Inspection on 15/08/05 for Ashley Lodge Residential and Nursing Home

This inspection was carried out on 15th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Ashley Lodge Residential and... 30/10/07

Ashley Lodge Residential and... 04/01/06

Ashley Lodge Residential and... 12/01/05

Ashley Lodge Residential and... 15/07/04

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Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Ashley Lodge Residential & Nursing Home Golden Hill Ashley Lane Ashley New Milton, BH25 5AH Lead Inspector Tim Inkson Unannounced 15 August 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ashley Lodge Nursing & Residential Home Address Golden Hill Ashley Lane Ashley New Milton Hampshire, BH25 5AH 01425 611334 01425 611334 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Ltd Mrs Joanna Dunbar CRH 50 Category(ies) of TI Terminally ill - 5 registration, with number OP Old age - 50 of places PD Physical disability - 10 PD(E) Physical dis - over 65 - 50 TI(E) Terminally ill - over 65 - 50 Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service users in the categories PD and TI must be at least 50 years of age. 10 service users may be accommodated at any one time who are in need of personal care only. Date of last inspection 12th January 2005 Brief Description of the Service: Ashley Lodge Nursing and Residential Home comprises two separate buildings/houses on one site. They are respectively known as Ashton House and Milton House. The home is owned and managed by BUPA Care Homes Limited (the organisation), a not-for-profit company. Both buildings stand in pleasant and well-maintained grounds, offering pleasant views from many bedrooms. The home is located in Ashley, within close proximity of New Milton, a small country town that offers a range of amenities including library, places of worship, a leisure centre, shops and restaurants.The accommodation at Ashley Lodge compromises 44 single rooms and 3 double rooms; 29 of the rooms provide en suite facilities. Ashton House can accommodate 28 and Milton House 22 residents. Both houses provide accommodation on two floors and have passenger lifts providing access to their first floor accommodation. Both house also have their own communal rooms i.e. lounges and dining rooms. There is one laundry and one main kitchen and both are located in with the homes main office in Ashton House. Meals are conveyed to Milton House in a heated trolley.The home is registered to provide nursing care and can accommodate up to 50 residents over 65 years in the category of old age and in addition individuals with physical disabilities or who areterminally ill. A limited number of residents between the age of 55 and 64 years may also be accommodated. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was the first of two that must be made to the home during the period, April 2005 to March 2006. It was unannounced beginning at 09:05 and finishing at approximately 17:10 hours on 15th August 2005. During the inspection records and documents were examined, an opportunity was taken to tour the premises, some staff working practice, an organised group activity and a meal were observed. The following people were spoken to during the visit; residents (15); visiting relatives (2), and staff (5). Other information that influenced this report was a pre-inspection questionnaire and documents returned by the home’s registered manager and comment cards from 14 relatives/friends/visitors and 4 from residents. At the time of the inspection there were 45 residents being accommodated, of these 43 were receiving nursing care and 35 were female and 10 were male. Their ages ranged from 57 to 102 years. The home’s registered manager was unavailable for most of the day but other senior staff including the in-house training co-ordinator and head of care, were able to provide assistance and information and discuss any matters of concern that might have arisen during the inspection visit. What the service does well: What has improved since the last inspection? Although there had been no requirements arising from the last inspection it was apparent from discussions with staff and residents and from observation that a scheme introduced to motivate staff to thinks pro-actively about the Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 6 needs of residents was benefiting the home. Staff were enthusiastic about their work and organised social and leisure activities for residents were particularly successful. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 and 5 There were good admission procedures in place that included; providing potential residents with information about the home and assessing their care needs before they moved into the home; and enabling potential residents to visit the home and/or have a trial stay before deciding whether to live there permanently. EVIDENCE: The home provided a “welcome pack” and there was one in the bedrooms of all service users spoken to and in other rooms that were viewed during the visit. There were also a copy of the pack and the home’s statement of purpose in the entrance halls to Ashton House and Milton House. The welcome pack was comprehensive containing details about the home’s facilities and included among other things, information about visiting arrangements, meals, smoking and the home’s complaints procedure. Folders in which were written plans setting out the care and support that each resident needed were in their bedrooms. These folders also included details of the assessments of the person’s needs on which the plans were based. An examination of 4 of these documents indicated that potential residents had their needs assessed before they moved into the home. