Inspection on 20/06/07 for Ashington Grange

This inspection was carried out on 20th June 2007.

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 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

Ashington Grange 02/07/08

Ashington Grange 20/01/06

Ashington Grange 09/09/05

Ashington Grange 24/02/05

Ashington Grange 15/07/04

Ashington Grange 28/01/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Ashington Grange Moorhouse Lane Ashington Northumberland NE63 9LJ Lead Inspector Aileen Beatty Key Unannounced Inspection 09:30 20th June 2007 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 Ashington Grange DS0000040474.V330117.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. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashington Grange Address Moorhouse Lane Ashington Northumberland NE63 9LJ 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) 01670 857 070 01670 854 144 ashingtongrange@highfield-care.com Southern Cross Home Properties Limited Mrs Jane Elliott Care Home 59 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (35) of places Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three specified persons under the age of 65 may be accommodated within the category of DE for as long as they are in residence. The CSCI must be informed at that time so that this condition can be removed. Two specified person under the age of 65 may be accommodated within the category of PD as long as they are in residence. The CSCI must be informed at that time so that this condition can be removed. 20th January 2006 2. Date of last inspection Brief Description of the Service: Ashington Grange is a two storey purpose built care home which is situated in a residential area and is approximately one and a half miles from the centre of Ashington. The home provides care for residents who have dementia and general nursing care for up to 59 older persons. The home also offers social and personal care for older people. The home is divided into two units called the Charlton Wing and the Milburn Wing. Each unit has its own facilities including single bedrooms, 10 of which are en-suite. Each unit has two lounges and dining rooms and there is safe access to the garden areas. Car parking areas are provided at the front and sides of the building giving level access to the home. The home shares the site with another home, which is owned by the same company. Fees range from £388.47 and £409.25 per week. Information about the care provided and facilities in the home are available in the service user guide and statement of purpose in the home. A copy of the most recent inspection report is also available. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was carried out over eleven hours on two days by one inspector, Aileen Beatty. The manager and deputy were on duty during the visits and assisted the inspector with the process. The manager provided CSCI with information before the inspection. Eleven residents and four relatives were spoken to individually. The inspector spent time in the lounge observing the care carried out by staff and also ate lunch with residents. Records looked at included, six care plans, training and staff records and the records for complaints as well as the health and safety, accident and maintenance records. The inspection found that the care provided is generally good and staff are committed to providing a high standard of care. There are some differences between the two sides of the home that need to be addressed. What the service does well: What has improved since the last inspection? A number of policies and procedures have been updated and a new file is available linking these to National Minimum Standards. Some areas of the home have been redecorated and new carpets fitted. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 6 Most requirements set at the last inspection have been met. What they could do better: 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. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a detailed statement of purpose and service user guide. Residents and their representatives are given good information on which to base the decision to move into the home. Detailed assessments are carried out to enable staff to plan care effectively before residents are admitted to the home. Residents, relatives and friends may visit the home to help them to decide whether it is suitable to meet their needs before they move in. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 9 EVIDENCE: The service user guide is comprehensive and contains all of the information identified in Schedule 1 of the Care Standards Regulations. It includes a large amount of information about the services offered by the home including information about staffing, who the home can care for, social activities, arrangements for religious observance as appropriate, fire safety, complaints, care planning, information about meals and mealtimes and the homes environment. The manager or deputy carry out an assessment on prospective new residents and this usually takes place in hospital or another care setting. The assessment is detailed and examples of completed assessments are contained in care records. These include information about their medical needs, dependency assessments, any infections and medication they may be receiving and a full body map outlining any existing injuries or wounds. A dementia assessment has been added to help identify the more specific needs of residents with dementia. The residents also have a care management assessment, which is given to the home on admission and from these documents an individual care plan is produced. All of the care plans looked at had these in place. Residents and their representatives are encouraged to visit the home and spend time. This results in them having good information on which to base their decision to move into the home. They may spend a short time at the home and build this up to slightly longer visits. An emergency admission policy is in place, which aims to minimise risks and distress to the resident. In this situation assessments of needs must be carried out within 24 hours of their arrival at the home. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Healthcare needs are well planned but not always evaluated regularly enough which could compromise care. Healthcare needs are usually fully met with good access to health professionals as required, which means physical needs are responded to promptly. The residents receive their prescribed medication in line with safe working practices. The medicines in the home are well managed and safely disposed of as necessary. Residents are generally treated with respect and their privacy respected. Staff have a lot of experience of caring for people who are dying and good procedures are in place. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 11 EVIDENCE: Care plans are available for all residents and are laid out in the Southern Cross house style. They are very well organised and contain a variety of assessments of needs and risks such as physical and psychological assessments, and the plans that have been written to address these needs. The care plans of six residents were read, three from each side of the home. The care plans and assessments are generally well written and the manager carries out regular audits to ensure they are up to date. The care plans on the Milburn wing (dementia unit) are not sufficiently up to date. Nurses are aware of this and find it difficult to maintain records due to other pressures in the unit (see staffing). Some care plans require some attention to the wording contained in them. For example, persistent use of the expression “ensure she is toileted”. Residents have good access to healthcare. A nurse practitioner from the primary care trust visits daily. She is able to prescribe some treatments and will consult a doctor when necessary. This has proven a very effective way to meet the health needs of residents and she is able to become familiar with them. A chiropodist visits every twelve weeks or sooner if required and on the day of the inspection, “Visioncall” visited the home and were carrying out a short training session for staff regarding eye care and sight issues. Staff are attentive to the needs of residents. One lady had dropped her glasses in her porridge. Upon noticing that they were dirty, a member of staff offered to take them away to clean them up. Other staff were seen checking hearing aids were switched on and working. Some residents need to use hoists to be transferred by staff. Staff were observed hoisting a resident in the dementia unit who appeared quite anxious about the process. Staff told them to lean forward and then said “are you ready” but didn’t actually say what they were going to do or why. Residents with dementia may never recall having been hoisted before and require effective instructions and sensitive support such as maintaining eye contact and offering reassurance. Another member of staff pulled someone away from the dining table in their wheelchair, which they swung round towards the door without saying they were going to do so and startling the resident. It is recommended some training takes place or that these issues are discussed during supervision with staff to remind them of the importance of effective communication. Residents were observed being cared for in both sides of the home but for a longer period in the dementia unit. The residents in this unit appear well cared for. They are alert and responsive and interested in their surroundings. Staff Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 12 confirmed that they have a policy to avoid using sedating medication. Although residents do appear to be settled generally, there were long periods that they were in the lounge alone with no staff present until an activity took place later in the morning. There were examples of staff behaviour that give the impression that the way they care for residents in the dementia unit is affected by a lack of sufficient staff at times. For example, instead of allowing residents to freely wander around the home they are sat down in lounges and there is a habitual tendency to tell people to sit down (not unkindly) when they attempt to get up or leave the room. In the Milburn wing, staff were observed by the inspector to be closely supervising a resident who was displaying risky behaviour. They appeared to be having some difficulty doing this and also meeting the needs of the remaining residents in the unit. Nurses were asked if they are able to increase staffing levels during such times and they stated staffing levels are set by the company in relation to occupancy. This is not an acceptable way to set staffing levels as they should fluctuate according to dependency levels. The home carries out dependency levels assessments on each resident every month but there is no evidence of any collation of these to give a pattern of overall changes in dependency that may affect staffing decisions. Nurses were advised that they should analyse dependency levels on an ongoing basis every few months. Medication procedures are generally good. The nurse on duty on the first day of the inspection described the process of ordering and receipt of medicines and how to dispose of them. There is a good sized treatment room where medicine trolleys are stored. A random check on the quantity of a controlled drug found the correct amount. Oxygen is stored in a separate cupboard and there is appropriate signage on the door if anyone is receiving oxygen therapy. The temperature in the treatment room and treatment room fridge are checked daily, and all items in the fridge are correctly dated when opened if required. There were some gaps noticed in medication records and the photograph of one resident was missing. Staff try to preserve the dignity of residents by ensuring they are appropriately dressed and knocking before entering rooms. There are incontinence pads stored in bedrooms and on floors in bathrooms. These should be stored discreetly so as not to draw attention to the fact that a resident has a continence problem should they wish to invite a visitor into their room. The home is used to caring for residents who are dying and there are detailed procedures in place. It is recommended that they look at some of the new models for planning terminal care. The manager acknowledged that she has volunteered to take part in a project looking at this issue. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most residents are satisfied with the flexibility of their routines and social activities, which meet their cultural, social, religious and recreational interests and needs. There are good arrangements in place to help residents maintain contact with families and friends. Residents are not always helped to exercise choice and control over their lives. Residents have a well-balanced nutritious diet, which offers choice and is good quality and well presented EVIDENCE: An activities coordinator is employed by the home and works thirty hours per week between the two sides. A good range of activities are available and the home also uses “Mind Active” a community based activity group who visit Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 14 homes in the Wansbeck area. A social profile is completed for each resident which describes their past interests. This is useful for planning activities. There was evidence that individuals needs were being met through a knowledge of their past history. One resident was in her room enjoying listening to her music. On the first day of the inspection, a residents meeting was being held on the Charlton wing, and Mind Active were also there. On the second day of the inspection, time was spent in the Milburn lounge where music and the TV were on at the same time. Later in the morning the activity coordinator led an activity with a ball, which most residents appeared to enjoy. This was, however, carried out while the TV and the stereo were both still on. The picture on the TV is also very fuzzy and difficult to watch. Some residents were reluctant to take part and were successfully cajoled into joining in. It is recommended that residents who do not wish to join in are not made to feel under pressure to perform. Relatives spoken to said that they are made to feel welcome at any time. One said that he finds the support from staff invaluable in helping him to cope with his wife’ s illness. Staff said that residents are given choices about most aspects of their lives including meals and when to get up. Some residents spoken to confirmed that they are able to choose what they want to eat and can get something different if they don’t like what is on the menu. Bedrooms are nicely personalised and reflect the interests and personal taste of the occupants. It was noted that on both sides of the home, clothes for the next day were hanging behind the door, having been chosen by staff. Residents should be encouraged to be as independent as possible and select their own clothes with help from staff if necessary. Residents should also be assisted to move freely around the home if they wish to do so and there should be sufficient staff on duty to enable this to happen. The standard of meals provided is good. One resident said “ next time you come you will have to try a bacon sandwich, they’re the best!” On the first day of the inspection, the inspector ate lunch with the residents. The inspector had a meal of roast pork, which was very tasty and well presented. There was a nice atmosphere during the meal and staff demonstrated a good rapport with residents who enjoyed a joke with staff. Some residents wear clothes protectors so they don’t have any food spilled on their clothing. Some of these are quite tatty and need to be discarded. The manager confirmed that new ones have been ordered. Residents requiring help were given this discreetly. Some menu cards are on the table, which is a good idea. Three out of four residents sitting in the dining area said they were unable to read the menus, which were deep peach writing on a paler peach background. It is recommended they be printed in a font that stands out more and is larger. The kitchen was inspected and found to be clean and tidy and well organised. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 15 Cleaning schedules are in place and new software for developing menus is being introduced into Southern Cross homes. A list of people who have pureed diets was displayed on the wall in one dining room. It is recommended that this be removed as it is institutionalised and confidential information. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a system for managing and dealing with complaints, which makes it possible for them to be investigated and action taken to address any issues identified. The residents are protected by the homes procedures from abuse. EVIDENCE: The complaints procedure is available in the service users guide and a copy is available at the front entrance as well as being displayed in other places in the home. The Manager records complaints made. There have been six since the last inspection covering topics such as general care and staffing. These have been documented and action taken to resolve the issues recorded. There have been no adult protection issues in the home since the last inspection. The manager stated that approximately 80 of staff are doing safeguarding adults training and are due to complete this distance learning soon. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Parts of the home are satisfactorily clean and well maintained. EVIDENCE: A tour of the premises was carried out on both sides of the home. These found that the Charlton Wing is much cleaner and better maintained that the Milburn wing. The reason for this is unclear. The tour of the Charlton wing found that this side of the home is clean and generally well maintained. Dining rooms and lounges are nicely decorated and bedrooms are homely and nicely personalised. The shower room identified at the last inspection is still used as storage and the home must put this room back into use or formally request a change of use Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 18 explaining how the regulations requiring bathing facilities will be met. The dining rooms are lovely, with tables set with cloths, napkins, and carnations. A new carpet has been provided in the smoking lounge, which is clean and tidy. Main lounges are nicely decorated and homely. The Charlton unit is generally clean. There is some malodour in identified rooms which the manager is aware of and is planning to address. A chair in the lounge has a damaged cushion and the carpet smells a little musty. Staff must remember to clean under cushions on wheelchairs as several of these were lifted and old food and other debris was found beneath them. The main entrance to the home is inviting and nicely presented. The front of the home is well maintained. The Milburn wing is shabbier in some areas and it feels like a different home compared with the other side. The office has some strips of carpet which staff have placed there to make it feel cosier as it used to be used for a different purpose and has linoleum on the floor. The result is scruffy and hazardous and gives a very poor impression to people visiting the office. Attempts have been made to use best practice in terms of use of colour. Some research has shown that by highlighting the handrails and skirting boards in a deeper colour, this assists people with dementia who may have perceptual difficulties. The inspector has seen this in a number of homes before where they have managed to highlight the features they want to but also maintained a tasteful and tidy décor. The paintwork in the Milburn wing is messy and chipped. Last year the manager acknowledged that the wrong colour had been used and this has not been changed. Some bedrooms are nicely personalised and the main lounge is also nicely decorated. There are tactile boards on the walls in corridors and bedroom doors have been painted different colours and a fake letter box, name plate and door knocker added. This is designed to help people to locate their own room. Staff reported that this has not made a great difference, and it was suggested that they look at other ways of attracting people to their own bedrooms. Attention must be paid to background noise in the environment, as the TV and stereo were on at the same time. This can be very unsettling for people with dementia. The corridor carpet outside the lounge is badly marked and needs to be replaced. The upstairs lounge carpet needs to be replaced and the wallpaper is damaged. A number of wallpaper borders and the mural on the wall in the corridor are damaged and are adding to the overall look of the unit. Some areas of gloss paint are damaged and need to be repainted, and a wall heater in the corridor is scraped and badly marked. A full audit of the environment is required. A good range of specialist equipment is available in the home. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 19 The window at the end of the mural corridor is covered on the outside by a plastic cover. This is badly scratched and prevents resident enjoying a lovely view of a playing field. The toilet opposite the upstairs store- room has an uneven floor and the linoleum is rippled. There was no flip top on the bin, and the extractor fan was very dusty. There are no pictures and it is very bare. There is good signage outside the toilets. This unit is less clean than Charlton wing, which is unsatisfactory. In one bedroom, there was a very dirty footstool and urine soaked chair. Teeth were lying in the sink. Tooth mugs are required in a number of rooms as some are missing and some have no lids. In another room there was evidence that a commode had been emptied but had not been properly cleaned. The back of the commode seat was dirty and badly marked. The inside of the patio doors in the lounge are dirty and the wall beside the bed of one resident is very badly marked. The dining room wall is marked with food where the trolley has been. Three nailbrushes were found in the bathroom and were not named. These should not be used because of a risk of cross infection. Tubs of cream had been opened and were not named. Using creams in this way is not acceptable. Pull cords in bathrooms are fitted with plastic cord covers making them easy to keep clean. There was some malodour detected in some bedrooms. Some rooms have recently been carpeted and this includes the en suite. One en suite carpet was soiled with faeces and should have been cleaned up by care staff. It was left for the domestic to deal with some time later. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some residents needs are met by the numbers and skill mix of staff. The staff are recruited and selected using a robust system, which ensures that they do not present a risk to the residents and have the necessary skills and qualifications to care for them. A good standard of training is provided to enable staff to care for residents effectively. EVIDENCE: Qualified nurses and care staff are employed in the home. They are divided to work between the two units. There are also designated domestic, kitchen, laundry, admin and maintenance staff. As previously mentioned, there was some concern on the second day of the inspection regarding staffing levels in the Milburn unit. There were two care staff upstairs, and one care worker and one qualified staff member downstairs. The nurse in charge must take telephone calls as there is no administrator on this side of the home. They must also administer medication to both floors Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 21 leaving one care worker at times to supervise. The nurse explained that when they go upstairs one care worker from upstairs should come downstairs. This, however is not always practical if the staff upstairs both need to help one resident. Nursing staff on this side of the home are aware that some records are out of date and acknowledge that this is due to lack of