Inspection on 24/05/07 for Ashley House

This inspection was carried out on 24th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 09/05/08

Ashley House 21/11/06

Ashley House 09/11/05

Ashley House 11/05/05

Ashley House 09/11/04

Ashley House 02/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Ashley House Ashley House Moulsham Street Chelmsford Essex CM2 9AQ Lead Inspector Kathryn Moss Key Unannounced Inspection 24th May 2007 09:00 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 DS0000017753.V341463.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 DS0000017753.V341463.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley House Address Ashley House Moulsham Street Chelmsford Essex CM2 9AQ 01245 494674 01245 493254 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) Dr Kuldip Singh Dr Amrit Kaur No registered manager Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, only falling within the category of Old Age (not to exceed 22 persons) 21st November 2006 Date of last inspection Brief Description of the Service: Ashley House is a large detached house, located in a residential area close to a park and a supermarket, and only a short distance from the centre of Chelmsford. The home has parking to the front, and a garden area to the rear. Accommodation is over two floors, with access via a through floor lift. There are ten single bedrooms (two with en-suite toilets) and six double bedrooms (one with en-suite toilet). The home has three bathrooms, several toilets, and two communal lounge areas (one with an integrated dining area). The home is registered to provide care and accommodation to 22 older people; it does not provide nursing care, and is not registered to admit residents with a diagnosis of dementia. Prior to 2007 the home was being managed by one of the owners, Mrs Singh: however, in January 2007 a new manager was appointed (Stephanie Kelly), who is not yet registered with the CSCI. The home’s Service User Guide is available at the home from the manager’s office. Information submitted by the home in May 2007 showed that the current fees for the home are £434.63. Residents pay for their own additional expenses such as hairdressing, chiropody, newspapers and personal toiletries. Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that started on the 23rd May 2007 but was mostly carried out on the 24th May in order to enable the new manager to be present. The whole inspection process lasted eight and a half hours, and included: • • • • • • • • Discussion with proprietor and manager Inspection of communal areas and a sample of bedrooms and bathrooms Inspection of kitchen and laundry Inspection of a sample of records and policies Conversations with 2 staff Conversations with 8 residents Feedback questionnaires from ten residents (completed with the assistance of relatives or the home’s care staff) Feedback questionnaires from two relatives This report also draws on any other information relating to the home received by the CSCI since the last inspection (e.g. notifications from the home, complaints, quality of care reports, improvement plans, etc.). The outcomes related to 24 Standards were inspected. There were 9 requirements resulting from this inspection, and 16 good practice recommendations have been made. The proprietor and manager were helpful throughout the inspection, and were progressing action to address most of the issues identified at the last inspection. The home provides a consistent level of care and support, with positive feedback from residents and relatives and with no concerns raised with the CSCI since the last inspection. What the service does well: Ashley House provides a homely and safe environment for people to live in. Staff appear caring and friendly, and were clearly well thought of by residents. Residents were positive in their feedback, with several of them saying that they liked living at Ashley House, and were happy and content there. The home has managed to maintain staffing levels well over the last year: because staff are not expected to work excessive hours, residents benefit from staff who are not over-tired and who have the capacity to cover extra shifts when short staffed, resulting in good consistency of staffing (i.e. rare use of agency). It was good to see staff spending time with residents in the lounge area, and residents clearly enjoyed the interaction they had with staff. Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: For some years now the home has not had a registered manager in post, and consequently lacked a clear and purposeful management approach. This has affected the development of the home and is reflected in many of the areas highlighted in this report. The home particularly needs to improve on levels of staff training and recruitment practices, and needs to develop formal auditing systems to monitor practices and procedures within the home (including medication practices). These issues are important for the safety and protection of residents: staff need to have the knowledge and skills to carry out their role, and management systems need to monitor that practices and procedures are being carried out appropriately. Some aspects of the fabric and furnishings of the home also need attention, in order to improve the environment for residents and to promote their health and welfare through ensuring safe facilities. This particularly relates to replacing worn furniture, and to making repairs to areas of the home (e.g. kitchen and bathrooms) where poor facilities and equipment may present infection control risks. Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 7 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 DS0000017753.V341463.R01.S.doc Version 5.2 Page 8 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 DS0000017753.V341463.R01.S.doc Version 5.2 Page 9 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, 3 and 4 (Standard 6 is not applicable at Ashley House) People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission assessment practices ensure that prospective residents can be sure that the home understands their needs. However, levels of staff training were not sufficient to ensure that all staff have sufficient skills and knowledge to meet residents’ needs. EVIDENCE: The home’s Statement of Purpose and Service User Guide were seen to be available in the home’s office, and had been updated to reflect the new manager. The proprietor stated that these documents are provided to all new residents, and was considering developing an information folder that could be made available in the lounge area, to contain these documents and other core Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 10 policies. This is encouraged, in order to make relevant information easily available to residents and their representatives. The manager stated most new residents are referred through Social Services. She confirmed that Social Services generally provide basic assessment information, and the home will then usually go and visit the person to carry out further assessment and complete the home’s assessment form. The file for one new resident was inspected and included a pre-admission assessment completed by the home prior to the person moving in, which covered all core areas of need. The home has equipment available to meet the range of needs of those people who the home aims to accommodate. Residents and relatives consulted as part of this inspection felt that the home was meeting residents’ needs, with all feedback questionnaires received from residents stating that they ‘always’ or ‘usually’ received the care and support they needed, and residents were generally very positive about the way staff cared for them. However, one person who provided feedback felt that not all staff had sufficient experience, and staff training records did not demonstrate sufficient training in some of the core skills and subjects required by staff to meet residents’ needs safely (e.g. moving and handling training, fire safety training, infection control training, etc. – see Staffing section). This needs to be addressed in order to ensure all staff have the skills and knowledge to meet the needs of residents. Residents’ contracts (terms and conditions of residence) were not reviewed on this occasion, but in ten feedback questionnaires received from residents, only one person confirmed that they had a contract. Whilst it is possible that other residents may have forgotten about the home’s contract, the manager should ensure that all residents, where able, are made aware of the home’s terms and conditions, including what they can expect from the service provided. Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 11 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 and 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans generally provided sufficient information to ensure that staff know what support residents need, and staff practices and approach promoted the privacy and dignity of residents. However, medication practices were not sufficiently robust to fully protect residents. EVIDENCE: The care files of three residents were inspected, and contained clear admission details (personal information and contacts, etc.). Although admission forms contained space to record people’s wishes in relation to arrangements following death, this section was not completed in all cases and no specific information was recorded regarding end of life care wishes. Files contained a range of appropriate assessment and risk assessment forms (e.g. risk of pressure areas, continence assessment, individual risks and moving and handling). Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 12 Each file contained a care plan, setting out how the person’s needs should be met: the home had implemented a new care plan format since the last inspection, which included pages covering specific areas of need (e.g. communication, insight, social and leisure; physical and mental health; personal cleansing and dressing; and diet, nutrition and medication). Information under each heading was clear, but generally quite brief: for example, regarding toileting needs one care plan stated ‘two staff to assist’ but did not describe what assistance was required; care plans relating to social or cognitive needs referred to the person’s interests, or to specific behaviours, but did not describe the action required by staff to support these needs. The home needs to continue to develop care plans, to ensure that they contain sufficient detail of the action required by staff to meet each need. At the time of this inspection the manager reported that no resident had a pressure area. Risk assessments on one of the files inspected showed that the person was at high risk of developing pressure areas: although it was confirmed that appropriate pressure relief equipment was in use, their care plan did not detail the preventative care required by staff, or the equipment in use. The proprietor provided evidence that this had been included in previous care plans, and the home needs to ensure that the new care plans clearly detail all pressure are care or preventative care. Residents consulted felt that they always or usually receive the care and support they need, and also confirmed that they receive any medical support they need. Care files contained clear records of visits by healthcare professionals, and there was evidence of regular support to the home by district nurses. Daily report records contained good information on how each person had been and what they had done, including reference to the food they had eaten. These showed an improvement in the type of information being recorded. The manager also confirmed that a record of food chosen at each meal was maintained as a record of individual’s nutrition. The home did not use a nutrition assessment tool, and does not currently weigh residents regularly: the manager stated that staff would note any obvious weight loss of gain (e.g. changes in the fit of clothes), and would refer concerns to the GP. The manager reported that the home had addressed a previous issue about set toileting routines in the home: a carer and a relative spoken to