CARE HOMES FOR OLDER PEOPLE
Ashlea Lodge Hylton Road Millfield Sunderland SR4 7AB Lead Inspector
Sam Doku Announced 3 June 2005 10:00 am 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 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 Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ashlea Lodge Residential Home Address Hylton Road Millfield Sunderland SR4 7AB 0191 510 9405 0191 510 9406 Telephone number Fax number Email 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 Care home only 40 Category(ies) of OP Old age (40) registration, with number PD(E) Physical dis - over 65 (8) of places DE(E) Dementia - over 65 (7) SI(E) Sensory Impair over 65 (5) MD(E) Mental Disorder -over 65 (4) Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13 December 2004 Brief Description of the Service: Ashlea Lodge is a two-storey building, which has been specifically designed to provide personal care for older people who may have a variety of needs. The layout of the building allows for the home to be divided into three separate units and each contains a lounge, dining room, kitchen, bathroom, toilets and en suite bedrooms. A garden, which is accessible to people who use a wheelchair is at the rear of the building and there is a car park at the front. The home is located close to St Marks Church and a GP’s surgery, both of which are easily accessed. The metro line has a station within walking distance from the home. In addition, there is a regular bus service, which stops opposite the home. Ashlea Lodge is situated relatively close to a shopping area, which has a post office, grocers and public houses. The home is registered to admit 40 people who may have physical disabilities or who may have dementia type illness. The home is owned by Winney Care Limited and is managed by Mr Daren Kennedy. Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The main inspection activities took place on the 24.5.05 but two additional visits were made on 31.5.05 and 3.6.05 to conclude the process. This process involved talking to service users, visitors, sitting in the lounge and observing staff interaction with the service users, discussions with the manager and care staff, tour of the house, inspection of the drugs administration system, examination of health and safety records and service users’ personal file including care plans. The inspector spent over five hours talking to service user, staff and visitors and observe care practices in the home. What the service does well: What has improved since the last inspection?
Health and safety issues relating to the storage of cleaning material had been addressed following the risks identified at the last inspection report. The care plans had been reviewed and redesigned but there is still a considerable room for improvement. Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 6 The home has recently appointed an Activities Coordinator who is responsible for organising social and recreational activities in for the service users. The manager stated that this is to ensure that service users engaged in recreational activities that are specific to their lifestyle and interests. However, the time allocated to her is limited to only one day per week. 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 Lodge CS0000034296.V181838.R01.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 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 standard(s) 3, 4, 5. The home has good policy in ensuring that assessments are completed prior to admission to ensure that the needs of potential service users can be met. Pre-admission information is available to prospective service users and their relatives as well as the opportunity to visit the home to enable them to make informed choice about whether or not Ashlea Lodge is suitable to meet their needs. EVIDENCE: The service users’ records that were examined contained evidence of preadmission assessments by social workers and by the senior staff of the home. The manager explained that it is the policy of the home that social workers provided a full assessment of the prospective service user to the home before admission is arranged. In an emergency admission it is expected that such assessments would be provided by the social worker within 48 hours of admission. The manager confirmed that it is the policy that a senior staff member would visit prospective service users in their own homes and carry out an assessment before admission. This is to ensure that the care needs of the service user are properly assessed and to assure the user that their need can
Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 9 be met. All the service users and relatives spoken with said they were visited in their own homes by a social worker and a representative of the service. They said they found the visits and the offer of the opportunity to visit Ashlea Lodge very useful. The manager explained that it is the policy of the home to offer pre-admission visits to Ashlea Lodge to prospective service users. He explained that there is the opportunity for weekend stays if individuals choose to. This is to allow for the smooth transition from living independently at home. Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 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 standard(s) 7, 8, 9, 10. The individual care plans set out the health, social and personal care needs of each service user and plans are formulated to meet those care needs. However, the lack of written evidence of how those identified needs are being met means that there is no assurance that in practice, service users’ needs are being addressed. The service users are treated with respect and dignity by the staff. EVIDENCE: Discussions with service users, staff and relatives confirmed that the service users’ health, personal and social care needs are being met. Examination of service users files indicated that their healthcare needs are being met in the home. The records showed evidence of visits to GP surgeries, District Nursing services, chiropody treatment, opticians, dentists and other healthcare professionals. In discussions with service users and their relatives, they all confirmed that their healthcare needs are met within the home and feel that the staff take active role in promoting this. However, some of the healthcare needs, which do not involve outside agencies are not well documented. For example, the pressure area risk assessment carried out for one service user lacked details and did not indicated how the
Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 11 final conclusion was arrived at. Some care plans, which demanded certain action by staff provided no further information as to how the care needs are being met. An example of this was where the care plan asked for staff to monitor the diet intake of one service user. There was no record of the service user’s diet intake, although in the proceeding four months, the review sheets simply recorded as “no change to her dietary needs”. A similar situation regarding the sleep pattern of one service user provided no written evidence of such observations being made. Two service users were noted to handle their own medication but no written risk assessment had been carried out to ensure the safety and wellbeing of the service users. A number of service users and their relatives were spoken with regarding privacy and dignity. They all confirmed that the staff respect their privacy, and treat them with respect and dignity. A number of practices were observed where staff demonstrated respect for people’s privacy and dignity. For example, staff were observed to knock on bedroom doors before making entry. Staff were also noted to speak discreetly to service users when offering assistance with personal task. Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 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 standard(s) 12, 13, 14, 15. The home operates in a way that encourages the service users to exercise choice and autonomy over matters relating to daily activities and health. This promotes a healthy lifestyle. EVIDENCE: A number of service users’ files were examined which showed , amongst other details, the service uses’ interests. The social activities file provided details of all the recent activities including music, chairobics, keep fit, dancing, art and craft, bingo and reminiscence. On the day of the inspection the service users and staff were engaged in small group discussions and music session. Some service users choose not to take part and stayed in the other lounges or in their rooms to watch TV. Those who were spoken with confirmed that social activities are regularly organised and they enjoy taking part. They emphasised that no one is made to join in any organised activities if they did not wish to, thus promoting their independence, choice and respecting their wishes. The home continues to encourage service users to use community facilities such as the local shops, visits to the hairdresser, GP appointments and local church. The manager stated that the local Salvation Army visits the home about once every six weeks. The local church vicar calls every week to offer
Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 13 prayers and communion to those who want it. This provides the opportunity for individual service users to continue to practice their religion. The manager confirmed that one service user remains actively involved with Age Concern and the staff support her to maintain her interests. The service users were very complimentary about the catering staff and quality of the meals provided in the home. Nutritional assessments have been carried out for those service users who require their diet intake monitored to ensure they receive adequate diet. The three weeks rotating menus provided evidence of varied and nutritious meals, including alternatives for the residents. This provides the service users with the opportunity to make choices regarding meals. The two dining areas are pleasantly furnished and provide spacious and congenial settings for the service users. At lunch time the tables were beautifully set with appropriate cutlery, condiments and choice of drink. A number of service users commented that if they wish to have their meals in their bedrooms, staff would make the necessary arrangements for this to happen. This provides some element of choice for service over where and when to have their meals. Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 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 standard(s) 16, 17, 18. The home has a clear and easy to understand complaints policy, which is accessible to the service users and relatives thus providing the opportunity for them to complain if they wish. Suitable arrangements are in place to ensure that service users are protected from all forms of abuse and to protect their rights. Such training and awareness amongst staff is one effective way of reducing the likelihood of abuse to service users. EVIDENCE: The manager has arranged for the home’s complaints procedure to be displayed in the home, thus making it accessible to both service users and visitors. The procedure is also included in the service user guide and statement of purpose. Service users who were spoken with stated that they are aware of the complaints procedure. Suitable training on the protection of vulnerable adults (POVA) has been provided for the majority of the staff working in the home. The staff who were spoken with showed an understanding of the POVA procedures and an awareness of the need to protection service users from all forms of abuse. Those service users who were spoken with indicated that if they have any concerns they felt confident to raise it with the manager or any staff without fear of intimidation. Some service users also confirmed that they feel their rights are respected by the staff. This was also confirmed by the relatives who
Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 15 were spoken with. Three other service users spoke about their past involvements in postal voting during local and national elections. The manager confirmed that all service users have been registered to receive postal votes. This ensures that the service civic rights are maintained. Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 16 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26. The home provides accommodation of a good standard. It is a safe, clean and comfortable environment, which promotes the service users’ privacy, independence. EVIDENCE: The records that were examined showed that safety measures relating to fire and environmental health matters were being observed. The fire-log book contained details of regular fire alarm tests and maintenance of fire detection and fire fighting equipments. Two staff members were selected at random to test her knowledge of the fire procedures in the home. They were able to describe what to do in event of discovering fire in the home. Fire risk assessment had been carried out including general risk assessment of the building. This included detection devices, chemicals, gas installation and electrical equipment. These arrangements have been maintained to ensure the safety well-being of the residents.
Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 17 Fire drills have been recorded in the fire log book but there is no indication of which members of staff were involved with the various drills. Records examined showed that only four out of the thirty-one staff had current and up to date fire safety training certificate. Regular update on fire safety training must be implemented to ensure the safety and wellbeing of the service users. A number of the service users who were spoken with stated that they found their rooms very comfortable and homely. Most of the residents have furnished their rooms with personal items thus ensuring a homely and familiar environment for them. A number of service users confirmed this. There are sufficient communal spaces in the home to meet the needs of the service users. This allows choice for those service users who would wish to use other communal areas than the ones commonly used by everyone. At the time of the inspection the home was noted to be clean and free from offensive odour. It was noted that all toilets had liquid soap dispensers. The laundry machines have facilities for sluicing and washing foul linen at very high temperature to avoid the spread of infection. The manager stated that the staff have had training in health and safety, infection control and food hygiene. These arrangements had been put in place to avoid the spread of infection and to promote the safety and wellbeing of the service users. The carpet in parts of the home are badly stained and detract from otherwise pleasant surrounding for the service users. This was pointed out by one service user and a visitor. Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30. The home provides adequate staffing levels to meet the needs of the service users. Suitable arrangements for staff training and supervision are in place to ensure that staff are equipped to provide a good quality service that benefits the residents. However, robust recruitment procedures are not in place to ensure the suitability of staff who work with vulnerable people. EVIDENCE: Details of staff rotas were examined during the inspection. It was noted that the home consistently maintains adequate staffing levels to meet the needs of the service users. Two relatives confirmed that they feel there is always sufficient staff on duty to meet the immediate personal care needs of their relatives. The list of training provided for the staff included moving and handling, first aid, protection of vulnerable adults, health and safety, food hygiene and nutrition. The staff who were interviewed confirmed the training they had received and felt that these had equipped them to do their jobs better. Two staff records were examined with the view to determine whether or not the company adheres to proper employment policies in recruiting staff. It was evident from the two staff files that proper recruitment procedures have not been followed by the manager. For one recently appointed carer, there was no application form available on her file although it was acknowledged that she was a domestic staff before becoming a carer. Evidence of CRB check could
Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 19 not be found in her file. In the case of another recently appointed carer, there was only one reference on his files. Recruitment procedures have been put in place to ensure further protection of residents from possible abuse from applicants who would otherwise be deemed as unsuitable to work with vulnerable people. In this case the manager had not followed the procedures, and therefore exposing service users to possible risk of abuse by not making the necessary checks as required. There is great emphasis on training the care staff to NVQ Level 2 or above. The manager confirmed that since the last inspection ten more care staff have completed the NVQ Level 2, making a total of eighteen out of the twenty-three care staff. Staff who were spoken with indicated that this had equipped them to provide better care for the service user. They also indicated that the training had enhanced their confidence and self-esteem and are therefore able to provide good quality care for the service users. Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 38. The manager provides good leadership and direction for the staff, resulting in consistently good quality care practices that benefit the residents. However, attention must be paid to reviewing the effectiveness of care plans and risk assessments to ensure the safety and wellbeing of the service users. EVIDENCE: Staff confirmed that they are able to approach the management to discuss any issues relating to both personal and professional matters. A number of service users who were also spoken with about the general management of the home confirmed that the management staff are approachable and always available to offer support and advice. This was further confirmed by three relatives who were visiting at the time of the inspection. The manager has put in place safeguards to ensure that service users’ finances are properly accounted for. Records of all transactions are available for each service user whose personal allowances is managed by the home.
Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 21 A programme of induction is in place for all new staff, and completed copies were available on the staff files. As a result, a number of service users felt that they are safe in the home and that newly appointed staff provide them with good care. A number of records relating to health and safety issues in the home were examined. These include electrical maintenance test certificate, water treatment certificate, record of water temperatures, fire log book, lift and hoist servicing records. These show evidence of servicing and maintenance being up to date, thus ensuring a safe environment for the service users. The kitchen was inspected and found to be clean and maintained to a good standard. A number of records were examined and these included record of food temperature, weekly cleaning rota, record of fridge and freezer temperatures. There were notices in the kitchen on prevention of food poisoning and food safety management system. Due to lack of space in the kitchen, the food trolley is stored in the corridor. The manager was advised to seek the advice of the environmental health officer regarding the storage of the trolley. Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x 3 x x 2 Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 23 YES Are there any outstanding requirements from the last inspection? 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 8 Regulation 14(2)(b) Requirement Where care plan asks for specific care need to be monitored by staff, then a record of such monitoring must be maintianed and regularly reviewed. The registered person must take appropriate action to ensure that sufficient hot trolleys are available so as to maintain satisfactory standard of food hygiene and conducive settings for meals at all times. The record of fire drill in the home must indicate which staff members had been involved in such drills. Risk assessments relating to self-medication must be carried and regularly reviewed to ensure the safety and wellbeing of the service users. Proper recruitment and selection must be followed at all times. Timescale for action 1 August 2005 2. 15 16(2)(g) 1 september 2005 3. 25 23(4)(a) 1 August 2005 1 August 2005 4. 25 13(2) and 13(4)(c ) 5. 29 19(4)(b) 1 August 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 24 No. 1. 2. Refer to Standard 9 12 Good Practice Recommendations Advice of the pharmacist should be sought regarding ventilation in the rooms where the mediceines are stored. The hours alocated for the activities coordinator to provide activities for the service users should be reviewed to ensure that the hours are adequate to meet the needs of the service users. The carpets in some parts of home are badly stained and should be cleaned or replaced. The advice of EHO should be sought regarding the storage of the hot trolley in corridor. 3. 4. 26 38 Ashlea Lodge CS0000034296.V181838.R01.doc Version 1.30 Page 25 Commission for Social Care Inspection 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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