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Inspection on 21/11/08 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 21st November 2008.

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

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 home is clean and maintained to good standards. And any repairs are dealt with promptly. A good range of social activities is provided and residents are offered the option to take part in them or to opt out if they wish. The new care plans have continued to be developed. The home deals professionally and swiftly with issues that potentially compromise the safeguarding of the residents. Residents commented positively about the home, " staff are very good" "it`s just like a hotel here" "nothing is any trouble for the staff" "good staff you could not ask for better" And similarly relatives of residents confirmed their satisfaction with the services being offered in the home.

What has improved since the last inspection?

The activities coordinator has now established a regular programme of activities. And has also implemented activities that interest residents. The acting manager has ensured that the correct information as part of recruitment is now obtained. A new television has been provided in the first floor lounge and following consultation with resident`s families this is going to be replaced with large screen television. The acting manager is addressing any shortfalls in the homes record systems and ensuring that information is up to date.

What the care home could do better:

The written plans of care should contain more information particularly for those residents who present behaviours that challenge. This should include the detailed actions that staff is taking to reduce/prevent the challenging behaviour. All staff that administers prescribed medicines must ensure that they witness the resident taking this before signing the administration sheet. This will ensure that the potential for error is reduced. Any incidents or events that have an impact on the well being of a resident. E.g. one resident physically threatening another resident. Must be reported to the commission. All staff and newly appointed staff must receive updated training in fire safety, moving and handling, health and safety, food hygiene and any other training that is relevant to maintain health and safety standards in the home. Records should be kept of all fire drills and fire instruction that staff take part in. And the registered provider should ensure that regular fire drills and fire instruction takes place for all staff in accordance with the guidance issued by the fire authority.

CARE HOMES FOR OLDER PEOPLE Ashlea Grange Residential Home Philadelphia Lane Newbottle Houghton-le-spring Tyne And Wear DH4 4ES Lead Inspector Clifford Renwick Key Unannounced Inspection 21st November 2008 07:20 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.V372777.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.V372777.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 584 8159 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 vacant 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.V372777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The SI(E) and MD(E) service user categories relate to current service users only. The service may from time to time admit person(s) who are under the age of 65, but who fall within the currently registered service user categories. 12th March 2008 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. The fees charged at the home range from £409 to £435 per week. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • • • Information we have received since the last visits in March in 2008. How the service dealt with any complaints & concerns since the last visit. Any changes to how the service is run. The Visit: An announced visit was made on the 21st November 2008. During the visit we: • • • • • • • • • Talked with a number of the people who live in the home and also staff who were on duty. Held discussion with the acting manager and also the area manager who was present during part of our visit. Observed staff working practices. Looked at information about the people who live in the home & how well their needs are met. Looked at other records, which must be kept in relation to health and safety and staffing. Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. Looked around the home to make sure it was well maintained, safe and free of any hazards. We also gathered information from looking at care records to assess how staff supports the residents with their assessed needs. We also focused upon looking at care files for 3 residents as a part of the inspection we refer to this as “case tracking”. And this involves looking at all records of the care for a named individual. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 6 • The owner also provided information to us in the Annual Quality Assurance Assessment confirming what improvements have been made since the last visit. And also what further improvements are planned. The people who live in this home prefer to be known as residents therefore this term of reference is used throughout the report. At the time of our visit there were 32 people living in the home. The person who is currently managing the service is referred to in the report as the acting manager. What the service does well: What has improved since the last inspection? Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 7 The activities coordinator has now established a regular programme of activities. And has also implemented activities that interest residents. The acting manager has ensured that the correct information as part of recruitment is now obtained. A new television has been provided in the first floor lounge and following consultation with resident’s families this is going to be replaced with large screen television. The acting manager is addressing any shortfalls in the homes record systems and ensuring that information is up to date. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No one is admitted to the home until an assessment has been completed and this ensures that peoples need’s can be met by the homes staff. And the home supports and encourages pre-admission visits to the home by prospective residents and or their relatives. This provides the opportunity for them to assess the home for themselves before making their decision about coming to live there. Intermediate care is not provided so this standard was not assessed. EVIDENCE: Three care files were looked at and this confirmed that an assessment of need was carried out prior to admission. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 11 The detail of the homes assessment varied with some containing basic information whilst another file contained a comprehensive assessment. In addition to this the home also attempt to obtain a full assessment from the social worker if they were arranging the placement. In discussion with staff they confirmed that once the initial assessment is completed this process continues once someone moves into the home. This was evident from the care files that indicated staff had continued to gather information as part of an ongoing assessment process. And from this individual plans of care had been implemented to demonstrate how assessed needs are to be met by the staff. In discussion with relatives who were visiting the service they confirmed that they had had the opportunity to visit the home prior to making a decision on behalf of their mother or father. They stated that they had found this helpful and made it much easier to make a decision. Though assessments are completed prior to admission the home do not confirm in writing to the families or the prospective resident, that on the basis of the assessment their needs can be met in the home. The Care Homes Regulations 2001 require that confirmation in writing is always provided and this was discussed with the acting manager. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While clear improvements have been made to the care planning process, this needs further development to ensure that people receive care in a way that they prefer. Nevertheless, health care needs are effectively met. Medication administration does not follow good practice to ensure that residents’ general health and wellbeing are safeguarded and promoted. Good staff interactions with residents confirms that residents are treated with dignity and respect at all times. EVIDENCE: Each resident has an individual written care plan that is completed by staff and is a process that is used to demonstrate how staff will assist residents with their assessed needs. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 13 Three care plans were looked at for residents who have a range of different needs. The care plans use pre printed pages and are easy to read and staff write information into boxes that set out the goals they wish to achieve with the different areas of needs. A record is also kept to demonstrate that the resident and their relative where relevant has signed and agreed to the care plan. There also sections that list the support that staff have to offer and what actions are to be carried out to ensure that that staff follow consistent practice. Some areas of the care plan were well set out and easy to understand and this demonstrated a clear process of what help someone needed and also what progress had been made. Particularly in the area of mobility and personal hygiene where staff had offered support that had led to improvement for two people. However for one person who has a diagnosed mental illness and results in them challenging staff when dealing with personal hygiene, the care plan is not clear. It requests that staff follow a specific action in supporting this person with their personal hygiene yet the consequences are that this triggers the challenging behaviour. In discussion with staff they confirmed that they are able to manage this area of the care in a different way than how it is set out in the care plan by matching a member of staff who the resident gets on with. This has had positive results for the resident and in some way has alleviated some of the challenging behaviour. However this is not documented in the care plan and as such the care plan is not an accurate reflection of the positive work being carried out by staff. In addition to this some of the terminology used in the care plan such as “ child like tantrums”, “ give X time out”, does not explain fully what this means in addition to being inappropriate terms to use. This was discussed with the acting manager who was advised as to how this could be recorded in a more positive manner. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 14 It was positive to note that as a result of these behaviours that challenge due to the residents mental illness. A referral has been made to a psychiatrist so that this person can receive an updated assessment. Staff are hoping that this will also lead to additional support being provided by the health services as they find some of the behaviour currently being exhibited difficult to deal with. For two of the other resident’s files that were looked at the life history section that is used to provide additional information about a person’s background has not been completed. This information when collected is then used to assist with the care process and also helps staff in developing activities and interests that fit with a person’s previous lifestyle. In discussion with staff they confirmed that they are dependent upon the families providing this information in many instances. As some resident’s have some memory impairment and cannot recall information and events. Other areas of the care files contained a range of different assessment documents that focused on mobility, nutrition, pressure care and these were completed and up to date. As part of supporting residents with their health needs regular weight checks are carried out on a monthly basis. Any sudden change in weight either a decrease or increase would be monitored. And if there were concerns a referral is made to the appropriate health professional. Records are available to confirm that residents receive support from visiting health professionals that include G.P.S, community nurses and the chiropodist. A daily record system is used to record day-to-day events and keep a record of how a resident spends their day. These records are used to keep staff updated and also to assist with the monthly evaluation of the care plans. This is a good system but some of the entries that have been made are basic and do not contain sufficient information. For example “good fluid and food intake” did not contain enough information about what this meant and whether this had any relevance to a care plan. In the first floor lounge a file was on open display and had a title “ residents bath book”, due to where it was anyone could read this file and the information it contained about the residents. The file contains information about when a resident’s bed should be changed and also an individual sheet for each resident indicating when they have had a Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 15 bath. This kind of record does not follow good practice and potentially comprises the privacy and dignity of the residents. Any record of personal