CARE HOMES FOR OLDER PEOPLE
Ashley House 155 Barlow Moor Road Didsbury Manchester M20 2YA Lead Inspector
Ann Connolly Unannounced 23 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 House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ashley House Address 155 Barlow Moor Road Didsbury Manchester M20 2YA 0161445 3776 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) Mrs Deborah Reynolds Ms Carmel McHale Mrs Deborah Reynolds Care home only 18 Category(ies) of Oldgae, not falling within any other category registration, with number (OP) (17) of places Physical disability (PD) (1) Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of service users accommodated is 18. 2. That one named service user is accommodated who is under the age of 65. 3. That the category of registration reverts solely to older people (OP) when this service user reaches the age of 65 or leaves the home. Date of last inspection 24 February 2005 Brief Description of the Service: Ashley House is a privately owned residential care home providing personal care and accommodation for 18 older people. The home is located in the Didsbury area of Manchester and is within easy reach of Manchester City Centre. The area is well served by public transport to the neighbouring areas of Stockport and Chorlton. In addition, the home is well positioned for local amenities such as shops, Didsbury shopping centre, hospitals and Manchester airport. The home is a large Victorian detached property that stands in its own grounds. Well maintained gardens provide pleasant outdoor facilities. Parking is at the side of the building and there is access to a large car park to the side of the building. The accommodation comprises of twelve single and three double bedrooms. All rooms have a wash handbasin and are individually furnished with some residents bringing their own furniture into the home. There are two pleasant lounges on the ground floor and these were decorated to a satisfactory standard. A separate dining room is available where seating in arranged in small group setting of four. Accessible toilets and bathrooms are located on both floors near to bedrooms and living rooms. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over a seven-hour period on the 23rd June 2005. During the inspection, time was spent talking with a number of residents, the manager and two members of staff to find out what it was like to live and work in the home. Time was also spent looking at medication, the care plan files, health and safety issues and meals. A tour of the building also took place. During this inspection only a selection of the key National Minimum Standards were assessed. In order to gain a full picture of how the home meets the needs of residents, this report should be read together with the previous and any future reports. What the service does well:
Ashley House provides a homely and relaxed environment for the residents living there. All residents spoke highly of the care and the staff in the home. Residents spoke positively about their experiences in the home and all of them said they felt that the staff responded well to any requests. One resident said, ‘ I have no complaints at all, staff are very kind and caring’. She went on to say that she hadn’t felt well during the night and that ‘the night lady was lovely’ and had been kind and supportive. One resident said she felt very much at home and said, ‘ I love the animals, especially the cat when he comes and sits on my knee’. Residents seemed very relaxed and many of them used their rooms to entertain friends and relatives. One resident said, ‘I have been here 11 years and I am very satisfied. I can go to my room whenever I want.’ The staff and manager appeared committed to providing good care to the residents. The staff made sure that resident’s healthcare needs were being met and arranged for doctor’s appointments and hospital follow up visits when appropriate. All residents commented on the good quality of the food served in the home. The meal served on the day of inspection was made using fresh meat and vegetables and there was a choice of roast chicken served with roast potatoes and vegetables or braised lambs liver. There was a high standard of cleanliness in all parts of the home. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 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. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 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 House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 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) 1 ,2 and 3 All existing and prospective residents needs were assessed prior to their admission and they and their relatives were provided with information about the home to help them in making decisions about their care needs. EVIDENCE: The home had a Statement of Purpose and Service User Guide together with a copy of the latest inspection report. These documents were made available to all residents in the home. Prospective residents and visitors to the home also had access to these documents, as they were located in the lounge area and were readily available. One resident who had been recently admitted to the home was familiar with the Statement of Purpose, demonstrating that the manager had made sure that residents were well informed about the services available in the home. All files examined contained an assessment carried out by the care manager, and a pre- admission assessment carried out by the manager of the home prior to arranging an admission date. The information contained in the assessments was used to develop the care plan. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 9 Terms and conditions were given to residents on admission to the home. The terms and conditions was in the form of the ‘Ashley House Client Agreement’. A copy of the client agreement was seen on a number of the files examined during this inspection. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 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 standard(s) 7,8 and 9 Information about some of the residents identified needs was recorded on the care plan, however, these required further development to ensure that all care needs were included in the care plan. The medication systems in place were unsafe and residents at risk. EVIDENCE: Each resident had a care plan that included background information and the reason for admission into the home. Daily recordings were made in the care plan, which highlighted any changes in needs and recorded visits from other professionals, for example the General Practitioner and the District Nursing Services. There was evidence that monthly reviews were taking place and the content of the review findings were recorded on the progress notes which could be cross referenced to the recordings of review dates. However, although there was evidence that reviews were being undertaken on a regular basis there were inconsistencies in maintaining up to date records. One plan did not include the recent changes in care needs. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 11 The care plans required ongoing development to ensure that all care needs were identified together with the strategies and interventions required to meet the needs of residents in the home. The file of a resident recently admitted to the home contained a number of identified needs in the care management assessment and these had not been integrated into the care plan. There was a medication policy in place and included guidance for staff to follow for managing the receipt and disposal of medication, homely remedies and procedures for residents wishing to self medicate. Medication was provided in a ‘Venalink’ monitored dosage system, however, on this occasion, medication was being inappropriately administered. Medication had been secondary dispensed from the ‘Venalink’ pack into pots, which contained slips of paper with the name of the resident for whom the medication was intended. Following the administration of the medication, the night staff had not signed the Medication Administration Record (MAR). The indication was that the manager would sign these retrospectively later in the morning. An Immediate Requirement Notice was issued during the inspection instructing the manager to follow correct procedures to ensure the safe handling of medication in the home. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 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 standard(s) 13, 14 and 15 Residents were encouraged to maintain contact with family, friends and the local community and were helped to exercise choice and control over their lives. A wholesome appealing and balanced diet was available to residents in the home. EVIDENCE: Residents spoken to during the inspection said they felt in control over the day-to-day aspects of their lives. Residents said that routines were flexible and that staff responded to their wishes and preferences. The inspection took place at 5.45 a.m. in the morning, and three residents were already up. Discussions with these residents confirmed that all of them had chosen to get up early. One resident said, ‘The staff are pretty good here, and I think I’m happy here. I prefer to get up early, I’ve always been like that. The meals are really good here, I enjoy them’. One resident said that her friend went out every Thursday to a local community centre where she was able to access classes and activities. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 13 All residents spoken to said their friends and relatives could visit any time. One resident said that she and her friend spent a lot of time meeting in her room. She said, ‘I am very satisfied. I can take my friends to my room when I want’. All residents spoken to spoke highly of the meals served in the home. The meal served during the inspection consisted of a choice of braised liver or roast chicken with stuffing, served with fresh vegetables and potatoes. It was noted that all produce used was fresh and home cooked. The meals were served in the dining room which was set out in small group setting seating four on most tables. Care staff served the meal and the whole experience for residents appeared relaxed, enjoyable providing an ideal environment for socialising. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 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 standard(s) 16 and 18 There were policies and procedures and systems in place, which enabled residents to raise any issues of concern as well as procedures that protect and safeguard their well being. EVIDENCE: The Commission for Social Care Inspection had received one complaint about the service, which highlighted five areas of concern. One concern was investigated by Manchester Social Services and was not upheld. The Commission investigated the remaining four aspects of the complaint and none of these were upheld. The home had a complaints procedure, which was included in the Statement of Purpose and Service User Guide. All residents spoken to said they felt confident in approaching the manager and the staff with any areas of concern. One resident said, ‘everything is excellent here. Things aren’t always hunky dory but you can always get Carmel and Debbie to sort it out for you’. Staff on duty made comments, which reflected the sentiments of the residents. One staff said she felt there was a ‘real openness’ about how the home was run and managed, and was impressed at the way residents were treated and encouraged to express any concerns. Staff spoken to had a good understanding of Adult Protection Procedures, and understood the importance of reporting any allegation of abuse. The home used the Manchester Multi-Agency policy for the Protection of Vulnerable Adults from Abuse.
Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 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 standard(s) 19,20,21,22,23,24,25 and 26 The home was clean, tidy and comfortable. Some risk assessments on the environment and recordings of water temperature need to be made to ensure that all parts of the home to which residents have access to are free from hazards to their safety. EVIDENCE: The home was clean, well maintained, accessible and suitable for residents with low dependency levels. Some area of the home needed re-decoration in order to maintain standards in the home. The grounds surrounding the property were tidy and well maintained and access to the garden was via a ramp. The home is an adapted house and would not easily meet the needs of residents with physical disabilities and this was reflected in the home’s admission policy. The home comprised of 2 spacious lounges and a dining room. Furnishings were domestic in character and appeared to be of a good quality.
Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 16 Three bathrooms and six toilets were located throughout the building providing easy access for residents. Adaptations including grab rails were fitted to promote independence. One of the bathrooms was fitted with an assisted ‘medic’ bath and a hoist was provided for the remaining two bathrooms. Residents had access to all parts of the communal space and to their bedrooms via the use of a passenger lift. During this inspection, it was noted that a number of fire doors had been wedged open. This posed a potential health and safety risk to people in the home in the event of an emergency. Some wardrobes in bedrooms presented a health and safety risk as they were unstable and likely to fall and cause injury to residents in the home. Residents spoken to expressed satisfaction about their rooms and there was evidence that rooms had been personalised. Since the last inspection all hot water outlets had been fitted with individual thermostatic mixing valves to ensure that water temperatures were regulated as close as possible to 43 degrees centigrade. Although this work had been carried out there were no systems in place to make regular recordings of water temperatures throughout the home and the manager must address this. The home had two cats and two dogs. Some medication for these animals was kept in an unlocked kitchen cupboard. These must be moved to a secure place to maintain a safe environment for residents in the home. Two residents spoken to expressed delight at having the animals in the home, and talked about them affectionately. One resident said, ‘ I have been here for 11 years and am very satisfied. I love the animals, especially the cat when he comes and sits on my knee’. It was noted that during periods of movement and activity, the animals were taken out of the building. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 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 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) 27,28 and 29 The home employed experienced staff and provided opportunities for training and development. However, the recruitment/vetting procedures failed to meet the regulations and had the potential to place residents at risk. EVIDENCE: There was evidence of ongoing training and development, which was available for all staff. One staff on duty had just completed her NVQ Level 2 award. It was evident that the staffing levels at the time of inspection were sufficient to meet the needs of the residents, however, the manager said that they were experiencing problems in recruiting staff. As a result of staffing shortages the manager was working long hours. This will need to be monitored to ensure that the rota is realistic and that staff are able to meet the day-to-day needs of the residents. The file of a newly appointed member of staff was examined. This file did not contain an up to date Criminal Record Bureau check or a POVA First check (Protection of Vulnerable Adults). The manager was informed that all staff must have a POVA First and a CRB check before commencing work. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 18 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) 34 and 35 The home had suitable accounting and financial procedures in place as well as procedures to support residents in managing their financial affairs. EVIDENCE: The home employed an accountant to manage the home’s accounts. Accounts are also sent to Manchester Children, Familiesand Social Care for inspection as part of their contracting agreement. The home did not manage any residents accounts. Some residents were able to manage their own affairs, and where this was not possible a family or a representative assisted them. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 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 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 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 x 3 3 x x x Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 20 Yes 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 7 Regulation 15 Requirement Care plans must be developed to ensure all care needs are identified and included in the care plan. Staff responsible for the administration of medication must follow correct policies and procedures to ensure the safety and well being of residents in the home. The manager must ensure that all parts of the home are safe. Fire doors must not be wedged open, wardrobes must be fastened to walls and a record of water temperatures throughout the home must be maintained. All staff must have a CRB disclosure prior to commencing employment. Timescale for action 1/8/05 2. 9 13 Immediate 3. 19 23 20/7/05 4. 29 19 schedule 2 1/8/05 Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 21 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. Refer to Standard Good Practice Recommendations No recommendations have been made as a result of this inspection. Ashley House F05 F55 s21531 Ashley House V235032 D230605 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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