Inspection on 23/10/07 for Ashley Gardens Care Centre

This inspection was carried out on 23rd October 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 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 15/04/08

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 Penny McMullan Key Unannounced Inspection 23rd October 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 Gardens Care Centre DS0000070352.V351953.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.V351953.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.V351953.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 First Inspection Brief Description of the Service: Ashley Gardens Care Centre is a purpose built property, offering a high standard of accommodation. Life Style Care (2005) Plc own and manage six other care homes. The home provides care to a mixed category of residents was opened in 2007; the Ashley Gardens project has been modelled on this concept of a large establishment, divided into separate units of care. There are five suites in the building, The Biggin Hill Suite for 20 residents, The Oasts Suite for 16 residents, The Medway Suite for 20 residents, The Hopfields Suite for 23 residents and The Invicta Suite for 10 residents. The Hopfields and Invicta Suites On the ground floor there are 33 single rooms, 23 are for residents with physical frailty over the age of 65 years requiring nursing care. There are three-day rooms, a lounge and dining room with servery, a quite lounge and hobby room. There are 29 single bedrooms rooms with a toilet and wash hand basin and three with a shower, toilet and wash hand basic. Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 5 The remaining ten bedrooms on the ground floor are for young physically disabled residents who require nursing care. There is a lounge/dining room with servery and a hobby room. All bedrooms have en suite facilities. The Medway and The Oasts Suites On the first floor there are 36 single bedrooms for residents over the age of 65 with dementia requiring nursing care. There are four day rooms, a lounge and dining room with servery, quiet lounge and an activity room. The bedrooms all have en suite facilities. The Biggin Hill Suite On the second floor there are 20 single rooms for service users with dementia over the age of 65 requiring nursing care. There is a lounge, dining room with servery, quiet lounge and an activity room. The bedrooms all have en suite facilities. There is a multi sensory room situated on this floor. The building is well designed to accommodate the category mix; the Physical Disability unit is accessible through the main part of the home, however a separate entrance has been created to allow choice for residents when entering and exiting the building. The kitchen and utilities are situated on the top floor. There is a large laundry room, storage facilities and boiler room. There are showers with lockers for male and female staff. The home has solar panels and has water storage in the grounds to ensure that the garden is water with re cycled water. There are two lifts installed within the premises serving each floor. The home is situated on the main road, with off street parking. It is close to local amenities, including a post office and local transport links. As the home is a new build the grounds and premises are of a high standard and well maintained. The garden area surrounding the premises has been laid to lawn with flower beds and ‘patio areas’ and is ‘fenced off’ from the road area and adjacent properties; service users accommodated on the upper two floors are able to gain access to the garden through ground level communal areas. The range of fees for this service is between £640 and £830 per week. Information on the homes services and the CSCI reports for prospective service users/relatives will be available in the receiption area of the home. The email address for the home is manager.ashleygardens@lifestylecare.co.uk Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key unannounced inspection carried out by two Regulatory Inspectors. The home is newly registered and is in the process of admitting residents throughout the categories of registration. At the time of the inspection there were 35 residents, living over three floors of the premises. The home is currently admitting no more that four residents per week. Information in this report includes feedback from people who use the service; information gained from postal surveys sent to residents, relatives, social and health care professionals and staff. The site visit includes, inspection of records, discussions with the Registered Manager, staff and various observations. The Annual Quality Assurance Assessment information is not available to be included at the time of this inspection. What the service does well: What has improved since the last inspection? What they could do better: To ensure that all the following can take place there needs to be enough staff on duty at all times. At the time of the visit 2 of the units only had 2 members of staff on duty. One lady said, ‘I don’t know where they are’. Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 7 Another said, ‘they are nice but they have no time to talk to you. I go for ages and I don’t see anyone’. The individual care of the people living at the home needs to be fully planned and implemented by the staff. At the time of the visit there were gaps in planning, which has lead to shortfalls in meeting the personal and healthcare needs of the residents. All risks need to be identified and strategies developed to make sure the residents are kept as safe as possible without limiting choices. The registered manager needs to make sure that there is evidence in place to support this and that staff are adhering to care plans. The home need to continue to work towards developing a more person centre approach. The care staff need to make sure they keep an accurate record of the food eaten by the residents and nutritional plans are followed. This will ensure that all the people at the home are receiving an adequate, healthy and nutritious diet and that any problems can be identified and acted on immediately. The home needs to continue to develop and provide activities and leisure pursuits for the residents both in and out-side the home. More opportunities and choices should be provided so that life style expectations are met. The home needs to be able to demonstrate how residents have made choices in their daily lives. The registered manager needs to ensure medication practises are reviewed and care staff adhere to the homes policies and procedures. Staffing levels are not sufficient and the home needs to review their staffing levels to meet resident’s needs. The home needs to implement a programme of staff supervision. 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.V351953.