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 9 One resident said: • “I had someone from here visit me at X House, she came to assess me”. Another said: • “I came here from hospital and “the manager” came to see me there” A number of residents were staying in the home for respite care at the time of the inspection and one man said that he was staying temporarily “in order to see what it is like”. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 There were good systems in place to ensure that the social and health care needs of residents were met and their privacy and dignity was promoted. EVIDENCE: A sample of care plans of 4 residents was examined. All the plans were comprehensive and based on assessments of the needs of the individuals concerned. The plans set out clearly the action staff had to take to meet the needs of residents and where relevant what equipment was required to promote their independence or ensure their comfort e.g. Zimmer frame, pressure relieving aid. Residents spoken to confirmed that the care and support they received was in accordance with the plans. • “They look after me very well, I can’t walk much they help me with that and with washing and dressing” • “I needed help for the first few days with dressing they did that with no problems” • “I get all the help I need with washing and bathing and so on” Where care plans referred to the use of equipment this was observed to be available and/or in place e.g. pressure relieving aid; commode; hoist; etc. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 11 Records indicated that care plans were reviewed/evaluated at least monthly and daily notes referred to the actions taken by staff to meet the needs set out in those plans. Records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. This was confirmed by residents who said that they saw and received treatment from among others, chiropodists, dentists and opticians and when required arrangements to attend outpatient clinics were made by the home. • “ I have a chiropodist see me about every 3 months, he is awfully good and sees me in my room. I had to go to hospital, they gave me a great welcome when I came back”. • “I saw the doctor about a fortnight ago - and I have been back to hospital to see the consultant – I am going to see the optician who is coming here this month – I see the chiropodist either this week or next week”. • “I have seen my doctor several times, I used to have ulcers and I have had eczema, I see the chiropodist every 6 weeks and if I needed an optician they would sort it out for me”. The home used a range of recognised methods of assessing residents health needs and for identifying appropriate interventions that may be required included consideration of; skin integrity; continence; mobility and nutrition. Consequently equipment or action plans were in place where necessary e.g. air mattress; hoist; provision of special diet and help and encouragement with feeding. There was documentary evidence that individuals’ health was monitored regularly e.g. temperature, blood pressure and weight. On of the registered nurses said that when necessary the home developed detailed and specific care plans for the management of wounds that included with the individuals permission the use of diagrams and photographs to enable progress with any treatment required to be monitored. All residents also said that the staff were polite and respected their privacy and dignity and that they were addressed by their preferred term. Comments from residents about the attitude and care practices of the home’s staff included the following: • “They call me by my first name it’s more comfortable and friendly” • “The staff are always very polite” • “The staff knock on my bedroom door, most definitely and always knock my bathroom door” • “They are very friendly and polite, they always knock on my door, and they never barge in. They cover me with a towel when they bath me”. • “My housekeeper calls me by my surname, I said call me R when I first came but she said she did not fell right doing that”. • “When they are bathing me they say I’ll go out and leave me for a minute or two so I am not embarrassed”. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 12 One resident who described “most of the staff” as “darlings” but that she had experienced two staff talking over her when they were helping her. “I need 2 staff to help me in and out of bed and one day these 2 were talking about their social life. One of them realised and apologised”. This matter was discussed with the registered manager who said that it would be brought to the attention of all staff in order to reinforce the importance of treating residents with respect and promoting their dignity. Aims and goals in care plans examined included references to these principles, e.g. “Dressing - enable A to express her sexuality” “Washing – use towels to preserve personal dignity” Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 There were a good systems in place for promoting residents preferred lifestyles and a organising a range of activities and events from which residents could benefit. Good links were maintained with the community and visitors were encouraged and made welcome. The meals in the home were good, providing variety, choice and catering for special dietary needs. EVIDENCE: The home employed 3 activities organisers and residents, visitors and staff spoken to said, that the home had a programme of regular organised social activities that consisted of among other things, quizzes, crafts, visiting entertainers and trips out. Some residents were also observed pursuing their own individual interests and pastimes e.g. tapestry. A printed programme of a week’s activity was circulated to all residents in the home. There were pictures on display of a recent strawberry and cream tea social event and also of the work that various departments had done for the day. These included the work of the catering staff