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Inspection on 11/06/08 for Ashley Down Nursing Home

Also see our care home review for Ashley Down Nursing Home for more information

This inspection was carried out on 11th June 2008.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

CARE HOMES FOR OLDER PEOPLE Ashley Down Nursing Home 29 Clarence Place Gravesend Kent DA12 1LD Lead Inspector Mrs Susan Hall Unannounced Inspection 11th June 2008 09:15 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 Down Nursing Home DS0000061039.V365203.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. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley Down Nursing Home Address 29 Clarence Place Gravesend Kent DA12 1LD 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) 01474 363638 01474 363638 ashley.down1@btinternet.com Ashley Down Care Home Ltd Manager post vacant Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That from time to time the service may admit service users under the age of 65. 3rd July 2007 Date of last inspection Brief Description of the Service: Ashley Down is situated in a residential area near to the town centre of Gravesend. The property is a detached, Grade II listed building, with seventeen single bedrooms, and one shared room. It is owned by Ashley Down Care Home Ltd., and the company have one other care home in the area. The company took over the home in 2004. The Director, Mr. Mahomed, is the named “Responsible Individual” for the home for regulatory purposes. He takes an active role in all aspects of the running of the home. The premises provide accommodation on two floors, with a large passenger lift providing easy access between floors. Ten of the single rooms have en-suite toilet facilities. There is a lounge with patio doors leading out into the front garden, a separate dining room, and a large reception area. The home has a patio area at the rear of the property, and parking spaces for several cars. It is close to usual town facilities, such as banks, shops, post office, pubs and places of worship. The current fee levels range from £550.00 to £625.00 per week, depending on the assessed needs of individual residents. Additional charges are payable for items such as chiropody, hairdressing, newspapers and toiletries. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall rating of the home has been assessed as good, 2 stars. This was a key inspection, which involves assessing all of the key national minimum standards, and takes into account all information obtained about the home since the last inspection. The inspection visit was carried out by one inspector, and lasted for just under eight hours. During this time, we (i.e. CSCI) talked with six residents, one relative, and five staff, as well as the manager and the director, who were available throughout the day. The visit included looking at documentation such as care plans, medication charts, staff files and maintenance records; observing staff practice; touring the building; and discussing ongoing plans with the director. CSCI sent out a number of survey forms to residents, staff and health professionals, and we received seven of these back, with helpful information. These all had positive remarks such as “ this is a very nice home and I have no complaints”; and “the home is very welcoming, clean and tidy, it is very homely.” A health professional wrote “on my visits to the home the staff are respectful to the residents and treat them with dignity. Residents speak fondly of the staff.” There have been no complaints made directly to CSCI during the past year, and no referrals to the Social Services Safeguarding Adults team. The director has brought about significant improvements to the fabric of the building since the last inspection visit, with redecoration of many areas, and purchasing new furniture and equipment. He has also appointed a new manager in February 2008, after the previous manager left employment. He is a level 1 nurse, and is currently working alongside the manager in all aspects of the running and management of the home. They anticipate that the manager will apply to CSCI for registration after completing a satisfactory probationary period. What the service does well: The home has a welcoming and friendly atmosphere, and is kept clean in all areas. Several residents commented that they feel it is an advantage to be in a home with just nineteen residents – smaller than many other care homes. The home has an established staff team who work well together. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 6 Residents said that the food is good, well cooked and with a good variety. The manager and director are committed to ensuring high standards of nursing care, and are constantly working to maintain and improve clinical care. This is reflected in the good quality of the care planning. What has improved since the last inspection? What they could do better: Care plans did not clearly evidence consent from residents for having their photographs taken; or photographs of wounds/pressure ulcers. Consent and risk assessments were not clearly provided for means of restraint e.g. bed rails, and wheelchair lap belts. The complaints procedure did not include timescales, and did not clearly state that a response of the outcome of any investigation would be given within 28 days (as per regulation 22). This was being amended on the day of the inspection. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 7 The kitchen and laundry facilities need upgrading, and the director already has plans in place for improving these. Some work on the kitchen had commenced on the day of the inspection. Three carpets were identified as needing replacement, and the director said he would ensure these are done. Soft furnishings throughout the home do not match, and do not enhance the home’s appearance in the way that they could do. The director stated that he is finalising a contract with a curtain supplier, and now that the re-structuring of areas of the building has been completed, upgrading of soft furnishings is next on the agenda. The staff training programme did not evidence that all care staff have completed basic food hygiene training; but the director was amending the documentation with immediate effect. Accident records are well completed but do not include the name and address of the person reporting the accident, and may not comply with the requirements of the Health and Safety Executive. 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. Ashley Down Nursing Home DS0000061039.V365203.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 Ashley Down Nursing Home DS0000061039.V365203.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): 1-5 (Standard 6 does not apply in this home). Quality in this outcome area is good. The home provides detailed information for prospective residents. Good preadmission assessments confirm that the home can meet the needs of individual residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose has been updated to reflect changes in management. It includes all the points required by the regulations, and is well set out, and easy to read. The service users’ guide is set out in large print, with a colour photo of the home on the front. It clearly states the aim of the home to provide a “safe, comfortable and secure environment”, with individuality of care, and maintaining residents’ dignity. The information included gives prospective residents a clear view of how the home operates, and includes data such as Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 10 numbers of staff on duty, arrangements for admission, arrangements for social activities, and for visitors. It also explains certain limitations of the building – such as it is unsuitable for electric wheelchairs inside the home. Residents and relatives are invited to visit the home before making a decision about admission, and can visit more than once if they wish to. Prior to admission, a senior nurse or the manager will carry out a pre-admission assessment. We viewed three pre-admission assessments and they were very well completed, including all aspects of care for people coming into the home. The management ensures that any necessary equipment is in place prior to admission. Each resident is provided with a contract, which shows the breakdown of the fees, and arrangements for cancellation of the agreement by either party. Residents who are funded by local authorities, have a signed contract in respect of the terms and conditions of the home, as well as a Social Services contract. Ashley Down Nursing Home DS0000061039.V365203.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): 7-11 Quality in this outcome area is good. Residents are confident that their personal and health care needs will be met, and recognise that staff give these a high priority. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are initially based on pre-admission assessments, and joint assessments from hospitals/Social Services where applicable. Residents are involved in their care planning, and additional information is obtained from relatives/other carers if indicated. Care plans are set out in individual A4 folders, with an index at the front to make it easy to find the information required. We viewed three care plans and found them to contain very clear instructions, detailing how to deliver personal and health care. Assessments are carried out on admission and updated every month. These include nutritional screening, falls risk assessment, moving and handling risk assessment, skin integrity assessment (“Waterlow”), and weight, Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 12 blood pressure and temperature checks. Data includes details such as “ needs two carers for transfer, use standing hoist; use sliding sheets for moving position in bed”. The assessments lead into care plans for all activities of daily living e.g. maintaining a safe environment, personal hygiene, mobility, sleeping, eating and drinking etc. Care plans are well written, with comprehensive information and clear instructions on how to carry out care. They are updated monthly or as needed. Care plans did not currently include a photograph of the resident, but these were being done. There are separate care plans for items such as wound care and diabetes. Wound care is well documented, with a completed wound care chart for each dressing change, and photos of the wounds. There are clear directions about what dressing to use. There are written records in the care plan for each dressing, and detailing changes in treatment as discussed and prescribed for by the GP. We could not see clear evidence that signed consent is obtained for taking photographs of wounds; and were also unable to evidence consent for restraint, such as use of bed rails, and lap belts for safety in wheelchairs. The manager said that there are written forms for obtaining consent for taking photographs of head and shoulders, and the home would include consent for photographs of wounds. They will also take action to ensure that consent is obtained for restraint procedures as applicable. The need for restraint