Inspection on 02/06/05 for Ashley Down Nursing Home

This inspection was carried out on 2nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashley Down Nursing Home 11/06/08

Ashley Down Nursing Home 03/07/07

Ashley Down Nursing Home 22/01/07

Ashley Down Nursing Home 24/04/06

Ashley Down Nursing Home 24/10/05

Ashley Down Nursing Home 06/12/04

Ashley Down Nursing Home 05/08/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Ashley Down Nursing Home 29 Clarence Place Gravesend Kent DA12 1LD Lead Inspector Elizabeth Baker Announced 02 June 2005 09:25 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 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 H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashley Down Nursing Home Address 29 Clarence Place Gravesend Kent DA12 1LD 01474 363638 01474 325460 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashley Down Care Home Limited Vacant Care Home 19 Category(ies) of Old Age, not falling within any other category registration, with number of places Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 06 December 2004 Brief Description of the Service: Ashley Down is a care home providing nursing care for 19 Older People (Old Age, not falling within any other category). Ashley Down Care Home Limited is the registered provider. Mr R Mahomed is a Director of the Company and is the named Responsible Individual for regulatory purposes. Ashley Down was first registered as a care home in 1985. The home, which is a Grade II listed building, is located in a conservation area near to the town centre of Gravesend. Shops, pubs, main post office, banks, places of worship and other amenities are easily accessible. Bedroom accommodation comprises 17 singles and one double room. Ten single rooms have ensuite toilet and washbasin facilities. There is an eight-person passenger lift. All rooms used by residents are connected to the nurse call alarm system. Communal accommodation comprises a day room, separate dining room and reception room. The home has a small secluded patio garden at the side of the property, which is easily accessible to residents. Car parking is limited. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over eight hours on the 2 June 2005. Lead Inspector Elizabeth Baker carried out the inspection. A partial tour of the home took place. Some judgements about the quality of care, life and choices were taken from direct conversation with residents, direct observations and evidencing records held at the home. Some records were inspected as part of case tracking and to assess progress on requirements and recommendations made at the previous inspection. A number of residents were spoken with of whom four agreed to be formally interviewed. A relative and some members of staff were spoken with. In response to the announcement of this inspection, the Commission received comment cards about the service from residents (17), relatives/visitors (8), GPs (2), Health Care Professionals (3) and Care Managers (2). Some of their comments and responses have been incorporated into the report. In the absence of a manager, Registered Nurse Mrs A Burmis assisted in the inspection process. The two Directors of Ashley Down Care Home Limited were present for part of the inspection. At the time of the visit 17 residents requiring nursing care were residing at the home. What the service does well: What has improved since the last inspection? Most care staff have now received appropriate training in providing care for residents with sight impairments. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 6 Some of the requirements and recommendations made at the previous inspection have been actioned. The new nurse call alarm system has additional aids, which helps residents with limited movement and sight impairment in obtaining assistance when necessary. What they could do better: A suitably experienced manager with the necessary skills, competencies and qualifications to manage the home must be appointed as a matter of urgency. In the interim the senior registered nurse must be afforded sufficient supernumerary time to supervise and manage staff. Robust recruitment vetting systems must be developed and followed. Permanent staff must not commence employment at the home until all satisfactory references, work permit permission and clearance checks have been received. The home must only admit residents whose condition and diagnosis falls within the home’s current registration criteria. Food preparation practices must be improved for residents’ protection. The range and availability of activities must reflect the capabilities, choices preferences of the current residents and be adequately resourced. A quality assurance system must be introduced as a way of obtaining residents’ and their representatives’ views on the facilities and services provided by the home. All complaints must be treated seriously, recorded and appropriately investigated. The complainant must be informed of the outcome. Staffing levels must reflect the assessed needs of the current residents to ensure they are appropriately cared for at all times. Registered Nurses must work within their professional Code of Conduct when delivering and evidencing nursing care and administering medications. As the majority of residents live at the home for the rest of their lives, information in respect of their preferences in respect of death and dying must be obtained and recorded to minimise additional stress at a sensitive time. The facility for medicine preparation, storage, safety and security must be adequate for a home providing nursing care. The provision must also enable nursing aids and sundries to be appropriately stored within. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 7 The inspection resulted in an immediate requirement notice being issued. A letter was subsequently sent to the Director requiring an urgent action plan to address the immediate requirements. 