Inspection on 25/10/06 for Ashley Grange Nursing Home

This inspection was carried out on 25th October 2006.

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 01/12/05

Ashley Grange Nursing Home 16/06/05

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 Inspection 10:00 25 October 2006 th 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 Grange Nursing Home DS0000015887.V308098.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 Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 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 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) Mr Trevor Stanley Abrahams (aka Ashley) Mrs Mary Abrahams (aka Ashley) Mrs Alexandra Mary Dempster Care Home 55 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (14), Old age, not falling within any other of places category (55), Physical disability (10), Terminally ill over 65 years of age (2) Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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). 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. The Mezzanine Room must only be used by able bodied service users because there is no level floor access. The Staffing Levels set out in the Notice of Decision issued on 17 March 2003 must be met at all times. 1st December 2005 3. 4. Date of last inspection Brief Description of the Service: Ashley Grange nursing home is registered to provide nursing care for 55 older people, 10 of which may be under the age of 65 but over 55 years old. The home is also registered to provide care for 14 people with Dementia. The home is situated in the village of Downton, which is seven miles from the city of Salisbury in Wiltshire. The accommodation provided throughout the home is of a good standard with a large communal area to the rear of the home, and two separate dining rooms. A good size patio area is situated off the communal room overlooking the countryside. A large parking area is to the front of the home. The home is privately owned with the providers remaining involved with the day-to-day management of the home. The manager of the home is Mrs Alex Dempster. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection commenced the 23rd October 2006 at 9.50am. The inspector returned to the home 27th October 2006 to complete the inspection. The manager Mrs Alex Dempster was available to assist the inspector. The inspector was able to freely tour the building, visit with many of the service users and observe the staff interacting and caring for service users. Prior to the site visit taking place, the inspector sent 20 surveys to the home to gain the opinions from the service users and relatives regarding the service provided by the home. All the surveys were returned. The majority of the surveys returned provided positive comments about the service provided at Ashley Grange. A family member also sent an e-mail to the inspector which again provided positive comments such as “In almost every respect the care he receives has been exemplary” and “The staff appear to be available when he needs them”. The inspector visited with many of the service users during the first day of the inspection. The care records of eight service users were closely reviewed, as was the medication procedure and other various records. The home met all the requirements from the previous inspection. Two good practice recommendations were set following this inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 6 The activities programme continues to develop, now providing a range of various activities. All staff had received infection control training. Wound care documentation was clear and provided good instruction of the treatment being provided to wounds. 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 DS0000015887.V308098.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 An admission procedure is in place and a pre-admission assessment takes place for all prospective service users. The home is not registered to provide intermediate care. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: All prospective service users are assessed by the registered manager, Alex Dempster, 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 care needs of the service user. Three pre-admission assessments were seen which provided information relating to long term health care needs and current needs. The manager will support the assessment where possible by obtaining more information relating to the needs of the service user from families and care managers. A record of the assessment is kept on the service users’ file and used towards implementing a care plan. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 9 Ashley Grange Nursing Home is not registered to provide intermediate care therefore Standard 6 is not applicable. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Each service user is provided with a care plan. The health care needs of the service users are monitored and service users are supported with personal care. The medication procedure was safe. Service users are treated with respect. Quality in this outcome area is judged to be good. This judgment has been made using the available evidence including a visit to this service. EVIDENCE: The care records of seven service users were reviewed. The care needs of the service users had been identified and a care plan was in place to support the individual care need. Pressure area risk assessments and falls risk assessments had been completed for all service users. Pressure relieving equipment was in place to reduce the risk of pressure damage in line with the outcome of the pressure risk assessment. Good documented evidence of all GP visits was recorded in the care records. Evidence was seen of monthly reviews taking place or when the care needs of the service users changed. The service user or next of kin was provided with Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 11 the opportunity to participate with completion of the care plan. Wound charts had clear information of what treatment was being used for the wound. The health care needs of the service users are closely monitored with appropriate action taken when their health care needs change. The GP visits the home twice a week. A GP visit was taking place at the commencement of the inspection. Service users with higher care needs had care/fluid charts in place. However when service users spent time in the communal room the charts were not maintained. A separate record