Inspection on 15/04/08 for Ashley Gardens Care Centre

This inspection was carried out on 15th April 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.

Other inspections for this house

Ashley Gardens Care Centre 17/11/08

Ashley Gardens Care Centre 23/10/07

Similar services:

Springfield House

The Shelley

Thorndene

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Ashley Gardens Care Centre Sutton Road Maidstone Kent ME15 8RA Lead Inspector Mrs Susan Hall Unannounced Inspection 15th April 2008 08:30 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 Gardens Care Centre DS0000070352.V361323.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 Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley Gardens Care Centre Address Sutton Road Maidstone Kent ME15 8RA 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) 01622 761310 manager.ashleygardens@lifestylecare.co.uk Life Style Care (2005) Plc Mrs Geraldine Pauline Alice Martin Care Home 89 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) 2. Physical disability (PD). The maximum number of service users to be accommodated is 89. Date of last inspection 23rd October 2007 Brief Description of the Service: Ashley Gardens Care Centre is a purpose built property, offering a high standard of accommodation, and which was opened in 2007. It is owned by Life Style Care (2005) Plc, who also own six other care homes. It is situated on the main road, with off street parking. It is close to local amenities, including a post office, large supermarket, and local transport links. Ashley Gardens provides care to a mixed category of residents in five different suites as follows: On the Ground Floor: The Hopfields Suite is for older people with nursing needs, and has 23 beds. The Invicta Suite is for adults aged over 18 with physical disability, and has 10 beds. On the First Floor: The Medway Suite is for older people with dementia and nursing needs, and has 20 beds. The Oasts Suite is for older people with dementia and nursing needs, and has Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 5 16 beds. On the Second Floor: The Biggin Hill Suite is for older people with dementia and nursing needs, and has 20 beds. Each unit is provided with suitable communal areas, comprising a dining room and servery, one or two lounges, activities and hobbies rooms, assisted baths/shower rooms, and sufficient toilet facilities. There is a multi-sensory room situated on the second floor. All bedrooms are for single use, and have en-suite toilet and washbasin facilities. Some also have their own showers. The kitchen, laundry and staff facilities are situated on the top (3rd) floor. All areas of the home can be accessed by two large passenger lifts. These have keypad codes to use for the units with dementia residents, to promote their safety. The Invicta Suite (for residents with Physical Disability) is accessible through the main part of the home, and has an additional entrance to allow choice for residents when entering and exiting the building. The home has solar panels, and has water storage in the grounds to ensure that the garden is watered with re-cycled water. The garden area surrounding the premises has lawns and flower beds and patio areas. These are fenced off from the side road and adjacent properties. Residents accommodated on the upper two floors are able to gain access to the garden through ground level communal areas. The range of fees is currently from £678.00 to £795 per week, and are arranged according to the level of individually assessed needs. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection, which covers all events and issues raised about the home since the previous inspection. It includes assessing all key standards; and most other standards were also assessed for this inspection. The previous inspection was the first one for the home since it opened in 2007. There have been a number of “teething troubles” over the past six months, as well as a number of referrals to the Social Services Safeguarding Adults team. Some of these referrals were made by the manager to keep the team fully informed of any concerns. The alerts have now been closed, but Social Services have continued their own monitoring programme with the home. There is currently an agreement in place that the home will only admit one new resident per week, so that new staff have time to get to know each new resident and their individual care. As the home’s “link” inspector, I carried out the visit over two days, lasting a total of 10.25 hours. I was accompanied by a Pharmacist Inspector on day one, who spent time looking specifically at medication management on one floor. This was because a few concerns raised had included medication administration. The Pharmacy Inspector’s assessment is included as part of this report in the section on Personal and Healthcare. We spoke with 13 staff (as well as the manager) and 11 residents. We also met one of the Directors, and the Regional Manager. The manager was present on both days of the visit. CSCI survey forms were sent out to residents, relatives, care managers and health professionals prior to the inspection, and 23 completed surveys were received, providing some helpful and detailed information. Chats with residents and survey form responses indicated that residents are generally settled in the home, and find the staff very kind and caring. Comments about the home included: “ I am very happy to be here. Everyone is very kind, and I am looked after well”. Another resident said they are “very comfortable, and the staff are very good”. A care manager said they are “one hundred per cent satisfied with the level of care the client is receiving” and that the home has the “potential to be a very good home in this area.” The home has made very good steps forward in many areas. This includes recruitment of more permanent staff, and a resulting decrease in the use of agency staff; implementing activities in the home; developing the care planning system; and implementing a formal staff one to one supervision programme. There have been no complaints made directly to CSCI about this home. