CARE HOMES FOR OLDER PEOPLE
Ashleigh House Care Home 18-20 Devon Drive Sherwood Nottingham NG5 2EN Lead Inspector
Andrew Sales Unannounced Inspection 4th April 2006 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 House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 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 House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ashleigh House Care Home Address 18-20 Devon Drive Sherwood Nottingham NG5 2EN 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) 0115 969 1165 Mr William Scott Graham Moulds Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8/12/05 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 homes bedrooms are single, and none of the bedrooms have en-suite 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 has recently appointed a new manager. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted by A.J.Sales on 4 April 2006 at 10.00am. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. All of the key standards were inspected on this occasion. As a result of some of the issues raised at the previous inspection, the inspector focused on particular standards on this inspection which relate to the health and welfare of the residents. What the service does well: What has improved since the last inspection?
The manager has continued to develop the care planning process and to make sure the needs of it’s residents are met and home complies with the national minimum standards. Recording of daily care and support and storage of information has also improved. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 6 What they could do better:
On the day of the inspection, one member of staff was identified without a Criminal Records Bureau disclosure (CRB). The home must ensure all staff have completed CRB disclosures prior to commencing work. This was identified at the previous inspection as an immediate requirement. Another member of staff has a CRB with disclosures, which warrant close scrutiny and further investigation. The proprietor and manager had not even seen this disclosure and the member of staff had commenced work prior to this being received. There are insufficient personnel records maintained at the home. Some staff records examined did not evidence sufficient pre-employment checks are conducted, prior to commencing work. There was no evidence of any recruitment process being employed. This was also identified at the previous inspection. Immediate requirement notifications have been issued to the proprietor in respect of the above issues and the commission is now considering enforcement action. The manager is not involved in the recruitment process and other management decisions in relation to the running of the home. In order to provide safe and effective systems of work and ensure residents have active involvement in decisions made, it is essential that she is afforded involvement and control in the management of the home and is involved in deciding what staff are selected to work in the home. The office is not equipped for a manager to effectively manage the home. There is insufficient worktop space, one fixed phone with no internet or facsimile facility. The home is required to have one of these means of communication. The phone is very loud and invasive to residents as the office door is adjacent to the dining room with a dining tables and chairs right outside the office door. More attention needs to be given to the effective management of risk within the home. In particular, the risks to residents, staff and environmental considerations. The proprietor was heard discussing a resident’s details and admission to hospital in front of other residents in the dining room, which does not promote a culture of privacy and confidentiality. There is no evidence to suggest that staff are regularly trained in any of the mandatory health and safety subjects, or in Adult Protection issues after they commence work. Staff have not received practical training in safe moving and handling techniques. The staff induction program does not meet the standards of the Skills For Care program, which sets out the minimum standards of induction for care staff.
Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 7 Although the manager try’s to secure the services of regular entertainment or visiting services to the home, this is not always successful. The social needs of residents need to be planned for and resources targeted towards providing for these needs. Some residents are unable to get out and spend a lot of time sitting around in between meals. A majority of staff however will try and spend time with residents when they are not involved in routine duties, however this is limited due to their commitments. The garden area to the rear of the property is littered with rubbish and building materials and is not accessible for residents. Requirements have been made with timescales in respect of all the above issues that require prompt action from the proprietor. 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 DS0000002188.V288156.R01.S.doc Version 5.1 Page 8 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 House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 3,4,6. “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents are appropriately assessed prior to entering the home. The home is capable of meeting the needs of residents it admits. The home does not provide intermediate care. EVIDENCE: The records of three resident’s were checked as part of this inspection. The files contained assessments conducted by the manager and where appropriate local authority extended social care assessments. All of the assessments were detailed and contained sufficient information to enable staff to ensure that they could meet the residents assessed needs. Residents spoken with said they felt staff were competent and polite and were aware of their needs. They also felt that staff understood the importance of residents undertaking tasks of their own at their own pace. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9,10. “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents receive a needs assessment prior to moving in. Residents care plans are reviewed regularly. The home is able to meet the healthcare needs of it’s resident’s. Medication is managed appropriately. Residents are treated appropriately. EVIDENCE: All of the residents whose records were checked as part of this inspection had assessment plans in place. The records show that the plans are being reviewed at least once each month and that residents, and where appropriate their representatives, are being involved in the review process. The resident’s whose plans were inspected, did not contain risk assessments. These need to be completed to ensure the safety of residents and staff, though it is acknowledged that established residents have completed risk assessments in place. The manager has continued to develop these plans to reflect the needs of residents admitted to the home. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 11 Resident’s care plans contain details of each resident’s individual health care needs, including a tissue viability and continence assessment. There is evidence that people have been appropriately referred to health care professionals. Care plans viewed, contained records of visits by district nurses, General Practitioners and other professionals. The manager said that two members of staff had recently had training in handling medicines and this was planned for the remainder of the group. There were a number of references seen in care plans for promoting physical activity through encouraging mobility. Staff were observed during the visit interacting professionally with residents. All three residents who spoke with the Inspector, commented very positively on the conduct and attitude of the staff. They reported that staff provide a good standard of care and areas of concern would be discussed with the registered manager. The proprietor was heard discussing a resident’s details and admission to hospital in front of other residents in the dining room, which does not promote a culture of privacy and confidentiality. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 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 the following standard(s): 12,14,15. “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” 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 and choices provided. Attention needs to be focused on meeting the social and recreational needs of all residents. EVIDENCE: A number of residents were observed coming and going to and from the home. Records showed that some residents regularly go out. Some of the residents spoken with felt they were happy with the level of activities within the home and outside. Other residents said they could not get out when they wanted to, as they had no relatives and staff did not have the time to assist them. The manager described some of the activity that was brought into the home but this was often discontinued due to lack of interest or resources. Some residents were observed spending long periods of time sitting in the lounge. Whilst social preferences are recorded on care plans there is no structure to assess residents wishes and allocate resources to meet these needs.
Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 13 All residents spoken with said they were pleased with the flexible routines within the home and that it was a relaxing place to be. Staff described flexibility over the daily routine and some residents said that they are able to decide when they want to do things. Residents were observed briefly, eating lunch during the visit. The food appeared well presented. Resident’s spoken with commented positively on the standards and quality of food. Staff spoken with, were well aware of resident’s individual preferences. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 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 the following standard(s): 16,18. “Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” The home has policies and procedures for dealing with complaints and adult protection issues. Residents are not safeguarded by the homes Adult Protection procedures. EVIDENCE: The home operates a complaints procedure and records complaints and outcomes. Complaints records were not assessed on this occasion, residents stated they had not had occasion to make any but would approach the manager or staff with issues if they felt it necessary. The Nottinghamshire Policy for the Protection Of Vulnerable Adults was observed, together with the homes polices on adult protection. After discussions with the manager and staff it was evident that a majority of staff require training in this area. This was identified at the previous inspection and requires immediate attention. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 19,20,25,26. “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The home is domestic, clean and hygienic. Residents feel comfortable in this environment. The manager has addressed measures to control legionella and control hot water temperatures. The gardens are inaccessible to residents and require clearing of debris. EVIDENCE: The home was observed to be clean and tidy at the inspection. Residents spoken with, said they felt it provided a homely atmosphere. The inspector spoke to residents in their own rooms, which were well maintained, domestic and personalised. The inspector observed a sluice in the laundry and staff spoken with, were aware of infection control procedures and were seen using protective clothing.
Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 16 The manager showed the inspector measures to monitor water temperatures and has instructed contractors to test water systems for the control of Legionella. Records were observed for a number of safety tests for the fire system, emergency lighting and electrical equipment. The gardens were observed to be full of debris and inaccessible to residents. Residents said they were not aware there was a garden. This requires attention and would provide a private area for relaxation and fresh air. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. “Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” Staff are being recruited to fill vacancies. The manager is not always engaging in sufficient super-numery management hours. The manager is not involved in the recruitment and selection of staff. Residents are not being protected by suitable recruiting procedures. Staff do not receive sufficient training, and require updates in health and safety subjects and subjects specific to the care of older people. Resident’s health and welfare is not being safeguarded due to the lack of staff training. The induction process for new staff does not meet national training standards. EVIDENCE: On arriving at the home the inspector found one member of care staff on duty, with fifteen residents in the home. They stated that a new member of staff had called in sick but had not arranged cover or was not aware of the procedure in the case of staff absence. Eventually the proprietor arrived and the manager was due on duty, cover was arranged swiftly. A cook and one domestic staff were also on duty. With a current occupancy of fifteen residents, from the staff rota provided, the staffing levels normally meet requirements. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 18 Six staff files were sampled. Some contained some evidence of applications, a majority did not have any evidence of the recruitment process and were missing, references and proof of identity. CRB checks were not available for one member of staff. A care worker on duty that day did not have CRB clearance prior to starting work. The CRB that had arrived for this member of staff had not been seen by the proprietor who is currently responsible for recruitment. This document contained disclosures that required immediate clarification and further evidence of the staff’s fitness. The previous inspection had already highlighted similar areas of concern. Immediate action is required to ensure suitable recruitment procedures are followed and the safety of the residents is maintained. We are now considering enforcement action in respect of the above issues. There was no evidence from staff, staff files or the manager to suggest that training is taking place. Staff are not trained in the basic health and safety subjects or subjects relating to the care of older people. One staff file contained evidence of a National Vocational Qualification (NVQ), but there is no evidence of an NVQ program in place. The staff induction was observed in paper form and does not meet the standards of the ‘Skills For Care’ program. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38. “Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” The home’s manager is committed and approachable but is not empowered to manage the home effectively. She is not afforded control over some basic management decisions. Key decisions are made by the proprietor. This results in some practices that do not promote and safeguard the health, safety and welfare of the people using the service. Resident’s views are not fully taken into consideration. Resident’s financial affairs are safeguarded. The Health and welfare of residents is not fully promoted. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 20 EVIDENCE: Residents said they felt the home was well run with the manager on hand for support and advise. Staff spoken with confirmed that they felt supported by the manager and that they are approachable to discuss any issues. The proprietor stated that a new deputy manager is being appointed to the home to support the manager and supervise the staff group. The inspector discussed issues around the management of the home with the owner and manager. Evidence indicates that the manager is not involved in some decisions made at the home including recruitment of staff and therefore has no knowledge of staff coming to work at the home. She has no control over the recruitment process which has resulted in staff starting work at the home who ‘may’ not be suitable. Residents said they are consulted over their care during the assessment and review process, but not over general issues in relation to the running of the home. The manager showed the inspector how residents finances are managed, with individual records held and transactions signed for with receipts for evidence. The manager stated that two of the care staff have received safe handling of medication training updates in the last year, but no other training has been provided. As described in standard 30 a majority of staff have not received training in the basic health and safety subjects and the most recent training certificates were dated 2003. The manager described how she ensures that systems and appliances are tested appropriately. Records of fire system tests and other health and safety records were observed and were found to be carried out at the required intervals. Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 21 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 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 2 2 3 X X X X 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 X X 2 Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13.4.a-c Requirement Ensure a risk assessment is carried out for each individual and for activities within the home Ensure residents privacy and confidentiality is promoted within the home Ensure the social needs of residents are planned for and met. Ensure the gardens are cleared, maintained and made available to residents. Ensure the office is suitably equipped Ensure suitable staffing levels are maintained at all times. Ensure appropriate recruitment processes are used and records maintained. Ensure the identified care worker with CRB disclosures is reviewed. Ensure all staff have CRB disclosures returned prior to starting work. Ensure the Staff Induction program meets national training standards. Ensure all staff receive Health
DS0000002188.V288156.R01.S.doc Timescale for action 30/07/06 2 3 4 5 6 7 8 9 10. 11. OP10 OP12 OP19 OP19 OP27 OP29 OP29 OP29 OP30 OP30, 12.4.a 16.2.m 23.2.o 23.1.a 2.a.i 18.1.a 19.1.a.b Sch 2 19.1.a.b 13.4.c 19.1.b.ii. Sch2.7. 18.1.a.c 18.1.c.i. 30/05/06 30/07/06 30/07/06 30/07/06 07/04/06 07/04/06 05/04/06 07/04/06 30/07/06 30/05/06
Page 23 Ashleigh House Care Home Version 5.1 12. 13. OP30 OP32 13.5 12.1.a,b. and Safety training updates each year. Ensure all staff receive practical training in safe moving and handling Ensure the manager is fully involved in all aspects of running the home. 30/05/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashleigh House Care Home DS0000002188.V288156.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Nottingham Area Office 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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