Inspection on 22/09/05 for Ashlee Care Home

This inspection was carried out on 22nd September 2005.

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

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

Other inspections for this house

Ashlee Care Home 25/07/07

Ashlee Care Home 24/04/06

Ashlee Care Home 04/05/05

Ashlee Care Home 24/07/04

Ashlee Care Home 10/05/04

Ashlee Care Home 11/12/03

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ashlee 89 Nottingham Road Long Eaton Derbyshire NG10 2BU Lead Inspector Jenny Thornton Unannounced 22 September 2005 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. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ashlee Address 89 Nottingham Road Long Eaton Derbyshire NG10 2BU 0115 9721732 0115 9222541 Bheewa@AOL.COM Mr A R Mahadoo 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) Mr A R Mahadoo Care home 21 Category(ies) of Older people registration, with number of places Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 4 May 2005 Brief Description of the Service: Ashlee is a care home for twently one people aged 65 years and over. It is a detached house in a residential area of Long Eaton close to the town centre and local facilities. The home has seventeen single and two shared bedrooms, five single rooms have ensuite facilities. The home is on two floors accessed by stairs and a passenger lift. Residents have access to a garden area. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 1.30pm. It took place over four and a half hours. The Inspector spoke to the provider’s son, two members of staff and seven residents. Several residents had difficulties in expressing themselves in words and were unable to contribute directly to the inspection, but they were observed throughout the visit as to how well their needs were being met by staff. The Inspector looked round the home and examined various records. The home has made good progress towards meeting the requirements and recommendations from the last inspection report dated 4th May 2005. What the service does well: What has improved since the last inspection? Improvements have been made to the ironing and presentation of residents clothes. Clear records have been put in place of resident’s money in safekeeping to safeguard their interests. Domestic hours have increased to ensure the home is kept clean at all times. A sink has been fitted in the laundry for hand washing. The hot water piping has been lagged and further radiator guards were due to be fitted to reduce the risk of scalding to residents. Various training was planned over the coming months to ensure staff have the skills to carry out their work. Further policies and procedures have been put in place to support the day-today running of the home. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 6 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. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 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 Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 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) 2 and 3 Procedures have been strengthened to show that residents or their representative have received a contract of residence, which safeguards their interests. All essential information and risk assessments needs to be promptly completed following a resident’s admission to the home to ensure that their needs are identified and fully met. EVIDENCE: Procedures have been strengthened to show that resident’s who purchased their care privately had received a copy of the home’s contract. A signed contract was available in the home for all residents except for one lady. The manager reported that the lady’s solicitor had not signed and returned this, despite requests to do so. Two care plans examined contained a good level of information about resident’s needs. Although staff had yet to complete all essential information and risk assessment forms for a resident who had been admitted two weeks ago. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 9 Clear care plans need to be put in place to show that resident’s needs are identified and are being appropriately met. Procedures for the safe keeping and handling of medicines have been strengthened to safeguard residents’ welfare. This needs to apply to persons who self-administer their own medicines. EVIDENCE: Records showed that residents or their relatives were being encouraged to read and sign their care plan to show that they have been involved in completing it. Two care plans examined did not detail how resident’s needs were being met. The provider’s son reported that new care plan forms were being produced, which will set out resident’s needs, and enable staff to deliver appropriate care. The manager has since confirmed that detailed care plans will be completed for all residents on receipt of the new forms. Work has been carried out to address the medication issues identified on the previous inspection report, to ensure that medicines are appropriately handled. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 10 The manager had arranged for further care staff to attend medicines training in October from a competent, to ensure that sufficient staff are trained to administer medicines at the home. A resident that had recently been admitted to the home was enabled to take a number of prescribed medicines she had previously taken responsibility for. The resident was reluctant to keep her medicines securely in her room in a lockable storage area. The resident’s appropriateness to self-administer certain medication was not subject to a written risk assessment, part of which is to ensure that medicines are kept safely. The resident’s care plan and medication records did not clearly show all medicines the resident was taking at the time of admission to the home, and which medicines the resident selfadministered. The resident’s relatives had obtained a prescription for various medicines, including items the resident self-administered. The medicines had been dispensed from a different pharmacy to the one the home used, and included some medicines that had been obtained and were being administered by staff. The manager has since confirmed that staff are currently administering all prescribed medicines and all medicines are now obtained from the home’s pharmacy. One resident was prescribed oxygen to self administer as he required. His bedroom contained five oxygen cylinders. The manager has since confirmed that empty cylinders have been returned. The need to display a statutory warning notice where compressed gas is kept was discussed the provider’s son. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 The home enables residents to exercise choice and control over their lives, where possible. EVIDENCE: Observations and discussions with residents and staff showed that residents are helped to exercise choice and control over their lives, where possible. Residents chose how they spent their day, and when they wish to go to bed and get up. Residents took responsibility for certain medicines and handled their own finances, where able. Some residents had limited ability to exercise choice and control over their lives due to poor physical and mental health. Resident’s social interests and needs were not fully assessed on this inspection. Records showed that some weekly activities were provided as identified on the previous inspection report. Discussions with residents and records maintained that individual needs were not fully met or care planned for. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 12 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) 18 Procedures have been strengthened to safeguard residents from abuse. EVIDENCE: The manager had obtained a copy of the Local Authority’s latest vulnerable adults policy and procedure, although the policy file contained a copy of the previous policy. The home did not have a separate policy but worked to this Local Authority’s procedure. The manager had attended the Local Authority’s training on vulnerable adults, and was due to provide the training to all staff at the end of September to ensure they are aware of the procedures. Staff had been instructed that they must attend the training. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 13 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 and 26 Further improvements have been made to ensure the home is safe and well maintained for residents to live in, although further areas require attention. EVIDENCE: All areas of the home were clean and free from odours at the time of the inspection. Domestic cover and hours have increased to ensure the home is kept clean at all times. Cleaning products were stored securely when not in use; a seperate lockable area has been provided. Residents’ consider that the environment is homely and comfortable. Arrangements were in place to ensure that the home is well maintained. The wallpaper was torn in two areas and the carpet at the side of the bed was stained in one ground floor bedroom. Curtain screening in the shared room on the first floor did not ensure residents privacy when personal care is given. Discussions with staff and observations showed that improvements have been made to the ironing and presentation of residents clothes. The manager has since confirmed that hand washing facilities have been provided in the laundry. At the time of the Inspectors arrival items of clothes and bedding were placed Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 14 to dry over the handrails in the ground floor corridor area near the laundry, which prevented residents from been able to safely access the rails. Staff on duty proceeded to remove the washing from the handrails. A couple of residents commented to the Inspector that they felt cold, and when brought to staff’s attention the heating was put on. Several bedroom windows remained open. The home has limited areas to store equipment. The mobile hoist was stored in a resident’s shared bedroom at the time of the inspection; neither resident used the hoist. The provider has confirmed that planned building work will include some storage areas. Also a new enclosed garden area and improved ramped access will be provided. The timescale for completion of this work is April 2006. The risk assessment of the radiators and pipe work had been updated to show that the hot water piping has been lagged and that further radiator guards were due to be fitted to reduce the risk of scalding to residents. Records showed that staff had recently attended training on fire awareness. However on arrival to the home the following fire doors were wedged open: • The dining room door from the corridor. Staff later removed the door wedge. • Two bedroom doors on the first floor. The provider’s son agreed to remove the door wedges and address this issue with all staff. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 and 30 Various training for staff was planned to ensure they have the skills to do their job, although further care staff need to achieve a national approved qualification. EVIDENCE: The staffing rota did not clearly show what hours ‘working’ night staff worked. There were times when only two members of staff were on duty in the day, although staff and residents generally considered that sufficient staff were on duty to meet residents needs. The home has a fairly established staff team, which results in residents receiving care from staff they know. The manager has since confirmed that there has been two staff changes since the last inspection in May 2005. Staff were due to attend further mandatory training. The manager had arranged key areas of training over the coming months including dementia awareness, loss and bereavement, moving and handling, first aid, and management of medicines and continence. The manager had yet to produce a clear annual training and development plan for staff to ensure that all staff receives appropriate training. Individual training records had been put in place for all staff, which listed training that staff had attended. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 16 Three members of staff have a nursing qualification, and a further three staff were undertaking nurse training. One member of staff had achieved a national approved qualification (N.V.Q) to support that they are trained and competent to do their job. The manager had set up N.V.Q. training for staff through a local college with a view to further care staff undertaking the training. The provider’s son said that there had been a delay in issuing new contracts of employment and the staff handbook to all staff. All staff would receive this by the end of September. Two new members of staff had been employed to work in the home since the last inspection. The Inspector found that the required information and documents had been obtained for the staff to work in the home and to safeguard residents with exception of the following: • The home had requested a new application form to include previous experience and skills and a full employment history from the Company that supplied its documents. Application forms in use did not request a full employment history or provide sufficient space to record this information and any gaps in employment. • A new form had been produced to record interviews with staff on which to determine the person’s fitness to work in the home. This had yet to be completed for new staff. • Staff files contained a satisfactory criminal record disclosure certificate including confirmation against the Protection of Vulnerable Adults list. One member of staff had taken up post in May and the home had obtained a copy of their criminal record disclosure certificate from their previous employer dated April 2005. • Reference request forms did not ask for verification of the reason why the person had ceased to work in a position, involving work with children or vulnerable adults; references obtained did not include this information. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 17 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) 33 and 35 Procedures were being strengthened to ensure the home is well managed. EVIDENCE: The Commission for Social Care Inspection approved Mr Mahadoo as the registered manager in May 2005. Mr Mahadoo was due to complete an approved management course in November 2005. Procedures for reviewing the quality of care and services at the home have been strengthened. Residents had completed further satisfaction questionnaires about the care and services provided. The manager had yet to complete a report of the findings. Resident’s, relatives or an independent person continued to manage resident’s finances and personal allowance. At the time of the inspection the majority of residents had a small amount of money in safe keeping at the home, and only the provider and his son had access to this. Checks carried out showed that Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 18 clear records were now kept of all transactions of resident’s money in safekeeping to safeguard their interests, although the person completing the record did not sign the balance sheet. The provider has facilities for communication by fax transmission from his own home. Mr Mahadoo said that someone is generally available at his home to receive a fax. However there may be an occasion when urgent information relating to medicines or medical device alert sent by fax was not available to staff. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 19 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 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 3 x 3 x x x Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 20 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 3 Regulation 14 Requirement All essential information and risk assessments must be completed for residents following admission to the home. Care plans must set out how resident’s needs are being met following admission to the home. This requirement was listed in the last report. Resident’s appropriateness to self-administer medication must be subject to a written risk assessment, part of which is to ensure that medicines are kept safely. Social activities must meet residents needs and preferences. Care plans must show how residents needs are being met. This requirement was listed in the last report. All staff must receive training to prevent residents from being placed at risk of harm or abuse. This requirement was listed in the last report. Privacy screening in shared rooms must ensure residents privacy for personal care. The home must provide suitable storage facilities for equipment. C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Timescale for action 31 December 2005 Revised timescale: 31 December 2005 30 November 2005 2. 7 15 3. 9 13 4. 12 16 Revised timescale: 31 December 2005 Revised timescale: 31 December 2005 31 December 2005 30 April 2006 Page 21 5. 18 13 6. 7. Ashlee 19 19 12 23 Version 1.40 8. 19 23 9. 10. 11. 19 28 29 23 18 19 This requirement was listed in the last report. The home must provide a safe garden area for residents and improved ramp access. This requirement was listed in the last report. Fire doors must not be wedged open. Further care staff must achieve N.V.Q Level 2 qualification or equivalent. A full employment history must be obtained, together with a satisfactory explanation of any gaps in employment for all staff working at the home. The registered person must obtain a satisfactory criminal record disclosure certificate for all staff applying to work in the home. A copy of a certificate from a persons previous employer is not transferable. The registered person must provide appropritae facilities for communication by facsimile transmission 30 April 2006 30 November 2005 30 April 2006 31 December 2005 31 December 2005 12. 29 19 13. 29 16 31 December 2005 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. Refer to Standard 9 9 18 Good Practice Recommendations Residents care plan and medication records should clearly show all medicines a resident self-administers. All rooms where oxygen is in use should display the statutory warning notice, compressed gas, no smoking or naked lights. The provider should provide a policy statement which states that the home works to the Local Authority’s vulnerable adults policy and procedure. The procedure file should contain a copy of the Local Authority’s latest C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 22 Ashlee 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 19 26 27 29 29 29 30 30 33 35 vulnerable adults policy and procedure. Staff should ensure that suitable heating is provided in all parts of the home used by residents. Clothes and bedding should not be placed to dry over the handrails in the corridor areas. The staffing rota should show what hours ‘working’ night staff work All staff receive a new contract of employment and the updated handbook A record of staff interviews should be kept to a consistent and adequate standard. Reference request forms should ask for verification of the reason why the person had ceased to work in a position, involving work with children or vulnerable adults. All staff should have an individual training and development plan. The manager should produce an annual training and development plan to ensure all staff receive appropriate training. The provider should complete a report and action plan of the findings of all resident satisfaction surveys. All entries and withdrawals of resident’s money in safekeeping should signed by the person completing the record. Ashlee C52 C02 S44372 Ashlee V245443 220905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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