Inspection on 17/11/08 for Ashlands

This inspection was carried out on 17th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashlands 08/01/07

Ashlands 02/12/05

Ashlands 03/10/05

Ashlands 31/08/05

Ashlands 01/03/05

Ashlands 09/08/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashlands 152 Southwell Road East Rainworth Mansfield Nottinghamshire NG21 0EH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrew Bailey     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Ashlands 152 Southwell Road East Rainworth Mansfield Nottinghamshire NG21 0EH 01623792711 01623792711 ashlands.care@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Manonmany Wragg Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 30 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Ashlands is a two storey detached building converted and extended to provide care for older people. The home has good access to local facilities. There is ample parking at the front of the home and there is a large pleasant garden area at the rear of the building, which is secure and well maintained. Ashlands is registered for 30 beds and may admit people with dementia. Bathrooms are located on both floors and some Care Homes for Older People Page 4 of 26 Over 65 0 30 30 0 Brief description of the care home rooms have private en-suite facilities. On the ground floor of the home there is a dining area and two communal lounges. The home has been adapted to meet the needs of service users with a physical disability. Adaptations and equipment include bath hoists, mobile hoists, handrails, grab rails and a passenger lift. Charges made by the home for residential care range from: £294.00 - £410.00 pw. There may be some extra charges, for example, private chiropody and hairdressing. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was on 8 January 2007. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views of the service provided. This process considers the homes capacity to meet regulatory requirements and minimum standards of practice. The inspection visit was unannounced and took place over a 7.5 hour period. There were twenty-two people living at the home on the day of the inspection. Four residents, three relatives, three staff, the acting manager and the registered provider Care Homes for Older People Page 6 of 26 were spoken with during the visit. We also spent some time observing the interaction of staff with people who use the service. We have also looked at information that we have received, or asked for, since the last inspection, which took place on 8 January 2007. The information included the Annual Quality Assurance Assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. The service has also told us about things that have happened at the home and these are called Notifications. We have considered the surveys that have been completed by people using the service and their views are included in the main body of the report. Records were examined during the inspection, including the care records of four of the people who were living at the home. This was part of the process called case tracking. Where possible we spoke with these people, or with a member of their family, during the inspection visit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive information to help them decide whether the service can meet their needs, and they have the opportunity to visit the home before choosing to live there. Evidence: Prior to this visit to Ashlands we received the homes Annual Quality Assurance Assessment (AQAA), a self-assessment document telling us about the service. The home told us that inspection reports are made avaiable at the home, and that contracts are issued to people using the service. The home does not provide formal intermediate care. The Statement of Purpose and the Service User Guide had been updated in June 2008, in line with changes to the home as a result of the recent increase in places, with the building of the extension. Care Homes for Older People Page 10 of 26 Evidence: The home is registered to admit older people, including those under the category of dementia. The acting manager told us that the staff training programme includes dementia training and that there is also written resource information available for staff to refer to (families can also access the written information about dementia). We case tracked four of the people using the service. Pre-admission assessments had been completed in all the cases that we examined. Where appropriate, social service assessments are received before people are admitted to the care home. We spoke with people using the service and they confirmed that there had been the opportunity to visit the home to help make the decision as to whether they wished to live there. People felt that they had received suitable verbal and written information about the home to help them make their decisions. Two of the people spoken with had received personal recommendations to them about the care home prior to making direct enquiries at the home. One person living at the home that we spoke with said that they had visited the home before deciding to live there. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are met and the principles of privacy and dignity are upheld by staff. The needs of people using the service are reflected in their care plans, ensuring that staff have detailed guidance to follow in caring for people. Evidence: The self-assessment information received before the inspection told us that people using the service are encouraged to be involved in care planning, but that it was hoped to encourage more family input with this in the future. The service also told us about developments made to the care planning process and the documentation used for this. The care records of four people who use the service were examined as part of the case tracking process. The acting manager told us that a lot of work had been done to improve the care plan record keeping since she took up post earlier this year. Care plans that we examined had been developed from the assessment information and those we looked at had evidence of relevant risk assessments, including risk of falls, nutrition and risk of developing pressure ulcers. Care plans had been reviewed Care Homes for Older People Page 12 of 26 Evidence: monthly and a new system very recently put in place to document the reviews in a more detailed way. Additional reviews of care take place as part of the social services review system. Some people living at the home, or their representatives, had