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 Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The home’s Statement of Purpose, Service User Guide and admission process does not prevent new residents being admitted into the home whose assessed needs fall outside the home’s registration category. This presents a potential risk to residents as well as a breach of the provider’s registration. EVIDENCE: The home has a statement of purpose and service user guide, which includes details of the home’s registration criteria including categories of registration. A newly admitted resident, assessed by a Registered Nurse in their former care home, has a medical diagnosis, which Ashley Down is not registered for. Care staff confirmed they do not have the requisite training to provide this specific care need. The home cannot therefore assure the resident and or his representative that all the care needs will be met. This admission constitutes a breach of registration conditions. An immediate requirement notice was issued to stop this practice. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7, 8, 9, 10 and 11 Residents are at risk as care records are not adequately maintained and medications are not properly supported. EVIDENCE: For case tracking purposes the care records of three of the four residents interviewed were inspected, together with that of a recently admitted resident. The care plans were not reflective of the current needs and problems of the residents with particular regard to emotional, eating and drinking, elimination, skin and mental health needs. Where “as directed” emoluments and creams had been prescribed, the respective care plan did not contain the specific administration directions. Where a scalp preparation required it to be applied twice a week, there was no recorded evidence this was being done. For a newly admitted resident, whose diagnosis falls outside the home’s registration category, there was no care plan component for the particular aspect of care. For a resident whose partner had recently died, the care plan inferred the partner was still alive in hospital. For a resident with swallowing difficulties, the care plan was inadequate of information as to the type of food to be avoided in order to prevent choking. Some care plans had been composed in Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 11 2003. Despite staff recording that the plans had been reviewed on a monthly basis, where there had been a significant change in the resident’s condition, this had not triggered a proper amendment to the plan of care. There was no specific information to inform care staff how to assist a resident with their toileting requirements, necessitating the resident to repeatedly having to inform new staff. The records contained limited social and biographical information. During conversations with care staff it was evident that more care needs were known and were being addressed. However, the content of care plans did not provide sufficient information to ensure care staff deliver the appropriate care for residents’ assessed needs. Some records contained input from GPs and specialist nurses, although specialist advice had not been sought for a resident whose assessed needs have detoriated. Seeking advice from a Parkinson’s specialist nurse would help the home in determining whether the home is providing appropriate care. The home has recently changed its medication administration system and relocated its clinical room. This is a retrograde step. There is now no washbasin for staff to use for hand washing or drug preparation purposes. The drug fridge is now kept in the kitchen. The new facility is not of sufficient size to ensure all necessary nursing aids and sundries, as well as medications, are securely and hygienically stored, presenting a potential hazard to both residents and staff. A medication administration record chart for a resident who is insulin dependent, contained unexplained gaps. It transpired a separate record is also kept in respect of the administration of insulin. The available information on this record identified one of the doses had been administered. Maintaining separate administration records is confusing and potentially hazardous to the resident, as it is difficult to establish what has actually been administered or not. Residents said staff assist them with their personal care needs in a way, which respects their privacy and dignity. Some residents have their own phones enabling them to remain in close contact with their families and friends. Care records contained insufficient information in respect of death and dying and last rites. As most residents live at the home for the rest of their lives, this omission can result in relatives and advocates experiencing unnecessary distress at a sensitive time Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13, 14 and 15 Resources are not adequate to provide well-organised, creative, stimulating and interesting social activities for all residents who live at the home. Although there has been an improvement in the quality and variety of meals, the provision still does not ensure all residents are satisfied. EVIDENCE: Residents said the choice and availability of activities are not so good as they used to be. Residents recalled how they liked going out to the nearby bowling green and enjoyed external entertainers who used to come into the home. Some residents said they were bored and watch the television because there was nothing else to do. Other residents said they enjoy company, but staff do not always have enough time to talk with them for a length of time. A number of residents said they prefer staying in their rooms because it can be difficult to communicate with other residents. Although the home employs an activities co-ordinator for 12 hours per week, activities had not been available at the home for a number of days because of staff absence. The staffing rota had not been increased to allow other staff to provide activities or spend more time with residents during this period of absence. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 13 A resident described how her relatives and friends visit regularly at different times of the day and evening. The resident was appreciative of this as company at this time was very important to her wellbeing. The care records of a newly admitted and confused resident did not contain sufficient biographical or social information. This situation makes it very difficult for staff to interact with the resident in order to minimise any fears or stresses the new surroundings may cause. Residents are encouraged to bring small items of furniture and other small personal effects into the home to make their rooms more homely. For a resident whose advocates regularly provide new property and provisions for the resident’s personal use, the corresponding care records did not contain this information. This failure would present difficulties in the event of items going missing or being misused. Residents can choose to eat their meals in the dining room or in the privacy of their rooms. The lunchtime meals looked and smelt appetising. Pureed meals are presented in an appropriate manner. Although most residents were complimentary of their meals, others were not. Fifteen of the seventeen returned comment cards from residents indicated they like the food. One respondent added the additional comment “food is disgusting”. A relative/visitor added the additional comment “poor quality of food and availability of essentials”. Some residents continue to receive food, which they cannot eat and drinks not made according to their liking. Whilst acknowledging the home has endeavoured to obtain residents views, revised the menus and again changed suppliers, this does not ensure all residents are provided with an appealing balanced diet to meet their individual needs and preferences. As meals are an important aspect of residents care, action must be taken to ensure staff involved in the preparation of meals are appropriately trained in menu planning and nutrition. To assist the home in this respect, details of two publications referred to in the current edition of the National Minimum Standards for Older People, as well as a contact number of the Institute of Public Health, an organisation which provides training and practical advice for care homes, were provided to the Directors during the visit. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16 Residents cannot be sure their complaints will be taken seriously and acted upon appropriately. EVIDENCE: A resident referred to an incident resulting in an official complaint being made directly to the home. This information was not seen recorded in the home’s complaints book. Some residents said they did not know who to speak to if they had a complaint. Two of the seventeen returned comment cards from residents indicated they do not know who to speak to if they have a complaint. One respondent added “no one to talk with [about] complaints”. Five of the eight returned comment cards from relatives/visitors indicated they were aware of the home’s complaints procedure. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19, 21 and 26 Residents live in a clean environment. Recent investment has improved the home’s safety for both residents and staff. Residents continue to be inconvenienced by the inadequate water supply for washing and bathing. EVIDENCE: The home was clean, tidy and odour free. Residents spoke very highly of the standard of cleaning and said their rooms are always kept very clean. The fire alarm and nurse call system have been replaced and an additional hoist has been obtained, making the home a safer place for both residents and staff. The provider continues to demonstrate its commitment to upgrading the home, resulting in a pleasant and homely environment for residents to live. However, it was disappointing to be informed on this visit that a previously identified water flow problem affecting some ensuite rooms and a particular bathroom has not been satisfactorily resolved. Although it does not present a scalding risk, the lack of hot water prevents some residents in washing and bathing as per their preferred choice. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 16 Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Residents are at risk due to inadequate recruitment processes, unsafe vetting practices and lack of specialist training. EVIDENCE: Care staff comprise Registered Nurses and Health Care Assistants. The home determines its care staffing levels based on the staffing notice issued in 1998, when dependencies of residents receiving nursing care were considered lower. In the absence of a registered manager, senior staff are expected to undertake certain management responsibilities. However the off duties provided at the inspection identified only two out of the four weeks for the month of June contained supernumerary time, which is not sufficient for a home of this size. Neither had the rotas been adjusted to allow care staff to provide activities during the activities co-ordinator’s absence. Some residents said although staff respond to the call alarm system quite quickly, they are not always available to provide the assistance at that time. Two of the eight returned comment cards from relatives/visitors indicated in their opinion staffing was not sufficient. Nine members of staff have left since the last inspection visit in December 2004. This situation does not promote continuity of care for residents. Staff files of three new permanent members of staff indicated the home had not undertaken all the necessary recruitment checks to ensure protection of Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 18 residents. The Criminal Record Bureau (CRB) check in one case had not been obtained until after the staff member had commenced employment. Another file contained no recorded evidence CRB clearance had been applied for by the home and the available references were addressed “to whom it may concern” and dated January 2004. Other files identified a reference had not been sought from the staff member’s last employment, even though this was a care home and for a staff member requiring a work permit there was no recorded evidence the applicant was authorised to work at Ashley Down. There was an incomplete and unsigned application form for another. An immediate requirement notice was issued to stop this practice. Fifty percent of Health Care Assistants are now trained to NVQ level II providing them with a qualification to carryout their duties in an effective manner. Indeed some of the employees have requested to continue the training in order to attain NVQ level III. Neither the Registered Nurses nor Health Care Assistants are currently trained in delivering care to residents with dementia. The home is not registered for this category of care. However this did not stop the home in admitting a new resident with this condition. This resident is potentially at risk of not being appropriately cared for. An immediate requirement notice was issued to stop this practice. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 and 38 Residents are at risk by living in a home that has no effective leadership. Staff need guidance and direction to ensure a consistent quality of care. The systems for resident consultation are poor with little evidence that residents’ views are sought and acted on. EVIDENCE: The home does not have a registered manager. The former manager was appointed to the position following the resignation and departure of her predecessor in September 2004. Since that time no formal application has been made to the Commission to register an appropriate manager. Residents spoken with said they don’t know who is in charge following the manager’s departure. The Registered Nurse, who has assumed some management responsibilities, is not qualified to manage, supervise and monitor the home. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 20 Neither has she been given supernumerary time to carry out additional duties and responsibilities. The home has purchased an “off the shelf” quality assurance manual, but has not instigated a quality assurance programme. A relative said they could not recall any residents meetings having been facilitated at the home since Christmas. Residents said they not been asked to complete a home’s satisfaction survey. Members of staff endeavour to ask residents for their views and opinions of some of the services provided. However this method does not guarantee residents’ views are taken seriously and used to improve the service. Although residents made positive comments about the staff team, some examples were given of poor communication, staff being unclear about what is expected of them and practices being inconsistent between shifts. Staff still do not receive supervision, despite this being made a requirement following the last inspection. Four pureed meals and sandwiches, which were all intended for the supper menu, had been prepared and left out in the kitchen at ambient temperatures, posing a potential health risk to residents. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 3 x 2 x x x x 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 1 2 2 x x 1 x 2 Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 21 Regulation 23(2)(j) Requirement All ensuites and bathrooms must be provided with an appropriate supply of hot and cold water. (Previous requirement timescale 30/01/05 not met) Care staff must not commence employment at the home until all satisfactory references, clearance disclosures and work permits have been obtained (Previous requirement timescale 31/12/04 not met) Written reports of the Responsible Individuals visits must be submitted to the Commission on a monthly basis. (Previous requirement timescale 31/12/04 not fully met) Staffling levels must be appropriate to meet the assessed needs of the current residents. (Previous requirement - timescale 31/12/04 not met) A Registered Manager who has the appropriate skills, competencies, qualifications and effective leadership experience must be appointed. In the interim period appropriate and Timescale for action 30/09/05 2. 29 19 2/06/05 3. 36 26 30/06/05 4. 27 18 2/06/05 5. 31 and 32 8 31/08/05 Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 23 6. 33 24 7. 18 36 8. 3 4 9. 10. 11. 7 9 9 15 13 13 12. 12 16 13. 30 18 14. 15. 15 16 16 22 16. 17. 38 32 23 24 sufficient management cover must be provided. (Previous requirement - timescale 31/01/05 not met) A quality assurance system must be introduced. (Previous requirement - timescale 31/03/05 not met) Formal supervision must be introduced. (Previous requirement - timescale 31/01/05 not met) The home must not admit residents into the home who are not within the current registration criteria Care plans must be complete of all residents current needs, wishes and problems. Registered Nurses must maintain accurate medication administration record charts Appropriate facilities for the secure and hygienic storage of medicines and associated nursing aids and sundries must be available. Resources to provide meaningful activities, occupation and stimulation must be available to meet the needs and capabilities of all residents Staff must be suitably qualified, competent and experienced to ensure all residents assessed needs are met. Residents must be provided with meals as per their individual preferences and needs All complaints must be recorded and investigated and the outcome conveyed to the complainant. Food preparation practices must be improved. Quality Assurance systems must be introduced to ensure H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc 31/08/05 31/08/05 2/06/05 30/06/05 02/06/05 30/06/05 30/06/05 15/07/05 30/06/05 30/06/05 2/06/05 31/08/05 Ashley Down Nursing Home Version 1.30 Page 24 residents views are sought and acted upon to improve services and facilities. 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. 3. Refer to Standard 11 14 Good Practice Recommendations Information in respect of residents wishes and preferences in respect of death and dying must be obtained and recorded. Records must be kept of all personal possessions and property brought into the home on residents behalf. Ashley Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone, Kent, ME16 9NT 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 Down Nursing Home H56-H06 S61039 Ashley Down V224339 020605 Stage 4.doc Version 1.30 Page 26 - 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. 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