Inspection on 18/11/05 for Ashley Court Care Home

This inspection was carried out on 18th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashley Court Care Home 08/08/07

Ashley Court Care Home 18/05/06

Ashley Court Care Home 16/06/05

Ashley Court Care Home 19/10/04

Ashley Court Care Home 24/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ashley Court Care Home Reservoir Road Kettering Northants NN16 9QT Lead Inspector Irene Miller Unannounced Inspection 18th November 2005 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 Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 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. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashley Court Care Home Address Reservoir Road Kettering Northants NN16 9QT 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) 01536 482777 01536 415654 Regal Care Homes Ltd Mrs Beatrice Emma Kelly Care Home 38 Category(ies) of Dementia - over 65 years of age (38) registration, with number of places Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No person in the category DE(E) can be admitted into the home when there are 38 people within the DE(E) category already in residence. By agreement there are 2 (two) female service users who have needs within the category of DE(E) and PD(E) By agreement 1 (one) male service user is accommodated with needs within the category of MD(E) The bedrooms with uneven floors are only used by service users who, following a risk assessment, are assessed as having full mobility with the use of mobility aids 16th June 2005 Date of last inspection Brief Description of the Service: Ashley Court is a care home providing personal care and accommodation for 38 older people over the age of 65 years with dementia. Ashley Court is owned by Regal Care Homes Ltd.Ashley Court is situated in a residential area on the outskirts of Kettering town centre. The home is set within its own grounds with an enclosed garden area. There are parking facilities at the rear of the building. Accommodation is on two floors and all bedrooms are single with en suite facilities. There are two communal lounges/dining rooms on the ground floor and a lounge and a dining room on the first floor. There is a small room on each floor that is available for private meetings. There is a passenger lift providing access to the first floor. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The primary method of inspection used was ‘case tracking’ which involved tracking the care of three residents, through a review of their records and discussion with them where possible. Observation of care practices, discussion with the registered person and the registered manager, residents, staff and a limited tour of the building. The inspection took place over a period of four and a half hours following approximately thirty minutes preparation, which included reviewing previous inspection reports, and other documentation. What the service does well: The home is flexible with the admission procedure; prospective residents are encouraged to visit the home prior to moving in and full pre assessments are conducted for each prospective resident to ensure that the home can fully meet their needs. The care plans addressing the residents health care needs were detailed and regularly reviewed, together with resident’s representatives. Records showed that health care services are accessed appropriately for Residents. Resident’s nutritional needs and weights are closely monitored, residents who are identified at risk of not receiving a sufficient balanced diet are referred to the general practitioner, and arrangements made for food supplements to be available. Residents who are on special diets are closely monitored and information is available within their care plans for staff to follow. The home has a flexible approach to the times of day that residents get up and go to bed, this was demonstrated within the care plans and daily reports viewed. There is a repairs and renewals programme in place to ensure that residents live in a home that is well maintained, safe and comfortable. There is a high commitment to staff training, which ensures that the residents receive quality and consistency of care. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 6 The leadership of the home promotes a high quality care, which safeguards the service users health, safety and welfare. 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. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 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 Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 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): 3,4 & 5 The admission process enables service users to make an informed choice before being admitted to the home. EVIDENCE: Full pre assessments are conducted for each prospective resident to ensure that the home can fully meet their needs. A new resident was due to be admitted into the home on the day of inspection the pre assessment documentation was reviewed which confirmed that full pre assessments of prospective Residents needs are carried out prior to admission. The home is flexible with the admission procedure; prospective residents are encouraged to visit the home prior to moving in Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 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): 7,8,9,10 & 11 The care plans communicate the individuality of each resident’s emotional, physical and spiritual needs. EVIDENCE: The care plans contained detailed instructions on the full range of care required by the residents and risk assessments were comprehensive, and specific to the individual residents. The care plans addressing the residents health care needs were detailed and regularly reviewed, together with resident’s representatives. Records showed that health care services are accessed appropriately for Residents. Resident’s nutritional needs and weights are closely monitored, residents who are identified at risk of not receiving a sufficient balanced diet are referred to the general practitioner, and arrangements made for food supplements to be available. Residents who are on special diets are closely monitored and information is available within their care plans for staff to follow. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 10 Residents who administer their own medication are supported in doing so, risk assessments are in place and regularly reviewed, medication records viewed were in good order. The staff were observed, treating the residents with respect and respectful of their dignity and the residents rights to privacy followed. Residents spoken to confirmed that they were happy with the care. Staff training has been provided on loss and bereavement, to enable the staff to support residents and their families at the time of death Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 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 lifestyle in the home meets the resident’s needs and expectations. EVIDENCE: Residents spoken with said that there was ‘things to do’, several residents were observed moving around the home independently as they wished, choosing were to spend their time. Records within care plans contained information on resident’s individual preferences in relation to their daily living activities to facilitate residents in pursuing their own interests. Visiting relatives expressed their satisfaction with the care that the home provided for their relative, and said that they felt confident that they could speak to the manager at any time. A Residents committee has been set up and minutes of meetings were viewed, through discussion with the registered manager the inspector was informed that there are plans to introduce relatives social events. The home employs an activity co-ordinator, records of activities undertaken included crafts, card making, flower arranging and sewing. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 12 The home welcomes visiting entertainers. It was confirmed during discussion with residents and their families and within the care plans, that the home makes provision for residents who wish to attend church services within the community. Through discussion with the registered manager and staff it was confirmed that the home has a flexible approach to the times of day that residents get up and go to bed, this was demonstrated within the care plans and daily reports viewed. The care plans demonstrated flexibility in accommodating the routines of residents as a result of previous occupations, for example waking in the early hours of the morning to start work. Staff welcome visitors into the home and they are able to visit in private. This was confirmed through observations during the inspection. The main kitchen and catering documentation was viewed, the kitchen was clean and well managed with records available of cleaning schedules, stock control, fridge and freezer temperatures and records of risk assessments covering the critical control points (CCP’s) following the processes from the food delivery through to the serving of meals to residents. Staff training is provided in food hygiene control. Resident’s food preferences were recorded within the care plans. The meal on the day of inspection was a choice of fried or poached fish sausages, chips and mushy peas and sponge and custard. The portions were ample and well presented. There are microwave ovens available within the small kitchenettes off the ground and first floor lounges, which facilitate flexibility when meals are taken. Resident’s weights are closely monitored and persons who are identified at risk of not receiving a sufficient balanced diet are referred to the general practitioner, and arrangements made for food supplements to be available. Residents who are on special diets are closely monitored and information is available within their care plans for staff to follow. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Vulnerable adults living at the home are protected from abuse. EVIDENCE: Staff training records demonstrated that training is provided on recognising and reporting abuse, the home has the local protection of vulnerable adults guidance available for reference. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Residents living at the home are provided with a pleasant, homely and comfortable environment. EVIDENCE: A limited tour of the premises was conducted; the residents bedrooms viewed were pleasantly decorated and contained small personal possessions, such as photographs, pictures and ornaments. All rooms had en-suite facilities. There is a repair and renewals programme in place; the home has recently purchased several new armchairs, curtains and soft furnishings. The registered manager explained that a new carpet is on order for the ground floor lounge, and non-slip vinyl flooring ordered for the first floor dining area. Work has begun on creating a sensory therapeutic area on the first floor, which will be available for use by residents with advanced dementia. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 15 Work has begun on creating a hairdressing room on the ground floor, through discussion with the registered manager the inspector was informed that a sink with a shower/rinse attachment has been purchased, a hairdressing chair and other equipment to create a hairdressing salon environment. Painting and decorating has begun on the corridors, and plans are underway to personalise the residents bedroom doors, and provide signage to aid residents in orientating themselves around the home There are two communal lounge/dining rooms on the ground floor and a small lounge and small dining room on the first floor. These areas were clean, pleasant and comfortably furnished There is a central lift for residents to access the 1st floor. The home was clean and free from offensive odours. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 16 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 & 30 There is a high commitment to staff training which ensures that the residents receive quality and consistency of care. EVIDENCE: Staffing levels are sufficient to meet the current needs of the residents. A deputy manager is due to take up post once satisfactory references have been obtained and clearance by the criminal records bureau There is a training plan in place and training records evidenced that staff receive mandatory induction training on moving and handling, food hygiene, fire procedure, health and safety and first aid. On the day of inspection there was a tutor visiting the home from the local College, supporting staff through an Infection Control distance-learning course. Discussion with the tutor and the registered manager confirmed that staff training has been provided on Medication and that two staff are booked to embark upon a Dementia Care course. In addition to the mandatory training provided, training has taken place on report writing, supervision and care planning. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 17 The National Care Standards target of 50 of staff being trained to a National Vocational Qualification level 2 has been exceeded, for this the home is to be commended. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 18 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): 31,32,33,36,37 & 38 The leadership of the home promotes a consistency of high quality care, which safeguards the service users health, safety and welfare. EVIDENCE: The registered manager is experienced and competent and upholds the values of person centred dementia care, through discussion with the Registered Manager it is evident that she has in-depth knowledge of the needs of the residents living at the home. The registered manager has achieved the National Vocational Qualification Level 4 in Management and the Registered Managers Award. A variety of records were viewed during the inspection and these were seen to be well maintained, up to date and accurate. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 19 The registered manager and the company self assess the systems in place to ensure that high quality care is consistently provided. Feedback from residents and their representatives on how the home can improve the service is encouraged. The registered manager was observed interacting well with residents and their visiting families, operating an open door policy. The staff team are appropriately supervised, staff spoken to said that they were happy working at the home and that they felt well supported by the management. Resident’s confidential records are stored securely. Within the care plans there was copies of advice notices from the medical devises agency, in relation to equipment in use and good practice guidelines ensuring that the health, safety and welfare of residents and staff are protected. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 20 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 X 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 3 Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 21 No 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations The level of detail regarding individual needs and preferences within care plans should continue to be reviewed. Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 22 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 © 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 Ashley Court Care Home DS0000050486.V265968.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!