Inspection on 06/09/07 for Ashgrove Residential Care Home

This inspection was carried out on 6th September 2007.

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 13/10/06

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 Unannounced Inspection 08:30 6 September 2007 th 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 Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashgrove Residential Care Home DS0000042148.V349371.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 Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th November 2006 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. Ashgrove Residential Care Home DS0000042148.V349371.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 6th September 2007 from 08.30 hours until 16.00 hours. The registered manager was available throughout the time to aid the inspection process, and during the inspection the deputy manager and one of the proprietors were also available to speak to the inspector. During the inspection the inspector undertook a tour of the building, was able to talk with and observe service users, relatives, staff members, the proprietor, the registered manager, the deputy manager and some ancillary staff. 5 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 an Annual Quality Assurance Assessment (AQAA) which was returned by the manager. Some health professionals were also contacted by telephone. Discussions were had with the manager around equality and diversity issues, and the manager was able to demonstrate a good understanding of the issues, and is aware of the some of the shortfalls in this area. Some of the residents were asked how they wished to be referred to in this report, and all said ‘residents because that is what they were’. Therefore, in this report the term resident/s is used. What the service does well: 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. Information about the home is quite comprehensive, and the manager has produced an information leaflet about dementia which is available to staff and relatives and copies are available in the reception area. Before prospective residents and their relatives make a decision on whether to move into Ashgrove Residential Home, prospective residents and their relatives are invited to visit the home. Care plans and risk assessments are good and cover all aspects of the care of the resident. The manager and staff are always keen to assist residents in Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 6 remaining at Ashgrove at the end of life, and as such the manager and staff have undertaken training in this important area. The manager has developed good relationships with health professionals and in particular with social workers, doctors and nurses at the Petersfield Centre, which is a NHS resource centre for people with dementia. Some signage is in place throughout the home which makes it easier for residents living with dementia to find their way around the home, and especially to toilets. Information is also available in pictorial format to enable residents living with dementia to make choices around meals. Such signage is also beneficial to residents who may have short-term memory loss or confusion. It was very evident from observation and discussions with staff, that the home is operated for the benefit of residents, and every effort is made to retain the independence of those living with dementia, and for them to continue to exercise choice and control over their lives. The routines of daily living are flexible and varied to the individual needs and capacities of residents, together with their religious and social preferences. One resident still attends weekly services at the church she attended prior to moving into Ashgrove. Visiting relatives told the inspector “although some areas could be improved, this is still the best home that we visit.” A resident told the inspector “staff are angels, and have great patience especially with those residents who cannot think for themselves, or who take a long time to do things.” The dietary and nutritional needs of all of the residents is given a high priority at Ashgrove, with weights being monitored on a regular basis and action taken as necessary if concerns are indicated. What has improved since the last inspection? There are now more activities taking place within the home, and people from a dementia workshop, Music for Health, visit the home on a monthly basis. This visit and activity are greatly enjoyed by all of the residents and they look forward to this. Good end of life care is from viewing the file of bedroom. Such care is family, district nurses, appropriate. being delivered at the home, and this was evidenced one resident, and being able to visit her in her being undertaken in co-operation with the resident, the the GP and other healthcare professionals where Ancillary staffing levels have increased especially at the weekends, and this has meant improved services in the kitchen, cleaning and laundry. Some of the bedrooms have been redecorated, and there is a programme in place for the remainder of the bedrooms to be redecorated. Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 7 Training is given a high profile and currently the manager is undertaking a distance-learning course on equality and diversity, and the deputy manager is undertaking a distance-learning course on diet and nutrition. What they could do better: Although the proprietors have plans for the extension of the home, it is essential that the existing building is maintained to a good standard. For example the extractor fan in the kitchen has not been in working order for several months. This is not an acceptable situation for staff who have to work in this area, and it is essential that the proprietors address this matter. Also it was evident that the dishwasher in use in the kitchen is domestic in design, which means that the washing of dishes takes a very long time, often to the detriment of the service. It is strongly recommended that the proprietors review this and give strong consideration to the purchase of an industrial machine which would make the working conditions for the kitchen staff more effective and less