is already evidenced in care plans, where it is indicated. Risks associated with the use of bed rails must be made clear. Social history and likes/dislikes are stored for individual residents in a separate folder, which can easily be accessed by the activities co-ordinator. There are very good records for multi-disciplinary visits – for example, from GPs, chiropodist, dentist, optician, and palliative care team. Most residents have the same GP, who now visits the home on a weekly basis as a routine (and also in emergencies). A daily record is written at the end of each shift, and these are properly timed, dated and signed. These are good records, with details of residents’ moods, eating and drinking, activities, and how hygiene and health needs have been met. Medication is stored in a recently refurbished clinical room. There are good storage and hand washing facilities. There was no evidence of overstocking. Homely remedies have been agreed with the GP for each person. These are clearly labelled as homely remedies, and a clear stock list is maintained, making these medicines easy to audit. Medication reviews are carried out at each GP visit. Creams and lotions are stored separately. The home currently has two residents prescribed for oxygen, and there was some discussion about ensuring safe storage for empty oxygen cylinders, while they are waiting for Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 13 these to be removed. Medication Administration Records (MAR charts) were viewed for all residents. These include a photograph of each resident, allergies, and details of items such as blood sugar records for diabetics. Two nurses sign handwritten entries. MAR charts indicate when drugs are receipted into the home. These are good records. All nurses are involved in carrying out medication ordering. The director and manager carry out medication audits every month. Care staff were observed as treating residents with respect and dignity. Residents said that the staff are “wonderful” and a relative said they are “amazing”. A health professional wrote in a survey that staff are competent, and show a caring attitude towards residents. One of the objectives of the home is to maintain residents dignity, and enable them to carry out tasks independently for as long as possible. The director and manager have built up excellent links with other multidisciplinary health professionals, including the local palliative care team at the Ellenor Foundation. They are enabling staff to develop increasing competence and skills in managing palliative care, and obtaining advice and training from the team. This is ongoing, and will include training in pre-and post bereavement counselling for relatives, as well as medical management and pain relief for the residents. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 14 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): 12-15 Quality in this outcome area is good. Residents benefit from a choice of activities, and are supported in going out in good weather. The home provides a good variety of home cooked food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities’ co-ordinator five days per week, and she oversees all activities in the home. Her hours are varied between mornings and afternoons, so that she can meet up with residents at times which suit them. She visits residents who are bed bound, or who choose to stay in their own rooms, on a one to one basis each day she is on duty. Joint activities include items such as games, quizzes, craft activities, bingo, musical entertainment and church services. There are also special “themed” days in the home for special events such as Mothers Day, Fathers Day, St. Patrick’s Day, and Bonfire Night etc. Residents were looking forward to a forthcoming barbecue when relatives and friends are also invited, and there is an entertainer (singer) booked. Residents said there is “usually plenty going on”, and that they “enjoy doing things together”. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 15 The activities co-ordinator keeps comprehensive information about residents’ past history, their likes and dislikes, and their interests. She maintains written records for each resident, showing the activities they have enjoyed taking part in, or if they have enjoyed observing others. The local Civic Centre has a “motivation class” for music and movement, exercises etc. once per month, and residents enjoy attending this. There are also shows and pantomimes at the Civic Centre, and this is a popular venue for outings. If the weather is fine, several may go together to the local gardens or pub, with the activities co-ordinator and one or two other staff. Visitors are welcome at any time, so long as it fits in with the resident’s wishes. There are cheese and wine events for relatives to attend as well as barbecues, so this helps to foster good communication between staff and relatives. Food is well managed in the home, with all food home cooked and offering a good variety. The cook keeps her training up to date with additional courses. Care staff carry out cooking on her days off, and these are staff who have carried out basic food hygiene training, and who are sufficiently experienced. The cook informs residents each morning of the menu choices, and will cook them an alternative option if they do not feel like the different dishes on the menu. There is a hot choice at teatime, as well as sandwiches, soup etc. Soup, cakes and pastries are all home made. Fresh vegetables are used on a daily basis, and fresh fruit is always available. Two people said that the meat is sometimes tough or gristly, and this information was passed back to the director to assess if a different meat supplier may be indicated. Residents can have their meals in the dining room, lounge, or their own rooms, according to choice. The kitchen was viewed and was clean and in good order, although it needs some attention. This is addressed in the section on “environment”. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 16 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): 16,18 Quality in this outcome area is good Residents are confident that their concerns and complaints are listened to and are dealt with appropriately. There are systems in place to prevent abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents said that they find staff are easy to talk to, and if they have any concerns they will talk to the staff or manager. The manager sees most residents individually every day, so it is easy for them to raise any issues or concerns immediately. The complaints procedure is on display in the entrance hall, and is included in the Service Users’ Guide. This did not include any timescales, and did not clearly state that a response of the outcome of any investigation would be given within 28 days (as per regulation 22). However, the Home’s administrator sent CSCI an updated copy the next day after the inspection, which showed that the amendments are being made. Complaints are currently recorded in a hardback notebook. There have been two during the past year, and the records show that these were dealt with appropriately. However, the director and manager agreed that it would be more suitable to record complaints individually (e.g. store them in a folder) so Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 17 that they can be sure that confidentiality of individual complaints is maintained. The home has copies of the Kent and Medway Adult Protection protocols, and staff are trained in the recognition and prevention of abuse. We saw copies of certificates in some staff records confirming recent training. This training commences during the induction period, and then there are (currently) yearly updates. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 18 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): 19-22 & 24-26 Quality in this outcome area is good. There have been significant improvements made to the environment during the past year, and residents appreciate the improved facilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home has been vastly improved during the past year in regards to redecoration and repairs to the environment. There has been much activity to improve the facilities, and this work is ongoing. The reception area, ground floor and first floor corridors and landings have all been redecorated in light colours, providing a light and airy environment. Repairs have been made to corridor walls. Some of the bedrooms have been redecorated, and many new furniture items have been purchased. This includes new beds, armchairs, and bedroom furniture. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 19 Window blinds have been fitted to windows in communal rooms and corridors, adding to a better cosmetic effect. The dining room carpet is worn in some areas, and the director stated that this is scheduled for replacement. Dining room tablecloths were of different colours, and soft furnishings in bedrooms did not match. This was discussed with the director and manager, and the director stated that now that structural and decorative processes have been completed, that soft furnishings are on target to be upgraded, with replacements where needed. He is also replacing two bedroom carpets which were identified as worn, and becoming unsafe due to creases in them. The lounge has a large flatscreen TV suitable for easy viewing. There are patio doors leading out on to the front lawn. Work has been commenced on improving the gardens, including a newly fenced patio area – providing a safer and pleasanter environment from the car parking area; and putting slow growing conifers around the front garden to provide screening from the road. This is a listed building, and permission has not been granted for a fence or wall in this area. Most bedrooms are personalised with residents’ own belongings, and all areas of the home are kept clean and tidy. Eleven bedrooms have en-suite toilet facilities. These are fairly small, but are adequate for many residents to access. Some residents also have a commode for night time use. There are a suitable number of disabled toilet facilities for residents to use, and two bathrooms – one on the ground floor and one on the first floor. These are both assisted baths, and the bathrooms are of a good size for taking wheelchairs, hoists etc. There is a passenger lift between floors. The home has a sluice room on each floor. The first floor sluice was out of action as the sluice disinfector was out of order. Action had already been taken to ensure this is repaired. Since the last inspection, new radiators have been fitted throughout the home. These have low surface temperatures. The provider employs a maintenance man to come into the home as needed, and the thermostats are checked on a regular basis. Hot water outlets are all fitted with thermostatic valves, and these are also checked. The kitchen is a reasonable size for the numbers of residents. The floor needs to be replaced, and this is already on the company’s improvement plans. Some of the wall tiles are of poor quality, and these are scheduled for replacement. A plumber was due to