Inspection on 16/06/05 for Ashley Grange Nursing Home

This inspection was carried out on 16th June 2005.

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 Grange Nursing Home 25/10/06

Ashley Grange Nursing Home 01/12/05

Ashley Grange Nursing Home 04/11/04

Ashley Grange Nursing Home 26/04/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Ashley Grange Nursing Home Lode Hill Downton Salisbury Wiltshire, SP5 3PP Lead Inspector Karen Mandle Unannounced 16th June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashley Grange Nursing Home Address Lode Hill Downton Salisbury Wiltshire SP5 3PP 01725 512811 01202 875088 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Trevor Stanley Abrahams (aka Ashley) Care Home with Nursing 55 Category(ies) of DE Dementia (10) registration, with number DE(E) Dementia - over 65 (14) of places OP Old Age (55) PD Physical Disability (10) TI(E) Terminally ill (2) Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The maximum number of service users who may be accommodated in the home at any one time is 55. 2 No more than 2 service users aged 65 years and over with a terminal illness may be accommodated at any one time. 3 No more than a total of 14 service users with dementia may be accommodated at any one time whether in the category DE or DE(E). 4 Service users in the categories DE and PD may not be less than 55 years of age and no more than 10 persons in total may be admitted over these two categories. 5 The Mezzanine Room must only be used by able bodied service users because there is no level floor access. 6 The Staffing Levels set out in the Notice of Decision issued on 17 March 2003 must be met at all times. Date of last inspection 4th November 2004 Brief Description of the Service: Ashley Grange nursing home is registered to provide nursing care for 55 older people apart from 10 people who may be under the age of 65 but over 55 years old. The home is also registered to provide care for a limited amount of people with Dementia. The home is situated in the village of Downton, which is seven miles from the city of Salisbury in Wiltshire. The home provides single room accommodation and shared rooms. The accommodation provided throughout the home is of a good standard, as are the surrounding grounds. The home is privately owned with the providers involved with the day-to-day management of the home. The Registered Manager has recently retired. However the Deputy Manager is currently acting as Manager for a 3 month trial period providing continuity within the management framework of the home. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 10.30am and was completed at 3.15pm. The inspector was assisted by the Acting Manager Alex Dempster RGN, who had an open approach to the inspection process and showed a clear understanding of her role as Acting Manager. The inspector was able to freely tour the premises and visit with many of the Service Users. Care records were inspected, as were medication records. What the service does well: What has improved since the last inspection? The ordering of bulk medication is now satisfactory as is the method of recording of medication orders onto the medication administration record. All Service Users weights are monitored monthly and a documented reason given if they are not. Accidents are fully recorded and the fire alarm is tested weekly. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 6 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. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 A clear admission procedure is in place and all needs are assessed during the pre admission assessment. Service Users and families can visit the home as many times as they wish prior to admission. EVIDENCE: All Service Users are fully assessed by the Acting Manager or Deputy Manager prior to admission to Ashley Grange Nursing Home to ensure that through the assessment process the home is able to meet the nursing needs and social needs of the Service User. The assessment is detailed providing information of all current health care needs. A record of the assessment is kept on the Service Users’ file. Service Users are encouraged and invited to visit the home prior to admission to meet with staff and other Service Users and view the accommodation provided. However due to poor health care needs pre admission visits cannot always take place. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8, 9 and 10 Health care needs of Service Users are monitored and appropriate action taken when health care needs change. The care plans fully address all aspects of care and are regularly reviewed. The medication procedure was safe. The privacy and dignity of the Service Users is fully supported by the care team. EVIDENCE: Each Service User is provided with a plan of care. The care plans are detailed and address current and long-term health care needs ensuring all care needs are fully identified and addressed. Monthly reviews take place or when care needs of the Service User change. Care/fluid charts were in place for Service Users with high needs, providing evidence of staff closely monitoring and supporting those Service Users. All care charts were up to date throughout inspection. All Service Users are registered with a local GP. Service Users reported they could see the doctor anytime, which the staff would arrange. Service Users who were able to communicate were complimentary of the care provided, as were two visitors the inspector spoke with. As recommended from the previous Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 10 inspection the weights of Service Users are now closely monitored and recorded ensuring all dietary needs are being met. Service Users confirmed that any nursing or personal care provided always took place in the privacy of their bedroom or bathroom. This was also observed taking place during the inspection The qualified nursing staff, are responsible for administering medications. The method of administration was safe and all medication was documented correctly and stored safely. The homes’ drug policy and procedure in the event of a medication error policy was not available with the drug administration records for a quick reference and guide to staff. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 The activities programme does not fully meet the social needs of all the Service Users. Meals are of a good standard with a varied menu but this is not displayed to the Service Users. Service Users are supported by the home to retain links with family and friends. EVIDENCE: An activities programme is in place but is rather limited. Further development is required to the activities currently provided to ensure that the social needs of all the Service Users are fully met. One to one visits by an activities person would benefit those Service Users who are not able or do not wish to participate with group activities. The home takes a good social history for each Service User, which can be used towards improving the activities programme. The main hot meal of the day was observed, which was well presented and Service Users reported the food as always good. Service Users were seen using both dining rooms or if they wished having their meal in their bedroom. The inspector was able to see the 4-week menu in place, which provided evidence of a wide range of meals being provided. However a menu was not displayed for the Service Users and when the inspector asked several Service Users what was for lunch they did not know. The staff were observed assisting those Service Users needing help with their meal on a one to one basis. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 12 Service Users can receive friends and families at any time they wish in the privacy of their own room or in a communal area. The visitors signing in book provided evidence of this taking place and visitors were observed during the inspection. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There is a clear complaints policy and procedure in place. An abuse policy is in place but staff were not fully aware of the local vulnerable adults procedure. EVIDENCE: A complaints policy and procedure is in place, which is available in the entrance hall to the home for Service Users and visitors. The home has an open attitude to complaints and any complaint received is recorded and addressed. Four Service Users confirmed that they would talk to the Manager if they had any issues or concerns regarding the service the home is providing. A policy and procedure is in place for dealing with any allegations of abuse supported by a Whistle Blowing policy. However not all of the staff were aware of the local vulnerable adults procedure. It will be required that the staff are provided with training in the local vulnerable adults procedure and have a copy of the “No Secrets” guidance available to them. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The home is well maintained providing a safe and very clean environment for Service Users to live in. The bedrooms and communal rooms are well furnished and provide a homely environment for Service Users. EVIDENCE: Ashley Grange provides a good standard of accommodation throughout for Service Users to live in. The home is well furnished with domestic furnishings and the décor throughout the home is well maintained. The home provides two, well furnished dining rooms, with a large communal room to the rear of the building. The home provides single and shared rooms with en-suite facilities, which are well maintained with domestic furnishings provided. Service Users are encouraged to have personal belongings around them. The bedrooms benefit from good views of the surrounding countryside. The cleanliness of the home remains of a very good standard. All the bathrooms, which were seen, were clean as were the bedrooms and communal areas. The carpeting throughout the home is good quality,clean and well maintained. Service Users were complimentary of the accommodation provided Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 15 and several commented on the high standard of cleanliness of the home. Cross infection management is appropriate and staff were observed using disposable gloves and aprons and washing hands between caring for Service Users reducing the risk of cross infection for Service Users. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home is able to meet the needs of the Service User group with the staffing levels in operation. EVIDENCE: Due to the nursing registration a trained nurse is on duty at all times supported by a team of carers. At the time of the inspection three trained nurses and nine carers were on duty. The home was calm and organised and through observation the staffing levels available clearly met the needs of the Service Users who were being provided with individual care. Two Service Users who required assistance from staff confirmed that they could get up in the morning when they wished and could go to bed when they wished, again providing evidence that the staffing levels met the individual needs of the Service User group. The staffing rotas were seen which provided evidence that staffing levels are maintained. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 Procedures are in place to ensure the views and opinions of the Service Users are heard regarding the service that the home provides. Training for staff and health and safety checks made in the home provide a safe environment for Service Users to live in. EVIDENCE: The home conducts an annual survey gaining the views of the service that the home provides from Service Users and families. The annual review will be taking place in the near future. Fire records indicated that the weekly testing of the fire alarm system was taking place and that the staff had received fire training. Emergency lighting was tested monthly and all fire exits were accessible. All hoists are regularly serviced ensuring the safety of Service Users. All accidents are recorded and monthly audits take place of the accidents. Appropriate safety checks are Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 18 made through out the home ensuring a safe environment for Service Users to live in. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 4 x x x x 3 x 4 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 3 Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16(2,n) Requirement The Manager will assess the current activities programme in line with Service Users individual social needs and introduce more activites to support their social needs. The Manager will ensure that all staff receive training on the subject of abuse and local vulnerable adults procedure. Timescale for action By 20th August 2005 2. OP18 13(6) By 20th August 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP9 Good Practice Recommendations The Manager should clearly display the menus for Service Users. The Manager should ensure that the homes medication policies and procedures are easily availalbe to the staff. Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashley Grange Nursing Home D51_D01_S15887_ASHLEYGRANGE_V202968_160605_Stage4.doc Version 1.30 Page 22 - 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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