CARE HOMES FOR OLDER PEOPLE
Ashleigh 7 St Johns Hill Wimborne Dorset BH21 1BX Lead Inspector
Jo Palmer Unannounced Inspection 10:00 24 February 2006
th 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 DS0000026758.V284855.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. DS0000026758.V284855.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ashleigh Address 7 St Johns Hill Wimborne Dorset BH21 1BX 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) 01202 883314 01202 883314 Mr C Dodla-Bhemah Mrs J R Dodla Bhemah Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places DS0000026758.V284855.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th September 2005 Brief Description of the Service: Ashleigh is a care home registered to provide accommodation to a maximum of 10 service users in the category OP (Old Age). The home usually accommodates 9 service users, as one double room is generally used for single occupancy. Ashleigh is a detached older style property located approximately one mile from Wimborne town centre. The house retains many of its original features and stands within its own, well-maintained gardens. Off road parking is provided. A three-storey building, accommodation is provided to service users on ground and first floor levels whilst the owners occupy the top floor as private accommodation. Access to the first floor is by means of a central stairway with chair lift. There are four bedrooms on the first floor and a bathroom and separate toilet. Two of these first floor bedrooms are reached by a further four steps without lift assistance. The ground floor comprises of five bedrooms, a communal lounge and a dining room, a bathroom and a toilet. The kitchen and laundry are also on the ground floor. Wimborne offers the amenities of a market town with high street shops, post office, banks and building societies as well as GP surgeries, a cottage hospital and various places of worship. DS0000026758.V284855.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection on 24th February 2006 lasted for one hour, forty five minutes. Mr Dodla-Bhemah assisted with the inspection process providing necessary information and access to records. Mrs Dodla-Bhemah was also present although was busy preparing the midday meal, one other carer was on duty. There were nine residents accommodated, one of whom was out for the day. The Commission for Social Care Inspection will assess a care home’s performance against the thirty-eight National Minimum Standards, specifically, ‘key’ standards at least once in the inspection year. The inspection of 13th September 2005 assessed the performance at Ashleigh against twenty-seven standards, all of which were met; this visit was a brief inspection with the intention on focussing on the remaining standards that had not been assessed during the last visit, in all, eighteen standards are reported on. For those standards not assessed and reported on, the reader is referred to the report of the last inspection dated 13th September 2005, which can be obtained either from the home or can be viewed on www.csci.org.uk The inspector spoke with Mr Dodla-Bhemah, took a tour of the property, examined relevant records and medication systems, spoke with two residents privately in their rooms and six residents collectively in the lounge. What the service does well:
Residents and their representatives are provided with sufficient information about the service provided at Ashleigh in the form of a Service User Guide and Statement of Purpose. Medication systems in the home are well managed following Royal Pharmaceutical guidance. It was evident that residents are able to maintain contact with their friends and a family, visiting is encouraged and facilities of the local community are used as appropriate depending on resident’s needs and abilities. The meals in this home are good offering both choice and variety using home cooked, fresh ingredients. There have been no recent deaths in the home although it was evident that procedures are in place informing staff on how to sensitively deal with such an event. There have been no complaints received either by Ashleigh or by the Commission in respect of the care and services provided and residents are assured through written procedure that their concerns will be taken seriously DS0000026758.V284855.R01.S.doc Version 5.1 Page 6 and managed effectively. Residents legal rights are upheld and all residents benefit from the support of their representatives with their affairs. Ashleigh provides a clean and well-maintained environment where residents are able to live with their own belongings around them, all areas of the home provide sufficient space for residents to move around freely, spend time alone or use communal space and benefit from each others company. Mr Dodla-Bhemah manages the home well and is continuing to measure the quality of the services and care provided to residents by means of satisfaction surveys, the results of which are published in a residents newsletter. Mr Dodla-Bhemah confirmed that all residents have representation and support in managing their financial affairs, Ashleigh therefore does not involve itself with residents finances. Staff are trained in relation to health and safety practices and inspection by the local authority in relation to food hygiene and environmental health had positive results. 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. DS0000026758.V284855.