Inspection on 12/12/06 for Ashley House

This inspection was carried out on 12th December 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

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

CARE HOMES FOR OLDER PEOPLE Ashley House 6 Julian Road Folkestone Kent CT19 5HP Lead Inspector Lisbeth Scoones Unannounced Inspection 12th December 2006 09:40 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 House DS0000067828.V317756.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 House DS0000067828.V317756.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley House Address 6 Julian Road Folkestone Kent CT19 5HP 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) 01303 241 024 Purelake Healthcare Limited Mrs Penelope Jane Davison Care Home 17 Category(ies) of Dementia (17) registration, with number of places Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection NA Brief Description of the Service: Ashley House is registered to provide 24-hour residential care for up to 17 people over the age of 65 with dementia. The house is a large, detached, Victorian style property situated in a residential area of Folkestone. It is near to a local park, and is within easy reach of the town centre, other local facilities, and the sea. The Home has recently been purchased by Purelake Healthcare Ltd and this is the first inspection under the new ownership. Accommodation is provided over 3 floors, with access to the first and second floors via a passenger lift and stairs in between. There are 15 single and one shared room. None of these have en-suite facilities. Communal space consists of a lounge at the front of the house and a lounge/diner, which overlooks the rear garden. A concrete ramp leads into the enclosed garden. The inspection report is freely available. The manager advised that weekly fees range from £435 to £460 with additional charges for chiropody and hairdressing. Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.5 hours. During this time, discussions were held with the manager Mrs Davison, proprietor Ms Suleyman and all members of staff on duty. Time was spent with all the residents and a visiting relative. A tour of the home was made and documentation read and discussed. The documentation related to care planning, medication, risk assessments, menus, duty rotas, audits, staff files, training records and training matrix. Prior to the inspection, the manager completed a pre-inspection questionnaire. Comment cards were left at the home for residents’ relatives to complete if they wished. Comment cards were sent to GP’ s and telephone contact was made with two care managers and two health care workers. Information thus received informed the inspection. At the time of the inspection, there were 17 residents living at the home (full occupancy). Staff on duty comprised the manager, deputy manager, senior carer and carer, the cook, housekeeper and two maintenance men. What the service does well: The home had a pleasant relaxed atmosphere. Residents looked comfortable and well cared for and said they liked the staff. A relative said; “Staff are good. You can’t fault them”. Residents spoke positively about the staff and seemed to get on well and feel comfortable with them. The home is well managed with a stable staff who know the residents well and who receive adequate training. Staff spoken to demonstrated a clear commitment to their work. Staff were observed to be looking after the residents in a kind, patient and respectful manner. A key worker system is in place. Routines are flexible and residents said they enjoy the meals provided. The manager said she feels well supported by the proprietor and her staff and that “things get done.” An upgrading and refurbishment programme is under way and the entrance hall and many of residents’ bedrooms looked comfortable and newly decorated. Residents are given the opportunity to personalise their bedrooms. The home has a good relationship with the GP’s, District Nurses and other care professionals. Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashley House DS0000067828.V317756.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 House DS0000067828.V317756.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives have the information they need to choose a home, which will meet their needs. Residents are provided with a contract setting out the terms and conditions of residence. Home staff carry out a pre-admission assessment to ensure that the resident’s needs can be met. EVIDENCE: The company has produced a Service User Guide and Statement of Purpose. Both documents provide prospective residents and their relatives with the information they need about the services the home provides. Minor additions Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 9 and changes would further enhance the information and these were discussed. A notice on display in the entrance hall states that both documents are available on request. A sample of a pre-admission assessment confirmed that all needs are assessed before a decision is made to become a resident at the home. The assessment is kept within the residents’ file and is the basis from which a care plan is formulated. All residents are given a contract stating the terms and conditions of residency. A sample of contracts was seen. Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health needs are met by a multi-disciplinary team of GP’s and specialists and recorded in an individual plan of care but attention is needed to include the provision of and participation in activities. Residents are protected by the home’s policies and procedures on the administration of medication but attention is needed in respect of out of stock medication, signatures and details of “as required” medication. Residents are treated with dignity and respect EVIDENCE: The manager is in the process of harmonising the care plan format with that used in another Purelake Healthcare home. Both managers work closely together. Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 11 A sample of care plans seen contained comprehensive information, was regularly reviewed and supported by risk assessments. For the majority of the residents a Life History had been recorded. The taking part in activities the home provides is irregularly recorded. See also standard 12. The home undertakes risk assessments to prevent skin breakdown and to ensure good nutrition. Residents are weighed regularly. It was recommended that any nutritional risk identified be recorded in the plan of care. The manager said she has a good relationship with the GP’s and other professionals. Their visits and communications are recorded on the multidisciplinary page in the care plan. Staff contact the district nursing staff, continence advisors, dentist, optician and chiropodist. When required, the local mental health team is actively involved with residents’ care. The home has good policies and procedures for all aspects of the administration of medication. The manager undertakes monthly audits and medication charts were well maintained and provided with a recent photograph of the resident. It was recommended that all handwritten entries are double signed and that criteria for “as required” medication are recorded. An “out of stock” issue and ways of addressing this was discussed. It is evident that medication is regularly reviewed. Staff were kind, helpful and patient in their dealings with the residents thereby promoting their dignity and respect for privacy. Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines within the home are flexible and offer the residents choices. Some activities are offered but such offers or residents’ participation are not regularly recorded. Residents are encouraged to maintain contact with their families and friends. Residents are provided with healthy, varied and balanced meals. EVIDENCE: As already referred to in standard 7, care plans contains a page for the recording of social activities but these are not routinely completed. It is recommended that the taking part in activities be consistently recorded thus providing evidence of the kind of social experience the resident enjoys. The home offers some activities as e.g. music and movement and musical events provided by a number of entertainers. On the day of the inspection, the majority of the residents were in the lounge with the staff and a visitor Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 13 present. It is evident that relatives are made welcome at any time to visit the residents. The visitor spoke highly of the homely environment that suited her relative. Some residents watched a programme on a large flat screen television. Staff included the residents in their conversations. A topic of conversation was the forthcoming Christmas party. The home does not have a designated activities organiser. However, staffing levels in the morning have recently increased thereby allowing extra time for staff to provide social activities for the residents. It is the proprietor’s intention to upgrade the garden ready for summer use, providing a much nicer, more spacious and furnished, suitable environment for the residents. There was a pleasant, unhurried atmosphere in the dining room. A member of staff put on a music tape, which residents enjoyed. The majority of the residents ate independently and staff kept discreetly in the background in case their assistance was needed. Menus demonstrated that residents are provided with a choice of healthy and balanced meals. Residents are given 4 choices at lunchtime. The kitchen does not provide a good working environment. See standard 19. Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home takes complaints seriously and actively tries to resolve these. Residents are protected from abuse: delayed staff training is now booked for January 2007. EVIDENCE: The complaints procedure is incorporated in the Service User Guide and thus known to residents’ relatives. Currently there are no complaints under investigation. It is evident that the manager takes all complaints and concerns seriously and acts upon them. Whilst staff demonstrated a good understanding of all issues regarding adult protection, including how to report this, no adult protection training has been carried out since 2004. This has now been addressed and will be provided in the very near future. Ashley House DS0000067828.V317756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s upgrading programme is well underway and when completed will provide good and suitable accommodation for the residents and a better working environments for staff in respect of catering, laundry facility and storage. The upgrading programme includes the garden which, when implemented, would provide a pleasant environment for residents and visitors. EVIDENCE: The new owners are committed to provide a good environment for the residents. A full time maintenance man has been employed. Since the takeover, much has already been achieved in respect of maintenance and Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 16 decorating of the home. This includes a sluice facility, tidy up of staff room and new hoist in a bathroom. As a result, a safer environment for the residents has been provided. Carpets are on order and bedroom furniture, including beds are replaced as part of a rolling programme. The entrance hall provides a welcoming environment for residents and visitors. A maintenance person was busy painting the corridor. Work is currently on going in the laundry room in respect of new flooring and wall finishes. The main lounge had a homely atmosphere with Christmas decorations up. No unpleasant odours were noted in the communal areas although