onerous. The lavatory cistern cover in the main bathroom is broken and has been taped with a silver cover. Again this is not acceptable and must be replaced. The proprietors are reminded that Ashgrove may be a business, but it is ‘home’ to the people living there, and as such they should be assured that all parts of the building are being maintained at all times to a high standard. Although the provision of activities within the home has improved, there is still room for improvement around residents accessing and engaging with the community. Although the increase in staffing levels has helped, residents are becoming more dependent especially around personal care and assistance at meal times. In view of this the proprietors are recommended to consider the engagement of an activities co-ordinator who could ‘organise and co-ordinate’ larger group activities which included visits to the community resources, such as local shops and the nearby theatre. This would certainly be beneficial to all of the residents, especially to some of those living with dementia since it would be an aid to them remaining in touch with life outside of the home. Since the previous inspection there has been a level of staff turnover, and many of the staff are now not reflective of the ethnicity and culture of the residents. It is essential that all staff receive training in equality and diversity issues, and that the management ensures that staff can communicate effectively with both residents and visitors to the home. Some relatives did tell the inspector that “it is not always easy to understand some of the staff, and they do not always seem to understand what we are saying, and just smile.” Relatives did go on to say that “we have only ever seen staff being kind and caring to the residents.” Although the care plans are comprehensive, the daily recordings should be more reflective of the outcomes in the care plans, so that such outcomes can be more effectively monitored. This was discussed with the manager during Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 8 the inspection and she will be making some changes to the recording of information. The proprietors are also reminded that it is a requirement that the monthly quality assurance visits under regulation 26 of the Care Homes Regulations 2001 are undertaken, with a report being produced and given to the manager. There was no evidence that such visits had been undertaken since April, 2007. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashgrove Residential Care Home DS0000042148.V349371.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 Ashgrove Residential Care Home DS0000042148.V349371.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 (standard 6 is not applicable to this service) People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Prospective residents 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 needs will be met. Both residents 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 by the manager on people wishing to live at Ashgrove and, wherever, possible the prospective resident is invited to visit the home. So that information is more accessible to people living with dementia, the service user guide should be produced in a Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 11 simplified format for their use. This was discussed again at the inspection with both the manager and the proprietor, and the proprietor has now undertaken to produce a simplified document and forward a copy to the Commission. 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. Staff at Ashgrove Residential Home have undertaken training in caring for people living with dementia, and are generally able to understand the constantly changing needs of these 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. 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. A copy of the Commission’s guidance on fee information was given to the manager during this inspection. Ashgrove Residential Care Home DS0000042148.V349371.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. The health, personal and social care needs of each resident 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. All residents are treated with respect and their right to privacy upheld. Residents can also be assured that at the end of life they and their family will be treated with care, sensitivity and respect. EVIDENCE: The files of 6 residents were inspected, and 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. Care plans had been updated to reflect changing needs and current objectives for health and personal care. However, it is essential that the daily recordings reflect the desired outcomes identified in the care plan. This was discussed Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 13 with the manager who will be introducing a new system of daily recordings. Residents and/or family are involved in the formation and review of the care plans. Residents 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 the manager always ensures that sufficient staff time is allocated to this. From observation it was not always apparent that staff recognised the importance of maintaining eye contact and interacting with residents. It is essential that all staff are able to communicate with residents and their relatives, in spite of some cultural differences. This was discussed with the manager during the inspection, and she will ensure that where necessary staff undertake further training in the importance of communication. Where necessary care plans contained continence programmes and staff were observed to be giving appropriate assistance where necessary in a kind and considerate manner. Where necessary the district nurses visit and are involved in the care programme for treating pressure sores, and currently there was one resident with a pressure sore and this was healing. The manager continues to have close working relationships with the health professionals at the local NHS dementia resource centre, and staff 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, and staff did ensure that residents used such aids and that these were clean and had batteries where necessary. 