signed the care records to show that they were aware of the content and agreed to the plans of care. However, the acting manager had recognised that the system could be improved and a revised system of seeking agreement has recently been introduced. In addition, summary sheets giving an overview of care needs, written in a person centred way, are also being introduced. A key worker (member of care staff) is allocated to each person living at the home. The key worker has a particular role in ensuring that individuals are having their personal needs met. There was some evidence within care plans of acknowledgement of where people had decreased ability to make decisions for themselves, but the acting manager has identified that more specific recording of competency will be required in line with the principles of the Mental Capacity Act 2005. Where there was documented evidence this was mainly from assessments undertaken by placing authorities. People who use the service, or their relatives, who were spoken with were able to confirm that the care needs of people are met. People also said that staff treat them with respect and have regard to their privacy and dignity. One person stated - I receive all the necessary care, and support is always at hand. The home is able to admit people with dementia and staff have received training on this condition to help them meet the needs of people using the service. There were some examples found of medication administration records where the actual dose administered of a variable dose medicine had not been recorded. It could be difficult to monitor the therapeutic effect of medication where there is no evidence of the actual dose administered. The audit trail of medicines is also difficult where it is not possible to demonstrate actual administered dosages. Staff receive medication training and staff spoken with confirmed that this training had taken place. Relevant written information about medicines is available for staff to refer to when needed. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities on offer and the standard of food are good, which meets the needs and wishes of the people living at the home. Evidence: In the self-assessment the home stated that activities programme had been improved in the past year. They told us that residents meetings are held and a motivation group (memory and stimulation) had commenced. Written feedback from the service user surveys that we received before the visit and verbal feedback from people on the day of the inspection confirmed that the activities programme is of a good standard. The weekly social and leisure events programme is displayed on the notice board. There is an activities coordinator who arranges the programme. She told us that feedback from people living at the home indicated that they preferred the activities to be in the afternoon and that some felt that it was too tiring if morning activities were also arranged. Records of participation in activities are held and the coordinator refers to the life histories file to match activities to peoples preferences and abilities. Families have helped to compile the life histories, where appropriate. A bonfire party was held and there are plans for the christmas period, Care Homes for Older People Page 14 of 26 Evidence: including a party and a trip to a local garden centre. Routine activities include darts, dominoes, manicures, armchair exercises and sing-a-longs. People we spoke with stated that there is a homely feel to the care home. One person said that My visitors are always welcomed and made to feel at home. We discreetly observed the midday mealtime and it was clear that staff were on hand to assist people if required. The mealtime was unhurried and people seemed to enjoy their meal. The cook ascertains the preferences from people during the morning and the menus offer two main meal choices to select from. Alternatives are available in addition to the menu items and special diets are catered for. Feedback from residents meetings has been used to influence the menus, a recent request being for mushrooms on toast. The catering facilities are well-organised and appropriate records are maintained, for example, cooked food temperatures and fridge and freezer temperatures. Care staff have received food hygiene training as part of a rolling programme of training provided by an external training company. Comments that we received about the catering included - Excellent food and Varied menu. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home responds appropriately to any concerns and complaints and aims to protect people from harm. Evidence: The AQAA self-assessment that we received prior to the inspection told us that staff have received training in the protection of adults (safeguarding training). During discussion with staff they confirmed that this training had taken place. There had been three complaints for the home to respond to in the last year. None were substantiated. Two of the complaints were initially brought to the attention of the Commission. The management investigated the concerns appropriately and within the expected timescales. Information about the homes complaints procedures are on display at the home and included in the written information provided to people living at the home. We spoke to people living at the home about the complaints system. They feel that they can talk to staff and can raise issues if they need to. They also feel that staff will listen to them and take action if needed. In addition to staff training, the local multi-agency safeguarding adults procedures are available for staff to refer to. The Department of Health No Secrets document is also available. We examined the homes policy and procedure for the protection of adults. We noted that this does not fully reflect and link to the information in the local multiCare Homes for Older People Page 16 of 26 Evidence: agency document. We also noted that the Protection of Vulnerable Adults (POVA) document is available, but that the home does not have a policy and procedure that refers to this important document. The acting manager and the registered provider agreed to amend their policies and procedures to ensure that there are clear links with external policy, procedure and guidance. There are suitable advocacy arrangements at the home, with written information available on display. There is currently advocate representation for two of the people living at the home. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and well-maintained home. Evidence: The AQAA self-assessment told us that the home had been recarpeted throughout and many areas redecorated in the last year. New furniture had been provided in the communal areas. A new kitchen had been provided and the laundry relocated as part of the extension to increase the number of places at the home. We undertook a tour of the building and it was evident that the standard of decoration and fittings is good and the building incorporates safety features such as radiator covers (some areas have underfloor heating). There are shower and bath facilities at the home (one of the baths is an assisted bath, with hoist). The showers are suited to the more mobile, as there is a step up required. However, the acting manager stated that the current residents all prefer to use the baths provided. The ground floor facilities include a dining room and two lounge areas. One of the lounges has a large screen TV provided. The premises are secure and the external doors are alarmed to alert staff. The rear garden area is private and secluded. The home has satisfactory infection control procedures and the staff training Care Homes for Older People Page 18 of 26 Evidence: programme includes infection control practice and safeguards. On the day of the inspection we found the home to be clean and tidy. When we spoke to people living at the home they commented that staff keep the home very clean. One person living at the home said My bedroom and all communal areas are kept immaculately. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training and robust recruitment practices promote the safety of people living at the home. Evidence: We spoke to the acting manager and to staff about the training programme at the home. Several of the care staff are qualified to National Vocational Qualification (NVQ) Level 2 and 3. A further five staff have recently commenced NVQ Level 2 and a further six staff have commenced NVQ Level 3. When their training is completed, there will be a majority of the staff with these recognised qualifications. This further assures that competent and well-trained staff care for the people living at the home. Routine training is organised on a rolling programme mainly through an external training company, with local authority courses utilised for safeguarding adults training. Training includes first aid, medication, infection control, continence, fire safety, dementia, equality and diversity, health and safety, manual handling and food hygiene. The acting manager has recently developed a training matrix to ensure that each member of staff has a comprehensive programme of training and that they undertake periodic training updates. The home told us in their self-assessment that they did not have a policy about Care Homes for Older People Page 20 of 26 Evidence: bullying and racial discrimination. When we spoke with the acting manager she told us that a policy and procedure has now been produced. We spoke with staff and with people living at the home (or their relatives). They told us that there are usually sufficient staff on duty to meet the needs of people. One person living at the home said There is always someone here to help if needed. The staff are lovely and all the staff are easy to talk to. Staff described how the home continues to improve. They feel that the management are approachable and that the staff are better trained than in the past. They state that staff morale is good and that they enjoy working at the home. Staff told us that they can and do access the care plan documentation and that they complete daily records about the care given to people living at the home. We asked staff about the recruitment and induction processes at the home and their responses backed up the information that we were given when we spoke to the acting manager. The acting manager showed us examples of completed induction documents and explained how the induction process has been further developed to ensure that it fully meets with recognised standards (Common Induction Standards). Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, safety and welfare of the people is protected by the management systems in operation at the home. Evidence: The home is currently managed by an acting manager, which means that she is not yet registered with the Commission for Social Care Inspection, but she confirmed that an application has now been submitted to the Commission for the registered manager position. Feedback from staff and people who use the service indicate that the acting manager is well regarded and has worked to improve the systems and procedures since she was appointed several months ago. The recording system for the management of personal monies held by the home on behalf of people living at the home was examined and was satisfactory. We also looked at a sample of the maintenance and servicing documentation and this was also satisfactory. Care Homes for Older People Page 22 of 26 Evidence: We looked at the quality assurance systems in place at the home. We were able to confirm at inspection that the mandatory monthly visits and reports by the registered provider are taking place. These regulatory visits are part of the quality monitoring processes, which act in the interests of people who use the service. The acting manager completes a range of audits of the service. These include audits of the medication system, care, catering and housekeeping. Staff meetings are held twomonthly, residents meetings are held two-monthly and carers and family meetings are held three-monthly. We discussed at inspection how the satisfaction survey process may be developed to provide feedback in a report format that could be included in the written information about the home that is available to current and prospective users of the service. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Regulation 13(2) Where a variable dose medicine has been prescribed the actual dose administered must be recorded To safeguard people and ensure that medicines are properly accounted for 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 18 The homes safeguarding adults procedure should be specific in describing how and when multi-agency safeguarding referrals are made. A procedure should be developed to describe how and when Protection of Vulnerable Adults (POVA) referrals are made. The results of service user surveys should be summarised, published and made available to current and prospective users of the service. 2 18 3 33 Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!