care such as bathing and which is recorded on the individual sheet is part of an integral part of the care and as such is better incorporated into the care plan. In discussion with the acting manager it was confirmed that only senior staff administer prescribed medicines. It was also stated by the acting manager that all staff that dispense medicines have received accredited training in the safe handling of medicines. Staff practices were observed during the administration of medicines at mealtimes. A senior member of staff was observed during the lunch period dispensing tablets from a named sealed blister pack into an unnamed medicine pot. These tablets were then left on the dining table for the resident. The senior member of staff did not observe the tablets being taken but signed the administration sheet. This is not good practice and dispensing medicines into unnamed pots leaves the potential for an error to occur such as someone else taking the medication by mistake. This was discussed with the senior member of staff who could offer no explanation for this practice though they did state that they would normally observe the person taking the medicine. A similar incident occurred during the evening meal when another senior member of staff was dispensing tablets into unnamed pots and leaving them on the table for residents to take without observing them taking the tablets. This was immediately brought to the attention of the senior person in charge and actions were taken to ensure that medicines were dispensed correctly. Medicine administration records were generally in good order however for four persons there were some unexplained gaps. Therefore it could not be determined if medicines/creams had been given or not. There were also some difference in the instructions as to how prescribed creams were to be applied and how often. The instructions on the administration sheet and on the packaging the creams were supplied in differed and this could lead to confusion when administering. This was discussed with the person in charge at the time of the visit who was advised of what actions needed to be taken. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 16 Observations made noted that staff treats residents with respect and dignity. Staff was observed knocking on resident’s door before entering the room thus promoting their privacy and dignity. Assistance with personal and intimate care was provided in a discreet and dignified manner. Discussion with the residents confirmed that staff always addresses them by their chosen form of address and were always polite towards them. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12. 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead fulfilling lifestyles through exercising choice and control over how they spend their day. People’s lifestyle is good with regular contact being maintained with relatives and friends and the residents receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: The residents’ religious and recreational needs are met. There are notices in home of the activities that is planned for the coming months for the residents. And this includes the forthcoming Christmas party. During our visit the residents spoke of the Christmas activities and how they were involved in making Christmas crackers and paper chain decorations. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 18 This was observed and the staff as well as the residents appeared to be having a great deal of fun whilst making these decorations. The activity was helped by the fact that staff had been involved in decorating the home with Christmas decorations and a Christmas tree to get people into the spirit. Discussion with relatives confirmed that the activities coordinator was great with the residents and they said that this was one of the positive aspects of the home. Three of the residents enjoyed playing dominoes and this was organised after lunch. The residents stated that they are free to join in social activities if they wish and that they are not made to join in activities if they do not want to. Activities are carried out in the lounge and though everyone may not wish to take an active part they also receive some stimulation by seeing what is going on around them. One resident who prefers to spend time in their room has Satellite television installed and also a good stock of refreshments as well as their own telephone. In discussion with them they said “its just like the Hilton what more could you ask for”. Relatives stated that there are no time restrictions on visiting the home and that this has made it easier for them to visit more frequently to suit their domestic circumstances. One family said that they visit at different times of the day and also in the week and that they always found the service to be consistent. They went on to say that staff always makes them welcome and always offer them refreshments. One resident said that they go out shopping every week with their family. There is a four-week rotational menu in operation in the home. And these demonstrated that the home provides wholesome and nutritious meals for the residents promoting healthy eating. Discussion with the cook confirmed that on the day fish was available for lunch and this could be cooked in different ways, fried, steamed or baked dependent upon the residents preference. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 19 Lunch was taken with the residents and it was hot and tasty and the portion was a good size. It was noted that alternatives meals were available for both the main course and dessert and some residents chose the alternative meal. Discussion with residents confirmed that they enjoy the meals in the home and they stated they are provided with good choice and that there is always plenty to eat. Mealtimes are unhurried and relaxed and catering staff brings the meals to the dining room in a heated trolley and ensure that the meals are served. This enables staff to spend more time with the residents during the meal so that they can offer assistance to the residents if needed. Dining rooms were nicely set out and it was good to see a well laid out table with tablecloths, place mats, napkins and a range of hot and cold drinks. This made eating in the dining room a pleasurable experience. It was good to note that friendships have been formed between a number of the residents and this results in them choosing to sit together during the meals. One resident helps another resident to the dining room by pushing them in their wheelchair and staff observe from a distance in order to ensure that there no health and safety issues for either of the residents. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A clear accessible complaints procedure gives residents and their relative’s confidence that they will be listened to and taken seriously. The manager and staff have a good understanding of local adult protection procedures, which helps to ensure the protection of residents from abuse. EVIDENCE: Information is on display that informs families what to do and whom to contact if they have any concerns. Should they wish to contact the area manager a telephone number is on display. In discussion with residents and also relative who were visiting at the time of the inspection they said that they had no complaints. The area manager had recently met with relatives in a relatives meeting to discuss changes with the management of the service and had also used this forum to discuss any concerns that relatives may have about the service. Since the last visit senior three senior staff have attended training in the Mental Capacity Act. This assisted them in being more aware of their Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 21 responsibilities in promoting the rights and welfare of the residents in their care. Appropriate policies and procedures are in place that promotes the safeguarding of vulnerable adults. And these were used recently in dealing with an incident that led to the previous acting manager being suspended and then subsequently dismissed for gross misconduct. The home involved representatives from the police, social services and the commission in dealing with this safeguarding issue. And this ensured that all procedures were followed correctly. Staff is aware of the guidelines that they have to follow to ensure that residents are safeguarded from potential abuse. And some staff has received appropriate training from the local authority in the protection of vulnerable adults. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely, clean and comfortable environment, which promotes their privacy, independence and comfort during their stay at the home. The home is clean, pleasant and hygienic which supports the health and lifestyles of people living there. EVIDENCE: The home provides good standard of accommodation that meets the needs of the residents. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 23 Bedrooms are individually decorated and residents are encouraged to furnish their rooms with personal items, making it pleasant and familiar environment for the occupants. Most of the residents have their own televisions and DVD players and some residents have their own telephone. Some of the residents said that it was good to have your own en suite toilet in the room as it meant that you could maintain your privacy. Staff checks hot water in bathrooms every time someone has a bath and this confirmed that hot water did not exceed 43°c. thus protecting the resident from any accidental scalding injuries. The home has written policies and procedures relating to safe handling of hazardous materials for staff to follow. However the acting manager indicated that a number of the staff require updated training in health and safety, infection control and food hygiene. The home was clean and free from offensive odour. The home have their own maintenance person who shares their time between this home and other homes owned by the company. They were present during this visit and were dealing with minor maintenance matters and repairs. There were no noticeable defects though wedging bedroom doors open was potentially compromising fire safety. This was discussed with the person in charge at the time of the visit. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is enough staff on duty to meet the needs of the residents. This ensures that safety and welfare is promoted. However some staff training needs to be updated to ensure staff has up to date knowledge in best practice. The ways that staff are employed is generally robust and makes sure that people living at the home are protected from those who are unsuitable to work with vulnerable persons. However some people have been employed without the necessary checks being carried out. EVIDENCE: The rotas confirmed that the home employs sufficient number of staff to meet the needs of the residents. The residents said that there is always enough staff on duty and discussion with relatives confirmed that there is always plenty of staff around when they visit the home. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 25 In addition to the care staff there are also sufficient domestic and catering staff to meet the needs of the residents. As identified during our last visit a number of staff require updated/refresher training in moving and handling, first aid, protection of vulnerable adults, fire safety, food hygiene and health and safety training. This remains the same with no training having been provided. In addition to this a number of new staff (9) have been employed and they too will require training in the above areas. In discussion with the acting manager she confirmed that actions had now been carried out to access training for staff. As an interim measure all new staff have been signed up to commence NVQ training appropriate to their work. Contact has also been made with a training agency and places have been reserved for some staff to undergo training in Infection control, nutrition and health and safe handling of medication. These are 12-week distance learning courses and staff will receive accreditation at the end of the course. The acting manager also confirmed that she is in the process of updating the training plan and identifying which staff needs full training and who requires refresher training. She confirmed that once this was complete training would be arranged in Fire safety, food hygiene, health and safety, COSHH, moving and handling and first aid. In discussion the acting manager confirmed that the person previously responsible for the managing of the service had not kept the training records updated. This had made it difficult to evaluate what training had taken place and what was needed. Nine new staff has been recruited since the last inspection and a person who is no longer employed in the home appointed these. And who was subsequently dismissed for gross misconduct. In looking at these staff files it was evident that the correct procedures had not been used when employing staff. For example one person had s significant gap in their employment history but there was no recorded reason to show why. For another member of staff there was insufficient information in the file and no proof of identity. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 26 The acting manager confirmed that these issues were being addressed and where a member of staff had been appointed without the necessary criminal record checks. These had now been applied for. The acting manager confirmed that no one is employed unless all of the necessary checks have been obtained. And any shortfalls in the current records had been attributed to the person who had previously managed the service. The company have made it a priority to ensure that all staff files are up to date and contain all of the information that is required by the Care Homes Regulations 2001. And work is currently being carried out by the acting manager in this area. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The acting manager is an experienced member of the existing staff team and makes sure that people who live at the home are supported properly. And external management support is available to ensure that quality of the service is improved for the people who live here. Steps are in place to ensure that the home is run in the best interests of the residents and that there welfare is promoted. However the lack of fire safety training for staff potentially compromises the fire safety within the home. EVIDENCE: Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 28 Since our last visit the person who had responsibility for the management of the service has been dismissed by the company for gross misconduct. This person is currently subject to a police investigation. The company have advertised for an experienced and qualified manager to take responsibility for the day-to-day management of the service. In the interim and experienced member of staff who has 7-½ years experience in the social care sector is carrying out the role of acting manager. In addition to this weekly support is provided to the acting manager by the area manager. Other support is available by telephone from the managers of other homes in the area that are owned by the company. The acting manager has been responsible for rectifying a number of shortfalls with the records systems in the home, a number of which have been attributed to the previous manager. Systems are in place for the management of monies held on behalf of the residents. And following a review new documentation is in use to make this system robust. This involves maintaining a record of any transaction carried out on behalf of a resident and having an appropriate numbered receipt to correspond with the transaction. Only the acting manager has access to resident’s finances and this limits the opportunity for potential errors to occur as well as guaranteeing the security of the financial systems. As previously stated in this report a number of staff require updated mandatory training in order to ensure that good health and safety practices continue to be followed by staff. In looking at the records of fire instructions and fire drills for all staff it could not be establish when staff had last received fire instruction. The last recorded fire drill had taken place in February of this year. In discussion with staff they too were unclear when the last period of fire instruction had taken place. Discussion was also held with senior staff on duty and they offered mixed responses of what action you would take in the event of a fire or the alarm sounding. And these differed from the actions that are listed in the homes fire procedures. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 29 As a result of this we issued an immediate requirement notice that stated within 7 days all staff must take part in at least 1 fire drill and receive 1 period of fire instruction. Both verbal and written confirmation was received following the inspection and this confirmed the requirements had been met. During our visit the area manager issued us with a completed questionnaire that we had sent to the home. This contained a range of information indicating what improvements had been made in the home and also what further improvements are planned for the following 12 months. Servicing records confirm that all portable appliances have been tested. A record is maintained of regular water temperature tests in the home. Regular servicing of fire equipment, gas and electrical appliances have been carried out by the contracted companies. In looking at the records systems an event had occurred in the home in August that potentially could have had an impact on the well being of a resident. The previous manager as required under the Care Homes Regulations 2001 did not report this to the commission. This was discussed with the acting manager who was advised of the need to report similar incidents to the commission. Following the dismissal of the previous manager the area manager called a meeting and invited relatives to attend in order that they could be updated with the current management situation in the home. This meeting was also used to discuss with families what improvements could be made in the service. As a result of this meeting the area manager confirmed that further meetings would be held with relatives as it was felt that this was a positive way of involving families in the future developments in the home. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 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 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 31 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 (1) (d) Requirement The registered provider must ensure that no service user moves into the home without receiving written confirmation. That on the basis of their assessment their needs can be met in the home. (Immediate) All staff who are authorised to administer prescribed medicines must Administer them in accordance with the guidance issued by the Royal Pharmaceutical Society. This will ensure the health and safety and well being of service users. (Immediate) The registered provider must ensure that any event that has an impact on the well being of a service user is reported in writing to the commission. (Immediate). All staff must have up to date statutory training. This will ensure that staff is up to date with current practice. Previous requirement of 30/06/08 not met) DS0000034293.V372777.R01.S.doc Timescale for action 21/11/08 2. OP9 13 (2) & 13 (4) (c) 21/11/08 3. OP18 37 (1) (e) 21/11/08 4. OP30 13(6) 30/04/09 Ashlea Grange Residential Home Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Individual plans of care should be developed as advised within the report and as discussed during the visit. Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashlea Grange Residential Home DS0000034293.V372777.R01.S.doc Version 5.2 Page 34 - 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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