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000026758.V284855.R01.S.doc Version 5.1 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 the following standard(s): Standard 1. Standard 6 is not applicable The home’s Service User Guide supplies residents and their representatives with detail of the care and services provided at the home in order that they can make an informed decision whether to move to the home. EVIDENCE: The home’s Statement of Purpose and Service User Guide were not directly assessed during this visit although Mr Dodla-Bhemah confirmed that this had not been reviewed since the last inspection which reported standard 1 as met. A review of the current copy of the Service User Guide held on file with the Commission, although dated April 2003, confirmed that information provided is relevant and detailed and would enable prospective residents to make an informed decision about moving to the home. There have not, however been any new admission to the home in the past year. Please refer to the previous inspection report dated 13th September 2005 for evidence that standards 2, 3, 4 and 5 were met. DS0000026758.V284855.R01.S.doc Version 5.1 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 the following standard(s): 9, 10 & 11 There are satisfactory arrangements for managing medication in the interests of residents. Residents are treated with respect by staff who have an implicit understanding of their needs and rights to privacy. Procedural guidance provides staff with information necessary to manage the death of a resident. EVIDENCE: Please refer to the previous inspection report dated 13th September 2005 for evidence that standards 7 and 8 were met. Systems of managing medication on behalf of residents demonstrates good practice, records are held detailing all medication administered and where residents retain control over their own medication, risk assessments are in place to ensure their continued safety. All medicines are securely stored and staff have received training in medication management. DS0000026758.V284855.R01.S.doc Version 5.1 Page 10 Residents spoken with confirmed that staff treat them respectfully and where intervention is necessary with personal care routines such as bathing, staff are sensitive tot heir needs and respectful of their rights to privacy. One resident stated that she thought of Mrs Dodla-Bhemah ‘as a daughter’ and a good friend as well as a carer, another resident stated that the staff are ‘very good indeed’. Standard 11 was not directly assessed; there have been no deaths at Ashleigh in the past two years. Mr Dodla-Bhemah confirmed however that procedural guidance is available for staff that, in the event of a death in the home, directs them to the proper course of action including contacting the relevant persons and the reporting procedures. DS0000026758.V284855.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 & 15 The care and social environment at Ashleigh allows residents to make decisions regarding how to spend their leisure and recreational time, all are able to receive visitors freely and go out with friends and family. Residents dietary and nutritional needs are met with a variety of home made dishes made with fresh ingredients. EVIDENCE: Although not directly assessed, it was evident from speaking with residents that they are able to make choices about their social care and recreational activity in the home. Residents spoken with confirmed that they can have newspapers delivered, library books are collected and returned, and occasional entertainment is organised in the form of singers and musicians. Residents also confirmed that they are at liberty to spend ‘private’ time in their rooms as they please or to meet with other residents in the lounge or over lunch to enjoy each other’s company. All those spoken with confirmed that meals in the home are good, and although none stated that they ever have to ask, alternatives to the set meal would be available on request. Fresh ingredients are used and vegetables in season were evident in the kitchen. One resident spoken with had a plentiful supply of fresh fruit in her room which she confirmed Mr Dodla-Bhemah provides on her behalf. DS0000026758.V284855.R01.S.doc Version 5.1 Page 12 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 & 17 Residents are assured that any complaints or concerns will be addressed and managed appropriately. Resident’s rights to participate in the civic process are upheld and their legal rights protected. EVIDENCE: The last inspection evidenced that Standard 18 was met. The complaints procedure was not examined during this inspection although discussion with residents revealed that they would now who to speak to if they were unhappy or had any concerns, all those spoken with confirmed that they had no complaints. Mr Dodla-Bhemah also confirmed that no complaints had been received. Mr Dodla-Bhemah also confirmed that all residents accommodated at Ashleigh are on the electoral register in order that arrangements for their participation in local and national elections can occur; Mr Dodla-Bhemah stated that several residents have a pre-arranged postal vote and others are able to go to the local polling station. All residents have representation with their personal affairs through family members or their solicitor. DS0000026758.V284855.R01.S.doc Version 5.1 Page 13 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 & 25 Ashleigh provides a well-maintained, comfortable environment for residents and although there has been no assessment of the premises to establish the extent of any specialist equipment needed to promote resident’s independence, access around the home for the current resident group is not restricted. Hot radiator surface temperatures where assessments of risk have not been carried out could compromise Resident’s safety. EVIDENCE: Mr Dodla-Bhemah confirmed that redecoration occurs as necessary, those areas seen including hallways and corridors, some resident’s rooms, the lounge and dining room were in a good state of repair. There is no written schedule of routine maintenance in respect of redecoration although planned servicing and maintenance of all equipment is carried out to a prescribed schedule. Access around the home for residents is not restricted, there is a stair lift providing access to the first floor and grab rails are provided where appropriate. Resident’s mobility needs are assessed individually as the need arises; all current residents are independently mobile although some use