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 8 Although the staff training programme is generally very good, it was evident from talking to staff that many have had insufficient training and experience in dementia care. All staff gain an understanding of dementia during the induction, but nurses and care staff need more detailed knowledge in caring for this category of residents. Care plans do not show consistency in regards to wound care management, and documentation needs to be reviewed to ensure that all wounds are clearly recorded at each dressing change, so that the progress can be monitored. Daily records are not always well completed, and some staff need further training to complete these with sufficient detail. The manager has now recruited activities staff, and they are having more training in caring for residents – especially those with dementia. However, there are few resources for them to use at present, and no items of interest on corridor or lounge walls, or in lounge areas. We saw few personalised items in bedrooms, and some residents are confined to bed with little to look at except their television. Staffing levels need to be reviewed in respect of night staffing on dementia units. 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 Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 9 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 Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 10 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. Preadmission assessments are carried out to a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose contains all the required information, and is included as part of the welcome pack. These packs are prepared with a colour brochure (including photographs of the home); the statement of purpose; the service users’ guide (set out as residents’ information); a copy of the complaints procedure; and a copy of the contract. Residents’ information is set out as separate sheets, which could make it difficult to easily find the piece of information required. The contract sheet states that the contract data includes the residents’ information sheet. This would be better as one clear contract document, so that the terms and Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 11 conditions of residency are clear. Each resident is provided with a contract, and these show the items which are included/not included in the fees. The manager said that she was aware that the service users’ guide would be improved by altering it in some areas, and is already dealing with this. Four pre-admission assessments were viewed from two different units. These had been completed by the manager or deputy, and have very detailed information. For example, these include details about how well the resident is able to communicate; if they have a history of falls; previous medical and family history; and current issues with mobility, eating and drinking, and general health. Mental status is also assessed, including the resident’s ability to understand what is said to them, and any behavioural problems. Residents are invited to view the home beforehand where possible, and to stay for lunch or tea. There is a four week trial period for long term care. Some residents may be admitted for short term respite care, and these have the same quality of pre-admission assessments as those for long term care. There was evidence of some residents being admitted for respite care, and settling in so well that they have decided to stay permanently. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 12 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 adequate. Good progress has been made with developing care plans. Daily records need to contain better detail. Some staff lack skills and abilities with dementia care, and documentation does not always demonstrate that the needs of dementia clients are being fully met. Records generally show good healthcare management. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six care plans were viewed from 3 units (Hopfields, Medway and Biggin Hill). The other 2 units do not currently have any residents. The manager, deputy and unit managers have been working hard to improve documentation, and there have been significant improvements made since the last inspection visit. They have also received advice and support from Kent Social Services, who have been monitoring the home after receiving some Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 13 Safeguarding Adults alerts since the home opened. These alerts have now been closed, but active monitoring has been continued. Each resident has a detailed admission assessment, and these are used as the basis for care planning. Care plans show the involvement of the resident and/or next of kin as appropriate, and initial assessments and care plans are re-evaluated every month. These include dependency assessments, nutritional assessments, checks for skin integrity, continence assessments and mobility assessments. Most were seen to have very clear details such as: “needs a standing hoist and two carers for all transfers” and then details for how transfers are to be carried out; and “has difficulty hearing, so use a louder voice and maintain eye contact”. Nutritional assessments do not just include specific diets and supplement drinks, but also state if the resident needs particular cutlery, and if they can hold this themselves or need assistance. Personal hygiene care plans state details such as carrying out mouth care, care of dentures, nail care, hairdressing and shaving. Residents are asked if they prefer to have a bath or shower, and how often. Food and fluid intake charts are used for residents who are unwell, and these are properly completed. Turn charts are used for residents who are at risk of developing pressure sores, and instructions state that they must have their position changed every two to three hours, and if a pressure relieving mattress and cushion are to be used. Wound care assessments are varied, with some units better at this documentation than others. Wound