time. It must also be assumed that some of the issues in terms of lack of cleanliness in some areas may be due to staff hurrying. The inspector was concerned that should the nurse and care worker be assisting one resident, the others would be left unsupervised, one of whom was identified as being at risk. There are predominantly general nurses employed in the home. There are no Registered Mental Nurses on days in the Milburn unit, which specialises in caring for people with dementia. The deputy has experience of caring for people with dementia and has completed some dementia training through Teesside University. The files of two newly recruited care staff were inspected. They contained all of the required information, including references and criminal records checks. Staff have received training in moving and handling, fire training, food awareness, COSHH, NVQ 2 and 3, first aid, basic food hygiene, bereavement awareness and incontinence management. Training is planned in adult abuse (ongoing) and “yesterday, today and tomorrow” training from the Alzheimer’s Society. Qualified staff are going to do a dementia care certificate. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 22 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager ensures that there are systems in place to make sure that the home is managed effectively, taking into account the needs and wishes of the residents. Clear and safe working practices are generally followed in the home in line with the company policies and procedures. Procedures are in place for the management of personal allowances. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager is committed to providing a high standard of care to the residents of Ashington Grange. There are rigorous self assessment tools for auditing performance in the home, provided by head office. Despite a commitment to the home and some very good standards demonstrated, there is a disparity between the two units with one maintaining higher standards than the other. There was some discussion about how the home might be organised differently to make managing each unit easier. The inspector acknowledges the difficulties with the layout on two floors and possible staffing restrictions. The shortcomings on Milburn unit appear to be related to organisational and staffing issues and not any lack of care or ability of staff. Visitors in the home said they were pleased with the care provided but feel that there are sometimes too few staff around to provide care in an unhurried manner. The fact that residents on Charlton unit who are able to communicate say they are very happy with the care provided demonstrates that the home is run in the best interests of the residents. The observation of the general wellbeing of residents on the Milburn unit shows that they too have a satisfactory standard of care at present although this will be compromised if staff are too busy to maintain satisfactory standards in record keeping and general hygiene. The manager holds regular surgeries and encourages relatives and visitors to go and see her. Although these are not well attended the manager remains accessible to residents and their representatives at all times. Arrangements for residents personal allowances were not fully inspected at this inspection and will be carried out at the next inspection visit. There are satisfactory arrangements in place for the maintenance of health and safety. Maintenance checks are carried out regularly including water temperatures, and emergency equipment such as fire apparatus. Staff must refrain from storing items, in particular heavy ones like fans on the top of wardrobes. There was “Steradent” found in one bedroom and this can be a choking hazard. There were also cans of beer in one room that were accessible to other residents. The domestic on duty demonstrated an awareness of safe working practices and confirmed they have received training in how to handle hazardous substances (COSHH). Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 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 X X 2 Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 (2) (b) Requirement Care plans must be evaluated regularly and written in a style that reflects person centred principles Medication records must be fully completed. Creams must be named and not communal supply. Photographs of all residents must be available on medication records. Residents must be offered choices in all aspects of their lives including choosing own clothes and where they want to go. A full audit of the environment in the Milburn wing must be carried out and an action plan provided to CSCI detailing how and when issues identified in the report will be addressed. The shower room must be brought back into use or change of use formally requested. OUTSTANDING All areas of the home must be DS0000040474.V330117.R01.S.doc Timescale for action 20/08/07 2. OP9 13 (2) 20/08/07 3. OP14 12 (3) 20/08/07 4. OP19 23 (2) (b) 20/08/07 5. OP21 23 (2) (j) 20/08/07 6. OP26 23 (2) (d) 20/08/07 Page 26 Ashington Grange Version 5.2 7. 8. OP27 OP38 18 (1) (a) 13 (4) (a) kept satisfactorily clean. Review staffing levels on the Milburn Wing and advise CSCI of action taken. Hazardous substances must be locked away. The emergency call system must be repaired or replaced 20/08/07 20/08/07 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. 2. 3. 4. Refer to Standard OP8 OP10 OP15 OP19 Good Practice Recommendations Staff should be reminded of best practice in relation to providing reassurance when hoisting residents. It is recommended that discreet storage is provided for incontinence pads. Table menus are written in larger font and made easier to see. Staff should be made aware of the importance of monitoring background noise. Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. Extracts may not be used or reproduced without the express permission of CSCI Ashington Grange DS0000040474.V330117.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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