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who come to live at the home can be sure a competent member of staff will do a full assessment of their needs. EVIDENCE: The care needs assessments contain all the necessary information and are of a good standard. Information is gathered from residents, hospital staff, care managers and relatives. The assessments explore all the relevant areas of care including, mental health, communication and behavioural needs. Relatives said that the manager of the home had involved him in the pre-assessments. One relative said ‘The manager asked me what I thought my father needed’. All the information is brought together to decide whether or not the home will be Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 10 able to meet the assessed needs. The manager now needs to make sure that all the information in the plans is used as a starting point for developing individual plans of care. The registered manager or the deputy manager carries out the pre-assessments. Both have the necessary skills to do the task effectively and thoroughly. Standard 6 does not apply. Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents cannot be sure that all their needs will be identified and met and that all risks are minimised. Action needs to be taken to ensure that the homes medication policies and procedures are adhered to and fully protect the safety of the residents. The home endeavours to promote resident’s rights and choices. EVIDENCE: The home is working towards developing a person centre approach to care and have the systems in place to promote and develop meeting the individual needs of the residents. The home is operating a key worker system. However during the visits shortfalls were identified in different areas of the care Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 12 planning system. These shortfalls had previously been identified by the homes audit systems and the management team are aware of them. However from looking at the evidence it was clear to see that the identified shortfalls had not been acted on and improved. The standard of care planning varied throughout the different units of the home. Some of the planning around personal care was of a reasonable standard and in some cases plans are positive and focus on what residents could do for themselves and the support they would need to achieve various aspects of personal care. Other plans are vague and gave no clear direction. They gave guidance like ‘full assistance needed with personal care’, ‘all care needed’. In most of the files viewed dementia assessments had not been completed. A lot of the plans did not contain the information gathered at the initial assessment. Therefore needs are not being met. In some cases needs had been identified and plans developed but staff are not adhering to them and care needs are being overlooked or missed. Daily records did not give a clear picture about how residents spent their time and did not relate to the individual care plans. It was evidence that staff do at times rely more on reporting significant events verbally and in the communication book rather than recording them in the daily notes. Some risks had been identified but risk assessments do need to be further developed and staff need to use them. The registered manager and area manager have identified the need for improvement in this area and have planned to make changes and work with staff to bring these documents and practices up to standard. There needs to be enough staff on duty to allow this to happen. The service has experienced some problems in making sure that everyone moving into the home is registered with a local G.P. This issue has now been resolved and the residents do have contact regular contact with G.Ps. Other specialist services offer advice, input and assistance when necessary. During the visit it was evidenced that the not all the residents health care needs are being identified and met. The manager needs to make sure that all the health needs of the residents have been identified and met at all times. She needs to ensure that all the care staff are aware of the needs and the action they have to take. This needs to be clearly and accurately documented. The staff are supposed to keep a record of meals eaten by the residents but this record is not always completed. Accurate records do need to be kept of the diet taken by the residents and where it is identified as a specific care need detailed records need to be in place. It was seen that diabetic residents were not having their blood sugars monitored as directed. Care plans are not being updated to reflect the changing health needs. A G.P. had visited one resident but there was nothing in place to indicate how his changing condition was Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 13 going to be monitored for improvement or deterioration and whether or not a change in medication was effective. Overall the medication is being administered at the correct times and in the correct doses, however on one unit is was identified that on several occasions the night staff had not signed for the medication so they was no way of evidencing whether or not it had been given. Controlled drugs are stored, administered and recorded according to guidelines. All medication is administered at the dose and frequency as prescribed by the doctor. The home has made appropiate arrangements for the disposal of waste medication. Some of the drugs administration sheets are completed by hand. This does increase the risk or errors occuring and is also very time consuming on a unit where there is only 2 staff on duty per shift. Many of the handwritten entries had not been countersigned. Some of the administration sheets being used were dated August and September but had been adapted by staff to be used in October. This was confusing and will increase the risk of errors occuring. Protocols and guidelines need to be developed for the individual residents who receive medication ‘when needed’. This will ensure that all medication is given safely and for specific reasons. It will also ensure a consistent approach by staff. One relative says that they treat her mother with privacy and dignity. Feedback from relatives expressed overall satisfaction at the care and support offered by the staff and they feel they are treated with dignity and respect. From observation it was clear that staff interact with residents respectfully and are polite and courteous. It is the homes policy to carry out an internal Dignity and Care Internal Audit twice a year. Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. At the time of the visit the home does not provide the residents with opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Family links are encouraged and maintained wherever possible and the home provides nutritious and varied meals for the residents. EVIDENCE: Staff were observed offering choice in a way that was appropriate to each resident’s understanding. Routines such as getting up, going to bed, mealtimes are flexible. The home does need to be able to evidence how residents make choices in their daily lives. Due to the numbers of staff on duty and the high dependency of some of the residents it is very difficult for care staff to organise and undertake activities Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 15 and leisure pursuits. 