Inspection on 15/05/07 for Ashleigh

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashleigh 06/12/05

Ashleigh 14/01/05

Ashleigh 08/06/04

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

CARE HOMES FOR OLDER PEOPLE Ashleigh 17 Beech Grove Ashton Preston Lancashire PR2 1DX Lead Inspector Mrs Felicity Lacey Unannounced Inspection 15th May 2007 10:00 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 Ashleigh DS0000009838.V340297.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. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashleigh Address 17 Beech Grove Ashton Preston Lancashire PR2 1DX 01772 723380 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) Mrs Gillian Wilcock Not applicable Care Home 11 Category(ies) of Dementia (11) registration, with number of places Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 Brief Description of the Service: Ashleigh is a care home, registered with the Commission for Social Care Inspection that specialises in providing personal care services for older people with dementia. The home is registered for eleven persons of either sex. The proprietor of the home is involved in daily management activities and is supported in her duties by a manager and two deputies. Ashleigh is situated on a quiet road, within easy reach of all local services and amenities. The home is arranged over two floors and is served by a passenger lift. Accommodation comprises of eleven single rooms, two lounge areas and a dining area. There is a pleasant enclosed garden at the side and rear of the premises and a car parking area for visitors. The home has established links with health support and social services. The proprietor and staff are experienced and skilled in providing specialist care for older people with dementia, and are committed to involving the residents and their representatives in the planning and delivery of care. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to Ashleigh. Information was provided by the owner and manager in a Pre Inspection Questionnaire. Three surveys were completed and returned by relatives and a survey was submitted by a social care professional. During the visit to Ashleigh time was spent observing daily life at the home, and in discussion with residents, staff, the manager and the owner. A sample of records and documents relating to the care and support offered at the home were looked at. Staff recruitment and training records were also sampled. A tour of the premises took place. What the service does well: Ashleigh continues to provide support and care for residents that is based on a good understanding of the needs of people who have dementia. The people who live at the home benefit from having their care needs met by a consistent group of staff. The owner of the home is closely involved in the management of Ashleigh and regularly spends time at the home. The staff at the home are committed to providing a high standard of care and create a homely atmosphere. The size of the home and the numbers of staff employed ensure that residents benefit from regular conversation and one to one time with staff. The owner and manager lead by example and support the staff in their roles. They are active in making sure that staff have full information needed to provide for a residents care needs. The advise of other professionals is sought when needed and put into practice. Comments received included: ‘Staff are very friendly and attentive.’ ‘Friendly welcoming staff who have made my mother feel at home. The home itself is spotlessly clean and tidy. My mothers clothes are always clean and ironed.’ ‘Ashleigh have been excellent managing residents medication and consulting GP’s with any concerns or for advice concerning medication.’ ‘I feel the service provided to older adults with dementia is excellent.’ ‘ The owner is very supportive and is fair to all staff.’ Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. People are admitted to the home following a full assessment of needs and this ensures that the home can provide appropriate support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files looked at contained relevant assessments that had been obtained prior to the person coming to live at Ashleigh. This information forms the basis of the homes own assessment and subsequent care plan. The service provides specialist care for people with dementia, and the care plans accurately record the type of dementia that the person has been diagnosed with. Surveys received indicated that the staff of Ashleigh understand and meet the needs of the people living at the home. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. The care plans should be accurately updated as this promotes consistency in the care provided. The staff of the home work in ways which promote privacy and dignity and shows respect for the rights of the people who live at Ashleigh. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The resident’s plan of care is drawn up over a period of time as the resident settles at Ashleigh and as the staff grow in understanding of the persons care needs. The care plans are reviewed but it was found that when considering the care plan of one resident it had not been updated to reflect a change in need. Although the staff group is small and much information is passed on verbally, it is important that the written care plan is kept up to date and gives accurate guidance regarding individual care needs, in this way consistency of care is promoted. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 10 The care plans seen showed that health needs were understood and acted upon. The manager and owner are active in gathering useful information to ensure that staff have a good understanding of particular health needs, for example an information file and a list of frequently asked questions had recently been compiled in response to a particular health need of a resident, this ensured good understanding of the condition and promoted good practice based on this knowledge. There was evidence of the staff liaising closely with other health and social care professionals to ensure that care plans were understood and contained important information. Relatives indicated that they were usually kept informed of any significant changes to the persons health needs. A professional who completed a questionnaire commented: ‘Ashleigh managers and staff appear very concerned about service users health care needs and consult GP’s, CPN’s and active social workers on a regular basis about any of their concerns. They also update professionals regarding any changes in a residents health on a regular basis.’ All staff who administer medication are trained in safe practices. Training is given a high priority and staff spoken with understood the medication practice of the home. The records seen were correctly completed and accurate. The importance of respecting the privacy and dignity of the people who live at the home was evident by staff practices. This was commented on by a professional who complete a survey and wrote: ‘From what I have witnessed all staff give service users privacy…they deal with service users in a dignified manner and appear to respect individual rights for privacy and dignity.’ Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. Some activities are on offer that reflect individual interests but there are limited opportunities for taking part in activities outside of the home. Resident’s benefit from a balanced diet, which promotes health. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some of the people living at Ashleigh have limited verbal communication skills, however the ways in which they acted showed signs of well-being. A number of residents were actively engaged in activities, and all residents showed interest in their surroundings. Activities are available in the home, these include jigsaws, bingo, and individual interests such as knitting. The care plans seen did not contain information relating to the social history of the people who had come to live at Ashleigh. The staff were aware of the previous lifestyles and interests of some of the residents however this was not recorded. It is important that when providing activities, particularly for people with dementia, that these are reflective of individual preferences and capabilities. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 12 The home does not provide any organised trips out, this is made clear at the time of a person deciding to come to live at the home. Some residents are taken out regularly by family members, and some who show interest are taken out by staff in the local community. The activities and social opportunities offered at the home could be improved. Currently there are no regular contacts with any religious organisations. There has been regular contact in the past when requested by individual residents and arrangements have been made to enable residents to continue to attend the church of their choice. Relatives are able to visit at any reasonable time. Relatives who commented found staff to be welcoming and friendly. As the residents all have a dementia diagnosis this impacts on their capacity to act independently, whilst this is understood, efforts are made to ensure that all residents are able to exercise choice and control over their day-to-day lives. This is achieved by understanding how each resident communicates, for example by understanding mood changes or body language. Risk assessments are conducted to justify any restriction that may be imposed on a resident. Meals are prepared by staff and the menu is regularly discussed. The home provides food that the residents enjoy and is nutritious. Mealtimes are unhurried and staff are able to offer assistance where necessary. One survey raised an issue about fresh produce at the home, the manager explained that meat is brought fresh, however fresh fruit has been provided but does not get eaten. Vegetables and other food is a mixture of fresh, tinned and frozen. The weight and dietary intake of residents is monitored to ensure they are benefiting from the diet at the home. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. Ashleigh has a complaints procedure which together with a high level of day-to-day contact with residents and relatives encourages any concerns to be made known and responded to. Staff understand safeguarding procedures and this promotes the welfare of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no recorded complaints since the last inspection. Relatives who completed surveys indicated they knew how to make a concern known. There were also examples of when concerns had been raised these had been dealt with appropriately. Ashleigh has an adult protection policy which is covered during induction training. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. All parts of the home are clean and this provides a pleasant environment in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is very clean and the staff are active in ensuring that there is no unpleasant odour. The importance of keeping the environment clean and tidy is appreciated and this provides a pleasant place in which to live. The home is arranged over two floors. There are two main sitting areas, one of which is also a dining room. There are plans to improve the outside seating area, as some of the flags have become worn and the surface is uneven. The home has good infection control measures in place and the Health protection Agency have given advice about good practice. The home has suitable laundry facilities. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Staff are competent and trained to meet the needs of residents this promotes good practice. Sound recruitment procedures are not consistently followed and this could compromise the welfare of residents.This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents at Ashleigh benefit from staffing levels which allow time for individual attention. The staff turnover is low, and there is a consistent and stable staff team. The staff team have received training in Dementia Care and 11 out of 12 staff hold a National Vocational Qualification at level 2 or above. The staff spoken with recognise the value of training and felt encouraged and supported by the manager of the home. The home operates a thorough induction programme and evidence was seen on staff files of this being completed. The staff files looked at showed that there is a recruitment policy in place and that all staff are required to complete an application form, references are obtained and staff are required to complete a probationary period. However in two cases the Criminal Record Bureau Disclosure check had not been carried out on employment, and CRB disclosures had been accepted from previous periods of employment. CRB disclosure checks are not portable and the home Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 16 must ensure that all required checks are completed, in this way the home is taking the required steps to safeguard the welfare of residents. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 , 38 Quality in this outcome area is good. Residents and staff benefit from living in a well run home. All aspects of health and safety are monitored and this provides a safe environment in which to live and work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is owned by an experienced and qualified social worker who is actively involved in the day-to-day operation of the home. She is supported in her role by a manager. The manager holds appropriate qualifications and continues to add to her skills, most recently undertaking a course in Equality and Diversity. The owner and manager are considered to be well motivated, supportive and fair by the staff spoken with. There are clear lines of accountability within the home. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 18 Ashleigh has Investors in People Award which is an external quality assurance scheme. There is no formal surveying of residents or their supporters, because of the small number of residents and the high level of day to day contact with residents, staff and relatives the owner feels able to gain the views of the people who use the service. Recently discussions had been held in an informal way which were looking at meals and mealtimes at the home, this lead to changes in the menu. Policies and procedures are kept under review. The financial procedures in place regarding the use of resident’s monies are understood. All transactions are now signed for showing the staff member who was responsible for the transaction. Staff receive regular formal supervision. This enables time to be taken looking a working practice and training needs. There is also an annual appraisal system in place to monitor performance and promote the continued professional development of staff. Staff receive health and safety training and updates as needed. The Pre Inspection questionnaire details the relevant health and safety checks that have been carried out. There is an accident book maintained at the home. Risk assessments are in place to ensure safe working practices. Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 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 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? NO 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 OP29 Regulation 19(1)(b) Requirement Staff employed at the home must have a current Criminal Records Bureau disclosure check carried out by the home. Timescale for action 14/06/07 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. Refer to Standard OP7 OP12 Good Practice Recommendations Care plans should be up to date and accurate. Residents interests should be recorded and they should be given opportunities for stimulation and leisure both inside and outside of the home, Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Ashleigh DS0000009838.V340297.R01.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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