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. The manager and the deputy recently attended a conference on the nutritional and dietary needs of people living with dementia. Information gained has been introduced into the menus at the home, and records indicate that some residents have been able to gain weight even though they are experiencing some difficulties in eating due to their dementia. Residents are never sent to hospital or to attend appointments outside of the home without being accompanied. Wherever possible family and friends are Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 14 encouraged to support these appointments, but where this is not possible then a member of staff will accompany the resident. The manager 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, and ensures that this is included in the care plans where necessary. Where necessary risk assessments are in place, but it is essential that staff ensure that where bed rails are being used, that these are used in accordance with the safe use of bed rails (a poster on this is located in the ground floor corridor of the home). Guidance from the Commission on the use of restraints was given to the manager during this inspection. 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. However, staff are reminded that they must continue to ensure that MAR (medication administration records) are completed at the time of the administration of the medication and not retrospectively. Staff monitor the condition of residents on medication and if there are any concerns the GP is informed and a review requested. At the time of this inspection there are no residents who were able to self-medicate. All of the care plans viewed had a medication profile of the drugs being administered to the individual. Staff were observed to knock on bedroom doors 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, although communication did sometimes appear to be a problem. In discussions with relatives the inspector was told “with some of the newer staff communication does seem to be a problem, but in spite of this we can honestly say that all staff treat the ladies very kindly and with respect.” From observations and from talking to staff it was evident that they enjoyed working at the home. 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, need to be included into the care plans. 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. Such a plan is in place for one resident, and this needs to be extended to all residents. Some staff have benefited from some additional training in this area, and this was evidenced in the care of a particular resident. It was evident that any resident wishing to remain at Ashgrove Residential Home rather than being transferred to hospital Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 15 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. Ashgrove Residential Care Home DS0000042148.V349371.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents generally find that the lifestyle they experience in the home matches their expectations and preferences, and satisfies their social, cultural and religious needs, but there is room for improvement around meeting recreational interests. Residents are encouraged to maintain contact with family and friends, but again there is room for improvement in local community contacts. All residents can be sure of receiving a wholesome, appealing and balanced diet in pleasant surroundings, and at times convenient to them. EVIDENCE: There is a general programme of activities available for all residents, and these include sing-along, board games, bingo, drawing, quizzes and visiting entertainers. Every month people from a dementia workshop, Music for Health, visit the home and residents enjoy this and many benefit from the interaction. One resident told the inspector “there are things to do but often I like to sit quietly and I can do this. Sometimes I like to watch television and can do this either in the lounge or in my bedroom.” Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 17 The inspector was able to observe some staff interacting well with residents, either talking to them, doing their nails or looking at magazines. More use is now being made of the dining room outside of mealtimes for the undertaking of activities. In this way residents who do not want to join in can sit quietly in the lounge, or watch television in the other lounge. It was apparent that whilst staff are undertaking activities with some residents, due to the increasing frailty of some of the residents personal care needs are taking up more time. Although a volunteer helps with craft activities on a Wednesday morning, and the more able residents enjoy participating in this, the manager and the proprietors must give consideration to the engagement of an activities coordinator. This person could then take a strategic view of the activities within the home, ensure that there are always appropriate and adequate resources, and arrange visits outside of the home for some of the residents. 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 often prove to be very difficult for those residents with dementia. The Commission views services for people living with dementia as specialist services, and the proprietors are reminded of this. People living with dementia demand, and require more staff time and input to ensure that they are able to retain, for as long as is possible, skills for daily living. As such residents become more frail, either with age or the advancing dementia, staffing levels must be reviewed to ensure that all needs continue to be met. 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 when the weather allows. 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. In fact one resident does still attend her local church for services. On the day of the inspection, residents were seen enjoying a harvest service in the home. 