Inspection on 28/11/06 for Ashley House Nursing Home

This inspection was carried out on 28th November 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashley House Nursing Home 26/01/06

Ashley House Nursing Home 09/06/05

Ashley House Nursing Home 14/01/05

Ashley House Nursing Home 15/07/04

Ashley House Nursing Home 09/02/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

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 Nursing Home 118 Trafalgar Road Cirencester Glos GL7 2EN Lead Inspector Mrs Janice Patrick Key Unannounced Inspection 4.00 28 & 29th November 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 Nursing Home DS0000016370.V314567.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 Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley House Nursing Home Address 118 Trafalgar Road Cirencester Glos GL7 2EN 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) 01285 650671 01285 650672 www.bupa.com BUPA Care Homes (BNH) Limited Mrs Ann Lillian Alden Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Temporary variation to client categories DE(E) for 1 (one) named service user. The home will revert to the original client category when this service user no longer resides at the home. Date of last inspection 26th January 2006 Brief Description of the Service: Ashley House is situated on the outskirts of Cirencester Town and is within walking distance of a main bus route and some areas of the town. There is also a public house and church nearby. The home predominantly provides nursing care to those over the age of 65 years of age but can provide personal care to the same age group. The Home is staffed with qualified nurses, 24 hours of the day. Private accommodation is provided in single bedrooms, all with ensuite facilities, some larger bedrooms are available for those who wish to share or have more space. Extensive communal areas are also available including an interior courtyard garden. The Home is predominantly private fee paying, but will consider potential residents who require some form of funding, on an individual basis. The current range of fees as from October 2006 is £708.00-£878 for a single room per week & £1,383.00 for a double room per week. The home makes available in the reception area the previous inspection report provided by the Commission for Social Care Inspection (CSCI). Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over two days between the hours of 4pm and 9.20pm on the first day, which enabled the inspector to observe the evening routine and meet with the night staff and 11am and 6.30pm on the second day. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Pre inspection surveys were forwarded to residents by the Commission for Social Care Inspection (CSCI) and 19 were received back. This inspection fell within a period of time when the Department of Health required particular questions to be asked of three residents in each Care Home being inspected by the Commission for Social Care Inspection (CSCI). These questions related to requirements within the Care Home Regulations for Older People 2001 and included: - the Service User Guide, information that should be provided to all residents in each care home. - awareness of changes to the cost of their care. - receipt of a contract and residents’ awareness of any changes to this. - the assessment process prior to moving into the home. - receipt of a copy of the complaints procedure and the residents’ awareness of how to make a complaint. The Registered Manager was made fully aware that residents would be asked these questions. Also as part of the inspection process the above three residents including two more were selected and their care and relevant records were inspected in detail. In addition to this many other related care records and documentation were inspected. Specific areas such as residents’ privacy and dignity, ability to make choices and have their preferences met were inspected. The degree of involvement and control over their care and inclusion in decisions made in the home was also inspected. Social and recreational needs were explored along with the arrangements to meet these. The choice and standard of food was inspected. Personnel records and the home’s standard of recruitment practice, along with staff training were all inspected. The general management of the home including all aspects of health and safety practice were explored and records inspected. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 6 The systems required to enable a home to identify shortfalls and improve on these were discussed. What the service does well: This home provides an extensive amount of relevant information for the prospective resident and their representative in order to help them make a decision about future care. This information is both obvious to the general visitor and very available for the existing resident or relatives to reference. The home also provides a fulltime receptionist who can help with any questions raised. Once the resident is admitted the system for invoicing and making residents aware of any financial information is extremely organised. Residents are actively encouraged to manage their monies for as long as they are able. Residents’ health care needs are well catered for both by the staff within the home and through links with external professionals. A strong emphasis is put on maintaining residents’ privacy and dignity and their ability to make choices and hold some control over their care. The home provides a well-organised activities programme for residents who wish to participate and has a strong link with the surrounding community. The standard of food provided is high with plenty of choice and availability. The home provides very comfortable accommodation, which is well maintained. Robust recruitment practices ensure the protection of vulnerable residents. New staff receive a good level of supervision and support from more experienced staff in order for residents’ needs to be met competently. The Manager has at her disposal a mature quality assurance system that helps identify weaknesses within the service, which are then improved upon. Robust health and safety checks are in place to ensure the home is run safely. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: A new requirement within the Care Home Regulations means that residents who are receiving some form of funding towards their fees must also be made aware of how much Registered Nurse Care Contribution they are receiving. A copy of the complaints procedure itself, placed with the ‘Useful Information’ folder in each bedroom, rather than a reference to the policy only, would be more helpful to residents. A broader knowledge of adult protection would benefit residents and enable the home to be aware of the county’s perspective and that of other agencies. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 10 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, 2, 3 & 6 Quality in this outcome area is judged to be excellent. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to provide the prospective resident/existing residents and visitors with a wide range of information, which relates to the home and fees, amongst other helpful literature. Arrangements are in place to ensure that residents are only admitted once the home is sure their needs can be met. EVIDENCE: As explained in the summary of this report information was gathered for the Department of Health during this inspection from three residents selected by the Inspector. This information was relevant to points 1, 2 & 3 of the above outcome and the results were as follows: - all residents had received and read the Service User Guide, called in this home, ‘Useful Information’. - each resident was able to confirm that they are made aware of any increases to their fees, by letter. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 11 - - two residents were able to confirm they had received a contract. One resident was relatively new so it was not applicable, but one who had been in the home for sometime was aware that there had been changes to his contract. a very longstanding resident (over 14 years in the home) knew of a contract but was not aware of any changes to it. all were able to confirm that before their arrival at the home someone spoke to them or visited them about what help and care they needed. In the main reception area there is an extensive amount of information both for visitors to the home and existing residents and relatives. This includes the home’s Statement of Purpose and Service User Guide, the most recent inspection report, advice on financial planning and fee payment, information on the Court of Protection & financial abuse, a check list/guide for those looking at care homes, a form for making complaints/suggestions, the home’s brochure and BUPA’s latest magazine. All of this was well presented and easy to see on entering the home. There is also a full time receptionist each day through to 8pm who can also help to answer any queries. One visitor who had experienced a short spell of respite care at the home had returned with a view of planning a possible permanent move into the home in the future. She was made extremely welcome both by the Manager and by staff who knew her from her previous stay. She was provided with a new brochure and given a guided tour of the home by the Manager. Invoices were seen for the three residents’ fees and sundries. These were easy to read and also gave information regarding the Registered Nurse Care Contribution (RNCC). Letters giving notice of a fee increase in April of this year were also seen for each resident. Copies of letters sent out in previous years were also seen for two of the residents. Acceptance forms signed by each resident were also seen indicating that they had received a contract. The administrator was also aware of who had Power of Attorney arrangements. Information regarding the RNCC amount is not given at present to residents who are receiving funding. BUPA are aware of the need to meet the new requirement, which requires everyone, irrespective of how their fees are met, to be made aware of any contribution towards their nursing care. Each resident could remember having a conversation or being visited by the Manager prior to admission regarding what care and help they required. Pre admission assessment forms were complete for two of the residents. One has been in the home for over 14 years and the Manager explained that this was before this information was recorded. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 12 A fourth resident had all the same information gathered as part of the Inspector’s general case tracking. This resident is registered blind and therefore the information is sent to her relative who has Power of Attorney. The Manager was asked to consider putting the written information given to each resident on admission, onto an audiotape for residents who have a visual loss. This resident thought this would be very helpful. A pre admission assessment was also seen. The RNCC amount was not showing on the current invoice as the resident is still awaiting an assessment by the RNCC team. A staff handover was observed between day and night staff. This was extremely detailed and demonstrated that the staff had good knowledge of the residents’ needs. One resident had mentioned during the day that she felt ‘cooped up’ it was suggested by the day nurse that it be handed onto the next days staff that they might suggest she go for a walk with a member of staff. This home does not provide designated rehabilitation care. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to help care planning become more person centred. Residents and their relatives can be assured that healthcare needs are met. The medication system is well organsied and systems in place help to protect residents from poor practice. The residents’ privacy and dignity is upheld. EVIDENCE: The written care plans for all five residents case tracked were inspected and all demonstrated that they were specific to the resident’s needs and showed an improvement in the content. One resident had signed his care plans and commented that if he does not agree with what is written he will ask for it to be altered. This resident is very capable of speaking out and saying how he wishes his care to be delivered. Another resident who would probably get muddled if asked to sign his care plans, had regular reviews carried out and the content demonstrated that staff Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 14 were being very sensitive to any changes they were observing in him. After talking with the resident and his wife, it was obvious that staff knew him quite well