to produce the refreshments and a display of vintage cars in the garden that belonged to one of the home’s staff. A lively quiz was observed on the morning of the inspection in which a large number of residents were taking par. On the afternoon of the visit a small group residents were seen going out in a minibus that the home had access to Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 14 for a drive in the New Forest and they were taking tea and cakes with them. A cross section of staff were helping with the event i.e. hotel services, an activities organiser and care staff. Records examined indicated that the leisure interests of residents and their participation in activities was noted. This ensured that the home could demonstrate that individuals’ needs for stimulation were being met. Comments from residents about the opportunity to participate in activities, the home’ routines and their ability to exercise choices in their daily lives included the following: • “There are a lot of activities but I don’t want to join them – I prefer my own company and I have friends that visit. There are no rules here that are thrust at you”. • “I am not a joiner, I have lots of old friends that come and see me but I did go on a trip out to the coast last week and really enjoyed it. I don’t believe there are any rules, or if there are they don’t apply to me, I can come and go as I want”. • “Every time they have an activity I go, I go to the quizzes and things”. • “I always join the activities - we have entertainers and a communion service”. • “They do well putting these games and trips on” • “I use the dining room but not the lounge because I am not a mixer”. • It’s my choice that I stay in my room and they have tried to encourage me to mix”. One of the activities organisers said that residents who are bedfast and too frail to participate in activities and also those who rarely leave their room received individual attention. This was confirmed by one resident who said, • “I don’t go to the lounge or dining room because it’s too much of an ordeal, but I have my library books and I read them and write letters. X comes round to see me and came in today and we chatted for about half an hour”. The home’s welcome pack included the following statement about visitors: • “Visitors are quite welcome at any time” All residents and visitors spoken to indicated that they appreciated the home’s flexible visiting arrangement and particularly the welcoming attitude of the staff. Comments from residents and visitors included the following • “I am very happy with the place” (visitor) • “I have visitors every evening and I am taken home at the weekends. My visitors get tea or coffee when they visit” (resident) • “We are always made welcome when we come and the staff are very polite” (visitor). All residents spoken to without exception were complimentary about the food provided by the home and comments about the standard of catering ranged from, “quite reasonable” ” to “very good”. They also said they were advised of the choices available and orders for meals were taken in advance, that they Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 15 had three meals a day and could have snack and drinks at other times. Information about the preferences of all and specific dietary requirements of some residents was readily available in the kitchen. A menu provided in advance was seen in the rooms of several residents spoken to and it set out the choices of food available for the 2 main meals of the day and also included a space for an individual to indicate where they anted to eat their meal. Other comments from residents about the home’s catering included: • “There are choices and the chef varies it quite a lot, it’s not easy to please everybody with food”. • “It’s really marvellous” • “It’s well presented and looks attractive, which is important if you have to be tempted. I am very impressed with the food”. • “There is plenty of it and I like the vegetables. They come round the day before with the menu and I have a list of likes and dislikes”. Some residents ate in their rooms and some in the home’s dining rooms or lounge. Staff were observed sensitively and appropriately providing help to those residents that needed assistance at meal times. A soft diet pureed meal was seen and all its constituents had been prepared separately. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There were satisfactory arrangements in place for protecting service users and responding to their concerns. EVIDENCE: There was a framed “poster” in the main entrance hall to the home setting out in large print the home’s complaints procedure. A copy of the procedure was also included in the home’s welcome pack that was available in every bedroom. All residents spoken to were confident about taking up any complaints or problems with the home’s registered manager or the staff. • “I would go to “the manager” if I had a complaint” • “I would speak to “the manager” if I was unhappy” • “I would speak to the person in charge. Oh yes! I am not afraid to speak up” The home kept a record of complaints and there had been none made to the home or received by the Commission for Social Care Inspection (CSCI) since the last inspection of the home on 13th January 2005. The home had a range of written policies and procedures concerned with the protection of vulnerable adults that included guidance to assist staff identify and recognise signs that may indicate that a person has been abused and the types of abuse that can occur. Staff spoken to confirmed that they had received training in adult protection matters and they demonstrated an awareness of abuse and the relevant procedures including the use of restraint and whistle blowing. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 17 The home’s welcome pack included details of the home’s policy about gifts and gratuities. There was some discussion about the home’s current policy and procedures about adult protection that stated that in the event of an allegation of abuse that the home’s manager must investigate the matter including interviewing the “victim”. The home’s head of care said that “the organisation” was reviewing this particular procedure. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 and 26 The home provided a comfortable, clean and safe standard of accommodation to meet residents’ needs EVIDENCE: The home is located in Ashley some one and a half miles from the centre of New Milton and all the amenities that are normally found in a small town. Within a short distance of the homes are a small number of shops and a public house. The home comprises two buildings Ashton House and Milton House. The former contained the kitchen, laundry and administration office for both buildings. Ashton House is the older of the two and part of the building was not originally purpose built and over a period of time had been extended. Accommodation was provided on two floors and there was a passenger lift to the first floor. Milton House was purpose built and accommodation was also provided on two floors and it was also provided with a passenger lift. At the time of the inspection the premises were in good repair and the home employed two staff that apart from doing repairs, ensured that the décor, gardens and utility systems e.g. central heating and electricity, were well Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 19 maintained. One of them was also responsible for regular testing of the fire safety system. The home had obtained planning permission to extend the premises and to construct more bedrooms and communal space and most residents spoken to were aware of the proposed development. Some expressed concern that their views of the homes gardens would be “spoiled” but a number were interested in and welcomed the opportunity to observe the building work. The home’s communal/shared areas comprised the following: In Ashton House there is a lounge and separate dining room on the ground floor and a second lounge on the first floor. In Milton House there is a lounge and a separate dining room on the ground floor. Both buildings shared a large relatively level expanse of lawn with trees and shrubs that separated them. There was a patio area some level pathways and ramps provided access for residents. At the time of the inspection there was some garden furniture set out in the grounds including parasols to provided shade. The lounges in both buildings were in use at the time of the inspection with an organised activity taking place in the lounge of Milton House during the morning. All residents and visitors spoken to said that the communal areas were comfortable and that the building was kept clean. There were no offensive odours at the time of the inspection and the décor and furnishings were in good condition and domestic in character. • “The accommodation is good. They keep it clean, there is not even a strong smell of disinfectant. I was sick last night and the nurse cleaned it up and they cleaned it again thoroughly this morning” • “They keep the place very clean, they are brilliant” • “They make my bed, and keep everything clean. The dining room is always lovely” Staff were observed during the inspection doing cleaning tasks and all staff were also observed at different times using protective clothing appropriately. There were a range of written policies and procedures available that were concerned with infection control and staff spoken to confirmed that they had received training in the subject. There were “gel” hand disinfection dispensers located strategically in the buildings and there were sluice disinfectors located on both floors of the home. The home’s laundry facilities were suitably sited and equipped and procedures for managing soiled items were appropriate Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 The skill mix of the home’s staff was good and they were deployed effectively to meet the needs of service users. Recruitment procedures for new staff were satisfactory EVIDENCE: The total number of staff employed to work in the home at the time of the inspection was 69, this included 12 registered nurses and 29 health care assistants and of the latter 17 had obtained at least NVQ level 2 in care (i.e. 59 ). The minimum staffing level maintained in the home at all times for registered nurses and care assistants was as follows: Ashton House 08:00 to 14:00 14:00 to 20:00 2 1 5 3 or 4 7 4 or 5 20:00 to 08:00 1 2 3 Registered Nurses Care Assistants Total Registered Nurses Care Assistants Total Ashley Lodge Residential & Nursing Home Milton House O8:00 to 14:00 14:00 to 20:00 1 1 4 2 5 3 H54 S11413 Ashley Lodge V243338 150805.doc 20:00 to 08:00 1 1 2 Version 1.40 Page 21 The home also employed, activities organisers and cleaning, catering, administrative, and maintenance staff. Residents said that staff were able to provide the help and care that they needed and they felt safe when staff assisted them. Most residents, visitors and staff spoken to said that there were enough staff on duty in the home at all times and all residents confirmed that the call system was responded to quickly. Staff were able to describe the contents of care plans, the specific needs of individual residents and the help they required. Comments about the abilities and approach of staff from residents and visitors included the following: • “There are enough staff for my use, I don’t know about the people who are very sick” (resident). • “They may need more staff because they are always running around. They do come quickly when I use the bell” (resident). • “I am very happy with the place - until the new manager came they used a lot of agency staff but it more settled now - the head of care is very good” (relative). • “Staff are pretty good - they know what they are doing – difficult fro them to do it without being competent!”