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 noon and 1.0 p.m. Tea – between 4.45 p.m. and 5.45 p.m. Supper – from about 7.30p.m. DS0000042148.V349371.R01.S.doc Version 5.2 Page 18 Ashgrove Residential Care Home Drinks and snacks are freely available between these times, and during the night. Breakfast and lunch were 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. Breakfast time is more staggered according to when a resident gets up. Those residents who require more assistance with eating are served their lunch before the majority of the residents have theirs. This ensures that these residents are not hurried but are given the full attention of staff. 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. As previously stated the manager and the deputy manager attended a conference on the dietary and nutritional needs of people living with dementia, and the information gained is now reflected in the meals served at the home. The deputy manager is also currently undertaking a training course on diet and nutrition. On the day of the inspection the cook was supervising a new cook and both were well aware of the recorded dietary and cultural needs of each resident. Staff were also very aware of the importance of providing “finger” foods where residents are experiencing difficulty in using cutlery, or who wander about during mealtimes. 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. This was also confirmed by visiting relatives who told the inspector that they visit at different times. Contact with family and friends is 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. However, with more staff input residents should be able to participate more in community activities. The home is situated very close to the Queen’s Theatre and residents should be encouraged to visit this venue more frequently, as with other community resources such as the local shops and restaurants. On the day of the inspection a relative came to take his mother and another resident to a matinee performance at the theatre, and with some forward planning more residents could possibly have participated with the assistance of staff to accompany them. Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 19 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, but more appropriate pictures and other materials along the corridors would be beneficial to the residents. Ashgrove Residential Care Home DS0000042148.V349371.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents 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 through staff supervision and training. However, information on the complaints procedure should be produced in a more user friendly format for those people living with dementia. 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 no formal complaints since the last inspection, but the manager must ensure that verbal and informal complaints are also recorded. The complaints policy and procedures are available within the home to residents and relatives. However, the manager should produce a simplified complaints procedure which could easily be used by some people living with dementia as this would enable them to have a greater insight in how to complain and what making a complaint means. 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 Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 21 behaviours of residents in case they are unhappy, and also ensure that such changes in behaviours are recorded in the daily records. In this way closer monitoring can be undertaken with the necessary changes to care plans being made. 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 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 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. She has obtained a variety of booklets and will be ensuring that residents, relatives and staff are aware of this new legislation, and that this is reflected in the care delivered at the home. 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. Ashgrove Residential Care Home DS0000042148.V349371.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents 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. Several residents have specialist beds and some have bedrails, which have been fitted within a risk assessment process. Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 23 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 some of the double bedrooms are being used as single bedrooms. The present occupants of the shared 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. Other alarm systems are also in place for residents who are prone to falling when in their bedrooms. There is a mixture of suitable baths and showers which gives a resident choice. The toilet door-frames have been painted in a different colour with appropriate signage to aid orientation for people living with dementia. However, the main bathroom cistern cover must be replaced as this is broken, and is currently covered with a silver tape. 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, but this work is still ongoing from the last inspection. Work is also ongoing 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. Some of the bedrooms have been redecorated, and work is ongoing to ensure that the remainder of the bedrooms are redecorated. 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 oven was out of order and awaiting repair but this was in hand. However, the extractor fan was not working, and had been out of order for several months. It is essential that the proprietors ensure that this fan is repaired/replaced for the health of the kitchen staff who are often working in a hot environment. The laundry area Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 24 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 washing machine was out of use as a spare part had been ordered, but this was still awaited. The proprietors do have plans for an extension to the current building, but this must not impact on the need for an ongoing programme of redecoration and refurbishment. 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. As a result the proprietors will be required to inform the Commission when the aforementioned repairs have been completed. Ashgrove Residential Care Home DS0000042148.V349371.