and were very aware of the care that was needed. One of the qualified nurses has been given the task of auditing the care plans and taking the lead on care plan training for staff, which will commence soon. The care documentation inspected demonstrated that many healthcare professionals are involved in the care of the residents as well as the home staff. Residents were attending hospital clinics or being seen in the home by a large range of healthcare experts. The local GP’s call in as required, there is also a regular chiropody clinic held in the home. Not all of the medication system was inspected on this occasion as the home has robust auditing systems of its own, the results of which were read. The supplying pharmacy also audits. Medication administration records (MAR sheets) for the residents who were case tracked were seen and the administration practices of two nurses observed. These were all satisfactory. Residents were able to confirm that their privacy is upheld at all times when personal care is being given. One resident in particular said she does not usually require the level of help she is needing at present, but was able to confirm that this was being carried out in a sensitive way. Staff were observed knocking on doors before entering and asking sensitive questions such as if someone wanted to use the toilet in a quiet and private way. A nurse during staff handover explained that she had given some information relating to a resident’s condition to an enquiring relative, but that she was not prepared to go into personal detail with them. Residents were also observed at all times to be spoken to respectfully. Shortfalls in residents’ abilities were dealt with in a dignified manner that was aimed to not cause embarrassment. One relative had not been happy to find out that a member of the opposite sex had been caring for a loved one. The resident is unable to speak for him or herself and the relative felt strongly that this should have been discussed with them so they could speak on behalf of their relative. The relative has raised this with the nurse responsible for the care delivery and this wish has been entered onto the resident’s file and will be respected where practicable. Ashley House Nursing Home DS0000016370.V314567.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is judged to be excellent. This judgement has been made using available evidence including a visit to this service. There is a lot of support given to residents in order for them to very much stay in control of their social lives and decisions relating to their care. Visitors to the home are viewed as an integral part of the residents’ lives. Arrangements are in place to provide extremely well balanced meals that are varied and available at anytime. EVIDENCE: Several residents spoken to said they were free to make choices about how they spent their time and issues relating to their care. All but one had frequent visitors who they were free to go out with if this was practicable. One resident was debating whether to spend Christmas with her family; two others were looking forward to spending time with an elderly relative who had taken up on their recommendation to spend a week’s respite in the home over Christmas. One resident likes to go for a walk each day ‘I am able to go out, it lifts my spirit’ ‘I love being out’. ‘You cannot fault this place’. This resident had moved into the home with her husband who had subsequently died. She was grateful Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 16 to the Manager for all of the many times spent with her during this difficult time ‘ I love her really, she is so sweet’. Another resident had enjoyed a trip on one of the inspection days to Bristol and returned in high spirits. This resident regularly goes into Cirencester with friends/relatives and is very much in control of his life and care. Another resident has a car that has been adapted to take his wheelchair. A friend drives and they are often out. Other residents who are more frail and not able to be out so much also agreed that the home does enable them to make choices over activities, food, what time they go to bed and get up. One resident agreed with all of this but was finding being in care generally difficult to get used to ‘I worry too much’. He was particularly fond of one carer who makes him laugh ‘she keeps me going’. One resident said ‘it is like a very social hotel’. Another resident commented ‘staff bend over backwards to help you’. One visitor spoken to did not feel as positively about the home, but this did seem to be a minority view. This visitor’s loved one is not so able to make choices and requires all help with daily activities. The visitor likes to be actively involved in this and all of the decision making for his relative, which the staff acknowledge at the same time as ensuring that the resident receives the correct care. Once a month a communion service is held, an organist attends and stays on afterwards to play favourite songs and hymns. The vicar was visiting a resident socially during this inspection. A Roman Catholic priest visits one other resident. The resident surveys demonstrate that the activities are popular with those who like to join in. Because there is such a wide range of capabilities two separate groups tend to take place. One group enjoy quizzes and games to keep the mind stimulated and are very quick according to the activities coordinator and another group is aimed at those who require far more support. The latter group had just completed wrapping chocolates in foil paper to hang on an advent calendar when this inspection began. It was planned that each resident within this group would have a chocolate in the days running up to Christmas, each time they met. A wide range of other activities are organised including trips out. The activities co-ordinator explained that the trips are also organised around the residents’ abilities. A long trip such as the shopping trip to Bristol, taking place during this inspection would be aimed at those who are able to sit for long periods, who are able to concentrate and can go long periods without requiring too much personal care. For those that require more support examples were given of a trip to a local farm and tea at a polo match. The activities co-ordinator explained that any of these can be left and the resident returned easily if they became too tired or poorly. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 17 One to one sessions are held in the mornings where residents who do not leave their rooms are visited. They may like something read, a letter written or just a chat. In the afternoons there is always something happening in groups. One resident attends a day centre once a week where she has formed many friendships. All bedrooms are provided with a telephone and incoming calls go through the home’s main switchboard; some residents have chosen to have their own private line installed. Care notes are kept in the resident’s bedroom, meaning residents have free access to these at any time. Any highly confidential information is kept separately but the resident is free to access this at anytime, which one resident said he did a while back. It was noted that the once held information on advocacy was not any longer in the reception area. The Manager was unaware that this had gone and will see that it is replaced. The head chef explained that all meals provided now have to fulfil set nutritional guidelines set by BUPA. In order to ensure this is being met, all meals cooked on a daily basis have to be audited and have to meet set criteria. For example have 5 pieces of fruit and vegetable been offered, have a set amount of calcium rich foods been included. Menus offer a choice at all meals with an extensive desert trolley at lunchtime. An improvement to the availability of food in the evening and during the nighttime has been made with a ‘light bites’ menu. Day staff were heard to be promoting this increased availability in ‘hand over’ to the night staff. The dining room was laid attractively and there was a social feel to each mealtime. Several residents enjoyed a glass of wine with their meal. There is a separate sitting for residents who require help to feed. The reason for this is to preserve the residents’ dignity and with a smaller group staff can sit and help each resident quietly. Residents can choose where they wish to eat, several had high tea in their bedrooms. Nearly all the residents spoken to said that the food has improved over the last few months. There was a change in head chef a few months back. Ashley House Nursing Home DS0000016370.V314567.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Residents/visitors should feel reassured that their complaint will be taken seriously when received, although an improvement in the information on how to make a complaint would benefit residents. The arrangements in place for ensuring that staff have knowledge on adult protection and elderly abuse issues need to be more robust in order to offer robust protection to vulnerable residents. EVIDENCE: As explained in the summary of this report information was gathered for the Department of Health during this inspection from three residents selected by the Inspector. This information was relevant to point 1 of the above outcome and the results were as follows: - all residents said they knew how to make a complaint - two were unaware of the home’s complaint procedure, one had requested a copy of it. The complaints procedure is on the wall in reception and although this was pointed out to one of the above residents, she had not seen it. All had read the information in the ‘Useful Information’ folder but this only informs them that any complaints will be dealt with via the home’s procedure, not what that is. The Manager agreed that it would be more helpful to have specific information Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 19 in the folder, such as a copy of the procedure and was going to ensure that this was in place following within this inspection. The home’s complaint file was inspected. One complaint since the last inspection was from a relative; a delay in being able to rectify the problem was due to contractors. Two other complaints were from a resident who writes to the Manager on a regular basis. One had been taken forward as a formal complaint the other had not. It was suggested to the Manager that as the resident had viewed the latter as a formal complaint, it should be dealt as such. All complaints are audited and responses to each were seen in the file. Some staff have received training in elderly abuse, but this has not been a specific subject of its own and has usually been within their induction training or affiliated to other trainings such as moving and handling training. One new care assistant could not remember being told about elderly abuse or the Whistle blowing Policy, however the individual’s mentor said this had been covered, as usual in her induction training. She will revisit this to ensure the care assistant has some understanding on the subject. The housekeeper was very aware that residents sometime talk to her team members about things that are worrying them, as the people they see regularly each day cleaning their rooms. She was able to explain what she would do if an allegation of abuse was made by a resident to her or reported to her by a member of staff. Consideration should be given to widening staff knowledge on this subject by some staff attending the ‘enhanced alerters’ training provided by the counties adult protection team, details of which was given to the Manager and this being cascaded to other staff, maybe in supervision sessions. BUPA has a policy with written procedures on Elderly Abuse & Adult Protection. The company has not reviewed this since 2003. Since this policy/procedure was written action on elderly abuse has become far more prominent and robust and the advice to staff within the procedure requires a review. This review is currently being carried out; therefore a requirement has not been given. Ashley House Nursing Home DS0000016370.V314567.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 & 26 Quality in this outcome area is judged to be excellent. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from living in a home that is clean, extremely comfortable and where they can choose to personalise their own private space. EVIDENCE: Since the last inspection in January of this year refurbishment of the dining room, lounge and reception area has been completed. A rolling programme of further refurbishment work for 2007 includes bedrooms and ensuites. Four ensuites have already been refurbished, changing the raised shower trays into floor drainage showers making them more suitable for the current residents’ to use, four more are planned for the New Year. The communal and private accommodation is extremely comfortable with each bedroom having a telephone and television provided as well as the required furnishings. All bedroom doors have been fitted with door furniture and a doorbell; this gives the sense that it is the person’s own front door. Many Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 21 rooms have been comfortably furnished with a mixture of the resident’s own furniture and belongings and that supplied by the home. One resident’s bedroom is in need of decoration, she is due to move out whilst her room is decorated in a colour she has already chosen. The home was well lit, warm and well ventilated at the time of this inspection. All main utilities are serviced; certificates to this effect were seen. Windows are appropriately restricted for health and safety reasons. Hot water outlets are regulated and monitored so that hot water is maintained at a temperature that will not cause scald injuries. The housekeeper ensures the home is kept clean and that the laundry runs smoothly. She was able to confirm that colour coding is used to aid infection control. The laundry was tidy and clean and several residents spoke highly of laundry person who they consider to be organised and efficient. One resident said ‘she returns my clothes the next day, pressed and hangs them up in the wardrobe for me and I have known items to be returned with buttons sewn back on’. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 22 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 & 30 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure the home is adequately staffed in order to meet the residents’ needs. Staff are provided with training in order to be able to care for residents’ competently. Robust recruitment procedures help protect vulnerable residents. EVIDENCE: The Manager confirmed that there is enough staff on duty each day and night to meet the needs of the residents. Six out of the nineteen resident surveys made comment about having to wait too long for staff to respond to the call bell. The Manager is supernumerary each weekday, her Deputy also has supernumerary hours in the week to co-ordinate clinical management tasks and organise general training requirements. There are 3 qualified nurses and 9 care staff on duty in the mornings. In the afternoon there are 2 qualified nurses and 6 care staff. During the night two qualified nurses work with 3 care staff. The care teams are supported by kitchen staff who cover the catering needs of the home from 07.00hrs to 7.30pm each day, there is also a breakfast assistant each day who serves in the dining room. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 23 Cleaning staff are on duty each day of the week. There is a fulltime administrator and maintenance person. A receptionist is on duty from 09.00am to 8pm everyday. Due to a lot of staff movement in the past 18 months the numbers of staff holding the National Vocational Qualification (NVQ) have dropped. However, there is a little more stability at present and four staff are currently completing this training, this includes two longstanding night staff. Four more staff are waiting to begin. There are 8 staff who already hold the qualification. The personnel files of two new staff were inspected, both contained all the required criteria including relevant police checks. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is judged to be excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from the home being competently managed by a person qualified to do so. Robust arrangements are in place to ensure the services and care provided remain at a high standard. Residents can be reassured that their personal monies are managed safely. Arrangements are in place to ensure the home is run and maintained safely. EVIDENCE: The Manager is a registered nurse and holds qualifications in management studies. She has managed this home for 10 years and provides strong leadership and expects high standards from her staff. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 25 The home meets with BUPA’s requirements to fulfil an ongoing selfassessment, which forms part of a robust quality assurance system continued over a working year. Audits were seen with action plans for most of the services and areas of care provided. Information gathered is analysed and if needed arrangements are made within set time scales to improve the area of service that could be improved. Residents’ pocket monies are not physically held, but ‘in house’ accounts are held on computer. Any expenditure is entered and an appropriate amount of interest is added. A statement is provided monthly or as required. The home administrator is aware of those that hold Power of Attorney and is extremely organised. All health and safety checks are carried out routinely and records are kept. Basic mandatory training such as fire training, moving and handling training and food hygiene training are on going and up to date. Fifteen staff in the home hold a First Aid Certificate. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 26 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 4 2 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5B (b&c) Requirement Timescale for action 06/02/07 2 OP16 5(1) (e) The Registered Manager must, irrespective of how a residents fees are being met inform each existing resident as to whether a nursing contribution is paid in respect of nursing being provided to him/her at the home. The Registered Manager must 22/12/06 ensure that a summary of the complaints procedure is placed in the Service User Guide (this relates to the ‘useful information folder in this home). 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 OP1 OP18 Good Practice Recommendations Information provided about the home and fees should be produced on an audiotape for those who have visual loss. Senior staff should attend the ‘enhanced alerters’ training and cascade relevant information back to other staff in the DS0000016370.V314567.R01.S.doc Version 5.2 Page 28 Ashley House Nursing Home home. Ashley House Nursing Home DS0000016370.V314567.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. 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