CARE HOMES FOR OLDER PEOPLE
Ashleigh Nursing Home 17 Ashleigh Road Off Narborough Road Leicester Leicestershire LE3 0FA Lead Inspector
Debbie Williams Unannounced Inspection 15th August 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 Nursing Home DS0000001885.V347306.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.V347306.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 ash_ashleigh@btconnect.com 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.V347306.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. 14th March 2007 Date of last inspection 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. A copy of the last inspection report was available at the home. Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over three and a half hours on the 15th of August 2007. The last key inspection took place in March 2007 and from this several requirements were made. This inspection was positive, as the providers were able to demonstrate they were working hard to meet previous requirements and in many areas had achieved this. The main method of inspection was called ‘case tracking’ which meant selecting three residents and tracking the quality of their care by checking records, discussion with them and with staff and observation of care practices. Residents case tracked were unable to make comment about the home due to their mental condition. Two relatives and one staff member was spoken with and the manager and the owners of the home were also available for discussion and feedback throughout the inspection. Staff records were looked at to make sure staff get the training they need and checks are carried out on staff before they commence their employment. A partial tour of the premises also took place in order to assess environmental standards. What the service does well:
The home has a friendly and homely atmosphere; relationships between residents and staff appeared very positive and respectful. Staffing levels were good and this enabled staff to spend time sitting and chatting with residents. The management team were approachable and inclusive, relatives and staff felt able to raise concerns or make suggestions as they arose. The providers were flexible in their approach to care practice and the day to day running of the home, therefore individual needs could be met and equality and diversity promoted. Staff were able to converse in a number of languages. Staff and managers had a good understanding of safeguarding adults’ policies and procedures; care staff had received training in this area. Professional input was sought on a regular basis ensuring that residents get the appropriate care that they need. Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection?
Since the last inspection residents have been provided with a written contract setting out the terms and conditions of residency. Care plans are being reviewed and evaluated more frequently. Medication procedures have been improved in order to ensure a safe system of administration. Staff have received further training and supervision regarding the safe administration, recording and handling of medication. A programme of refurbishment and redecoration has begun, some floor coverings have been replaced and maintenance work carried out. Recruitment procedures have been reviewed and staff responsible for recruitment and personnel have been instructed and supervised to ensure the correct procedures are followed in order to protect residents. A programme of staff training has been commenced, dementia care and the management of challenging training will be provided to care staff, this will ensure that staff can meet the specific needs of residents with dementia. A contract for the routine maintenance and servicing of moving and handling equipment has been commenced. The range and frequency of recreational activities had been increased. The findings form the last relative satisfaction survey had been collated. These had been fed back to relatives within a newsletter, along with the action the providers would be taking in response. Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 7 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 Nursing Home DS0000001885.V347306.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.V347306.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 and 5. (Standard 6 does not apply to this service) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with the information they require before moving into the home. Resident’s needs are assessed but assessment information did not fully address all needs. EVIDENCE: A copy of the Statement of Purpose and contract of terms and conditions were seen. The Statement of Purpose contained the information required by residents and prospective residents. A copy of the home’s terms and conditions were seen in the care records of case tracked residents. Relatives
Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 10 spoken with confirmed that a pre admission needs assessment had been carried out and that a contact of terms and conditions and Statement of Purpose had been provided. The providers confirmed that a full needs assessment is carried out before residents move into the home, where possible social service and or hospital assessments are also used as part of the assessment process. Assessments are carried out by one of the owners or by the manager, both of who are qualified nurses. A four-week trial period is offered to all residents before a decision is made to permanently move into the home. Assessment records for three case tracked residents were inspected. Assessments were mostly comprehensive and included risk assessments but did not include nutritional needs assessments or nutritional risk assessments. A requirement was made at the last inspection regarding nutritional assessments. The providers were aware of this shortfall and were planning to introduce nutritional assessments for all residents. Assessments included the cultural, religious and social needs of residents. Ashleigh Nursing Home DS0000001885.V347306.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are met and medication policies and procedures minimise risk. EVIDENCE: Care plans for three case tracked residents were inspected. Care plans appeared to address all assessed needs. Although nutritional screening had not been implemented, one resident who was receiving a specialist feeding programme had all the information and instruction required by staff to meet this need, this included details of how to contact the dietician.
Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 12 Risk assessments and care plans for the prevention of pressure sores were in place. Records of GP and psychiatrist visits were seen. Care plans were mostly reviewed at least monthly with only one instance of a care plan not being reviewed within this timescale seen. Care plans did address resident’s cultural, religious and social needs and preferences. All medication is administered by qualified nurses. Administration records for three case tracked residents were seen and these appeared to be accurate. Storage areas also appeared to be in good order. Since the last inspection a separate document has been introduced to record the administration of as required medication that is used for agitation or anxiety, instruction stating when to use this medication is also included. The manager said that supervision had taken place regarding medication with all qualified nurses, evidence of this was seen for one staff member. Interaction observed between residents and staff members appeared positive and respectful. Two relatives spoken with said that all staff were friendly and respectful. Ashleigh Nursing Home DS0000001885.V347306.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents experience a homely and relaxed lifestyle individual residents needs and preferences are mostly met. EVIDENCE: Resident’s life history and social interests were recorded within individual care plans. One resident who was confined to bed due to physical and mental disability did have their choice of music playing in their room but it was recommended that further stimulation could be provided with refurbishment and redecoration of their room and further personalisation (pictures photographs etc) in consultation with the residents family. Advice should also be sought from the resident’s psychiatrist regarding social isolation. During this inspection staff were seen interacting with residents in a meaningful way. One staff member spoken with said they enjoyed working at
Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 14 the home because staff were given time to sit with residents and spend time with them. Relatives spoken with were happy with the range and frequency of activities provided, musical entertainers and ‘sing alongs’ were provided and staff took residents out for walks in the park. Records of activities provided were seen and these included walks out, entertainers, sing alongs and gardening. Relatives spoken with said that routines of daily living and preferences were established at admission. Relatives spoken with said they were made welcome by staff, could visit anytime and could see their relatives in private. Menu records were seen, a varied diet was on offer with alternative choices provided. Specific religious/cultural diets were being provided. Relatives spoken with said the quality of meals was good and that their relative had put on weight since they moved into the home. One staff member spoken with said the food was very nice and the cook was good. The cook was spoken with and said that enough resources were available to provide a varied and nutritious diet and that there were snacks and sandwiches available for residents at all times. The providers were in the process of implementing nutritional assessments for all residents Ashleigh Nursing Home DS0000001885.V347306.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures in place minimise the risk of harm for residents. EVIDENCE: The home has a complaints procedure that states that complaints must be responded to within 28 days and details of how to contact other agencies such as social services are included. The complaints procedure was seen in the reception area of the home. Relatives and staff spoken with said that the management team were approachable and responded appropriately to complaints. A record of all complaints received was maintained. One staff member spoken with confirmed they had received training regarding the protection of vulnerable adults and was aware of the correct procedures to follow in the event of suspected abuse. The care manager was also able to demonstrate a good knowledge and understanding in this area. The manager said that all staff were instructed to read the safeguarding policies and procedures and that in house training was provided, records of this were seen. Ashleigh Nursing Home DS0000001885.V347306.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment; further refurbishment and redecoration would ensure all areas of the home were pleasant and comfortable. EVIDENCE: A partial tour of the premises was undertaken and this included the private accommodation of case tracked residents. All areas seen appeared clean and hygienic, the general decoration and furnishings were in need of updating and or replacing. The providers said that a programme of refurbishment was in progress. The floor covering near the kitchen had been replaced and there were plans to replace the floor coverings in some bedrooms. All bedrooms will
Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 17 be upgraded and furniture replaced as necessary. New electrical profiling beds were being purchased and a new shower facility was to be installed. The provider’s newsletter that provides information to relatives detailed all these refurbishment plans. Resident’s private accommodation was personalised and homely in appearance. The private room of one resident was in need of some redecoration and further personalisation. Staff spoken with were aware of infection control policies. Ashleigh Nursing Home DS0000001885.V347306.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by the numbers and skill mix of staff. Residents are protected by the home’s recruitment procedures. EVIDENCE: At the time of this inspection there were 18 residents living in the home. The staffing roster was inspected. There is always at least one qualified nurse on duty; there were four care staff on duty during daytime hours and two at night (one staff member from 10 pm to 3 am. Staff and relatives spoken with felt there were appropriate numbers of staff on duty. One staff member reported that staffing levels were good and enabled them to spend quality time with residents. Staff records for two staff members were inspected. Staff records contained certificates of training provided, this included dementia awareness, moving and handling and fire safety. Annual appraisal and supervision records were also seen. Criminal Record Bureau checks and two written references were seen for both staff members. Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 19 The provider said that challenging behaviour management training was being arranged for all care staff. ‘Skills for Care’ (a national training organisation) induction training was being implemented, two staff members had already completed this and all other staff were to commence this induction training. There were three staff members with a national vocational qualification in care. The providers intended to enrol further staff on national vocational qualification training. Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 20 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): Standards 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of residents and minimises risk. EVIDENCE: The home is run and managed by two proprietors and one manager, two of whom are registered mental nurses. The manager plans to commence registered manager training. Staff and relatives spoken with felt that the management team were approachable at all times. The provider’s newsletter was seen and this provided outcomes and findings of the last relative’s questionnaire and action the providers were taking in
Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 21 response to this. A suggestion box is also used for relatives and staff to make suggestions or provide feedback. The Investors in People Award which is an award regarding quality assurance has been achieved and was last renewed in January 2006. The providers also plan to implement an in-house programme of risk assessment and quality assurance. Certificates of maintenance and servicing were seen for the passenger lifts and the hoists. The providers annual quality assurance assessments confirmed that all electrical, gas and fire detection equipment had been maintained and serviced. The fire risk assessment and records of testing and fire drills were seen. Where the providers manage resident’s personal money, records of all transactions are maintained and two signatures obtained. Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 22 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 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 23 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 OP30 Regulation 18 Requirement Ensure that all staff members receive all required training appropriate to their role. This includes all mandatory health and safety training, induction, dementia training and any other training relevant to the needs of residents. This is to ensure that residents are in safe hands at all times. Ensure nutritional screening is carried out and kept under review for residents that have identified nutritional and dietary needs. This is to safeguard residents’ health and wellbeing. Timescale for action 30/10/07 2. OP8 13 30/09/07 3. OP19 23 The programme of refurbishment 30/01/08 and redecoration must continue until all areas of the home are brought up to a reasonable standard and an attractive and comfortable environment is provided. Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 24 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 OP12 Good Practice Recommendations It is recommended that further stimulation could be provided for the resident who was confined to bed due to their physical and mental condition. Refurbishment and redecoration of their room and further personalisation (pictures photographs etc) in consultation with the resident’s family would provide a more stimulating and comfortable environment. Advice should also be sought from the resident’s psychiatrist regarding social isolation. Ashleigh Nursing Home DS0000001885.V347306.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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
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