CARE HOMES FOR OLDER PEOPLE
Ashleigh Nursing Home 17 Ashleigh Road Off Narborough Road Leicester Leicestershire LE3 0FA Lead Inspector
Keith Williamson Unannounced Inspection 13th June 2006 09:00 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 Nursing Home DS0000001885.V299707.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 Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ashleigh Nursing Home Address 17 Ashleigh Road Off Narborough Road Leicester Leicestershire LE3 0FA 0116 2854576 0116 2854576 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) Mr Ashley Cox Mrs Zarina Cox Mrs Zarina Cox Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Learning registration, with number disability (1), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (21) Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To admit a named person of category LD (55 ) named in variation application No.1847 dated 12 January 2004. Date of last inspection 11th August 2005 Brief Description of the Service: Ashleigh Nursing and Residential Home is registered to admit up to 21 people over 65 years of age who have dementia or mental health care needs. The home is situated near to the centre of Leicester and is a short walk away from main bus routes. Accommodation is available to both the ground floor and first floor, this being accessed by a passenger lift. Residents have their own private bedrooms or share in double bedrooms. All areas of the premises are accessible for people with mobility impairments. The rear of the building offers a small garden area with a patio. The laundry facilities are situated in a separate building. All external doors are alarmed. The current range of fees charged fall between £291 and £475 per week. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views of the service provided. The primary method of Inspection used was ‘case tracking’ which involves selecting clients and tracking the care they received through looking at their records, talking with them where possible, and looking at their accommodation. This inspection took place over one weekday, commencing at 10.00am took seven and one half hours to complete, and was assisted by the manager. An opportunity was taken to look around the home, view records, policies and care plans and to talk to residents and staff. Six of the residents were seen during the inspection however few were able to give the inspector their impressions of the home, one relative was also seen during the inspection and declined to pass comment on the home. Residents spoken withy in the inspection process did not pass comment on the home. What the service does well:
The home has a friendly and relaxed atmosphere. Individual pre-admission assessments were viewed on all residents’ files. Staff employed at the home have a good understanding of the residents individual care needs and they offer support in a professional and dignified manner. Residents have positive choices within the home, in the choice of lounge seating, clothes and meals. The home has a supply of nursing equipment such as hospital beds and air mattresses. Residents’ bedrooms were personalised. Staff have a good understanding of adult protection and are aware of what to do should they suspect anything untoward. Professional input is sought on a regular basis ensuring the residents get the appropriate care that they need. All staff stated that they were well supported by management and both the residents and staff benefit from the family ethos that was evident throughout the home. Staff can communicate in a number of languages. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
The Statement of Purpose could be updated and revised, contracts between the home and individual residents could have bedroom numbers entered into them. All care plans could have detailed instruction on how to care for residents, risk assessments could be entered in all files, as could specific staff instruction and risk assessments on “as required” medications. Health monitoring could be enhanced for all residents in the home, and the accurate self-caring abilities of residents could be entered on each care plan, as could each resident’s selfcaring details. Care plan and nurse monitoring records could be reviewed more regularly. Social care activities could be planned for more regular intervention, with records of activities being completed regularly on residents’ individual daily records. Social care information could be entered into care plans. Records of complaints could be commenced and be inclusive of all complaints to date, to enable manager to monitor these for “themes” and act appropriately. The re-decoration and maintenance programme could be prioritised to include essential work to flooring to reduce the risks of cross infection to residents in the home. A planned programme of furniture replacement is also advisable. The staff recruitment procedures require to be tightened up to ensure the safety of this frail resident group. Quality assurance could be expanded to include all residents, their relatives and any professionals visiting the home; the results of these questionnaires could then be entered in the Statement of Purpose. The information on serious accidents and occurrences in the home could be forwarded more regularly to the inspector. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 7 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 Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 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 Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 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): 1, 2, 3 & 6. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. Prospective residents do not benefit from accurate and updated information. The admission process ensures that the residents identified care needs are recorded. EVIDENCE: The Statement of Purpose was viewed, and is displayed in the homes reception area, this document provides valuable information for prospective residents and their relatives and requires to be updated and revised. Contracts were seen on a sample number of residents’ files the addition of the bedroom number on this document would enhance the residents’ security of accommodation. Pre-admission assessments were seen on all residents files sampled on the day; these provide a valuable insight into the care needs of individuals being admitted to the home.
Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 10 Standard 6 was not applicable at the time of the inspection. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 11 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 poor. This judgement has been made using the available evidence including a visit to the service. Residents are currently looked after well in respect of their health care however lack of care planning detail, risk assessments and risk assessment reviews for some residents could potentially put their health and welfare at risk. EVIDENCE: A sample of three residents care plans were viewed, two of the plans had a good amount of detail and instruction to enable care staff to provide the appropriate care, however one plan for the recently admitted resident had little detail or instruction enclosed, therefore offering an unequal service. In the pre-admission assessment of this third resident it was clearly stated that the resident had a “history of falls”, and had cot sides in place, yet no appropriate risk assessments were in place. Risk assessments were in place for only one of the three case tracked residents, this is not appropriate, as it does not afford suitable protection for this frail resident group. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 12 The recording of health interventions again varies from plan to plan, with no consistency in what information is recorded. No information to the self-caring abilities of individual residents was evident in the sampled plans; nutritional screening was evidenced in one of the plans. Care plan reviews do take place, but are not regular in occurrence. Waterlow nursing assessment tools were evident in files, though one had not been evaluated and reviewed since May 2004. Medication is well ordered, stored and administered appropriately, with no missed signatures in the medication administration records (mar charts). Unused medication is returned to the pharmacist or destroyed in line with current guidance, all transactions being recorded appropriately. Medication records could have specific instruction for staff administering “as required” medications. Discussion with staff and observations during the inspection showed that the staff had a good awareness of ensuring residents privacy and dignity. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 13 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, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. Residents experience a homely lifestyle, however limited social care information does potentially affect the quality of life. EVIDENCE: Residents are offered a limited range of social and recreational activities these are currently not planned in advance, not recorded on taking place and relies on staffs’ availability and personal knowledge of residents’ current abilities. There is a lack of detailed social care information in the care plans, to enable care staff to provide a suitable and varied social care programme. Staff when spoken with confirmed a range of activities take place a differing times of the day. Staff assist residents to maintain links with relatives and the local community, visiting times to the home are open. Through speaking with staff it was evident that choice is promoted for residents in the home. The main meal was observed, with three choices of main meal on offer. A special diet is produced for residents who have differing cultural needs, dietary supplements are in use for a number of residents in the home. The current
Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 14 menu was not seen on this occasion, as it was the subject of being redraughted, this will be viewed on the next visit to the home. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using the available evidence including a visit to the service. There are policies and procedures in place for complaints and the protection of vulnerable adults from abuse, however the lack of complaints records could result in vital information being misplaced. EVIDENCE: The information on complaints is in place and mentioned in the Statement of Purpose, which is available in the foyer of the home. Through speaking with staff it was apparent that they have good knowledge of how to deal with complaints and concerns. There has been one concern since the last inspection; this was not recorded by the manager appropriately at the time. The home currently has no means of recording concerns (complaints) or there outcomes. Staff showed an awareness of the adult protection policies and whistleblowing procedures. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 & 26. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to the service. The standard of the environment provides residents with a comfortable and homely place to live, however isolated areas have the potential to place residents at some degree of danger. EVIDENCE: The public areas of the home have been recently decorated, providing a homely environment. The inspector noted whilst walking around the home that there were a number of areas in need of re decoration. This included a bathroom area and the bedroom belonging to one of the resident’s case tracked. The registered owner explained that an ongoing decoration programme was in place to address these issues. Further issues in the (shared) bedroom of the same case tracked resident, was that of the furniture being in need of repair or replacement, and the flooring which was worn and punctured, therefore not enabling the appropriate cleaning and disinfection to take place.
Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 17 The floor covering mentioned in the last inspection report, to the downstairs corridor is still taped with black and yellow tape and should be replaced in the near future. Personal possessions were evident in the rooms that were viewed and specialist equipment including a hospital bed and pressure mattress were in place. Staff on being spoken with demonstrated a good awareness of hygiene and control of infection. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 the available evidence including a visit to the service. Residents are not supported or protected by the homes recruitment policies. EVIDENCE: The staff rota was viewed; this accurately recorded the numbers of staff in the home, this included trained nurses as well as care, domestic and catering staff. Of the staff files viewed staff are being recruited without the appropriate references being in place, these were obtained as “character” references and were from persons other than the last employer, this practice is unsafe and does not fully protect residents in the home. Staff have undertaken a number of the statutory training courses required by law, further courses are planned, new staff have completed an induction prior to commencing employment. A number of staff can communicate in languages other than English, this reflects the diversity of residents in the home. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 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, 33, 35 & 38. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to the service. The management approach does not promote effective care practice in the home for residents’ care and protection. EVIDENCE: The current manager is a qualified Psychiatric Nurse, and shall shortly commence the National Vocational Qualification level four award. There have been some questionnaires distributed out for quality assurance purposes, though the findings off these were not available for the inspector to view, nor entered into the Statement of Purpose. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 20 Resident financial records were not viewed, as these are not kept in the home for security reasons. The records were not produced throughout the inspection; these will be inspected at the next inspection of this service. Staff were observed, and showed a good understanding of moving and handling residents. Other records were viewed, and accident reports are completed appropriately and there is correlation between these and the residents’ individual daily records. There is evidence to suggest the commission for social care inspection are not informed of accidents affecting the well being of residents in the home, this has been mentioned in previous inspection reports, and the registered provider must ensure compliance with this area, and adhere to the guidance prepared by the commission for social care inspection. Currently the management structures within the home do not fully support effective and safe care practices in the areas of care planning and staff recruitment. Further records and documents that are not regularly reviewed are care plans, risk assessments (including the fire risk assessment), fire alarm and emergency lighting tests. Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 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 15 Requirement The registered provider must ensure residents care plans are accurately maintained including regular evaluation and reviews. The registered provider must ensure that all the necessary risk assessments are completed to ensure the safety of the resident and act on the findings. The registered provider must also ensure that all risk assessments are appropriately reviewed. The original date of the 11th August 2005 was not met. The registered provider must ensure that all floor coverings in the home are fit for purpose. The registered provider must ensure, that proper recruitment procedures are in place, so residents are protected at all times. The registered provider must ensure that all documents and records pertaining to health and safety within the home are fully completed and up to date. Timescale for action 16/07/06 2. OP8 13 16/07/06 3. 4. OP19 OP29 12 19 16/08/06 16/07/06 5. OP38 13 16/07/06 Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 23 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 OP1 Good Practice Recommendations The registered provider should ensure that the Statement of Purpose is updated periodically, to ensure prospective residents and their families have the appropriate information to hand. The registered provider should ensure that a contract is available on file for all residents in the home, and the bedroom number is also entered into the contract. The registered provider should ensure that social care opportunities are recorded individually for residents in the home. The registered provider should ensure that all complaints, including the outcome and any subsequent changes to policies or procedures, are recorded appropriately and made available for inspections. The registered provider should ensure that residents financial records are available for inspection. 2. 3. 4. OP2 OP12 OP16 5. OP35 Ashleigh Nursing Home DS0000001885.V299707.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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