CARE HOMES FOR OLDER PEOPLE
Ashlea Grange Residential Home Philadelphia Lane Newbottle Houghton-le-spring Tyne And Wear DH4 4ES Lead Inspector
Miss Andrea Goodall Unannounced Inspection 19th September 2005 09:30 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.V250064.R01.S.doc Version 5.0 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.V250064.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ashlea Grange Residential Home Address Philadelphia Lane Newbottle Houghton-le-spring Tyne And Wear DH4 4ES 01287 624968 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.V250064.R01.S.doc Version 5.0 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. 27/04/05 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. 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.V250064.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was an unannounced visit, which took place over one day by 2 Inspectors. One Inspector spent the visit talking with the Manager, examining records, and talking with about 3 staff and 5 residents. The other Inspector spent the visit gaining the views of around 15 residents and 3 visitors, examining the premises, and sampling a lunchtime meal. The Manager has been in post for around 11 months. She has recently been registered with CSCI. Since the last inspection the Provider has received one MAPPVA (Multi Agency Panel for the Protection of Vulnerable Adults) alert. The MAPPVA matter has been investigated and included full liaison with the CSCI and the Social Services Department. The Provider has also received one complaint about the service, which is currently being investigated. What the service does well: What has improved since the last inspection?
The Residents Contract have been reprinted so are now much easier for people to read. Most care staff have now had some training in understanding people with mental health needs, which should help them to provide a better service for the small number of residents with those needs.
Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 6 There has been a significant improvement to care plans records, which now have clear guidance for staff to know how they should help each of the people who live here. A few more staff have completed NVQ level 2, so now more than half the staff team have this care qualification. The rest of the staff team are either training towards or nominated for future training in this qualification. The former Acting Manager has been checked for her fitness and is now the Registered Manager. Staff said that they feel that the daily management of the home is clearer, and they feel more directed and supported. 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.V250064.R01.S.doc Version 5.0 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.V250064.R01.S.doc Version 5.0 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): 2 and 4. (Standard 6 is not applicable to this home) Each resident has a written contract that gives them clear details of the terms and conditions of their residence at Ashlea Grange. Staff have had training to support them to understand the specific needs of some of the people who live here. EVIDENCE: Following a recommendation at the last inspection the Provider has reprinted the Residents Contract in larger print that is easier for people to read. The contracts include information about the level of fees, so that residents can see the contributions made by them and any by the Social Services Department. Some of the new contracts have been signed and dated by residents or their representatives, and the Manager anticipates that the rest will be signed in the near future. One copy of the contract is kept in residents care files for easy reference. The home is registered to provide care for people with dementia care needs and senior staff have now completed training in ‘Positive Dementia Care’. This
Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 9 training is to be cascaded to all care staff so that they can understand the needs of people with dementia and how to support them. The home is also registered to provide a small number of places for older people with mental health needs. Following previous requirements, care staff have recently now had brief training in Insight into Mental Health, so that they might have a better understanding of how to support people with mental health needs. Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 & 10. Residents individual needs are set out in a plan of care and the care planning system has improved. Medication that needs to be kept in a refrigerator is not securely or appropriately stored. The home does not always ensure that the dignity of less able residents’ is maintained at all times. EVIDENCE: There are care plans in place for each of the people who live here that outline their individual needs. There have been significant improvements to the care plans since the last inspection. There are now much clearer details about the actions that staff should take to help someone with their needs. There are also much better details in the monthly evaluation records of what support has been given and of any changes in needs. Care plans are much better organised and easy to follow. However some other areas of the care files were not up to date. These included monthly weight checks, which have not been carried out for some months (due to broken equipment). Some moving & assisting plans did not tally with moving and assisting assessments where there have been changes in need. For example, one person now needs a hoist and/or 3 staff to assist, but
Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 11 this contradicted the care plan that stated that person could weight bear. This contradictory information does not support care staff to know how to provide the right help for that person. A random check of medication was completed. Staff are accurately recording the administration of tablets plus amounts of medication received and returned the pharmacy. The current medication book (BNF) is out of date and staff undertook to buy a new one. On the whole medication is stored securely. Ashlea Grange still does not have an appropriate drugs fridge. Medication such as liquid antibiotics and insulin must be stored at below 8°c. Currently these are kept in one of the dining room fridges in a metal box. However this practice does not ensure that the medication is safe, or that it is stored at a regulated temperature. The Owner was required to purchase an appropriate drugs fridge following the last inspection but has not. The Manager stated that she will monitor the temperature of the fridge and purchase a drugs fridge. (Since the inspection she has contacted CSCI to discuss the suitability of some of the fridges she is proposing to buy.) Staff on the ground floor were very attentive towards residents and assisted people to meet their personal care needs in a discreet manner. However on the first floor staff were not meeting the personal care needs of the less-able residents. Throughout the inspection some residents were seen to have remnants of food remaining on their faces and clothes. Both gentlemen on this floor were unshaven and looked quite dishevelled. Some of the ladies had facial hair and staff cannot be sure that this is the way they would have wanted to present themselves if they were well enough to manage their own care. Following previous inspections similar issues have been raised and action had been taken to sort this matter out, but this has obviously not been sustained. Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 There are insufficient social and leisure activities for residents. The lack of social activity during the day has a negative effect on people’s sense of wellbeing. EVIDENCE: The lack of social activity continues to be an issue for the people who live at Ashlea Grange. Residents and relatives commented about the need to have more activity both in the home and outside. Residents found the inability to go out particularly frustrating. People often just wanted to pop to the local shops but could only do this if their relative took them. They said that staff were very caring but seem too pushed or too busy to take them out. They said staff brought items in for them but they would relish the opportunity just to get a bit of fresh air. Since the last inspection the part-time Activity Co-ordinator has left. Staffing levels are sufficient for the Manager to provide dedicated time each day for some form of activity. The Manager stated that she nominates people to undertake this task each day, but specific time is not provided for staff to plan and arrange an activity so these tend to be sporadic. Also the Manager has not looked at the skills that staff possess in respect of having the ability and confidence to run an activity. Although staff had the time to sit with residents
Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 13 throughout this day they rarely spoke to people. The Manager recognised the need to ensure a range of people worked each shift so that a mix of more outgoing/quiet staff is provided. Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The Complaints Procedure is advertised widely in the home so that all residents are aware of how to voice any concerns about their care. 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, which is made available to visitors and social and health care professionals. 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. The information is very clear, but refers to the wrong Inspection Unit and gives the wrong address and telephone number, which can easily be changed. There has been one complaint by a relative about the service and the Provider is investigating this matter. Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21 & 26. Ashlea Grange provides a good standard of personal and communal accommodation. The home’s premises are maintained to a satisfactory standard. EVIDENCE: There are sufficient bathrooms and toilets for the number of places at Ashlea Grange. These facilities are decorated and maintained to a good standard and were free of clutter. The hot water was being provided at the recommended safe temperature. Communal areas are light, airy and comfortable. A range of sitting areas is provided, although the way furniture has been arranged does not encourage people to engage in social conversation. The smoking lounge and entrance to the home are going to be redecorated. The Manager was made aware that the light fittings have to be checked as they were causing marks on the walls. She stated that some light fittings had recently been changed and that the remainder would be, but was aware that this needed to be done as a priority.
Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 16 All of the areas of the home that were seen were kept clean and tidy. Staff have completed training in Infection Control. Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 and 28. All care staff have either attained, are training towards, or are nominated for NVQ qualifications in order to provide a well-trained workforce to meet residents’ needs. Care staffing levels have remained at minimum levels, which is sufficient to meet the current number and needs of residents. EVIDENCE: At this time 12 of the 20 care staff have attained a care qualification through NVQ level 2 (4 of whom have achieved NVQ level 3). Four other staff are undergoing training towards this qualification and the rest of the staff team are nominated for future training in this. In this way the home hopes to provide a well-trained workforce to support the people who live here. 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. Although there has been a lower occupancy at the home recently, there are still a significant number of people who have dementia, confusion or mental health needs and some people have significant physical or mobility needs. The continued care staffing levels means that people get sufficient support with their needs. Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 & 38. There continue to be improvements to the daily management of the home, and clearer direction for staff. The quality of the service is not fully reviewed by the Provider to ensure the consistency of care provided. Financial systems do not ensure that 3 residents receive their personal monies individually. The practices of staff when supporting residents in wheelchairs presents a health & safety risk. EVIDENCE: Since the last inspection the Acting Manager has been registered as the Manager. She has many years experience of working in health & social care settings in a senior capacity. The Manager confirmed that she is currently undertaking training towards NVQ level 4 and the Registered Managers’ Award, which are suitable qualifications for her role and will support her in the management of the home. Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 19 The Provider has a quality assurance procedure, which should be used to review the service provided. This procedure has yet to be fully implemented at the home, and the Manager requires further guidance if this is to be a meaningful exercise that reviews the quality of the service. The outcomes of the reviews then provide the basis for an annual development plan of future goals for the home. In the meantime the home uses a number of methods to gain the views of the people who live here, including Residents Meetings, complaints and a Residents Questionnaire. The questionnaires indicated that most people are satisfied with most aspects of the service, except the lack of activities. During this visit residents repeated their comments about the lack of activities. The questionnaires were all completed by staff on behalf of residents, but this was not made clear on the written responses. Most people who live here have their finances managed by a relative or representative who leave small amounts of monies at the home for them. Three people have their weekly personal allowances forwarded to the home by Social Services Department. However the Provider proposes that one bank account be opened for the 3 residents (as a business account in the name of the home) in which the weekly Social Services Department cheque can be banked. This is not acceptable. Each person has a right to his or her own bank or savings account. The Manager discussed the difficulties of arranging bank accounts for people in care, and advice was given about savings accounts. Despite instruction by the Manager, staff still manoeuvre wheelchairs without ensuring residents are using footplates. This practice is highly inappropriate and could cause someone to have a significant injury to his or her feet. Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x x 3 3 x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 x x 2 Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 21 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 OP7 Regulation 15 Requirement 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. A suitable medication fridge must be obtained in which to securely store medication that requires refrigeration. Staff must support residents with personal grooming to ensure that their dignity is upheld at all times, especially after mealtimes. A range of activities must be made available both within and outside the home (Previous timescales of 1/1/05 and 1/6/05 not met). The quality assurance system must be put into practice, and the outcomes used to develop an Annual Development Plan for the home. (Previous timescale of 1.8.05 not met.) Individual residents personal monies received by the home on their behalf must be managed separately (e.g. paid into an
DS0000034293.V250064.R01.S.doc Timescale for action 01/11/05 2 OP9 13(2) 19/11/05 3 OP10 12(4)a 01/11/05 4 OP12 16(m) &(n) 19/11/05 5 OP33 24 01/01/06 6 OP35 20(1)a 01/11/05 Ashlea Grange Residential Home Version 5.0 Page 22 7 OP38 13(4) and (5) individual savings account in their name only, or kept at the home for their access). Staff must ensure that footplates are used at all times when transporting residents in wheelchairs. 01/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP9 OP12 OP16 Good Practice Recommendations The weight of each resident should be measured on at least a monthly basis to ensure that their nutritional needs are being monitored. An up-to-date BNF (British National Formulary) medication book should be obtained. Staff should set aside some time to engage residents in conversations, and specific times should be planned for activities. The complaints procedure on cassette tape needs slight amendment to include the name, address and telephone number of the CSCI. Ashlea Grange Residential Home DS0000034293.V250064.R01.S.doc Version 5.0 Page 23 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
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