in a small number of bedrooms an odour was present. Ways of dealing with this problem were discussed. As yet no work has been undertaken in the kitchen, which is too small for purpose, the floor is lifting in places, has poor ventilation, lack of storage and the dishwasher has broken down. The proprietor is well aware of the need to address this urgently. The Environmental Health Officer recently visited the home and will return when the upgrading is completed. The kitchen was clean and the chef has been given additional hours for this purpose. On the day of the inspection, a second maintenance man was installing “door guards” to communal areas thus ensuring that these can be safely kept open. It was recommended that the Fire Officer be contacted to discuss compliance with the Fire Safety Regulations and review the home’s Fire Risk Assessment. See also standard 38. Ashley House DS0000067828.V317756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is adequately staffed and staffing levels for the morning shift have recently increased in order to provide adequate resources outings and social interaction. Residents are supported and protected by the home’s recruitment policy. Staff receive adequate training, including NVQ. Adult protection and dementia care training is overdue and to be provided in the very near future. EVIDENCE: The manager is in control, manages well and feels supported by the company. The staff rota indicates that staffing levels are adequate and had recently been increased for the morning shift. See standard 12. Staff said they enjoy their work and look forward to more training. They work well as a team. Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 18 A sample of staff files was examined and evidenced good recruitment procedures. No care staff are currently undertaken induction training but new staff would be provided with the Skills for Care induction training. A senior carer has a NVQ 3 and the home has a high level of NVQ trained staff. The deputy is considering undertaking NVQ 4. The manager and her deputy have attended dementia care training, which will soon be extended to all staff. All staff are provided with statutory training. The new owners are keen to provide their staff with more training as indicated on the staff-training matrix. Individual staff training profiles are maintained. Ashley House DS0000067828.V317756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and managed by a competent committed person. Residents and their relatives are regularly asked for their views on the services the home provides. Good systems are in place to deal with residents’ personal allowances. Staff are well supervised but the formal recorded process needs to be extended to all staff. Residents’ health is promoted and a visit from the Fire Officer would further safeguard the safety of the residents. Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager assisted the inspector throughout the day in a professional and helpful manner. She feels well supported by the new company and has an effective deputy. She is to re-start her RMA training at college as soon as a place becomes available and has recently become the registered manager following a Fit Person interview with the CSCI. Staff confirmed that the manager is a good listener. An effective key worker system is in place. Staff commented favourably on the monthly staff meetings, which are well attended. Staff said they feel involved in the programme of change. Good audit systems are in place in respect of care planning, medication, accidents, falls and policies and procedures (last reviewed in September 2006). Recently the company has carried out a quality assurance programme. Formal monthly visits by the provider are undertaken and copies of reports are sent to the CSCI. The home deals with the management of residents’ personal monies in an efficient well-recorded manner. The manager has recently started the process of formally supervising her staff and a supervision diary has been introduced. Such supervision must now be extended to all staff. The manager said that part of the process would be delegated to her deputy. The issue of supervision and appraisal training was discussed and is to be addressed. Staff receive all statutory training, which includes Fire Safety and moving and handling. Accident records are well maintained and audited. See also standard 19. Ashley House DS0000067828.V317756.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 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 2 2 x x x x x x 3 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 3 3 x 3 2 x 2 Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A 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 OP15 Regulation 23 (2) (b) (c) Requirement Timescale for action 30/06/07 2 OP19 23 (2) (b) 3 OP26 13 (3) 16 (2) (j) To ensure that the kitchen be upgraded and refitted to provide adequate areas for food preparation and storage as recommended by the Environmental Health Officer. To ensure that the home meets 30/06/07 a good standard of internal decoration and that the garden is designed to meet the needs of the residents To complete the laundry room to 31/01/07 a satisfactory standard in respect of impermeable floor and wall finishes 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 OP12 OP18 Good Practice Recommendations For the home to evidence that residents are provided with and involved in social activities That all staff receive adult protection training DS0000067828.V317756.R01.S.doc Version 5.2 Page 23 Ashley House 3 4 OP36 OP38 That all staff are formally supervised To confirm that the Fire Safety Regulations are met and the Fire Risk assessment is current Ashley House DS0000067828.V317756.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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