commence work fitting a new sink unit. The dishwasher was resting on a raised stainless steel base, with some wood between to stop it vibrating. This cannot be cleaned properly. The provider said that this is all part of the kitchen refurbishment which is already planned. He is also purchasing a new upright freezer, in place of a chest freezer, which is less suitable. The kitchen windows were closed, as there is no mesh at the windows, and in spite of a fan, the kitchen was very hot. The flycatcher was Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 20 not working. A recommendation was given to fit mesh fly screening at the windows and the director agreed to do this. The laundry has two washing machines and two tumble dryers fitted into a very small, inadequate space. There is minimal hanging space for clothes, and no other storage. There is a small sink for hand washing. The room was out of commission on the day of the inspection as a plumber was exploring a leak caused by a lime scale build up in the pipes. Ironing is carried out in a small area outside the laundry. The director stated that he is in the process of having the laundry room refurbished, including a new floor. Sheets are sent out to a commercial laundry, so just clothes and towels are laundered in the home. The director has also made some new staff areas out of previously unused space, including an administrator’s office, a staff dining area, and a room which doubles up as his office, a training room, and a room for meetings with relatives/care managers etc. He has made a small self-contained flat on the first floor with a separate entrance, so that this could be used for a manager if required (or for visiting relatives to stay). The company are taking a proactive approach in improving the environment. So as the processes of refurbishing the kitchen and laundry have been commenced, there is no need to make a requirement for these. However, there is a recommendation to inform CSCI of the scheduled dates for completion, and when work has been carried out. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 21 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): 27-30 Quality in this outcome area is good. Residents benefit from a well recruited staff team, who are committed to providing good standards of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels are currently set as one trained nurse (RN) throughout the 24 hours; three care staff in the mornings, two care staff in the afternoons, and one at nights. These are assisted by an administrator on four days per week, two domestic staff each day (except for one at weekends); one cook; and an activities co-ordinator on Mondays to Fridays. There is often more than one trained nurse in the home, as the director is currently in day to day control of the home. He is a level one nurse, and is mentoring the new manager in managing the home. They are working together on all aspects of home management, including clinical care. On the day of the inspection the director and the manager were on duty, as well as another trained nurse. The management will need to keep care staffing levels under review. There were fifteen residents staying in the home on the day of the inspection. The premises are a large building with many corridors, and having only two care Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 22 staff on duty in the afternoons, and one carer at night may be insufficient numbers when all rooms are occupied. There is a recommendation to review these levels. The director and manager carry out recruitment interviews together. Four recruitment files were viewed, and these demonstrated that there are good procedures in place. All files included the required information – for example, a photograph, properly completed application forms, job description, health questionnaire, full employment history, POVA first and Criminal Record Bureau checks, two written references, and an interview record. Copies of training certificates are kept on file. There is a detailed and comprehensive induction programme, which is in accordance with Skills for Care. One carer has completed NVQ level 2 training, and three others are currently working towards this. This means that the home does not have 50 of care staff trained to NVQ level 2, but are working towards this. There are good staff training records, although the matrix does not clearly show if all staff have completed all mandatory training. This was particularly noticeable with basic food hygiene training, which all care staff should complete, as they are all involved in handling food. The director stated that the company is committed to ensuring that all staff keep up to date with mandatory training. This is commenced at induction, and continued with ongoing updates. There are good records for staff training, stored in individual files. These records also confirm that nurses are enabled to update and increase their nursing skills and competencies. For example, files showed training courses in use of syringe driver, medication management, and nutrition. Residents spoke highly of how well staff care for them, with comments like “they are very caring”, and “they are excellent”. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 23 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): 31-33 & 35-38 Quality in this outcome area is good. The director is working alongside the new manager to ensure all aspects of the home are managed effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new manager was appointed in February 2008. She is a level 1 nurse, with experience in caring for older people, and is currently on a six month probationary contract. She has not yet commenced RMA/NVQ 4 training, but is booked to start this in the autumn. The director – who is a level 1 nurse, and has completed the Registered Managers’ Award and NVQ 4 – is currently in day to day control of the home, and is mentoring the manager, and monitoring all aspects of the home. He is also the home’s Responsible Individual. He Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 24 informed the Commission in writing of this arrangement in February 2008. It was evident that they are working well together. The manager is taking an increasing lead in clinical management, while developing confidence in other aspects of management. The staff work well together as a team, and there is a general willingness to help each other, and assist with other jobs. For example, there is currently only one cook, but care staff who have completed basic food hygiene, and are satisfactory cooks, are covering her days off. All staff have formal one to one supervision, and this provides the opportunity to share concerns and ideas, as well as training needs. This is currently being carried out every three months, and this system is working satisfactorily. Staff also have annual appraisals. Monthly staff meetings are carried out, and this is another opportunity for voicing ideas. Residents are able to share any concerns with the manager on a daily basis, as she has a visible presence on the floor, and is involved in day to day care provision. Feedback is also obtained from relatives and other visitors on a daily basis, and at regular events. These include cheese and wine evenings, and a barbecue arranged for the next month. A survey was carried out by the home in February 2008, with approximately 50 of residents completing survey forms. This gave the opportunity for individual feedback on the day to day running of the home. Residents’ money is managed by themselves or their appointed representatives. The home keeps small amounts of pocket money for some residents. These are stored safely and individually, and each transaction is documented, and all receipts are retained. Records in the home are well maintained, and appropriately stored to protect residents’ confidentiality. Maintenance and servicing records were viewed for fire alarm systems, hoist servicing, commercial waste contract, gas, electricity, legionella check, lift servicing, and PAT testing. A maintenance man is employed to come into the home as requested, to carry our repairs, and general decorating. Other services are contracted in separately. Accident/incident records are well recorded. However, these do not contain the name and address of the person reporting the accident, and may not comply with HSE legislation. There is a recommendation to check this. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 25 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 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 X 18 3 3 3 3 3 X 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X 3 3 3 3 Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 26 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. 1 Standard OP8 Regulation 12 (2) Requirement Care plans must contain evidence that: • consent has been sought from residents for taking photographs of wounds; • consent has been sought from residents for the use of restraints such as bed rails and wheelchair lap belts; • risk assessments must be in place where bed rails or lap belts are used. Timescale for action 31/07/08 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 2 Refer to Standard OP15 OP16 Good Practice Recommendations To review the general quality of the meat, and change suppliers if indicated. To ensure that the complaints procedure contains all the required data. To file complaints, and the action taken, in an individual DS0000061039.V365203.R01.S.doc Version 5.2 Page 27 Ashley Down Nursing Home 3 OP19 folder, to ensure that confidentiality is maintained. To ensure that all scheduled alterations for the building are carried out as planned, namely: • To upgrade the kitchen with a new floor, new wall tiling, upright freezer and mesh fly screens. • To upgrade the laundry so that it maximises the space, and provides a safe working environment. The upgrading includes fitting a new floor. • To ensure that the first floor sluice disinfector is repaired. • To replace the carpet in the dining room. • To replace two identified bedroom carpets. • To improve soft furnishings throughout the home. • To improve the patio area so that it is more attractive for residents. To inform CSCI when the above work is carried out. 4 OP27 5 6 OP28 OP30 7 OP38 To review the numbers of care staff on duty in the afternoons and at night times, ensuring that there are sufficient numbers of competent and experienced staff on duty at all times. To continue working towards 50 of care staff with training in NVQ level 2 in care. To ensure that all mandatory training for staff can be clearly evidenced; And to ensure that all care staff complete basic food hygiene training. To ensure that the home complies with other legislation: i.e. to check that accident records are maintained in accordance with Health and Safety legislation. Ashley Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 © 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 Down Nursing Home DS0000061039.V365203.R01.S.doc Version 5.2 Page 29 - 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. 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