2 staff members have been given time to organise and do activities and there was an activities programme on one of the units. It was very basic and there was no evidence in place to show that the activities actually took place. A record is kept of when residents do activities but it was seen to be on an adhoc basis. One residents’ record stated that she had done 2 activities in the past 2 months. On the day of the visit there was no activities organised or seen to happen. Some residents were watching TV in the lounges or in their bedrooms but there was little opportunity to do anything else. One member of staff said that they had been doing arts and crafts with a theme of Halloween and the decoration had begun in the hobby room. Staff said that residents are offered hand massages and beauty treatments. Staff and relatives reported that residents do enjoy partaking in activities when they are provided. The home does have the some visits from out-side entertainers. The home have recently employed 2 new members of staff who will be activities co-ordinators. One had just started and the other was receiving induction training. They were getting to know the residents and what they like and dislike. The plan is to introduce group and individual activities. The manager needs to look at ways of implementing more structure and organisation to daily activities to ensure that all the needs of the residents are met. The home needs to ensure that daily activities are planned in advance following consultation with residents. This will allow both residents and staff to be prepared. It will also offer guidance and direction to ensure that the activities take place and are not just something that happens on the spur of the moment. Visitors are welcome within the home at all reasonable times and no restrictions are imposed. Residents are able to receive their visitors in the privacy of their own rooms or in the quiet communal area. The more able residents at the home felt that they were able to have choice in regards to their day-to-day lives. Staff said that there are no set times for getting up or going to bed. They said that residents can stay in their own rooms or spend time in the communal areas. Residents are encouraged to bring their own personal possessions into the home and are able to choose where they wished to be either in the lounges, bedroom or walking round the home. The menu appears varied and nutritious and there are photographs to assist residents to choose their meals and staff of how to present meals. On Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 16 admission to the home each resident has a detailed list of their likes and dislikes which is signed off by the Chef to ensure an accurate record is kept in the kitchen. Residents are offered a choice of meals on a daily basis and records were available to demonstrate this. Specialist diets are provided. Residents can eat in the dining rooms or in the privacy of their own room. Meal times were relaxed and unhurried with residents being able to take their time to enjoy the food. Staff were observed assisting residents to eat in a respectful way. Drinks and snacks are available throughout the day and food is available from the servery on each unit. This is to ensure that residents who may not eat their lunch can be provided with a meal later in the day or evening. Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 17 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): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident complaints will be listened to and dealt with appropriately and arrangements are in place to ensure residents are protected from abuse. EVIDENCE: The complaints procedure is on display in the reception area of the home. The Registered Manager has an open door policy and holds a ‘surgery’ each week for staff, residents and relatives. A complaints file is in place and two complaints have been received since registration, which have been satisfactorily resolved. All staff have received training in adult protection and are aware of protocols and procedures. The home currently has an ongoing adult protection and is responding to the issues appropriately. The sound recruitment process ensures that residents are receiving care from staff that has been appropriately vetted. Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from an environment, which is spacious, well maintained, clean, and comfortable. EVIDENCE: Furnishings and decoration within the premises is to a high standard; colour within the corridor areas on walls and doors has been used creatively to help residents recognise certain areas in the home. There are plans to further identify the doors of the bedrooms with individual preferences. Projects are also in place to change one hobby room into a shop and to provide hanging turn around canvases to convert another hobby room into a theatre or church Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 19 for when residents receive church services. The garden area surrounding the premises has been laid to lawn with flowerbeds and patio areas. The grounds are secure and accessed through ground level communal areas. CCTV has been installed for security purposes, monitoring the entrance and the surrounds of the property. There are sluicing facilities on each floor of the home. The laundry is well equipped with three industrial washing machines and three tumble driers. There are systems in place to control infection. Feedback from surveys, and discussion with residents confirms the home is always clean, fresh and tidy. Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are receiving care from qualified trained staff, however there are currently insufficient staffing levels to ensure residents needs are fully met. Residents are receiving care from staff who have been appropriately vetted. EVIDENCE: The planned structure of the home is for each floor to have a Unit Manager who will be a registered nurse. There is currently one Unit Manager in post. Each unit has a qualified nurse on duty. There are also senior carers and carers on duty. There is a Chef and two kitchen assistant, three housekeepers and two Laundry Assistants. A full time maintenance person and one administrator are also in post. Staff on the Biggin Hill unit were very busy in the morning, making beds, doing baths, and getting breakfast. There was little meaningful interaction with residents during this time. Five residents sat in one lounge; two members of staff went in looked around and left. In the other lounge there were four Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 21 residents. There was no member of staff