confirmed that this had changed; support with toileting was now being provided flexibly and individually. Continence promotion was not specifically discussed on this visit. Moving and Handling assessments were in place, and staff were observed encouraging people to mobilise. However, staff had not received sufficient training in moving and handling (see Staffing section), and it was noted that two residents were using walking frames that had not been supplied for their use (i.e. had other peoples’ names on them). One person said that they found their frame too large and difficult to manoeuvre. The manager is advised to ensure that residents are appropriately referred and assessed for correct Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 13 mobility equipment. It was good to hear that the home had ordered a standing hoist, in order to meet people’s needs in relation to support when transferring. A concern had been raised at the previous inspection about many residents remaining in their armchairs throughout the day, including for meals, and whether the use of cantilever tables placed over their legs discouraged them from mobilising. On this inspection this was discussed with the manager who said that they encourage residents to sit at dining tables for meals and that more people now did this. She also said they had consulted residents about the tables, and residents had been clear that they liked having the tables, and felt able to push them away if they wished to get up. The staff should continue to encourage residents to mobilise and change position during the day. Residents spoken to were happy with the way staff supported them, and were generally positive about the staff team, finding them kind and supportive. Records identified the names people preferred to be called by, and staff were seen to treat residents in a dignified and respectful manner. A care professional who provided feedback prior to the inspection stated that they had always found staff in the home to be kind and patient. A lack of privacy at sinks in shared rooms was discussed, and the proprietor reported that most residents currently sharing rooms are not able to use the sinks; however, privacy screens must be provided if these rooms are ever used by someone who is able to use their sink independently. The home’s Medication Administration policy was not reviewed on this visit. At the last inspection there had been several requirements relating to medication practice, and most of these had been addressed well: the store cupboard was observed to be locked, and the person in charge held the keys; a controlled drugs cabinet was being used appropriately, and a controlled drugs record book had now been obtained; homely remedies (e.g. paracetamol) had been obtained, and manager described appropriate recording practice. Stocks of medication were stored securely; bottles of liquid medication and eye/ear drops were not currently dated on opening, and this is recommended. Some practice issues of concern were noted on the inspection regarding decanting medication and leaving drugs unattended: an immediate requirement notice was sent to the home following the inspection, and the proprietor subsequently confirmed that the issues had been addressed and would be monitored. The home had recently changed to Boots for their medication supplies, and Boots provided printed Medication Administration Records (MAR) detailing each person’s medications. Staff had clearly recorded the date and quantity of all medication received, and controlled drugs were appropriately recorded. In one instance the MAR just stated ‘as directed by GP’: although the manager had written ‘PRN’ alongside this, full details needed to be recorded (i.e. the maximum number of tablets and frequency per day); the home should request that the GP revises the script to show full directions. Not all changes to Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 14 medication instructions (e.g. ‘discontinued’) had been signed and dated by the person making the record. This should be addressed. MAR were generally well completed; although the home’s policy was to record each time PRN medication was offered, some gaps were seen in one record and the manager needs to ensure consistent practice. The home should also ensure that a photo of each person is maintained with the MAR. Staff training records showed that all staff responsible for administering medication had recently received training from Boots. However, this was only training in the use of the Monitored Dosage System, and did not constitute comprehensive medication training. The proprietor was advised to ensure that all staff responsible for medication receive full training in the use and administration of medicines, and was referred to the Skills for Care Knowledge sets for guidance on the minimum content of medication training. Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 15 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 and 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides flexible routines, and opportunities to meet a variety of social, recreational and religious interests and needs. The home provides a healthy and balanced diet. EVIDENCE: During the inspection most residents were observed to spend most of the day in the main lounge area. It was good to see breakfast still being served to some people at 10am: one person who was still having breakfast confirmed that they had only just got up as there was no reason to ‘rush and get up’, whilst another said that they chose to get up at about 6am and usually therefore had breakfast earlier, around 7-7.30am. This showed that daily routines were flexible and individual. Following a requirement made at the last inspection, the home had made progress at developing activities for residents. In questionnaires completed by Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 16 residents, six stated that there were ‘always’ or ‘usually’ activities available for them to join in with, whilst four felt there were only ‘sometimes’ activities available. However, five residents