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Inspection on 13/06/06 for Ashlea Grange Residential Home

Also see our care home review for Ashlea Grange Residential Home for more information

This inspection was carried out on 13th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff have consistently been described by residents and relatives as `kind, caring and with hearts of gold`. Staff obviously valued the people using the service and as far as possible respected their wishes. Staff looked at the needs of residents and how these could be met, often working to help people maximise their mobility and independence. Residents said ` the staff are very busy but if you want anything will get it for you`. 85% of the care staff hold NVQ awards and the operational director has helped senior staff organise training specific to the needs of the residents. The home provides a complaints procedure on cassette so that residents with poor sight have got information about how to tell someone if they are not happy with the care.

What has improved since the last inspection?

A new regional manager has come into post and the majority of shortfalls identified at the last inspection have been rectified. For a short period CSCI agreed that staffing levels could be reduced. Winnie Care Limited has now increased the staffing levels because more people have moved to the home. They are also looking at having more staff on duty than the required minimum and have plans in place around so this can be achieved. The range and volume of activities has markedly increased. Residents discussed the trips that had been put on, the various in-house activities and what was planned. Throughout the visits staff chatted to residents, engaging in friendly banter and discussing local events. Everybody joined in conversations with staff and each other. Staff also organised cards ad domino games. Many areas of the home have been redecorated and plans are in place to continue this work throughout the home. Also new furniture and carpets are being purchased. Winnie Care Limited has improved the way personal allowances are looked after and are making sure people have separate bank accounts, where this is needed. A quality assurance system has been put in place, which provides a greater amount of information.

What the care home could do better:

Although a lot of work has been completed to put appropriate records in place. There are still marked gaps. Staff need to show that when residents behaviour or health needs change they have recognise this and are taking action. Staff also need to monitor people`s health and behaviour so they can spot what might make things better or worse for the person. Finally staff need to record what they are doing to meet people`s complex needs.