present. There was some interaction between the residents and a staff member came lead the resident away and then left the room. Staff were task orientated at this time. In the afternoon there was more staff with the residents and staff interaction improved. The home is currently using agency staff to cover some shifts. The same agency is used to ensure continuity of staff. The home is trying to recruit nurses but they are having problems identifying nurses who have mental health qualifications. At the present time there is only one nurse who has a qualification in mental health employed by the service. Another unit also had insufficient staff on duty to meet the needs of the residents. Three residents need assistance with eating and four of the residents are double handers. There were only two members of staff on duty. The home needs to review the staffing levels to ensure resident’s needs are met and take into account the number of admissions when additional staff may also be required. There is ongoing recruitment drive for carers and nurses. The number of carers with NVQ 2 is just below the 50 target. The registered manger says this will be addressed once the full compliment of staff is employed and a NVQ programme will be introduced to address any shortfalls. A requirement has therefore not been made in this report. The home has a training matrix and in house training is provided by the Deputy Manager currently 12 hours per week on a Monday and Tuesday. The Registered Manager says that additional training courses are being externally sought to ensure that all mandatory training is provided. The home is aware of the shortfalls in some areas, which are being addressed on the training programme. As the training programme is ongoing and additional training is being booked a requirement will not be made in this report. Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 22 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): 31,33,36,38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a home, which is run in their best interest and their finances are protected. The lack of staff supervision will leave the staff not feeling supported and valued. The home is providing a safe environment for residents and staff. EVIDENCE: Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 23 The Registered Manager is qualified and experienced in providing dementia nursing care. There are clear lines of accountability in the home. A Deputy Manager, and Unit Managers who are registered nurses on each floor. The home is yet to appoint a specialist nurse for the physical disability unit. There is an ongoing recruitment drive as the home takes further admissions. The effective management of the units is therefore crucial to ensure the skill mix of staff is in place and the group work well as a team to meet resident’s needs. There have been two relatives/resident meetings held since the home has opened however at the time of the inspection the minutes of the meetings were not available. The Registered Manager holds a weekly survey for relatives, visitors and residents to voice their opinions or concerns and ensures that she walks round the home every day as part of her quality assurance programme. The head office has forwarded quality assurance questionnaire to relatives and residents and the responses are forwarded back to head office to be summarised and forwarded to the home. The results are published in the Service User Guide. The home also produces a newsletter, which is displayed in the reception area and on the notice board. The area manager visits the home monthly for a quality assurance audit. Some residents are supported with their finances and the home has a system in place to ensure that all transactions are recorded and signed. Records are in good order however some were countersigned and others had a single signature. The home needs to ensure that a consistent procedure is in place to safeguard residents and staff. Some residents also have their finances managed by their family, solicitor or representative. Arrangements are in place to ensure personal possessions are recorded and secure storage is available if required. The home needs to implement a supervision programme for all staff. The Registered Manager and Deputy Manager have worked on the floor providing direct care to residents and have observed staff care practices, however this has not been recorded. Mandatory training is being provided to all staff and the home needs to ensure that the current shortfalls are addressed. The Registered Nurses have requested to complete a first aid course, which is in the process of being booked. All safety checks with regard to equipment used in the home have been carried out and the fire book is in good order. Accidents are recorded and reported and risk assessments are in place. All staff complete an induction, which is linked to Skills for Care. Ashley Gardens Care Centre DS0000070352.V351953.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X 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 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? First 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 OP7 Regulation 15 Requirement The registered manager develops and agrees with all residents /representative an individual care plan, which includes all the health, social and personal care required by the person, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations. The plans need to be implemented and updated to reflect changing needs. Daily records need to contain relevant information about the day of the residents. The registered manager needs to ensure that all the healthcare needs of the residents are identified and met. Accurate records need to be kept to evidence this is happening. Policies and procedures for receiving and administering medication need to be adhered to. DS0000070352.V351953.R01.S.doc Timescale for action 31/12/07 2. OP8 12(1)(a) (b) 30/11/07 3. OP9 13(2) 30/11/07 Ashley Gardens Care Centre Version 5.2 Page 26 The home needs to develop individual protocols for ‘when required’ medication, including topical creams. To ensure that all hand written entries on the mar sheets are countersigned to reduce the risk of error. 4. OP12 16(2)(m) The service needs to consult and involve residents about their interests and make arrangements for them to enable them to engage in local, social and community activities To review staffing levels to meet resident’s health and social care needs. To implement a programme of supervision 30/11/07 5 6. OP27 18(1)(a) 18 1)(2) 31/10/07 31/12/07 OP36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashley Gardens Care Centre DS0000070352.V351953.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. Extracts may not be used or reproduced without the express permission of CSCI Ashley Gardens Care Centre DS0000070352.V351953.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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