health and safety company, and a representative of that company is now working closely with the manager and staff to address some health and safety issues. Key members of staff now have specific areas of responsibility, and carry out weekly audits on health and safety in their areas. In line with the new fire regulations which came into effect on the 1st October 2006, an appropriately qualified consultant has undertaken a fire risk assessment at Ashgrove and the report is still awaited. Notifications under regulation 37 and reports under regulation 26 of the Care Homes Regulations continue to be received. DS0000042148.V314461.R01.S.doc Version 5.2 Page 29 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 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 X 2 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 2 X 3 DS0000042148.V314461.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 Requirement Timescale for action 18/01/07 2 OP7 3 OP12 4 OP15 5 OP24 6 OP36 5(1)(b)(b The registered persons must a)(bb)(bc( ensure that the service user bd) guide complies with the revised regulations, and that a format is devised which can be more meaningful to those residents living with dementia. 15 The registered persons must ensure that the service user’s plan includes strategies for dealing with challenging behaviour, continence care and more detailed life histories 16(2)(m)( The registered persons must n) ensure that the activities available on a daily basis are suitable for all residents, either in small groups or individually. 16(2)(i) The registered persons must review the menus to ensure that the likes/dislikes of residents are taken into account. 16(2)(c) The registered persons must ensure that there is suitable and appropriate flooring in all bedrooms in accordance with the wishes of the individual resident. 18(2)(a) The registered persons must ensure that all staff receive DS0000042148.V314461.R01.S.doc 18/01/07 18/01/07 18/01/07 18/11/06 18/11/06 Version 5.2 Page 31 regular supervision to include 1:1, group and direct observation. 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 Refer to Standard OP12 Good Practice Recommendations That activity resources are made more readily available on a day to day basis so that residents can dip in and dip out according to their wishes. DS0000042148.V314461.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000042148.V314461.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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