CARE HOMES FOR OLDER PEOPLE Ashlea Grange Residential Home Philadelphia Lane Newbottle Houghton-le-spring Tyne And Wear DH4 4ES Lead Inspector Mrs Katie Tucker Key Unannounced Inspection 11:00 13 and 27th June 2006 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 Ashlea Grange Residential Home DS0000034293.V298091.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. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashlea Grange Residential Home Address Philadelphia Lane Newbottle Houghton-le-spring Tyne And Wear DH4 4ES 0191 5848159 0191 512 0089 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) Winnie Care Limited Mrs. Michelle Butler Care Home 40 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (40), Physical disability over 65 years of age (8), Sensory Impairment over 65 years of age (3) Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Provider must address any recommendations made by the Sensory Disability Team The SI (E) and MD (E) service user categories relate to current service users only. 19 September 2005 Date of last inspection Brief Description of the Service: Ashlea Grange is a large modern, purpose built care home that provides 40 places for older people some of whom may have dementia care needs, physical or sensory disabilities. The accommodation is within 40 single rooms, all with en-suite facilities. There is a good range of sitting areas and sufficient bathrooms, some with specialist lifting equipment, to meet the needs of the people who live here. The fees charged at the home range from £346 to £361 per week. There is level access into the home, and wide corridors allow easy access by people who use a wheelchair. The accommodation is over 2 floors, which are served by a passenger lift. The home has good links with the local community. It is close to local amenities such as shops, pubs and churches and is on a direct bus route to Sunderland. The Provider, Winnie Care Limited, operates a number of other homes for older people in Sunderland and the North East region. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 2 days. One inspector spent 10 hours at the home speaking to people using the service, staff and visiting relatives. Prior to the visits the inspector also spoke to other professional that visit the Ashlea Grange. Several residents were identified. The care they received was tracked through discussions with all concerned and by looking at the service user plans. Also information supplied by the home, comment cards and information from POVA investigations were used to make decisions about the quality of service. Ashlea Grange provides a service for older people and people with a dementiatype illness. Some of the people experienced difficulty communicating their views verbally. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. During this inspection all of the key standards were checked. What the service does well: What has improved since the last inspection? A new regional manager has come into post and the majority of shortfalls identified at the last inspection have been rectified. For a short period CSCI agreed that staffing levels could be reduced. Winnie Care Limited has now increased the staffing levels because more people have moved to the home. They are also looking at having more staff on duty than the required minimum and have plans in place around so this can be achieved. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 6 The range and volume of activities has markedly increased. Residents discussed the trips that had been put on, the various in-house activities and what was planned. Throughout the visits staff chatted to residents, engaging in friendly banter and discussing local events. Everybody joined in conversations with staff and each other. Staff also organised cards ad domino games. Many areas of the home have been redecorated and plans are in place to continue this work throughout the home. Also new furniture and carpets are being purchased. Winnie Care Limited has improved the way personal allowances are looked after and are making sure people have separate bank accounts, where this is needed. A quality assurance system has been put in place, which provides a greater amount of information. 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. Ashlea Grange Residential Home DS0000034293.V298091.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 Ashlea Grange Residential Home DS0000034293.V298091.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 The assessment information is improving but the information contained in the assessment is still limited. Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Case tracking showed that the information contained in the assessment was limited. It consisted of the information the social worker provided and a basic assessment of people’s physical needs. Often these documents were incomplete or had minimal information and had not been up dated as people’s needs changed. This led to difficulties in identifying the areas of need that were most pressing. The upstairs unit care for people with a dementia and although staff were recognising the importance of people’s life histories this information was not used very well in the assessment. Staff had worked hard to improve the assessment information but the records had not helped them. Winnie Care Limited recently introduced a new assessment record and are training staff around how to use this tool. Staff need to bear in mind that residents need to show they have been involved in completing this record and many could write some of it. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Although staff care practices are good. The service user plans do not reflect the care that is offered at Ashlea Grange. And, the medication system needs to be followed consistently. Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The flaws in the assessment document have led staff not completing care plans around people’s greatest needs. When writing care plans, staff do include the full amount of information needed to show how to meet someone’s needs. But tend to concentrate on physical healthcare needs when often residents’ main needs relate to social or emotional needs. In practice staff were meeting resident’s needs and were very aware of the best way to work with people but this was not recorded. Therefore their good practice was not evidenced. The regional manager is aware that plans must reflect how people’s aims and goals are met. And, the plans need to take into account information about each person’s social background, lifestyle preferences and interests. That residents or relatives need to show that they have been consulted about the proposed care and agreed to the plan. The regional manager is very aware of Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 10 the shortfalls and is looking at how to introduce person-centred care planning to the home. This is widely recognised as a good model of care delivery. Although risk assessments are being generically used, assessments for showing that the risks people take have been judged to be acceptable need to be more widely used. Also risk management strategies must be applied more widely. These types of plans show the strengths people have and the common day risks they can continue to safely take. Staff impose limitations on some residents because of their dementia or physical health needs such as needing to be accompanied when outside the home. When limitations are imposed for a particular individual this needs to be recorded. When residents have to follow Ashlea Grange’s house rules can be recorded in a standard contract. Discussion was also held around how to change staff practice so on admission resident’s were encouraged to be as independent as possible so were confident that they could continue to make their own drinks, go out on their own and organise their day. The principle senior care has promoted and developed the medication system and on the whole this has proved to be effective. However, on occasions other staff are forgetting to record how much medication has been received. This practice creates difficulties in completing an audit trail, monitoring the use of medication and recording returning medication. Currently three systems for the administration of medication are used, Nomad, lose medication and as required recording. The regional manager is considering how to make the system simpler. Staff and residents had formed good working relationships and this assisted and contributed to the pleasant atmosphere that was present. During this visit staff had made sure that everybody’s personal care needs were met. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Many improvements have been made to the way people are valued and their lifestyles at the home. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Lack of activity has previously been a major issue for residents. However residents said that in recent months this had been much improved. Staff were said ‘to still be pushed’ but were now able to spend time with them. Many positive comments were made about the weekly trips that had been organised and people who came into the home to complete activities. A wide range of activities was being provided and staff were trying to tailor these to people’s preferences and cultural needs. However the times and frequency of this occurring remains dependent upon the demands staff face in meeting residents personal care needs so is still restricted at times. Residents said they would like the opportunity to go out to local shops but had to wait until their relatives could accompany them. The staff can only provide this activity on rare occasions so some people rarely go out of the building to the local shops. Staff do bring items in for people but many residents said they would just like to ‘pop out once in a while’. Staff need to show that prior to preventing people undertaking these everyday activities that risk assessments Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 12 are completed. It was suggested that residents were encouraged to run their own meetings. The quality of the food and quantity and choices were of a high standard. However, case tracking showed where people have poor appetites staff need to show what is being done to make sure residents are getting an adequate diet. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The owners take, when needed, make sure changes to practice are put in place and sustained. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The home has a Complaints Procedure, which is written in plain English, and this explains how to make a complaint and to whom. All the bedrooms have a Service Users Guide (information pack), which contains the Complaints Procedure, so that residents can refer to it at any time in the privacy of their own rooms. The Complaints Procedure is also published in the home’s Statement of Purpose. The home also provides the Complaints Procedure on cassette tape so that people with poor sight can listen to the information, and there is a spare cassette player for this. There is one person with a visual impairment living at the home and they have been given their own copy. There has been three complaints made about the service and Winnie Care Limited investigated these matters and put measures in to resolve them. Ashlea Grange has an appropriate protection of vulnerable adults policy and follow Sunderland Social Services Department guidance. This guidance does, however, require Winnie Care to put in a section about what they would do if an allegation of abuse were made. One protection of vulnerable adults concern has been raised since the last inspection. The regional manager addressed all concerns effectively and where necessary took appropriate action. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The home is clean, warm and well-maintained offering resident’s a homely and safe environment in which to live. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Winnie Care Limited is completing a full refurbishment of the home. The lounges, dining rooms and a number of bedrooms have been redecorated. Some new furniture has been purchased for the bedrooms. More new furniture for bedrooms and communal areas is being ordered. And, it is anticipated that all of the work will have been completed by the end of the year. The upstairs unit has been specifically set up to provide dementia care but some aspects of the environment do not meet people’s needs. The regional manager is very aware of small environmental changes that could be made to make the environment more user friendly, such as using different colour schemes in different areas. These changes have started to be introduced. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Care staffing levels have remained at minimum levels, which is sufficient to meet the current number and needs of residents. Staff are receiving appropriate training and staff files are satisfactory. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The minimum care staffing levels for Ashlea Grange are 5 care staff (including one senior) on duty throughout the day and 3 night staff (including one senior) on duty throughout the night. These hours exclude the Manager’s hours, which are supernumerary. Staffing levels meet these requirements but discussions were held around meeting people’s dependency levels. Winnie Care Limited plan to increase staffing levels to 6 care staff during the day once 35 people live at the home. Staff recruitment practices were looked at and action is taken by the regional manager to ensure all requirements are met. Staff receive a range of training but there were some gaps. Thus not all of the staff had received the training they needed around using the hoist and mandatory training. Plans were in place to ensure these shortfalls were addressed. Staff are being given access to dementia care training and working with people who have mental health needs. Those who had completed this training found it to be very useful. 85 of care staff have completed NVQ Awards. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 There continue to be improvements to the daily management of the home, and clearer direction for staff. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the manager has left and a new manager was just starting. He was has yet to commence the registration process. Winnie Care Limited has a quality assurance procedure, which is now being used to review the service provided. The outcomes from the reviews are to provide the basis for an annual development plan for the home. However, the system does not ensure that regulation 37 notifications are made when appropriate. Failure to notify CSCI of incidents at the home can mean additional support is not offered when needed. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 17 The personal allowances are now in good order. Only small amounts of money are held on behalf of residents. When money collects this is sent to the appointee or relative to put in people’s savings accounts. No health and safety issues were noted at the time of the inspection. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 18 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 1 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 3 Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement The assessment record must assist staff to record information about all needs. Life histories must enable staff to gather useful information for the care of people with a dementia. Service users or their representatives must be involved in the writing of assessments. 20/02/07 Any assessed change in need of a resident must also be reflected in their plan of care so that staff know exactly how to support them. (Required at the last inspection – timescale 01/11/05). Care plans must reflect th3e action staff are taking to meet service users main needs. Risk-taking assessments must be in place. All limitations imposed by the home on service users must be identified and the reasons for this recorded. Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 20 Timescale for action 26/12/06 2. OP7 15 3. 4. 5. OP9 OP12 OP33 13 (2) 16 (2) (m &n) 37 Service users or the representative must record that they are involved in the drawing up of plans. Staff must record the amount of all medication received into the building. Dedicated activity hours must be provided. The manager must ensure regulation 37 notifications are made. 03/10/06 03/10/06 05/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashlea Grange Residential Home DS0000034293.V298091.R01.S.doc Version 5.2 Page 22 - 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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