CARE HOMES FOR OLDER PEOPLE
Ashleigh House Care Home 18-20 Devon Drive Sherwood Nottingham NG5 2EN Lead Inspector
Stephen Benson Unannounced 11 May 2005 9:30 am
th 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. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ashleigh House Care Home Address 18-20 Devon Drive Sherwood Nottingham MG5 2EN 0115 969 1165 N/A N/A Mr William Scott, 7 Woodthorpe Drive, Woodthorpe, Nottinghamshire NG5 4FT Graham Moulds Care Home (CRH) 19 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) Category(ies) of Old age, not falling within any other category registration, with number (OP) 19 of places Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: N/A Date of last inspection 20/11/04 Brief Description of the Service: Ashleigh House is a care home providing personal care and accommodation for 19 older people. The home provides short and long term care. The home is owned by William Scott, which is run as a family business. The home is located in a residential area of Sherwood close to shops, pubs, the post office and other amenities. The home was opened in 1987 and consists of 2 converted terraced houses with a purpose built extension. 15 of the home’s bedrooms are single, and none of the bedrooms have ensuite facilities. Bedrooms are located on 3 floors and there is a passenger lift. The home has a small enclosed garden and a small car park. The home does not have a website bnut further information is avaiable from the manager. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the first of two unannounced inspections to be carried out between April 2005 and March 2006. The inspection lasted for 5 ½ hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records and discussing this with them. Other residents were spoken with and additional records were seen. A discussion was had with the manager, both of the care staff on duty were spoken with and care practices were observed. Other residents were spoken with but no relatives or visiting professionals were seen during the inspection. The premises were not inspected in detail but various areas of the home were visited as part of the inspection What the service does well:
Care plans described the assistance residents needed and included a variety of personal, health and social needs. There was some involvement in care plans by residents over agreement or consent issues. A record is made of all medical appointments and those seen showed that recent and regular appointments have taken place including hearing and sight tests and district nurse and doctor visits. One resident said that staff will always call a doctor if she wasn’t well. There were a number of references seen in care plans to promoting physical activity through encouraging mobility and there are weekly movement to music sessions. One resident self medicates some of her medication and there was a risk assessment for this and a consent form in her care plan. Staff said that they had recently had training in handling medicines from the pharmacist and described correct practice for administering medicines. The Medicine Administration Records were correctly completed and medicines were appropriately stored. Staff described flexibility over the daily routine and residents said that they are able to decide when they want to do things. Staff described promoting choice in areas where residents are able to do so. Residents said that they were happy with the food and got enough to eat The home was clean, tidy and fresh smelling. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 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. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.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 Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.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 The needs of residents will be assessed prior to admission EVIDENCE: The majority of residents are funded through care management arrangements and therefore already have a community care assessment carried out as part of that process. In the eventuality that a resident does not have a care management assessment then the manager said that he would carry out an assessment and a form for doing this has recently been prepared. This standard could not be assessed in detail, as there has not been a new admission for over a year. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 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, 8, 9, 10 and 11 Care plans do not have all the relevant information in including risk assessments and any limitation placed on a resident. They should not have an unsupported diagnosis. There are concerns about the respect shown to residents. EVIDENCE: A sample of 3 care plans were inspected and these were well organised making them easy to follow. They described the assistance the resident needed and included a variety of personal, health and social needs. There was a system for reviewing and updating the plans, which had been done regularly until September 2004 but somewhat patchy after this time. There was some involvement in care plans by residents over agreement or consent issues, but did not include comments on the care they require. One resident regularly goes out and there was a letter of agreement on file, but there was no risk assessment regarding this. Another resident has his cigarettes looked after for him but there was no mention of this. A record is made of all medical appointments on a separate sheet in care plans and those seen showed that recent and regular appointments have taken place. These included hearing and sight tests and district nurse and doctor
Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 Page 10 visits. One resident said that staff will always call a doctor if she wasn’t well The doctor was called for one resident who complained of not feeling well and was admitted to hospital. Staff were observed making the necessary arrangements for this. There were a number of references seen in care plans to promoting physical activity through encouraging mobility and there are weekly movement to music sessions. One resident said he had a cataract and was waiting to see the optician. The manager said that this is currently being monitored to see if any intervention is required. There was reference seen in care plans to residents having Munchausen’s Syndrome, but this was not supported by a qualified assessment and should not be used in this way One resident self medicates some of her medication and there was a risk assessment for this and a consent form in her care plan. Staff said that they had recently had training in handling medicines from the pharmacist and described correct practice for administering medicines. The Medicine Administration Records were correctly completed and medicines were appropriately