of fluid intake and care provided was recorded but not kept as a permanent record to evidence that service users had been provided with the support that they required. It was discussed with the manager that the care records should be maintained at all times and kept as a permanent record. The inspector visited with many service users during the first day of the inspection. Many of the service users were unable to fully communicate but those who were able to provided positive comments regarding the care at the home such as “They look after me very well” and “Someone is always here to help me”. Service users felt that their health care needs were being met. Other health care professionals had been contacted and had visited the home to support the special needs of service user, such as the Parkinsons Nurse. The medications procedure was safe. The qualified nurses are responsible for administering the medications. The medications were stored correctly and safely, as were the controlled medicines. The controlled medication register was correct. The disposal of medication was in line with current legislation. The medication administration records were up to date. Personal care was provided behind closed doors either in the privacy of the service users’ bedroom or bathroom. The staff were observed knocking on doors before entering. The service users were well groomed with personal care needs being met. A service user reported to the inspector that she had recently moved into the home and she was very pleased that the home had arranged for her own hairdresser to visit and continue to take care of her hair. The care staff were observed interacting with service users in a friendly but respectful manner. Service users were being addressed by their preferred name. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The activities provided met the social needs of the service users. Service users are supported to retain links with family and friends. Service users are provided with choice and control over their own lives where possible. Service users were complimentary of the quality and standard of food. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The home continues to further develop the activities provided. Activities are provided from 2pm – 5pm seven days a week. An entertainer visits the home twice a month, which a service user described as “a fun music afternoon”. The activities for the month are displayed on the notice board. Other service users, who did not wish to participate in activities, reported they enjoyed the daily newspaper, reading, watching TV and receiving visitors. Service users are encouraged to spend time in the communal lounge for morning coffee and afternoon tea. A simple record is kept of the activity provided and which service users participated. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 13 Service users are supported by the home to maintain links with family and friends. The visitors signing in book showed visits taking place throughout the day. A family of a service user who spoke with the inspector, expressed how grateful they were that they could have lunch at the home three times a week providing a good opportunity to maintain regular contact with their relative. The inspector was able to visit with service users who chose to spend much of their day in the privacy of their bedroom. It was discussed with service users how the staff supported them to maintain control and choice over their own lives. One service user said, “ I can spend my day as I wish and I always get up when I want to”. Another service user who had recently been admitted to the home said, “ I have decided to have my meals in my bedroom as I’m not keen to go to the dining room and no one seems to mind”. The inspector also spoke with service users who were in the communal lounge to evidence if they had chosen to be there. A service user said, “ I like being in here with other people during the day and watching what is going on”. The home provides two dining rooms where many of the service users were observed having their lunchtime meal. Staff were seen assisting those service users requiring help with their meals on a one to one basis. The main hot meal of the day is served at lunchtime. A choice is provided if a service user does not like the main meal. Service users confirmed this. A service user said, “If the meal arrives and I don’t like it I send it back and they always make me something I do like”. Another service user reported the quality of the food as “very good”, as did many of the other service users when asked. The inspector was invited for lunch, which was of a good standard. Fresh vegetables and meat are delivered to the home three to four times a week. The kitchen was clean and organised. Nutritional risk assessments are in place and service users’ weights are monitored monthly, to ensure that nutritional needs are being supported. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A complaints policy and procedure are in place. The staff had received training in abuse awareness. The employment procedures are robust and protect the service users. Quality in this outcome area is judged to be good. This judgment has been made using the available evidence including a visit to this service. EVIDENCE: A complaints policy and procedure are in place. The complaints procedure is openly displayed in the home. A record of complaints is maintained along with the outcome of the complaint and what action (if required) was taken by the home. Through discussion with the manager, it was evident that she had an open and positive approach to complaints. Whilst visiting with service users, the issue of what they would do if they had a concern or complaint about any area of the service provided by the home was raised. The majority of service users response was “ I would talk to the Matron”. Three service users said they would talk to their family who would see the Matron. The staff had received training in abuse awareness, which is also included in the induction programme for newly employed staff. The Manager is fully aware how to implement the local vulnerable adults procedure. The employment procedures are robust and protect the service users as much as possible. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Ashley Grange continues to provide a good standard of accommodation. The home is very well maintained throughout and the cleanliness of the home remains of a high standard. The bedrooms were well furnished and personalised. Infection control measures are in place. Quality in this outcome area is judge to be excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ashley Grange continues to provide a good standard of accommodation throughout the home. The home is very well maintained. Two full time handy men are employed to ensure that the home is well maintained providing a safe environment for service users to live in. On the ground floor is a large communal lounge to the rear of the building overlooking the countryside. Two dining rooms are located on the ground floor. The garden and large patio are Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 16 to the rear of the home, which are well maintained and provide a pleasant out door area for service users. The home provides single and shared rooms. Many of the bedrooms were visited. The bedrooms were furnished with good quality domestic furnishings. It was evident that service users had been encouraged to personalise their bedrooms. A service user expressed how important it was to her that she was able to have photographs of her family around her. Another service user living on the ground floor had enjoyed being able to spend time sat outside on the patio during the summer. The cleanliness of the home continues to be of a high standard, which service users and visitors were complimentary of. The communal bathrooms and toilets were all very clean, as were the carpets throughout the home. No unpleasant odours were apparent. Infection control measures were in place and clinical waste was dealt with appropriately. The laundry facility was clean and organised. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The staffing levels provided can meet the nursing and personal care needs of the service users. The procedures for the recruitment of staff are robust and provide the necessary safeguards to offer protection to the service users. All staff had been provided with mandatory training. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Ashley Grange was providing nursing care for 54 service users. The home was operating the staffing levels in line with a condition of registration and in accordance with the number of service users. Three qualified nurses were on duty at the time of the inspection supported by a team of carers. The manager is also a qualified nurse who works Monday to Friday. The home employs two deputy managers who work alternate weekends ensuring the home has a manager on duty seven days a week. A team of domestic staff, kitchen staff and administration staff are employed. The home was organised and calm. Service users were complimentary of the support provided by the staff. The home continues to support the care staff with NVQ training with over 50 having achieved NVQ Level 2 or 3. The recruitment files of five members of staff were reviewed. All files contained two references, application form, contract of employment, terms and conditions of employment and appropriate police checks. Interviews take place Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 18 with two members of staff. Recruitment procedures are robust and protect the service users. All new staff had been provided with an induction programme and work a probation period of three months. All staff had been provided with mandatory training. However the manager is currently working towards further developing the homes’ training programme to try and provide more training for staff, which relates to the specialised care needs of the service users. The home provides an induction programme for new staff, which is also being reviewed to ensure that it programme fully relates the needs of the service users and can be completed in a reasonable amount of time. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, and 38 The manager is competent and provides good leadership to the home. Quality assurance systems are in place gaining the views of the service users and families. Service users financial interests are protected by the systems in place. The home is well maintained providing a safe environment for service users to live in. Quality in this outcome area is judged to be excellent. This judgment has been made using the available evidence including a visit to this service. EVIDENCE: The manager, Alex Dempster, is a qualified nurse and has much experience in caring for older people. Mrs Dempster has a good understanding of her responsibilities as the registered Manager of a large nursing home. Several service users openly made comments about Mrs Dempster such as “Alex the Matron is always cheerful and helpful” and “We see a lot of the Matron here”. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 20 Three members of staff confirmed that the Manager was easy to approach and had time to listen. Alex Dempster is currently working towards Level 4 NVQ in Management. Quality assurance systems are in place in the form of annual questionnaires designed to gain the views of the service users and families. Also, following the death of a service user the manager will write to the family to gain their views of the care and support that had been provided during this time. The Administrator of the home was able to clearly demonstrate how the home safely managed service users pocket/personal money. Audit systems were in place ensuring that service users were safeguard by the procedure. The home is well maintained throughout, providing a safe environment for service users to live in. Accidents are recorded, providing information of how the accident occurred and what action was taken by the home. The manager regularly audits the accidents record to assess if any pattern can be identified and therefore reduce if possible further accidents occurring. Electrical equipment is tested annually and the servicing of the hoists and passenger lift takes place six monthly, by an outside contractor. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X 3 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X x 3 Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP8 OP36 Good Practice Recommendations The Manager should ensure that the care/fliud charts are recorded throughout the day. The Manager should continue to develop how supervision is provided to the staff. Ashley Grange Nursing Home DS0000015887.V308098.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 DS0000015887.V308098.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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