Inspection on 13/03/06 for Ashley House

This inspection was carried out on 13th March 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashley House 15/01/09

Ashley House 23/01/07

Ashley House 14/07/05

Ashley House 31/01/05

Ashley House 24/08/04

Ashley House 19/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashley House The Avenue Langport Somerset TA10 9SA Lead Inspector Loli Ruiz Unannounced Inspection 12:00 13 March 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 House DS0000016071.V280321.R01.S.doc Version 5.1 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 DS0000016071.V280321.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashley House Address The Avenue Langport Somerset TA10 9SA 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) 01458 250386 01458 250386 South West Care Homes Ltd Susan Frances Timbrell Care Home 25 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. REGISTERED FOR 25 OLDER PERSONS IN CATEGORIES OP AND DE (E) WITH A MAXIMUM OF 6 DE(E) 14th July 2005 Date of last inspection Brief Description of the Service: Ashley House is situated in a residential area close to the centre of Langport. Service user accommodation is provided over two floors. There is a stair lift, assisted bathrooms and call system available at the home. Most rooms have en suite toilet facilities. Communal areas comprise of a lounge, dining room and large conservatory. The home has pleasant gardens that are accessible via ramps and wide steps. Ashley House is registered with the Commission for Social Care Inspection to provide care for up to 25 people over the age of 65 years who require assistance with personal care, including six service users who with dementia. The Registered Manager is Mrs Susan Timbrell. The Registered Provider is South West Care Homes Ltd. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the planned annual programme of inspection. The inspection was unannounced and carried out by one inspector over one day. The previous inspection was also unannounced and took place on 14th July 2005. On the day of the inspection there were twenty service users residing at the home and one person was in hospital. During the course of the inspection service users, visitors, staff members and the Registered Manager were spoken with. Care practice was observed, records examined and a tour of the premises was made. What the service does well: What has improved since the last inspection? What they could do better: Since the inspection, the manager has confirmed that a requirement and recommendations made in this report have already been met or are in the process of being met. Work is still required in the three bathrooms so that they are all appropriately refurbished and adapted to the needs of people living in the home. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 6 The manager could work out a strategy to ensure that essential up-to-date documents are displayed for everyone’s information. These include the latest inspection report, the complaints procedure and the day’s menu. The manager must ensure that all mobile equipment without exception is serviced at 6 monthly intervals to comply with LOLER. The carpet that is becoming threadbare and has a gap at a central join, in the corridor downstairs, should be replaced and the join made safe. 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 House DS0000016071.V280321.R01.S.doc Version 5.1 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 DS0000016071.V280321.R01.S.doc Version 5.1 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): 1,3. NMS 6 is not applicable. NMS 2,4,5 were fully met in July 05. Service users have the opportunity to meet the manager after referral and are given appropriate information on which to make a decision about coming to the home. An assessment of need, completed prior to any service user moving in, enables judgement and agreement about how the assessed needs will be met in the home. EVIDENCE: Mrs Timbrell visits prospective service users following referral to assess with them their needs and discuss provision available at Ashley House. All appropriate information is provided and prospective service users and their relatives are invited to visit prior to making a decision to come to the home. The home’s Statement of Purpose and Service User Guide with details of the services and facilities offered at Ashley House are included in a folder for each room. However, a number of service users did not appear to be aware of this document, perhaps having tidied it away and forgotten about it. Mrs Timbrell agreed to look at ways of displaying these documents again at the entrance of Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 9 the home so that they are also available to visitors. Documents displayed should include the latest inspection report and the complaints procedure. There is a notice by the front door inviting visitors to ask for the inspection report but it would be better if this document was available and people did not have to ask for it. Evidence of good pre-admission assessments were evident within service user plans. Where involved, the assessments of professionals were included and contributed to the plan of care. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 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): 7,8,9,10, NMS 11 was fully met in July 2005. Appropriate actions are taken to meet service users health and personal care needs. There are good Care Plans that provide staff with the information required to fully meet service users needs. Staff are provided with appropriate medications training. Staff treat service users with dignity and respect. EVIDENCE: Care plans for three selected service users were inspected. These included details of individuals’ needs, daily routines and preferences. Care plans were thorough and included detailed directions to staff of the level and type of assistance to be provided to each person. A moving and handling assessment had been completed for each service user. Two of the care records refer to service users new to the home, who had still to confirm that they would be staying. One was of a service user with specific health care needs. This Care plan had been regularly reviewed and updated as required and evidenced the Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 11 involvement of the service user. The new care plans had not yet been formally reviewed with the service user although they personally indicated that their needs were well met in the home and there was indication of a general improvement in these persons wellbeing since admission. All care plans evidenced access to NHS and other health care services. One of the service users said “ I am wonderfully looked after” “ I would not be so well if it was not for the staff here”. The general health of another