DS0000026758.V284855.R01.S.doc Version 5.1 Page 14 walking aids. It is recommended however that Mr Dodla-Bhemah secure the services of an occupational therapist to assess the extent of the disability equipment, aids and adaptations required to maximise resident’s independence around the home. The home was a suitable temperature for the time of year and weather conditions and residents spoken with confirmed that they were warm enough. Radiators around the home do not have low surface temperatures and are not guarded; no individual risk assessments have been carried out to promote resident safety. Following the inspection, information was sent to Mr DodlaBhemah outlining the expectations of the Health and Safety Executive in relation to hot surface risk assessments. DS0000026758.V284855.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. Please refer to the previous inspection report dated 13th September 2005 for evidence that standards 27, 28, 29 & 30 were met. EVIDENCE: DS0000026758.V284855.R01.S.doc Version 5.1 Page 16 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, 36 & 38 The management arrangements of the home support good care practices for residents; Mr Dodla-Bhemah is progressing a quality assurance exercise that will ensure the home continues to be run in the best interests of residents. Systems are in place to ensure residents have representation for managing their financial affairs. Good Health and Safety practices in the home promote resident safety and welfare and staff are trained in relevant areas of health and safety practice. EVIDENCE: Mr & Mrs Dodla-Bhemah are registered providers, Mr Dodla-Bhemah takes much of the management responsibility of the home and organises the home’s administration. Mr Dodla-Bhemah has attained an NVQ level 4 and the Registered Managers award.
DS0000026758.V284855.R01.S.doc Version 5.1 Page 17 The last inspection reported that standard 33 was met, Mr Dodla-Bhemah has developed questionnaires for residents and their relatives requesting information on the care and services provided, from these a report in the form of a newsletter is produced to inform residents of the overall results. Questionnaires are designed around various aspects of the service, a recent questionnaire seen that is due to be issued is around provision of food. Mr Dodla-Bhemah confirmed that he does not manage any resident’s finances on their behalf, all residents have representation with their financial affairs from their next of kin or appointed solicitor. Mr Dodla-Bhemah ensures that all staff receive an annual appraisal identifying their training needs and covering all areas of practice. Supervision of staff was previously carried out on a three monthly basis and a record held of issues discussed, this however has lapsed in favour of the annual appraisal. Being a small home with just three staff, Mr Dodla-Bhemah confirmed that he works closely with all staff employed and continual discussion and supervision is carried out. Mr Dodla-Bhemah was advised to ensure that although this is an informal method of supervision, any significant matters are recorded. A report was seen relating to a recent Food Hygiene inspection carried out by East Dorset District Council Consumer Protection Service confirmed that there were no concerns and that good practice was maintained. Any accidents that happen in the home are reported appropriately using the Health and Safety Executive recommended reporting format that complies with data Protection legislation. There have been three reported accidents since the last inspection, none of which resulted in serious injury. Mr Dodla-Bhemah is advised to ensure that the index of the reporting system is used correctly to ensure ease of reference to each accident report. All staff have received training in areas relating to moving and handling and infection control. DS0000026758.V284855.R01.S.doc Version 5.1 Page 18 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 3 11 3 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 3 18 X 3 X X 2 X X 1 X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 DS0000026758.V284855.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement All service users must have an assessment in relation to the risks of accidental scalding posed by unguarded pipe-work and radiators. In the absence of risk assessments, all pipe-work and radiators must be guarded or have guaranteed low surface temperatures. Timescale for action 1 OP25 13 30/04/06 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 OP22 Good Practice Recommendations An assessment of the premises by qualified persons, including an occupational therapist, should be made to establish the extent of the disability equipment to be provided and environmental adaptations required to meet the needs of service users. 1 DS0000026758.V284855.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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