care was seen for one person where each wound was individually assessed, and each dressing change was clearly documented and correctly entered on an assessment chart. Other records were not so clear, with only occasional assessments, and signatures for when dressings have been changed. Each dressing change should be clearly documented, with the progress of the wound, and this was discussed with the manager and deputy manager. Daily reports are written at the end of each shift. These varied in quality and content. Risk assessments are well designed and completed. Some viewed are for the risk of falling out of bed, risk of using bed rails, risk of using the toilet or bathroom unsupervised, risk of falls when walking, and risk of having hot drinks placed in reach of residents who may spill them. Residents with dementia have an additional dementia assessment shortly after admission. Three were viewed, and two had been carried out very well by unit managers, and with the assistance of relatives. However, another one had been carried out by an agency nurse who did not know the resident, and did not include help from a relative, although one often visits. This did not show a proper representation of the resident’s background and usual manner and mood. Care staff showed a good understanding of dementia care, and a caring and empathetic attitude, even though most have so far only had basic training about dementia during the induction. Further training is being carried out. It was clear that much progress has been made since the last inspection, but the Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 14 staff as a whole do not yet have sufficient skills and experience in dementia care. The inspection included an hour spent in the television lounge of Biggin Hill Suite, carrying out an observational inspection (Short Observational Framework Inspection, or SOFI). This is time spent observing how residents and staff interact with each other, and is carried out to a specific pattern. It was noticeable that although there was some excellent interaction between staff and residents, there was over half an hour when there were no checks and no contact with staff. Staff were observed as treating residents with a gentle and friendly manner, and carefully explaining the care actions they were carrying out. Residents on the ground floor spoke highly of staff saying “they’re very helpful”, “I am very comfortable here, the staff are good”; and “the staff are lovely”. The home is fortunate in having a GP who is the visiting medical officer (VMO), and who visits the home at least once per week. This has enabled staff to develop a rapport with the practice, and to have more confidence in asking for advice or visits as needed. Care plans showed referrals to other health professionals such as physiotherapists, speech and language therapists, community mental health nurses, tissue viability nurse, and dietician. End of life care is well documented in care plans. Residents and/or relatives are usually asked about any specific preferences as part of the admission process. Additional help and support with end of life care is obtained from palliative care nurses at the Heart of Kent Hospice. Pharmacist Inspector Jeanette Datoo assessed medication, as follows: Medicines are stored tidily and securely for the protection of people who use the service. Not all medicines in the drugs fridge were in keeping with the manufacturers’ directions for cool storage, so people might unnecessarily be given very cold medicine. Named photographs are available to aid identification of people. Medication audits for each person are regularly completed. We looked at medication records for four people, which showed that records are kept of the receipt and administration of medicines, but not all records were clear. For example, a dose of one tablet had been signed as given but the dose was still in the monitored dosage system blister pack. There were also some other discrepancies, and the manager said that these would be immediately investigated. Staff keep detailed records of unwanted medicines, which are currently returned to the supplying pharmacy. There was a question in regards to the validity of the licence for this method of disposal, and we reminded the manager that it is the registered providers’ responsibility to ensure that disposal of unwanted medicines complies with relevant legislation. We saw a nurse giving out some of the lunchtime medicines, and observed that this was carried out well. During the round she also checked that people in their rooms had what they needed. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 15 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 adequate. The activities co-ordinators and care staff are working hard to develop suitable activities for each floor, and for individual residents. More training, and increased resources, will assist in this process. Food is well managed in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activities programme has been considerably developed since the last inspection. There are two activities co-ordinators, and care staff take part in providing and assisting with activities as much as possible. The co-ordinators have good plans for how they wish to develop and improve the activities programme, but are currently frustrated by lack of resources, and insufficient training and experience. They have both attended “Reminiscence and Recall” training, and are booked to attend a course on “Therapeutic activities in dementia care”. They both said they are looking forwards to this. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 16 A carer is employed in an extra capacity for 8 hours per week to carry out one to one care doing hand massage and manicures. She is also booked to attend a training course for this. The co-ordinators know what they are aiming at, and are fully committed to meeting the needs of the residents. There are some joint activities to invite residents to, such as arts and crafts, jigsaws, and watching films together. The activities co-ordinators spoke knowledgably about the different types of films residents like, and make sure that the choice of films is suitable for different individuals. They are carrying out lots of one to one care at present, talking with residents, taking them out shopping, playing games such as scrabble, or helping them to relax in music lounges or the multi-sensory room. There is some current difficulty due to the home having to use some agency staff, who do not know the residents, and may not be able to get particular residents up in time for specific activities they would enjoy. This is gradually improving with a higher proportion of permanent staff. The activities co-ordinators have found that residents with dementia do not usually want to go to activities rooms on other units, as they do not recognise the other units, and it is disorientating for them. The home may find they need an activities co-ordinator for each floor when the home is full. Residents with dementia care should have the stimulation of a range of activities or one to one care throughout the day, and this is not possible as yet. There are currently insufficient resources for the activities co-ordinators to work with, for example, no items from the past to jog residents’ memories, and no tactile boards, or memory boxes. There are very few pictures or interesting features on corridor walls or lounges, and few items were seen to personalise bedrooms. Some residents are confined to bed with nothing to look at apart from bare walls and TV (if wanted). However, these difficulties have been recognised, and we are confident that they are being addressed. Most residents on the ground floor are very unwell, and prefer one to one input than group activities. This takes additional time. There are some good specific group activities arranged to include relatives and friends. These are displayed on a notice board on the ground floor near the lifts, and include items such as musical entertainment and parties. There are some thoughtful touches too, like each lady receiving a small gift on Mother’s Day. Visitors are made welcome in the home, and this was remarked on by relatives and health professionals in survey forms. They noted that they can speak to staff easily, and can ask questions. The manager has commenced a friends group, for relatives to meet informally with each other and with staff, so that they can ask simple questions about how the home works, and receive support from each other. This is proving to be very valuable, and is a separate meeting time from formal resident and relatives meetings. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 17 Residents said that they enjoy the food, and it is well cooked. There is a fully qualified chef manager, who prepares menu changes in discussion with the manager. He was just completing new “Spring time” menus, and these run on a four weekly basis until the next season. The chef has sent out questionnaires about the food to residents, and was collating the answers, so as to have more ideas about items they would like to try. There is a detailed daily menu, and these are displayed on boards in the dining areas. There is a wide variety of items for breakfast, and a different cooked item each day. There are different choices for lunch and tea, and morning coffee and afternoon tea are provided. These are accompanied by biscuits in the mornings, and home made cakes in the afternoons. All dishes are home cooked – including home made soups and pastry. Fresh fruit is provided daily to each servery area, adjacent to the dining areas on each floor. Meals are transferred via hot trolleys, and served by staff, who know the individual amounts and can check specific diets are adhered to. Pureed meals are served as individual items on the plate. The chef makes special diabetic desserts and cakes. There is a night box in each servery area, so that residents can have a sandwich or soup etc. if they are hungry at night. The kitchens were seen to be clean and well organised. The chef keeps excellent records for all aspects of kitchen management. Records are retained of what each person eats each day, and care staff keep records for the amount of food eaten at each meal. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 18 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. The complaints procedure is clear and easily accessible to everyone, and complaints are well managed. There are good programmes in place to protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure is displayed in the entrance hall, and is included in the welcome pack given to each resident on admission. It clearly states that complaints will be acknowledged within 48 hours (and usually sooner), and that a response with the outcome of any investigation will be made within 21 days. People are encouraged to put complaints in writing, so that the response and outcome can be easily tracked. The complaints procedure has clear details about the pathway to follow (go to the manager first, and then the regional manager etc.) and also reminds people that they can go to Social Services or the police if appropriate, as well as to CSCI. The complaints log showed a few complaints which had all been dealt with appropriately. The home has had several Safeguarding Adults referrals to Kent Social Services since the last inspection. Some of these were directly referred to the Safeguarding Adults team by the manager, ensuring that they are kept fully up Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 19 to date with any incidents of concern. These investigations are now closed, but Social Services are continuing with their own monitoring programmes. The management staff have been completely co-operative throughout these proceedings. All staff have training in the recognition and prevention of abuse during the induction. This is a three hour training course, and staff are required to attend updates every few months. Good records confirm that this training is taking place, and that all staff attend. There is specific training in regards to understanding and using the whistle blowing policy. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 20 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): 19-26 Quality in this outcome area is good. The home has been purpose built, is spacious and modern, and meets the needs of the residents. The décor and equipment are well maintained, and the home is kept clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As a modern, purpose built home, the premises are well designed to meet the needs of residents. Décor, furniture and furnishings are all of a high standard. All suites were viewed. Two are not currently in use (the Invicta Suite on the ground floor, and The Oasts on the first floor), as the management are completing staffing and care management for one unit at a time. There are a number of lounges/dining areas and quiet rooms for each unit, and hobbies and activities rooms. There is also a multi-sensory room on the second floor. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 21 Outside areas are secure for residents with dementia, and include lawns, patio areas and flower beds. There are plans to make a sensory garden and a raised herb garden. Residents who enjoy gardening will be able to take part in these areas. The memory (Italian) garden was being commenced the next weekend, with friends and volunteers of the home working with staff, and possibly some residents, to get this under way. Disabled toilet facilities, and bathrooms and showers, are provided in suitable numbers. All toilet facilities are colour coded to help residents with dementia to locate these. Baths have assisted hoist facilities, and showers are fitted with shower chairs, grab rails etc. All bedrooms have en-suite toilets and wash hand basins, and some have their own shower as well. The building was seen to be suitably equipped with items such as mobile hoisting facilities on each floor, (and with good storage areas); and good profiling nursing beds, pressure relieving equipment and hand rails. There are call bell points in all areas. The home is kept clean by a team of housekeepers, with at least one on duty for each floor every day of the week. This enables them to work to specific routines, and to get to know the residents. Relatives said in surveys that the home “is always clean”. The laundry is situated on the top floor, and is well organised. It is equipped with three commercial washing machines and three tumble driers. There are separate entrances for dirty and clean clothes. There are dedicated laundry staff on duty seven days per week to ensure that clothing is properly laundered. There is a request for relatives to ensure that all clothing items are clearly labelled prior to admission. Some items still go astray, and there is a system in place for identifying lost property. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 22 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. Staffing levels have improved, and are being kept under review. Recruitment is well managed; and there are good staff training programmes are in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels have improved since the last inspection, and are determined according to residents’ dependency levels. Each unit manager is required to produce a monthly report with the dependency ratings for each resident, based on detailed assessment information. The numbers of staff are worked out using the “residential forum staffing tool” as a basis. This indicates how many hours of care are needed for effective management according to the dependency levels of residents. The Medway Suite has been running with 5 carers and 1 nurse throughout the day, for 16 residents. This is sufficient for care staff to supervise residents who are mobile, and to take part in some activities with them. However, there has only been 1 nurse and 1 carer on duty at nights. So if the nurse is administering medication (which can be slow with this category of residents), it only leaves one other person on the floor. If this carer is giving personal care or helping someone to the toilet, there is no one to oversee the rest of the residents. This does not demonstrate there are enough staff at night, although Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 23 it has been sufficient in practice until this point. The manager said that staffing levels are permanently under review, as the units are gradually increasing with the numbers of residents in them. There is a better skill mix of Registered General Nurses (RGNs) and Registered Mental Nurses (RMNs) now. This should provide some RMNs to advise re dementia care, and other RGNs to oversee nursing care. They will be able to access advice from each other across the units if needed. There is an ongoing recruitment drive, and there was an “open day” on day 2 of the visit. This enables applicants to see round the home, chat with management staff, and discuss their suitability for vacancies. There have been some good results from these open days. Staff recruitment files are excellently put together. Three were viewed, and contain all the required data. The manager retains an interview record, and ensures that any gaps in employment are discussed. Staff files confirmed that POVA first and CRB checks are carried out prior to confirmation of employment, and nurses’ PIN numbers are checked. The home uses an agency to provide nurses and care staff to cover annual leave and sickness. There is less agency use than formerly, and the manager aims to have sufficient permanent staff in place before long. The staff training programme is overseen by the Deputy Manager. There are very good programmes in place ensuring that all staff have a comprehensive induction, and then opportunity for ongoing training. The induction includes all mandatory training, plus some additional subjects, providing training in the following items: health and safety; fire training; first aid; infection control; moving and handling; basic food hygiene; dementia care; and effective communication parts 1 and 2. All ancillary staff have the same induction training, but with some modules tailored to meet specific roles. There are many other training courses arranged for staff to attend, including T clinical training throughout the year provided by the Heart of Kent Hospice in Maidstone. There is also a Carers’ Education Programme which was suggested by the Community Psychiatric Nurses. This is a six week dementia course, which includes family members who are caring for people with dementia in the community. Care staff can see how dementia impacts peoples’ lives prior to residents being admitted. Two care staff have completed this and found it excellent. They are sharing the content with other staff. Other courses include tissue viability training, continence training, updates from external trainers in abuse awareness, and moving and handling; and risk assessment training for all nurses. All nurses attended a medication safety course on the first day of the inspection visit. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 24 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, and 35-38 Quality in this outcome area is good. The manager is providing a clear lead to staff, and effective management for the running of the home. Good quality assurance procedures are in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is trained in general nursing and in dementia care, and has completed the Registered Manager’s Award. She is experienced in all aspects of running a care home with nursing, and provides excellent leadership and motivation to the staff. Setting up a new care home is not without difficulty and she has shown perseverance and tenacity in sorting out different problems. Staff spoke highly of her management style, with comments such as Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 25 “she is always on duty, and is always there for staff as well as residents”; and “we can speak to her at any time, she is excellent”. We chatted with different staff over the two days, and they had clear knowledge of their different roles and responsibilities. There is a unit manager for each unit now, which is bringing about stability on the units. There are regular staff meetings for all levels of staff, and these are a helpful venue for discussing ideas and issues. Quality assurance procedures have been well developed. The regional manager carries out monthly regulation visits, and some audits for the home – including an external medication audit. The home holds residents and relatives meetings on a regular basis, and these have minutes taken which are available to those who cannot attend. There is also a “friends” meeting, which is strictly informal and not minuted, and gives relatives the opportunity to chat with each other and to staff. The home sends out a newsletter to keep people updated, and has a notice board in the entrance area to inform visitors of events. This includes fund raising activities for the Ashley Gardens Residents Fund, with items such as a Quiz Night with fish and chip supper, and a St. George’s Day event. Survey forms are sent out to residents and relatives at regular intervals and for different subjects. The home has the same systems in place as previously for managing pocket monies for a few residents. These are stored and recorded individually, and all receipts are retained. Items are countersigned. Other residents’ finances are managed by their next of kin, or designated relative, advocate or solicitor. Policies and procedures are in place for all aspects of running the home. These are accessible for the staff. All staff are trained in safe working practices, and training records reliably confirmed this. The home has a full time maintenance man who oversees the day to day running of the home, and checks fire systems, water temperatures etc. Some servicing records were viewed and were up to date. Accident records were viewed and are well completed, and in accordance with HSE legislation and the Data Protection Act. The manager audits these each month, looking for any trends such as the time of day when accidents occur, or if they involve a specific unit or person. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 26 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 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 2 3 3 Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 27 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 (1) (a) Requirement Timescale for action 30/06/08 2 OP12 16 (m,n) 3 OP27 18 (1) (a) To ensure that all staff working on dementia units have specific training in dementia care, as well as the dementia awareness training at induction; so that they can deliver appropriate mental health care as well as physical health care. To inform CSCI of the way this will be carried out by the proposed date. To further develop the activities 31/07/08 programme, so that there is a suitable range of activities and items of interest, for all categories of residents accommodated in the home; with particular reference to ensuring sufficient stimulation for residents with dementia. To keep levels of staff under 31/05/08 review, with specific reference to ensuring there are sufficient numbers of care staff on night duty in dementia units. Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 28 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 OP8 Good Practice Recommendations To ensure that all wound care is clearly documented, with clear descriptions of the state of the wound at each dressing change. And to ensure that daily records contain sufficient information to provide a clear picture of each resident’s day. 2 OP9 Staff should be aware of and follow the manufacturer’s directions for the temperature at which medicines should be stored. To further develop the activities programme, so that there is a suitable range of activities and items of interest, for all categories of residents accommodated in the home; increasing the resources as needed. 3 OP12 Ashley Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 29 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 Gardens Care Centre DS0000070352.V361323.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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