Inspection on 22/01/07 for Ashley Down Nursing Home

This inspection was carried out on 22nd January 2007.

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 24/04/06

Ashley Down Nursing Home 24/10/05

Ashley Down Nursing Home 02/06/05

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 Key Unannounced Inspection 22nd January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashley Down Nursing Home DS0000061039.V321592.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.V321592.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.down@btinternet.com Ashley Down Care Home Ltd 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.V321592.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. 15th August 2006 Date of last inspection 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. 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 of a day room, a separate dining room and a reception room. The home, which is a Grade II listed building, is located in a conservation area near to the town centre of Gravesend. Shops, pubs, a main post office, banks, places of worship and other amenities are easily accessible. There is a small, secluded patio garden at the side of the property, which is accessible to physically disabled residents. Car parking is limited. Inspection report summaries are kept in the nurses’ office and are available on request. A notice advising of the availability is displayed in the entrance vestibule. Current fees range from £416.63 per week excluding the NHS registered nursing care contribution (sponsored residents) to £540.00 per week including the NHS registered nursing care contribution (private residents). Additional charges are payable for chiropody, hairdressing, newspapers and toiletries. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key but third unannounced visit to the home for the inspection period 2006/07. Because of the Commission’s ongoing concerns about the service, a random unannounced visit was made to the home on 15 August 2006. Lead Inspector Elizabeth Baker carried out the visit on 22 January 2007, which lasted just over seven hours. As well as touring the home, the visit consisted of talking with some residents and staff and inspecting some records for case tracking purposes. Four residents, one visitor and one member of staff were interviewed in private. A number of other residents and staff were also spoken with. The home manager and administrator provided assistance throughout the visit. Feedback was provided to the home manager at the conclusion of the visit. At the time of compiling the report, in support of the visit, the Commission received comment cards about the service from four residents, three relatives/visitors, one care manager and one GP. At the Commission’s request the home manager completed and returned a pre-inspection questionnaire. Some of the information gathered from these sources has been incorporated into the report. At the time of the visit 15 residents requiring nursing care were residing at the home. Since the last key unannounced visit, the Commission has not received any formal complaints about the home. What the service does well: What has improved since the last inspection? The choice, variety and presentation of meals have much improved since the last visits. Numerous positive comments were received including “now offered desserts at suppertime”, “there is a better choice of meals now and cooked breakfasts are available”, “I am asked what I like and dislike”, “the presentation of meals has much improved and I get more spicy meals now, Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 6 which I like”. Systems for staff recruitment have improved and are now subject to more rigorous checks. This ensures residents are better protected. Staffing levels have increased and more assistance is now available to those residents who require this level of care, particularly at lunch and suppertimes. The range of activities continues to increase. Residents spoke enthusiastically about going out to a pantomime and of the new exercise and motivation sessions, which have just been introduced. The home manager is now provided with more administrative time to assist her in ensuring the home is appropriately run and managed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 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 Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Because of the type of language used in certain parts of the home’s contracts, not all residents may completely understand the terms and conditions of staying at the home. Not all of the information gathered at the initial stage of admission is adequately recorded, potentially placing some residents at risk of their complete needs not being met. EVIDENCE: All residents no matter how funded, are now provided with a contract. The contract, which comes in two versions, includes details of the room to be occupied, fees, core services provided, terms and conditions of occupancy and rights and responsibilities of both parties. However both contracts contain legalistic phrases and jargon and some terms, which could be misinterpreted as unfair. For this reason it is strongly recommended that the contracts are reviewed in line with the Office of Fair Trading publication “Guidance on unfair terms in care home contracts – a guide for professional advisers (2003)”. This Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 9 and other associated documents can be obtained direct from the Office of Fair Trading on 0870 60 60 321. Prospective residents are usually assessed in their current environment prior to a decision of admission being made. The information gathered at the assessment visits is recorded on a form to assist staff in making a meaningful judgement on whether the prospective resident will be appropriately cared for at the home. When available, the home is also provided with comprehensive information from care management. However the assessment of a newly admitted resident identified that only brief statements of the residents needs, preferences and wishes had been obtained. Unfortunately the resident’s care manager had not provided comprehensive information. Other information about the resident recorded on the admission assessment was also found to be incomplete and in some circumstances inaccurate. As this information is used to compose the resultant care plan, care staff should obtain as much information as possible and ensure it is accurately recorded. The home is not registered for intermediate care. Standard 6 is not applicable. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care records are still not wholly reflective of residents’ complete care needs and preferences, potentially placing them at risk. Medicine management and storage facilities have improved, reducing risks to residents. EVIDENCE: Three care records were inspected as part of the case tracking process. The plan for the most recently admitted resident indicated the resident had signed it. However the other two plans had not been signed. The plans were supported by a number of associated clinical risk assessments, including admission assessments, skin integrity (Waterlow model), nutrition, moving and handling and in one case a pain assessment chart. Signed consent forms were seen in respect of the provision of bedrails. However it has not been the home’s practice to include details of contra indications to this provision. Indeed the review of accident forms identified one resident had suffered a fall from the bed, even though the bedrails were in situ. The corresponding bedrail assessment form made no reference to the hazards of providing such Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 11 equipment. The assessment was composed in February 2005. Care records also contained details of input from other health professionals including GPs. A GP for one of the residents is actively pursuing physiotherapy input for them, as the resident is anxious to receive this treatment. The admission assessment for one resident indicated the resident might experience seizures and hallucinations. However the respective care plan did not include this vital information. A pain assessment chart was in use to monitor the progress of the treatment plan. However during a conversation with another resident it became apparent that this resident also experiences pain. There was no accompanying pain chart for this resident. The resident also commented that they took pain relief medication for the condition. The corresponding care plan made reference to this. However the resident’s medication administration record chart did not include this particular medication. The clinical room, in which medications are securely and hygienically kept was clean and tidy. Limited life preparations were appropriately stored and an audit of controlled drugs found the stock and CD register to be in order. An old style medication dosage code had been recorded in one resident’s care plan and accompanying daily record. This is despite the professional body of registered nurses discouraging the use of such codes on the grounds that errors could be made. Residents spoken with said they are treated with respect and dignity when being assisted with their personal hygiene needs. Residents were seen appropriately dressed for the time of day and season, with attention to detail where this is particularly important to them. Some residents are provided with bedrails and protective covers. During the day the covers, when not in use, are stored in residents’ respective wardrobes. Wardrobes are small and the cramped situation results in some residents not being offered the clothes they would prefer to wear. Indeed a service user survey form in support of this visit indicated “I would like my preferences of clothes to wear to be considered, side mattresses to be placed on bed under cover as there is not enough room for my clothes in the wardrobe when [side mattresses] are in there”. Since the last key and random visits, staff have attempted to obtain details of residents’ funeral preferences and wishes. This is good practice as it ensures vital information is available to staff at a sensitive time. However the records inspected still lack information as to residents’ spiritual and or cultural needs and preferences. Indeed for a recently admitted resident, one of the reasons for the placement was because of the home’s proximity to the resident’s place of worship. However the resident’s records indicated religion as “unknown”. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are now offered a good choice and variety of meals. The range of activities has increased and residents are kept informed of events and activities, helping them to make informed choices of how to spend their time. EVIDENCE: Residents said how pleased they are with the activities that are now being offered. Since the last key and random visits motivation and exercise sessions have been introduced. One resident spoke of her enjoyment of going out of the home to see a pantomime at a nearby theatre. It was the resident’s first trip out since 2005. Another resident said there is more occupation in the home now. Through choice not all residents join in with communal activities. Where this is the case the activities co-ordinator visits residents in their own rooms for general chats and occupation. Activity records are now being kept and care records inspected contained social history details. Visitors were seen coming and going throughout the visit. Bedrooms visited had been individualised with personal affects to make the rooms more homely. One resident said how much they enjoy staying in their own room to watch the TV and was enjoying the Australian Open Tennis at the time of the interview. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 13 A new chef has just been appointed. On this visit residents were complimentary about the meals they now receive. Comments included “the food is very nice – the manager has introduced wine or sherry with Sunday lunch”, “vast improvement in meals, with better choices”, “new chef visits every day to get our views and choices of meals”, “there is now more variety for meals and presentation of meals has much improved”, “cooked breakfasts are available”. The home manager said the new chef is very keen to make sure all the meals are to the resident’s liking. And to assist in this the chef has already made use of nutritional publications the home has acquired following past recommendations made by the Commission. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although systems are in place for residents and others to make a complaint, having to put this in writing during the stage process, may prevent an important matter being drawn to the provider’s attention. Staff are now appropriately trained to recognise all forms of adult abuse, which increases residents’ protection from potential risks and harm. EVIDENCE: Residents spoken with described appropriately what they would do if they had a complaint or a concern. The provider has produced a complaints procedure. The Welcome Pack, kept in each bedroom, contains a copy of the procedure, and a further copy is publicly displayed in the entrance vestibule for visitors’ ease of access. However a review of the procedure informs the reader that as part of the process they are required to put the complaint in writing to the proprietor. However not all complainants may be able or willing to put a complaint or concern in writing, to the provider or indeed manager, and may be put off from pursuing an unsatisfactory matter further. The home maintains a complaints record book. A review of this identified that a situation, which the Commission had been made aware of, had not been included in the book. Details had been kept in the resident’s individual files. However including reference to such matters in the complaints record book may assist the home in monitoring trends for quality assurance auditing purposes. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 15 Since the last visit, including the provider and home manager, 18 members of staff have received training in adult protection and prevention of vulnerable adults. Being appropriately trained should ensure staff are more aware of what constitutes adult abuse and of the action they need to take if they have a suspicion abuse has taken place. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Continued refurbishment of the environment will enhance residents’ quality of life. EVIDENCE: Since acquiring the home in 2004, the provider has being working through an improvement and upgrading programme including renewing the nurse call system, replacing some carpets and decorating numerous rooms. The small gardens are kept nicely for residents to enjoy. However it was noted on this visit that remedial work following the new nurse call installation has not been completed in all areas. Indeed this is particularly evident in the one double bedroom and some corridors on the ground floor. Where some doors throughout the home have been “touched up” the colour of the paint is not the same as the original and now gives a grubby appearance. It was also noted that the heating in the double bedroom was noticeably cooler than that in Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 17 other bedrooms visited. Indeed the temperature was 64 degrees Fahrenheit with the room’s fixed heating appliances both on. The room has two windows, one of which is a French window type. At the time of the visit draughts were noted coming from both windows. The one resident occupying the room was not present at the time. This was a contrast to other bedrooms visited, which were warm and cosy. Indeed two residents said that their rooms sometimes get too warm, but they are able to control the temperature if they wished. The home was clean and odour free. Although the sluice rooms are small, items were appropriately stored on this visit. A high number of residents require assistance with moving and transferring by the use of hoists. However it was discovered on this visit that there are insufficient individual slings for all residents requiring such assistance. To minimise cross infections, it is recommended that individual slings be provided for each resident who requires them. Kent Health Protection Unit’s publication “Guidelines for Infection Prevention and Control in the Community” (January 2006) provides additional information on this subject. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is better staffed now, although less use of agency and bank staff would improve residents’ quality of life. Better systems are now in place for the recruitment and appointment of staff, reducing potential risks to residents. Staff morale has improved resulting in a workforce that works more positively with residents to improve their whole quality of life. EVIDENCE: Since the last visit, the provider has agreed with the home manager to provide additional cover at lunch and supper times. This is good practice, as many of the residents living at Ashley Down require assistance with their meals. This cover is being provided by staff already employed at the home but working additional hours. The off duty rota records this. The off duty also identifies that the home manager now has three days dedicated to administrative duties, which is required to ensure the home is appropriately managed. This supernumerary time more or less meets that required and agreed between the provider and the Commission during a meeting in April 2006. This matter will continue to be monitored at subsequent inspections. Two of the three returned comment cards from relatives/visitors indicated in their opinion there are not always sufficient staff on duty. An additional comment recorded Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 19 staffing levels are always a problem at weekends and holiday periods. A review of the off duties for the period 4 December 2006 to 21 January 2007 confirmed this. This is usually the time when agency/bank staff are used. Service user survey forms contained additional comments including “I wish the staff was more regular. I see so many strangers at weekends and holidays. I have to explain what I need help with to each new member of staff,” and “short staffed at weekends”. The returned pre inspection questionnaire indicates 20 of unregistered care staff are now trained to NVQ level II care. A newly appointed care worker spoke enthusiastically about her role, responsibilities and future training intentions, including enrolling on the NVQ care course. Recruitment and vetting practices continue to improve. The files of two newly appointed staff members identified requisite references had been sought and obtained. CRB clearance had been obtained prior to them commencing employment. Where there had been an issue requiring further clarification, advice was sought from a care home association. Records of conversations between the home and the association are recorded. However a record of a matter requiring further clarification between an applicant and the administrator had not been recorded, which could present a problem for the home if an investigation had to be carried out. Other than the manager and administrator, staff are provided with permanent contracts after their initial probationary period. However neither the manager nor administrator knew why their contracts were different. Indeed the administrator’s short-term contract expired in May 2005 and the home manager’s is due to expire in March 2007. This situation could prove unsettling for senior staff in an environment, which requires stability. The file of a newly qualified nurse contained a reference from a tutor that in their opinion the new registrant would need support with medicine administration as a qualified nurse. The home manager has shadowed the nurse and is offering continued support and supervision. The home manager is now striving to identify where accredited training can be accessed so that the new registrant receives appropriate post registration training. It is the home manager’s intention that this training could also be used by other registered nurses for medicine administration re-fresher training. The home has recently introduced involving residents in new staff interviews. This new practice is providing useful information for the manager, as points she had not considered important, but are obviously so to residents, are now being identified and discussed. This is good practice and the home manager should be complimented on this. The pre inspection questionnaire indicates that during the last 12 months staff have received training on various subjects including moving and handling, Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 20 dementia, fire training, first aid, nutrition, Parkinson’s disease, diabetes, sight training, stroke and health and safety. New staff work through an initial brief induction programme, and records are maintained. To ensure care staff are receiving the appropriate level of induction training relevant to working in a care home, the Skills for Care website www.skillsforcare.org.uk provides useful information for home managers in the development of induction programmes. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 21 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home manager provides clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. The introduction of structured supervision will ensure staff have the skills to provide appropriate care to residents. EVIDENCE: The manager is a Registered Nurse. Because the manager does not have a management qualification, she has enrolled on an appropriate course and expects to complete this later this year. Although the manager has been in post for almost a year, the Commission has not yet received a formal application from the provider for the manager to be registered with the Commission. During the visit it transpired there had been some confusion in Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 22 that the manager was under the impression that she had to have the management qualification before applying. This is not so. The Commission looks for evidence that the home manager is or intends to undertake the training to acquire the requisite qualification. The manager ensures her own post registration educational requirements are met by undertaking various clinical training sessions. The manager has recently undertaken courses on Phlebotomy, Nutrition, Parkinson’s disease, has applied for syringe driver training and is applying to undertake a two-day palliative care course. The Commission prior to and during the visit received compliments and positive comments about how the home is now managed and run. These included “Since the new manager was employed I am now kept informed of important matters affecting my relative/friend”, “recent initiatives introduced by Isabel like – key worker systems, program of exercises – are excellent” and “Isabel is very efficient and is completely in charge – vast improvements now”. Although the home does not have formal quality assurance audits undertaken by external bodies, the manager endeavours to obtain residents and relatives views by various methods. These include surveys and meetings. Residents meetings are carried out monthly and are in the main well attended, sadly relatives meetings are poorly attended. The pre inspection questionnaire indicates the majority of policies and procedures were reviewed in July 2006. The new member of staff said they had started reading the policies and procedures and knew were they kept if they needed to refer to them. The provider continues to visit the home weekly and provides the Commission with monthly reports. The administrator maintains records of residents’ moneys where the home provides assistance for this. Monies are held securely and are only accessed by the administrator or the manager. This is good practice. However access to monies is not always available to residents at weekends or bank holidays. Restricted access is not mentioned in the service user guide. Including this would enhance the current provision. Supervisory practice and supervision meetings are being introduced. Any training needs identified through these processes will be recorded in the new training record books, which each member of staff is now being supplied with. On this visit no personal details referring to residents were seen displayed in communal areas. This is good practice and maximises residents’ dignity and confidentiality. The pre inspection questionnaire indicates the home’s equipment is serviced and maintained regularly. However the questionnaire indicated that fire training was last carried out in April 2006. Good practice guidance suggests Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 23 staff receive such training twice in a 12-month period. It is strongly suggested that this is clarified with an appropriate fire safety specialist. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 24 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 3 Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30, 36 Regulation 18 Requirement Timescale for action 31/05/07 2 OP3 14 3 OP7 15 4 OP25 23 Formal supervision must be introduced. This is currently being introduced and will be inspected at the next visit. Pre admission and admission 28/02/07 assessments must be complete of all relevant information in order that the resultant care plan can be implemented. Where agreeable, residents must 31/05/07 be involved in the composition of their care plans and the records evidence their involvement. Residents’ bedrooms must be 28/02/07 kept draught free and adequately heated at all times. 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 OP2 Good Practice Recommendations Contracts should follow the principles of the Office of Fair DS0000061039.V321592.R01.S.doc Version 5.2 Page 26 Ashley Down Nursing Home 2 3. 4 OP15 OP28, 30 OP7 5 6 7 8 9 10 11 12 13 14 15 OP7 OP8 OP9 OP10 OP11 OP16 OP26 OP29 OP31 OP35 OP38 Trading publication “Guidance on unfair terms in care home contracts – a guide for professional advisers (2003). A method of recording food stocks must be introduced. Not discussed on this visit. 50 of care staff must be trained to NVQ level II care. Bedrail risk assessments must include details of contra indications, as well as input from the resident and other professionals such as the care manager, GP, advocates and the All medical problems identified in pre admission assessments should be cross-referenced to the respective care plan. Pain assessment charts should be used to monitor the effectiveness of residents’ pain relief treatments, where there is an identified need. Registered Nurses should refrain from using codes and abbreviations in residents’ care records. Residents should have the right to choose their clothing and be provided with sufficient storage facilities to ensure their clothing is kept in a good condition. Care records should contain details of residents’ spiritual and cultural wishes and preferences in the event of death and dying. Complaints should have the right to complain verbally at all stages to the provider and or manager. Residents requiring hoist assistance should be provided with individual slings to minimise cross infections. Staff should be provided with current contracts. The registered manager must successfully complete the Registered Manager Award Course. Restrictive access by residents to their personal monies should be recorded. Prospective residents should be informed of such restrictions. Fire training should be carried out at least twice during a 12-month period. Ashley Down Nursing Home DS0000061039.V321592.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local 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. 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