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Generally residents needs are being met by the numbers and skill mix of staff, but these could be better met to the benefit of both residents and staff with increased interaction and communication between some staff, relatives and residents. Residents are protected by the home’s recruitment policy and practices and the training provided to all new and current staff. EVIDENCE: The files of three new staff were inspected and these were found to be in good order and contained the necessary references and criminal records bureau disclosures. Also all staff have been issued with a contract of employment. All new staff undertake induction training in accordance with the requirements of the regulations and the Skills for Care. However, the manager must ensure that staff have good communication skills as this is essential in the delivery of care to vulnerable people. Where problems are identified, then the manager must ensure that suitable training is made available in this important area. Staff requiring risk assessment under health and safety have had these Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 26 undertaken, and this was confirmed in discussions with a member of staff who had had a risk assessment undertaken for her. 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 continues to ensure that staff put into practice skills learned during their training. More than 50 of the current staff have achieved NVQ level 2 and above at the date of this inspection. The manager is currently undertaking distance learning in equality and diversity issues, and the deputy manager is undertaking distance learning in diet and nutrition. Where a care home is registered to care for people living with dementia, it is essential that staffing levels constantly 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. Also external activities for some residents can also be improved. Staff spoken to were well aware of the procedures for reporting any suspected adult abuse, and were also conversant with the home’s whistle blowing policy. Ashgrove Residential Care Home DS0000042148.V349371.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents 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. Staff are appropriately supervised to ensure they continue to develop the skills necessary for the delivery of care to vulnerable people. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 28 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 continues to undertake relevant training to ensure that the care at the home meets the needs of the residents. From observation and during discussions with some staff, residents and relatives 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 always feel that I can speak to the manager if I have any concerns, she is very approachable.” A resident told the inspector “Lesley is really nice and nothing is ever too much trouble for her. I know that I can be a nuisance sometimes.” From viewing records and talking to some staff it was evident that they are receiving adequate and appropriate supervision. In discussions with the manager and the deputy manager they confirmed that they are also putting into place a system for direct observation of care practices as part of the ongoing supervision programme. Where possible 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 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. Key members of staff continue to 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 now available within the home. Notifications under regulation 37 continue to be received by the Commission, and accident records are being maintained in good order. However, reports under regulation 26 of the Care Homes Regulations have not been undertaken by the proprietor since April, 2007. It is a requirement that such visits are undertaken on a monthly basis, with the necessary report being produced. These visits and reports are an essential element in the ongoing quality assurance monitoring of the service being delivered. Reports should be Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 29 detailed in all areas, and guidance on the content of these reports can be found on the Commission’s website. Until further notice the proprietor will be required to forward a copy of each month’s report to the Commission for information. Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 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 3 X 2 Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 31 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 OP13 Regulation 16(2)(m)( n) Requirement Timescale for action 30/09/07 2. OP16 22 (2) 3. OP19 23 (2)(b)(c) 4. OP30 18 (1)(c)(ii) The registered persons must ensure that all residents are given the choice of participating in external activities according to their needs and wishes. This is to ensure that residents in care homes do not become isolated from the general community, and continue to feel part of society. The registered persons must 31/10/07 ensure that the complaints procedure is in formats suited to meet the needs of all of the residents at the home. This will ensure that everybody will feel able to complain if they need to. 30/09/07 The registered persons must ensure that the building and equipment used in the home is maintained to a good standard and in working order. This refers particularly to the kitchen extractor fan and the toilet cistern in the main bathroom. The registered persons must 31/10/07 ensure that all staff working at the home are able to communicate appropriately with DS0000042148.V349371.R01.S.doc Version 5.2 Ashgrove Residential Care Home Page 32 5. OP38 26 residents and visitors. This will ensure that the needs of residents are properly identified, discussed with the individual and met through service delivery. The registered person must ensure that the monthly visits and associated reports are undertaken, and a copy of each report forwarded to the Commission. These visits must be part of the quality assurance systems to monitor that quality care is always being delivered to vulnerable people. 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 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. Ashgrove Residential Care Home DS0000042148.V349371.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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