Inspection on 28/07/05 for Ashgrove Residential Care Home

This inspection was carried out on 28th July 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 Residential Care Home 06/09/07

Ashgrove Residential Care Home 13/10/06

Ashgrove Residential Care Home 13/10/05

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 Harbinder Ghir Unannounced Inspection 28 July 2005 10:00 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 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 Residential Care Home Version 1.40 G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc 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 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 Mr Pathmanathan Elango Mrs Rajakala Elango Ms Lesley Burkett CRH Care Home 26 Category(ies) of OP Old Age (26) registration, with number of places Ashgrove Residential Care Home Version 1.40 G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one named person over 65 with dementia. Date of last inspection 10 March 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 compromise a linked pair of Edwardian houses which have been suitably modernised over the years. All rooms are spacious, airy and bright. They all have hand basins, TV points and a call system. The home has a passenger lift. There is a lounge and dining room overlooking the garden, which is with disabled access to the grounds. There are car parking facilities to the front of the property. The home is located on a busy road in Hornchurch, and is close to local services and facilities which are easily accessible by car or by public transport as is the M25, A12 and A127. Ashgrove Residential Care Home Version 1.40 G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission was represented by Harbinder Ghir, Regulatory Inspector who was at Ashgrove House from 10.00 a.m. until 3.45 pm. During that time some residents and staff agreed to speak with the Inspector. The home and some records were inspected. The focus of the inspection was to assess progress made to meet notified required and recommended actions in the last inspection report, gaining evidence against standards from records, observation and discussion. 6 requirements made at the last inspection have been restated, as they were not complied with. Failure to comply by the new timescale will result in the commission considering enforcement action to secure compliance. What the service does well: What has improved since the last inspection? What they could do better: The assessment, care planning and risk assessment formats must improve to ensure the needs of all residents are being met and the care provided is reflected in the daily log. Staff supervision needs to be made a high priority for the home, as staff are not being supervised at least 6 times a year, resulting in staff not being aware of developments within the home concerning the welfare of residents. Staff would also benefit from regular team meetings as an opportunity to encourage team building. A comprehensive training programme is also required to meet staff training needs and a training matrix to keep log of all training attended and required. Ashgrove Residential Care Home Version 1.40 G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Page 6 A daily log of nutrition intake for each resident also needs to be maintained by the home. Residents would greatly benefit from regular day trips as the last one arranged was last year. The home needs to complete regular environmental risk assessments to keep up with maintenance work urgently required throughout the home. Infection control needs to be made a priority for the home. 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 Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 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 standard(s) 1,2,3,4,5 The homes Statement of Purpose and Service User Guide is inadequate and only partly contains the information that prospective service users need to be clear about the services the home provides to meet their needs. Both documents need updating. A comprehensive assessment of service users is not completed prior to admission to ensure identified needs can be met by the home. EVIDENCE: The Statement of Purpose and Service User Guide were seen, which did not provide comprehensive and detailed information about the service as required by the regulations. Advice was given to separate the documents, for them to be more clear and concise with all relevant information included. Copies of both documents are given to all residents prior to admission and are readily accessible via the manager. Residents are provided with a statement of terms and conditions when moving into the home. Evidence was seen of the homes contracts, which were very detailed. The admission procedure is not adequate to guide staff on the actions to be taken to ensure that new residents’ needs are properly assessed and planned for. Four files were inspected, all did not have full pre-admission assessment Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 9 information recorded on them. The pre-assessment form is tick box formatted which is very brief and concise. The manager confirmed that trial visits are encouraged and are an opportunity for potential residents and their family to identify how appropriate the home is for them in meeting their needs. Residents are offered to stay for meals and have the option to stay overnight. The home does not provide intermediate care. Previous requirements made in relation to standards 1 and 3 have been restated, with a new target date for compliance. Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 10 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 standard(s) 7,8,10, 11 The care planning system is not clear and consistent to provide staff with the information they need to meet residents’ needs. The recording of daily entries is brief and does not provide the reader with comprehensive information of residents’ individual care and support needs provided by the home on a daily basis. Personal care is offered in a way that protects residents’ privacy, dignity and promotes their independence. Residents’ wishes in the event of death had not been established in care plans. EVIDENCE: Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 11 Individual plans of care are available but information in relation to aspects of health, personal and social care needs is generalised, brief and basic. Care plans identified risks but lacked detailed information on preventative measures. Care plans and risk assessments were not reviewed monthly. Daily entries of case recording seen on 4 care plans were generalised, repetitive and very brief and did not reflect the care and support provided by staff. This was particularly evident for one resident who was placed on a toileting programme as a result of incontinence but there was no record of this or a risk assessment and associated plan on the care plan. The home promotes and maintains residents health through supporting and facilitating medical appointments as required. Privacy was maintained through lockable toilet and bathroom doors and residents could make telephone calls in private. Appropriate screening was provided in all shared rooms. Residents felt that staff were kind and gentle this was confirmed by observation. Residents are not consulted regarding their wishes concerning terminal care and arrangements after death. The home has a comprehensive policy in the event of death and care and support is provided for relatives after bereavement. Visitors are made welcome at any time. The home does not have a private visitors room. Previous requirements made in relation to standards 7 and 8 have been restated with a new target date. Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Social activities are organised daily within the home. The meals in the home are nutritious offering both choice, variety and catering for special diets. Residents’ needs are promoted and they are encouraged to exercise rights and choices. EVIDENCE: The home has two exercise classes organised twice weekly, which includes a group and one to one session. There is also a weekly activities timetable, which was displayed for all residents in the main lounge. A log is kept of all those activities conducted by the activities co-ordinator and those who participated. Residents spoken to stated that they enjoyed the daily activities and live entertainment provided. Residents also stated that those independent enough are encouraged to go out or to be taken out by their families. Residents spoken to said the routines of daily living were tailored to their individual preference as far as was practicable. One resident stated that she could go to bed late at night and have a lie in if she wanted to. Residents had access to their daily records if they wished. Residents would benefit from more day trips Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 13 arranged by the home to promote more community contact, as the last one arranged was last year. A number of residents were spoken to and everyone commented on how they enjoyed the meals and commended the cook. They stated they had plenty of choice and variety. The cook verbally asks each resident what they would like to eat for lunch and tea, which includes two choices and a diabetic choice. A record of what each resident has chosen is kept. It was advised that the home also keeps a record of what each resident has had to eat and what amount of portion he or she has eaten, in order to monitor their nutritional intake and for this information to be recorded in the daily log. The menu for each day was displayed in the main lounge. Residents spoken to were aware of what was for lunch. Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a clear complaints procedure and residents and relatives are aware of how to complain and feel that their views are listened to and acted upon. EVIDENCE: The home has a clear step-by-step procedure that meets the requirement of the regulations. The complaints procedure was displayed within the home and evidence was seen of it included in the statement of purpose and service user guide. The home has received no complaints since the last inspection. Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 15 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26. Improvements to the environment will enhance the residents’ quality of life as will additional maintenance. Residents were put at risk due to some infection control issues. EVIDENCE: The premises were comfortable and free from offensive odours. Furnishings and fittings were domestic and unobtrusive. The home has one dining room and one main lounge, which are homely and comfortably furnished. Lighting in communal areas was dull and would benefit from being brighter in character. Carpets throughout the home required replacing, and all communal bathrooms need to undergo a redecoration programme. The overall condition of bathroom floors and fittings were in urgent need of repair and all communal bathrooms throughout the home lacked basic hand washing equipment increasing the risk of infection. Appropriate storage for equipment found in hallways needed to be located within the home, which was hazardous for residents, and staff. The Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 16 gardens are well maintained and are equipped with suitable furniture. The home has a lift, a ramp leading to the garden and adequate aids and equipment were provided throughout the home. Service user rooms were decorated and furnished according to the wishes of the occupant. All rooms are lockable which staff can override in an emergency. All service users have a key to their rooms. Appropriate screening was provided in all shared rooms. However, all rooms did not have bedside lighting or window restrictors. The home has a sluicing facility located in the laundry, which was clean. Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 There is a good match of qualified staff offering consistency within the home. Recruitment processes are robust and offer protection to people living at the home. EVIDENCE: The staff duty rota was seen; this showed that staff were working appropriate hours. Staff were observed to respect residents and were accessible and approachable. One resident spoken to stated that the staff were very approachable. The home does not have a ratio of 50 and above of NVQ trained staff but does benefit from a permanent staff team. The manager is in the process of completing her Registered Managers course. Two staff files were inspected and indicated residents were protected through the use of robust staff recruitment processes. Staff received a comprehensive induction programme. Staff training was organised but the home had no system of monitoring individual staff training needs. It was advised that a staff matrix is devised. Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36,37 Residents benefit an experienced manager who recognises their needs and manages the home well. The manager has a clear vision for the home, which she has effectively communicated to residents, relatives and staff. The systems for Service User consultation are poor with little evidence that Service User views are sought or acted on. Staff supervision needs to be a high priority for the home, as staff are not being supervised regularly. EVIDENCE: The manager has many years experience of working with this service user group and is in the process of completing the Registered Managers Award. The home does not have any systems in place to identify the views of its Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 19 residents’ on a regular basis. Resident meetings are not held and resident surveys are not devised. Such quality assurance methods would allow the home to gather residents views, comments and suggestions would lead to the development of the service. The homes provider must ensure regular Regulation 26 visits are completed as the commission has not received regular reports. This is a legal requirement and demonstrates how the provider is monitoring that the home is operating in accordance with regulatory requirements and national minimum standards. Staff supervision is not taking place regularly. The manager informed that the process of supervising all staff had just commenced. During the inspection all residents care plans were kept in a secured place when not in use. Documentation seen was completed appropriately. Residents could access their records if they wished. Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 3 3 3 2 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x 1 x x 2 3 x Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4, 5 Requirement The registered person is required to review and update the Statement of Purpose and Service User Guide. Timescale not met of 30/04/05. This requirement is restated. The home to complete adequate pre-admission assessments, from which a care plan can be devised and delivered.Timescale not met of 30/04/05. This requirement is restated. Care plans to be more detailed, comprehensive to meet the needs of the individual resident. The registered person must ensure that monthly care plan reviews are completed. These are to be signed and dated. Timescale not met on 30/04/05. This requirement is restated. The registered person must ensure that monthly risk reviews are completed and must review individuals risk assessment when any changes occur in care needs. These are to be signed and dated. The registered person must Version 1.40 Timescale for action 30/09/05 2. 3 14/15 30/09/05 3. 7 15(2) 30/09/05 4. 7 15 (2) 17 (1) (a) 30/09/05 5. 6. 7 17(a) 30/09/05 Page 22 Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Schedule3 7. 8 13 8. 10 15 & 17 (1) (a) Schedule 3.3 (q) 9. 11 12 (2) 10. 19 23 (2) (b) (j) 11. 25 13 (4) (a) (c) 16 (2) (i) 12. 26 13. 14. 28 33 18 (1)(a) 24, 26 ensure that daily individual records of nutritional intake are recorded in detail. Risk assessments to be specific and linked to the care plan. Timescale not met on 30/04/05. This requirement is restated. The registered person must ensure that care staff demonstrate how individuals lifestyle, wishes and choices have been made by recording appropriately in the daily report log. The service users wishes concerning the arrangements after death are discussed and carried out. The registered must person must ensure routine environmental risk assessments throughout the home internally and externally are completed regularly and actioned and are to be kept on file. All tempretures in rooms to checked and logged.The electric heater to be removed from room 15 due to health and safety issues. All windows where required are fitted with window restrictors and all rooms are equipped with bedside lighting. All bathrooms are provided with paper towels, liquid soap, swing top bins to reduce the risk of infection. The provider to achieve a 50 staff ratio of NVQ qualified staff. Quality care surveys with residents and relatives must be completed and the reports provided to service users and to the Commission for Social Care Inspection when complete. The registered provider is required to underatake monthly monitoring Version 1.40 30/09/05 30/09/05 30/09/05 30/08/05 30/09/05 30/09/05 30/12/05 30/09/05 Ashgrove Residential Care Home Page 23 G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc 15. 36 18 (2) visits and forward the reports to the to the Commission for Social Care Inspectin. Timescale not met on 30/04/05. This requirement is restated. The registered person shall ensure that persons working at care home are appropriately supervised. In that: staff are supervised at least 6 times a year. 30/09/05 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. 3. 4. Refer to Standard 12 25 30 22 Good Practice Recommendations It is recommended more time day trips are organised for residents. It is recommended that the lighting in all communal areas is bright in character. A training matrix or training programme is devised which is kept up to date and keeps tracks of all staff training needs. It is recommended all equipment is appropriately stored throughout the home, to keep communal areas and hallways free of obstruction. Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex 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 Ashgrove Residential Care Home G55_S0000042148_Ashgrove_V241282_280705_Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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