spoken to during the inspection confirmed that there were activities that they could join in with if they wished, staff were seen spending time with residents doing puzzles and drawing, and people were seen with word quizzes and reading books. A carer spoken to confirmed that staff try to do activities each afternoon, and the manager stated that an hour each shift is now allocated for staff do spend with residents doing activities. A weekly ‘programme’ was seen displayed on the lounge wall showing a range of suggested activities. The proprietor stated that this had been developed based on suggestions made by residents at a residents’ meeting, and will be reviewed. One relative noted that staff were trying to engage residents in activities, and another observed that staff spent time chatting to residents. Care plans did not contain much information on the action required by staff to help people occupy their time and receive stimulation, and should be developed further. An activities record book was being maintained, showing the activities initiated each day and who had participated: although this provided a useful record of activities, the home is recommended to explore ways of recording this information on individual care records, in order to be able to monitor each person’s involvement with activities and whether care plan aims are being achieved. Opportunities to go out of the home were not frequent, but the proprietor stated that staff can take people out to a local park and supermarket. Two residents were supported to attend a local day centre, and another person was taken to church by friends. A monthly church service is held in the home, and a priest visits some individual residents. The proprietor stated that entertainment is occasionally brought into the home, but there was no other regular community contact. The home’s visitors’ book showed that visitors were able to come to the home at any time. As noted in the previous section, the home had take action to address issues relating to autonomy and choice regarding toileting routines in the home. It was also good to see that residents’ meetings had been taking place regularly this year, as these are a good way of consulting with residents and involving them in the running of the home. Relatives had also been invited to the meetings, and the manager stated that there had been a good attendance (e.g. nine residents and three relatives at the last meeting). The manager said that activities and meals had been discussed at the meetings and that minutes had been taken, but these were not available in the home at the inspection. It is recommended that minutes are typed up and displayed in the home promptly after each meeting, to remind residents and relatives of the discussion and of any action agreed. Several rooms viewed were well personalised, showing that residents could bring their own possessions into the home with them. Some shared rooms provided limited personal space: whilst noting that the space in these rooms cannot be changed, the manager should Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 17 be aware of ensuring that people make an active and informed choice to share these rooms. Access to advocacy services was not discussed on this inspection. Service users consulted were generally positive about the meals, with several confirming that there were alternatives available; comments on the variety were mixed, with one person saying they were ‘happy with the variety’ and another saying ‘we get offered an alternative, but not always a lot of variety’. The proprietor stated that menus had been revised following discussion in a residents’ meeting. Menus submitted as part of this inspection showed two choices each main meal, with a satisfactory range of meals. However, over a four week period there appeared to quite a lot of repetition of meals (or similar meals), and it is recommended that the home explore a broader range of options. A range of different foods were available at breakfast and teatime. Specific dietary needs were not specifically discussed on this inspection. Cold drinks were seen to be available in the lounge, and were being regularly offered to residents. Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 18 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 and 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practices in the home generate few complaints, and residents are confidant any concerns will be listened to. EVIDENCE: The home’s complaints policy was seen displayed in the entrance hallway. Feedback questionnaires completed by residents confirmed that they ‘always’ or ‘usually’ know who to speak to if weren’t happy, and most said they knew how to make a complaint (a couple just stated that they had not had any complaints). Similarly, relatives who provided feedback confirmed that they knew how to make a complaint, and generally felt the home had responded appropriately if they had raised any concerns. However, one person felt that sometimes when issues were raised the management responded in a way that suggested that they thought there was not a problem, when the complainant felt there was: the management should ensure that all concerns are taken seriously and looked into. No complaints about Ashley House have been received by the CSCI since the last inspection. Following a previous requirement, since the last inspection the home had maintained a clear complaints log, showing any complaints received Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 19 and the action taken (with separate records where necessary). The record showed six complaints or concerns recorded since the last inspection, and indicated that appropriate issues were being recorded. The home’s Protection of Vulnerable Adults (POVA) policy was not reviewed on this occasion. POVA issues were discussed with the new manager, who showed a good understanding of types of potential abuse. No POVA concerns have been raised in relation to the home in the last year. POVA was also discussed with a carer, who confirmed that they had done some in-house training (using a DVD training pack): they said they had found this useful, confirmed that it had covered Whistle Blowing, and were clear on reporting any concerns and of who to report these to. POVA training was raised at the last inspection, as not all staff had completed this training. The manager stated that this is being delivered in-house using a POVA DVD and worksheets: evidence of this was seen, although this was still in progress. Training records for 16 staff (excluding manager and proprietor) showed that 5 staff had still not completed this training. As this was a requirement at the last inspection, it should be completed with some urgency. Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 20 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, 20, and 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally provides a safe, maintained and clean environment, which is suitable for residents’ needs. However, the poor condition of some equipment and work areas presents a risk of cross-infection. EVIDENCE: The home has a decoration plan, which showed that most rooms had been decorated in the last year, including the lounge and dining room, and corridors. This was good to see. Decoration of the main lounge in lighter colours, and the fitting of new blinds, made the room seem lighter. The smaller quiet lounge had also been decorated and equipped with more comfy chairs, which made it a more homely and useable space for residents and Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 21 staff: the proprietor confirmed that this room is now used more (e.g. by visiting families), and is encouraged to monitor that this room remains tidy and does not get used for storage. Bedrooms viewed were generally in a good state of decoration, and were clean and tidy: many items of furniture were old and worn, and in need of replacing: the proprietor stated that the home has applied for a grant in order to upgrade bedroom furniture, and this should be progressed as soon as possible. A hoist was observed to be present in a shared bedroom, although neither resident required its use: the manager was advised to ensure that residents’ bedrooms are not used to store equipment. The home’s kitchen remains in very poor condition, with damage to work tops and doors missing from storage cupboards. This does not present a good impression, and potentially presents some infection control hazards. Issues relating to a leaking sink and food and chemicals stored in the same cupboard had been addressed since the last inspection. The state of the kitchen has been raised on inspections for several years now, and an improvement plan submitted to the CSCI by the proprietor in February 2007 confirmed that this will be addressed this year. At the time of this inspection, areas of the home viewed were clean and tidy, and there were no obvious areas of unpleasant odour. Residents were very positive about the new cleaner, and reported that the home was usually ‘fresh and clean’. During a tour of the home, several bed valances were observed to be grubby, and the manager was asked to ensure there was a clear plan in place to ensure that these are regularly laundered. Supplies of continence pads were observed on top of a resident’s wardrobe, with some pads loose (i.e. outside of the plastic bag): the home is encouraged to review storage arrangements to ensure that pads are stored hygienically and discretely. This had also been an issue on the previous inspection. Four new commodes had been purchased following the last inspection to replace those that were worn, and a corroded toilet frame repaired; this was good to see. On this occasion another toilet frame was seen to be corroded and flaking, and needed repairing to avoid presenting an infection control hazard. A crack was also seen in bath seat that needed repairing (also noted on previous inspections, and subsequently repaired). Wall tiles had not yet been replaced in a small area in one bathroom, and the proprietor stated that this will be re-tiled when the kitchen is refurbished. The home needs a system for regularly identifying issues such as these, and the manager stated that she was in the process of implementing a room check form in order to monitor maintenance and Health and Safety issues. Soap and paper towels were seen in all bathrooms and in the laundry on this visit, and a staff member now has responsibility for ensuring supplies of soap, paper towels and disposable gloves are maintained in the home. The laundry area remained unchanged, although some equipment was out of action and awaiting repair at the time of this inspection. The manager confirmed that Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 22 previous issues relating to the use of a hand wash sink for soiled laundry have now been addressed, and staff now only use the sluice sink for soiled items. It was recommended that this guidance should be added to the written laundry procedures present in the laundry area. Training records showed that very few staff had received specific training in infection control, but the home has obtained a DVD training pack on infection control and planned to deliver this training to all staff. The manager was advised to obtain a copy of the Health Protection Agency’s guidance on infection control in residential care homes, and also given information on the Skills for Care Knowledge Sets (which include infection control). Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 23 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 and 30 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels meet residents’ needs, but levels of staff training are insufficient to ensure that residents are in safe hands at all times. EVIDENCE: Current staffing at Ashley House consists of three staff throughout the day, and two at night. A sample of recent rotas viewed showed that this level of staffing was consistently being maintained, and staff confirmed that the home employs sufficient staff to enable them to cover most shortages on shifts. It was good to see that staff do not routinely work long days, giving them capacity to take on extra shifts when need arises. When asked if staff are available when needed, most residents completing feedback questionnaires stated that staff were always or usually available, with one adding that they sometimes had to wait a while; one person felt staff were only sometimes available. One resident spoken to confirmed that at night they could call staff if they needed help, and that staff generally came promptly. The Manager felt that current staffing levels were sufficient to meet the needs of residents, and stated that a key worker system was being introduced. The home also employs a part-time cook and a part-time domestic assistant. It Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 24 was good to see both these staff engaging with residents during the course of their work. Staff observed and spoken to showed an understanding of their role, and showed patience and care in their interaction with residents. The files of four new staff were inspected for evidence of recruitment practices. All files contained POVAfirst checks, but only two of the staff had evidence of a full Criminal Records Bureau (CRB) check received: the proprietor stated that they were still waiting for one CRB check, and thought the other had been received but could not locate this at the time of this inspection. The manager was advised of the requirement to demonstrate clear supervision processes for any staff starting work before a full CRB check has been received. One file did not contain evidence of a form of ID, and two files did not yet contain photos of the applicants: the proprietor stated that these were in progress. All files contained completed application forms, containing employment histories. In one case the applicant had not included any dates in their employment history, suggesting that at recruitment the home could not have checked for any unexplained gaps in their employment history. One file only contained one reference: the proprietor stated that a second reference had been received, but this could not be located at the time of the inspection. The other three files both contained two references received before the person started work: however, in one instance, although two references had been obtained, a reference did not appear to have been sought from the previous (care) employer, and a reference from a former care employer had been sent for but not received. The need to ensure that references from any last care employer are sought and followed up was discussed with the manager. Recruitment records therefore still showed an insufficiently rigorous practice with respect to carrying out pre-recruitment checks. It was good to see that the home was using an induction checklist based on the Skills for Care ‘Common Induction Standards’: the proprietor stated that she goes through each section with new staff, and signs this off (with evidence seen). Training information showed that of 16 current care staff (excluding manager and proprietor), 7 had completed NVQ level 2; no staff were currently doing this training. Information submitted prior to the inspection indicated that very little training had been done over last year, showing only POVA (still in progress), moving and handling, and Boots (Monitored Dosage System) medication training. On the inspection, a carer who had been in post almost a year stated that the only training they had received since working at Ashley House was internal training in fire procedures and POVA. The proprietor had still not developed a summary of staff training to enable staff training and skills to be easily monitored. Following the inspection the home submitted a summary of staff names and the dates they attended training in core subjects: this showed significant gaps in many core subjects. Out of 18 staff (including the owner and manager) only five had evidence of moving and handling training (none since 2004/2005), only one had evidence of fire safety training, only four had Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 25 evidence of food hygiene training (although care staff are responsible for serving breakfast and tea within the home), and only three had evidence of infection control training. This needs to be addressed with some urgency. The proprietor confirmed that training in fire safety, moving and handling and infection control is currently being done in-house using DVD packs. The manager advised that she is trying to organise other training, and evidence was seen of a list of suggested topics that she was considering, depending on staff interest and training needs. This was good to see, and it is encouraged that this be progressed as soon as possible. In relation to moving and handling training, the proprietor completed a threeday moving and handling trainer’s course two years ago, but has not delivered formal staff training sessions in this subject. She stated that to-date most Moving and Handling training has been specific to moving individual service users, that there had been a recent in-house session on the use of equipment, and that new staff are generally trained by senior staff on the job. She stated that she was planning to use a DVD training pack to deliver training in-house and was advised that all staff must receive regular and comprehensive moving and handling training, delivered by a qualified trainer, and covering all aspects of moving and handling (theory, legislation, anatomy/back care, practical techniques, equipment, etc.). This must be addressed as soon as possible in view of the poor evidence of staff training in this subject. Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 26 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 and 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of a registered manager has prevented the home from developing clear management processes. Practices in the home protect residents, and promote a safe environment. EVIDENCE: The home has now been without a registered manager for several years, and for much of this time the proprietor has covered as acting manager of the home. As noted at the last inspection, although the proprietor and staff are commended for their hard work and commitment, the lack of a registered Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 27 manager had resulted in a lack of a planned management approach and a failure to meet some aspects of the Care Standards. The proprietor has been required to address the lack of registered manager at the last two inspections. A new manager was subsequently appointed in January 2007, but has not yet applied for registration with the CSCI; reasons for this were given at the inspection, and an application is expected in due course. The new manager has several years experience working with older people as a carer and a senior carer within a residential care home, and has previously achieved NVQ level 2 and was working towards NVQ level 3 when she changed jobs. She was advised to enrol on NVQ level 4 in management and care as soon as possible, and to submit an application for registration as soon as she is able. The new manager showed a good understanding of issues relating to the home, and was being supported in her role by the proprietor. The home has a quality assurance survey form that has previously been used to seek residents’ views on the quality of care provided to them. It was noted that where residents are unable to complete this independently, relatives or staff members assist them: the inappropriateness of care staff helping residents to complete questionnaires about the care being received was discussed, and it was recommended that the home consider other ways of providing residents with support with this task. A report on the outcomes of a survey was produced in early 2006, but no recent report was available. No other survey forms are currently used by the home (e.g. to seek feedback from relatives, healthcare professionals, etc.). It was good to see that residents’ meetings had been regularly held this year, and that relatives had also been invited. The manager is encouraged to ensure that minutes of these meetings are made available in the home to residents and relatives, as these can provided evidence of consultation and of any action taken in response to suggestions made. The home does not currently have an annual development plan, and there are no formal auditing tools in use in the home. The manager was in the process of developing a checklist for monitoring maintenance and health and safety issues around the home, and is encouraged to develop ways of formally monitoring and auditing other practices (e.g. medication, accidents, care plans, staff training and supervision, etc.). Money looked after on behalf of residents is securely stored and clearly recorded. Cash is held in individually, and individual record sheets show all transactions: a sample resident’s cash, record sheet and receipts were checked, and balanced. The proprietor stated that she checks each person’s record and money once or twice a year, and signs the record sheet to confirm that this has been checked. The home’s Health and Safety policy was not viewed on this occasion. As noted in previous sections, staff training information showed an inadequate level of staff training in a number of areas reflecting health and safety issues (e.g. food hygiene, fire safety, infection control, moving and handling, etc.), and this needs to be addressed. Information submitted prior to the inspection Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 28 showed that equipment and utilities were regularly serviced, and further evidence of this was not therefore checked during the inspection. Evidence was seen of regular internal checks on fire alarms, emergency lighting and extinguishers, and also on hot water tap temperatures to ensure that hot water is maintained at a temperature that does not present a risk to residents of scalding. Hot water taps that did not have restricted temperatures (e.g. kitchen and laundry) were also checked to monitor that central hot water was maintained at a suitable temperature to reduce risk of Legionella. Records of Fire drills were inspected, and showed when drills took place and who attended; there was no specific system for monitoring whether all staff attend drills, and this should be implemented. It was recommended that the home check with the fire officer to confirm the recommended frequency that staff should attend a drill. The proprietor was aware of the new fire Regulations, and confirmed that the home has a fire risk assessment. A general work activities risk assessment was viewed: this covered an appropriate range of issues, with brief details of the action to minimise risks. It was recommended that this be reviewed as some relevant work activities and areas were not covered (e.g. use of hoover (re trailing flexes, lifting, etc); wet floors; the ramp at the front door; the garden; risk of legionella; etc.). It was good to see that the risk assessments were regularly reviewed. Accident records were not viewed on this inspection. Infection control issues have been commented on in a previous section. Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 29 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 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 15 Requirement To promote and protect residents’ health, where someone is identified as at risk of developing pressure areas their care plan must clearly detail the preventative care that staff are expected to provide. Medication practices must be monitored to ensure that they adequately protect residents. In particular: 1. Staff must not decant medication into other containers. 2. Staff must not leave medication unattended 3. Changes to medication details made by staff must be signed and dated by the person making the entry. 