service user had improved with increased appetite. The local GP practice has allocated a GP to the home who carries out weekly visits when there is anyone wanting a consultation. All staff members involved with medication, that is supervisory staff and established senior carers, have completed the care of medicines course. The pharmacist visited recently and left a good report about the management of medicines in the home. Medication administration was observed and carried out appropriately. Medicines were securely stored and the manager returns medication at regular intervals for appropriate disposal. Records inspected were appropriately maintained, they included the record of returns and MAR sheets. All transcriptions were supported by two signatures. The manager indicated that all new furniture purchased includes lockable space so that all those holding their medication do so safely. The manager agreed to contact the pharmacist with regards to the packaging of Temazepam. It is recommended that this be in the original package so that it can be stored in the CD cupboard. CD records were up-to-date and appropriately signed. Service users are provided with assistance to undertake personal care tasks as required. Personal care is provided in private. The home works closely with the District Nursing Team. Service users confirmed that staff treat them with dignity and respect. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 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): 12,13,14,15 The home has taken appropriate action to meet individual service users’ social needs. Service users are encouraged to exercise choice over their lives. Meals are of a high standard and offer a well-balanced diet. EVIDENCE: Service users are encouraged to maintain interests and hobbies as evidenced during the visit. A daily plan of morning activities is displayed at the entrance hall and staff provide opportunities to ensure that individual preferences are catered for. Activities included board games, nostalgia, bingo, quiz, armchair exercises, what’s in the news, manicures, favourite hymns, indoor sports, sherry evenings and arts and crafts. Celebrations were planned to mark a service user’s 100th birthday. There are performances by theatre and musical groups twice a month and in the warmer months outings are organised. Visitors are welcomed, as evidenced during the inspection and by service users testimonies of staff enabling communications with relatives and friends. Holy Communion takes place at the home each month. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 13 Service users are able to spend time in communal areas or their own room, as they prefer. Individual choices are respected and staff discussed with the inspector efforts made to meet the social needs of everyone. Information has been displayed regarding Age Concern’s advocacy service and guidance for individuals who are privately funded. Meals are prepared at the home according with the service users’ dietary needs and preferences. Service users spoke highly of the meals provided. The lunch and tea meals were observed. They were served in a pleasant dining room and in bedrooms, as preferred by each person. The meals looked appetising and were served in good portions. Meals were freshly prepared and the 4-week menu evidenced a good balance of meals and ingredients. Although service users have menus in their rooms and they are asked for their choice on the day, the day’s menu should also be prominently displayed by the dining room. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 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. NMS 18 was fully met in July 2005 The home ensures that any complaints or issues raised are listened to, and appropriate action taken. EVIDENCE: No complaints had been received since the last inspection. Service users, relatives and friends spoken with, confirmed that they were able to raise any issue of concern with the staff in the home, and that their wishes were listened to. Staff and management were described as very good or excellent. Conversations with staff also evidenced understanding of service users rights and to a good ethical code of conduct. The complaints procedure should be displayed in a prominent place at the entrance of the home as already mention in NMS 1. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 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): 19,20,21,22,23,24,25 & 26. Service users benefit from an attractive and comfortable environment that is cleanly maintained and it is decorated and refurbished according with an ongoing planned programme of improvement. Service users benefit from adequate communal space and from personalised bedrooms, many of which have en-suite facilities. Bathroom facilities are being upgraded and they should all be also appropriately adapted, so that they can be used. EVIDENCE: Service user accommodation is provided over two floors. There are two assisted bathrooms, a stair lift and call system available. Automatic fire safety door closures have been fitted where required. All but two service user rooms have en suite toilet facilities. Two rooms on the first floor may be used as doubles by those wishing to share. Service user rooms have been decorated Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 16 and furnished to a good standard. Bedrooms have natural light and those seen had open views. Bedrooms have locks and the manager is replacing furniture that needs it. She ensures that any new furniture has a lockable space as some rooms still have none. Communal areas comprise of a lounge, dining room and large conservatory. There are also attractive gardens that are accessible via ramps or wide steps. There was a small area of carpet at the entrance of the downstairs corridor that had threadbare patches and a gap where two carpet pieces meet. This should be put right at the earliest opportunity as it could soon become dangerous if the carpet lifts or deteriorates. The home plans to upgrade the assisted bathroom on the ground floor. The bath on the first floor has been replaced and redecorated to a good standard although it has no bath-chair and it is not used for this reason. There are 3 bathrooms and they all should be adapted. Bathrooms have now been fitted with mixers to ensure water is served at a safe temperature. Window openings on upper floors have been restricted and guards have been fitted to all radiators that are in use. All areas seen, including the laundry, were found to be clean and well organised. Red alginate bags are used as required. The home follows good practice in relation to infection control as evidenced by equipment and material provided and by staff practices observed such as hand washing, use of protective clothing according to task, and disposal of materials. The boiler room now has a large outlet and ventilation pipe fitted. The hot water cupboard is maintained bolted to ensure safety. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 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. NMS 30 was fully met in July 2005. Service users benefit from adequate staffing provision and from a qualified, committed and stable staff team. Service user’s welfare is protected by the recruitment procedures in the home. EVIDENCE: On the day of the unannounced inspection, there was the Registered Manager, a senior care assistant, two other Care Assistants, Cook and Domestic staff on duty. There was also the administration assistant. Domestic staff work only in the mornings. The afternoon has a minimum of 3 care staff. The Manager and staff confirmed that staffing levels have been maintained and absences covered mostly by existing staff. Very occasionally agency staff are also used. Service users and staff confirmed that, though staff were busy, the pace was good and that they had time to spend with service users. This was evidenced in practice. In the afternoon one staff member in the duty rota was not able to work and the hours were covered by existing staff and by the manager. The senior staff team members have worked in the home for a number of years and provide good continuity and support for new staff members. Two new staff live in the premises and are available for on-call duties. Newly appointed staff are provided with a through induction program. Staff are encouraged to undertake further training, including study for NVQ training. The Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 18 Registered Manager completes a training needs assessment each year to ensure that appropriate courses are provided. She confirmed that the home has a level of qualified staff at NVQ II or above, that exceeds the 50 minimum required. The inspector spoke with a number of staff on duty. All established staff had NVQ. They had completed a care of medicines course and confirmed having statutory training that included regular fire instruction and safe handling. The statutory training record, however, was not inspected in this occasion. Two new staff members were undergoing induction, each supported at the pace that they needed. Staff said that they were well supported by their own team, the manager and also the provider who visited the home regularly and was described as very approachable. Dementia training was planned to be provided next. Recruitment files were examined for the most recently employed members of staff. These were found to contain all of the documentation required under Schedule 2 of the Care Home Regulations 2001. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 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): 31,32,33,34,35,37,38. NMS 36 was fully met in July 2005. Service users benefit from a qualified and experienced manager, who is approachable, provides leadership and support to the staff team and organises the home to safeguard the best interests of service users. Records relating to service users are stored securely. Service users welfare could be jeopardised by equipment that is not serviced at intervals that comply with LOLER. EVIDENCE: The Registered Manager, Mrs Sue Timbrell, has many years experience of providing care to older people and has obtained the NVQ level 4 qualification in Management. Service users and visitors spoken with confirmed that the Manager and staff were approachable. Staff indicated being well supported by the hands-on manager and to having frequent and supportive staff meetings. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 20 Records relating to service users are stored securely. The home will keep money securely for any service user that wishes them to. A sample of service users moneys and transactions were inspected. Appropriate records are maintained of all transactions involving service user finances. The home has appropriate Employers Liability insurance. The old certificate had expired but the new certificate was found and displayed before the inspector left the home. Fire safety equipment has been serviced and tested as required. Staff evidenced being provided with regular fire safety training. Servicing records relating to the stair lift, heating system, portable appliances had been appropriately maintained. The mobile hoist was last examined on 7/9/04 and August 05. It has a service contract that states 2 services a year but the February 06 service had not taken place. The manager called the company who promised to visit within 24 hours. The manager must ensure that services take place at the prescribed intervals and should have a strategy to remind contractors that are unreliable. The bath chairs are checked for safety by staff but also need to be serviced twice a year as all other mobile equipment. The manager could not tell when the bath chairs had last been serviced by an appropriate person. The manager evidenced that the hard wiring had been checked and faults found had been corrected after the last inspection. The cupboard housing the hot water tank has been fitted with a high bolt to ensure service users are not at risk from very hot pipes there. Hazardous substances had been stored securely. Accidents had been recorded and reported as required. Health and safety notices were displayed in a number of locations throughout the home. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 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 X 3 X X N/A 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 X 3 3 3 2 3 2 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 X 3 2 Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP38 Regulation 13(5) Requirement All mobile equipment, including the bath chairs must be inspected on a six monthly basis to comply with LOLER regulations 1998. Previous unmet requirement. Timescale for action 30/04/06 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. 3. 4. Refer to Standard OP1 OP9 OP19 OP22 Good Practice Recommendations Information about the home, the complaints procedure and the latest inspection report should be clearly displayed at the entrance of the home. The manager should negotiate with the pharmacist so that Temazepam tablets are delivered in a container that fits in the CD cupboard. It is recommended that the carpet in the downstairs corridor be replaced and the join be made safe. The bathroom on the first floor should be properly adapted so it can be used. DS0000016071.V280321.R01.S.doc Version 5.1 Page 23 Ashley House 5. OP24 It is recommended that the plan to provide furniture with lockable space in all bedrooms is carried out. Ashley House DS0000016071.V280321.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 House DS0000016071.V280321.R01.S.doc Version 5.1 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!