stored. Part of this inspection was spent investigating a complaint made regarding the privacy and dignity of a resident not being respected when getting her dressed by not drawing the curtains in her bedroom. It was accepted that this had taken place and staff spoken with said that their normal practice was to draw the curtains. However there were full and thick net curtains at the window and it was not possible to see into the room from the outside, so whilst the practice of drawing curtains is the correct practice to follow the complaint that her privacy was being compromised is not upheld. There was a stained glass panel on the internal door which could be seen through which could compromise the occupants privacy. Another part of the complaint was that staff had been unable to produce the district nurse notes when requested. The manager explained that this had happened, as they had not been left in a blue folder, which is normal practice, and they were soon located when the member of staff who had stored them came on duty. This part of the complaint is upheld, as the notes should have been available. The final part of the complaint is reported in the staffing section of this report. Residents said that they received support from staff in their personal care and positive comments were made, but there were also some comments made that one member of staff was a bit rough when helping with bathing. This was passed onto the manager and this was repeated to him. The manager must take immediate steps to ensure that this does not reoccur. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 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) 12, 13, 14 and 15 The daily routine is flexible to meet the preferences of residents and they are encouraged to exercise choice. Residents are generally happy with the food provided, although complained about not having a drink of their choice at a recent meal. The kitchen is in poor condition. EVIDENCE: Staff described flexibility over the daily routine and residents said that they are able to decide when they want to do things. Records showed that residents regularly go out. A record is made of activities provided and who attended, it was pointed out to the manager that there were a number of activities pursued by residents that were not being recorded for example one resident case tracked regularly goes to a local church. Another resident said he enjoyed reading and there were plenty of books available in the home. Visitors are welcome and can go to the residents’ room or one of the communal areas. Staff described promoting choice in areas where residents are able to do so, however there is a practice of putting some residents clothes out in the morning when cleaning their room for the following day. There was no explanation offered for doing this and is denying these residents the opportunity to choose what they are going to wear.
Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 Page 12 There was a note on care plans explaining the residents right in accessing their records. There is a 4 week rolling menu which includes a choice of meal. A record is made of each meal in a menu book even if it was as it appeared on the menu. The cook was told that it is only necessary to record any variation from the menu or alternative meal provided. Residents said that they were happy with the food and got enough to eat and the same opinion was expressed by staff. All the required safety checks of food and storage temperatures are carried out. The kitchen is in poor condition and requires refurbishing. Residents complained that on Saturday teatime they had been given hot chocolate to drink rather than tea and been told that they had to drink this. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints are not being identified and dealt with. More emphasis is needed on ensuring residents are protected. EVIDENCE: A complaint made to the Commission for Social Care Inspection was investigated during this inspection (See sections Health and Social Care and Staffing of this report). During the inspection it transpired that there have been some complaints made to staff by residents that have not been acted upon. The manager said that he was unaware of these and they had not been recorded. These included some practices that gave cause for concern. There is a complaints book but no recent complaints have been recorded. Staff spoken with were unaware of the adult protection procedures, although these were available in the office. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Attention is paid to make the environment pleasant for residents. EVIDENCE: The house has an unusual layout and includes a number of changes of levels. The décor is acceptable although somewhat dated in some areas. The manager carries out some of the maintenance tasks and the home is mainly in good repair. There were some maintenance tasks seen that need attending to. There were 2 handrails which were not properly secured and the fire door to the first floor lobby had a severe closing action. Some of the beds are old and shabby and need replacing. The home was clean, tidy and fresh at the inspection. There is a sluice in the laundry and staff were aware of infection control procedures and were seen using protective clothing. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 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) 29 and 30 Staff have not had all the training they require to fully carry out their duties. EVIDENCE: There is an outstanding requirement regarding staffing levels that is being addressed following an additional visit to the home in April 2005. A new member of staff is about to commence working in the home at the end of the week. A staff file was already prepared and included an application form, 2 references and a Criminal Records Bureau Check, which the applicant bought with her. This is over 1 year old and a current one must be applied for. The file also contained the induction programme and training record. Staff said that they had received training recently on the management of medicines and had requested updates on other mandatory training. The manager said that arrangements were in place for some staff to commence NVQ level 2 training, but no other training is planned at present. Training records are not up to date and need to be reviewed to identify which training, including updates, staff require. The final part of the complaint investigated was whether staff had the appropriate skills to provide the support to feeding a resident who was very poorly. The manager said that this had been difficult and they had asked for assistance which had led to the resident being admitted to hospital. This part of the complaint is upheld as staff must have the skills required to support residents they are caring for.
Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 Page 16 Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 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) 31, 32, 33 and 38 There are systems in place to raise concerns with the manager, but this has not resolved conflict within the home. Attempts are being made to find out residents views. More work is required on prevention of Legionella. EVIDENCE: The manager has been in post for over 2 years and reported he has completed NVQ level 4. The manager said that he feels he has the skills and knowledge to hold the post and has a job description. Staff said that they found the manager approachable and could raise issues with him. Staff meetings are held every three months and extended handovers are held to discuss current issues as they arise. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 Page 18 It was evident that a considerable amount of conflict exists between staff at present with some not wanting to work with others. The manager was aware of this and recognised that this must be addressed. The manager reported that an exercise in seeking residents views on their care has been carried out and is currently being analysed for inclusion within the home’s brochure. An additional visit was carried out on 13th April to inspect compliance with outstanding requirement s. A copy of this additional visit report is available with this report. The fire log was up to date and food and cleaning materials appropriately stored. British Gas has serviced the boiler recently. There is a file on preventing Legionella and some safe practices have been employed, however there is not a plan of plumbing within the home and temperature tests are not being carried out in water storage areas. Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 1
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 3 1 x x x x x 2 Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 Page 20 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 7 Regulation 15 Requirement Ensure that care plans are regulalry reviewed and include residents comments on the care they require Prepare a risk assessment for the resident who regularly goes out and record the restrictions on holding cigarettes Medical diagnosis should not be used unless this is supported by an assessment by an appropriately qualified profesional Ensure that glass door panels on bedroom doors cannot be seen through Ensure that residents are not subjected to any rough treatment when being assisted with personal care Refurbish the kitchen Timescale for action 1st July 2005 1st June 2005 1st June 2005 2. 7 12 3. 8 12 4. 5. 10 10 12 12 1st July 2005 Immediate 6. 7. 8. 9. 15 15 16 18 16 16 22 12 Ensure that residents have a suitable drink of their choice with their meal All complaints received must be Immediate dealt with through the homes complaints procedure Staff must be aware of the Adult 1st July Protection Procedures 2005
C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 Page 21 1st December 2005 Immediate Ashleigh House Care Home 10. 11. 12. 13. 14. 15. 16. 17. 19 19 29 30 30 32 38 23 16 19 18 18 18 23 Secure the handrails to the lowr floor and enusre the door closer on the first floor works Replace beds as required 1st June 2005 1st September 2005 Apply for a current CRB for the 1st June new member of staff 2005 Review training record to identify 1st August which training, including 2005 updates, staff require Ensure staff are fully trained to 1st August carry out the their duties 2005 Address and resolve the issues 1st July of conflict within the staff team 2005 Test temperatures in water 1st July storage areas 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. Refer to Standard 14 Good Practice Recommendations Cease practice of getting residents clothes out the previouisn day Ashleigh House Care Home C53 C03 S2188 Ashleigh House V226324 110505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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