4. The medication administration record must show full administration details for any PRN medication. This is a repeat requirement in relation to decanting medication and recording practices (last timescale 15/1/07). To ensure the protection of residents, staff administering DS0000017753.V341463.R01.S.doc Timescale for action 09/07/07 2 OP9 13 09/07/07 3 OP9 13 30/09/07 Page 31 Ashley House Version 5.2 4 OP18 13(6) medication must receive comprehensive training in the safe administration of medicines, and this should be regularly updated. To ensure the protection of residents, all staff (care and ancillary) must complete appropriate training in abuse awareness and the home’s procedures for responding to suspicion of abuse. 30/09/07 5 OP26 13(3) This is a repeat requirement (last timescale 15/1/07) To ensure the health and safety 30/11/07 of residents, the home must have suitable arrangements and facilities to prevent the spread of infection in the home. This particularly refers repairing food storage and preparation areas in the kitchen, replacing tiles on bathroom walls, and monitoring and repairing damaged toilet and bathing equipment. This is a repeat requirement (last timescale 15/1/07). To ensure the protection of 09/07/07 residents, robust recruitment procedures must be followed and all required checks must be carried out on prospective staff prior to them starting work. This particularly relates to obtaining appropriate references and checking employment histories to ensure there are no unexplained gaps. This is a repeat requirement in relation to operating robust recruitment procedures (last timescale 15/1/07) 6 OP29 19, Schedule 2 Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 32 7 OP30 18 To ensure that staff have the knowledge and skills to safely meet residents’ needs, they must receive regular relevant training. The home therefore must implement a clear training and development programme for all staff. This particularly relates to ensuring that all staff attend updates in all core training as soon as possible (e.g. moving and handling, fire safety, food hygiene, infection control, etc.). The home also needs to provide training to develop staff knowledge and skills in issues relevant to the individuals they support (e.g. continence, nutrition, end of life care, specific conditions, etc.). 30/09/07 8 OP31 8(1)(b)(i) The home needs to implement management systems to monitor staff training, and to identify when updates are due. To ensure that the home meets 31/07/07 the regulatory requirements, and for the development of the management of the home, the Registered Person must take action to register a manager with the CSCI as soon as possible. This is a repeat requirement for the second time (last timescales 30.11.05 and 15.1.07) To ensure the safety of staff and residents, all staff must receive suitable training in fire prevention and the home’s fire procedures. 9 OP38 23(4) 31/08/07 Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 33 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 OP2 OP7 Good Practice Recommendations The manager should make sure that all residents are aware of the terms and conditions of their residence in the home, and are reminded of their rights in relation to this. The home should develop care plans, ensuring that these contain sufficient detail of the action required by staff to meet each person’s needs. Where possible, residents or their supporters should be involved in the development of their care plans, and this should be evidenced. It is recommended that a photo of each resident is provided with their Medication Administration Record. Bottles of liquid medication should be dated on opening. The home should continue to develop opportunities for activities, consulting with residents over this. The home should develop care plans relating to social and recreational needs, and explore ways of recording activities on individual records. Staff are encouraged to explore and provide more opportunities for people to go out of the home, and for contact with the local community. It is recommended that the home continue to review menus and meal choices, to ensure a sufficient variety of meals are available, that meet residents’ choices and preferences. The home should continue to promote an ethos that encourages people to express any complaints and concerns, and responds to these positively. It is recommended that continence pads are stored in a manner that promotes the dignity and privacy of the resident, and ensures hygiene is maintained. It is recommended that the registered person establish a planned programme for replacing furniture that is becoming worn. This should include the provision of lockable storage facilities for service users. The Registered Person should continue to monitor staffing levels to ensure that staffing meets residents’ needs throughout the day. DS0000017753.V341463.R01.S.doc Version 5.2 Page 34 3 OP9 4 OP12 5 6 OP13 OP15 7 8 9 OP16 OP24 OP19 10 OP27 Ashley House 11 12 13 14 OP29 OP30 OP31 OP33 15 16 OP38 OP38 The provider should ensure that evidence of identification and a current photo is obtained for all new staff and retained on their file. All training should be provided by someone who has the knowledge and skills (including qualification, where applicable) to deliver training in each subject. It is recommended that the manager enrol on appropriate management training as soon as possible. To ensure that the home is run in the best interests of residents, the home should establish and maintain a system for evaluating the quality of services provided at the care home. This must include systems for obtaining feedback from residents and their representatives about the quality of care in the home, but should also include other quality monitoring processes, including an annual development plan and internal auditing practices. It is recommended that the manager review the home’s risk assessment on safe working practices to ensure that it covers all relevant work place risks and activities. It is recommended that the manager implement systems for monitoring staff attendance at fire drills, and to ensure that all staff attend fire drills each year. Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Ashley House DS0000017753.V341463.R01.S.doc Version 5.2 Page 36 - 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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