(resident). • “There seem to be enough staff and if they can do something straightaway they will. There is a panic button and I pressed it by mistake the other day and about 5 of them came running” (resident). • “Sometimes there are not enough, but it depends on the sort of day it is and if there is anyone sick or on holiday” (staff member). • “I think there are enough and our managers are happy to get out on the floor and help us” (staff member). • “I am confident that they know what they are doing – I usually get help quickly, I think that there are enough staff” (resident). Records of staff that had been employed in the home since the last inspection were examined and there was evidence that all the required pre-employment information and checks had been obtained and carried out properly before they started work. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 and 36 The home’s management approach and quality monitoring and recording systems were good, ensuring the promotion of an inclusive, relaxed, responsive, living and working environment. Staff were also supervised appropriately and residents interests were safeguarded. EVIDENCE: Residents and visitors all said that the staff were friendly and supportive. Comments about working relationships, the approach of staff to residents and general atmosphere generated in the home included the following: • “We have quite a lot of laughs it is a happy place – the manager is awfully good to me – I think they spoil us – the staff are extraordinarily nice – I love everything they do for me” (resident). • “The atmosphere is pleasant – and they keep us informed” (resident). • “It is lovely here – it’s the friendliness and that” (resident). Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 23 • • • • • • • “The manager is very pro-active, organised and good at coaching and making people look at their potential – the atmosphere is good which is why I work here” (staff member). “Staff are pretty good and the atmosphere is pretty good” (resident). “I love the staff, we have good groups here, the working atmosphere is really nice, everyone is friendly – it’s comfortable everyone is approachable, management is good, it’s run well, management get on the floor to help us – its not us and them but real teamwork – I enjoy coming to work” (staff member). “It’s very nice and generally very happy – I was lucky to have found this place – they look after me well and it’s so friendly” (resident). “They are splendid they are all my friends”(resident). “I love it here, the staff are so nice and helpful – the atmosphere is very good” (resident). “We are a good team – happy – we all get on well. It’s a job you have to enjoy and have to want to do.” (2 staff members). Residents and staff spoken to said that there were regular meetings held in the home to discuss various matters. One resident said, “they keep us informed”. Staff said that meetings were arranged for the various staff groups and also general staff meetings were held. Minutes form a recent meeting for residents and relatives were seen and t was apparent that the proposed extension to the buildings had been one of the items discussed. The home was accredited with the national “Investors in People scheme”. It is based on staff being trained and competent to ensure that the objectives of the business can be achieved. The accreditation is subject to external assessment by “the body” that gives the award every 3 years. The home conducted regular internal reviews of systems and procedures, e.g. care plans. As part of a large organisation monthly visits to the home were made by a senior manager and reports were produced of such visits and copies were sent to CSCI. During such visits records were examined and staff, residents and visitors were asked for their views about the home. The organisation also sent questionnaires to relatives, staff and residents and one visitor confirmed that he received questionnaires seeking his opinions about the quality of the service provided by the home. Questionnaires sent to staff sought their perceptions of the home’s management in 4 areas: people, customers, finance and leadership. The home was participating in a national scheme (Personal Best) arranged by the organisation i.e. BUPA Homes. It was described by staff spoken to as “team building” and “knowing what residents need”. The registered manager and head of care said that as a result of promoting the scheme, staff were highly motivated and involved and “went the extra mile” referring to a recent strawberry and cream tea event and the contributions that staff had made from their own time to ensure its success. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 24 The home had a number of comprehensive written policies and procedures that were made readily available to staff and where they could obtain advice and guidance. There was evidence form dates on these documents and discussion that they were amended and updated. The home looked after money for some residents that had either been provided by relatives or at the request of individuals who wanted money kept for them by the home for safekeeping. The home kept records of individuals’ accounts and this included details of all withdrawals and deposits and any interest earned. Staff spoken to confirmed that they received regular individual supervision sessions and also had annual appraisals. This was confirmed by examination of a sample of 4 staff records. • “I have supervision with a registered nurse and also appraisals – the supervision is about every 1 to 2 months it is sometimes combined with training - we have health care assistant meetings” (staff member). “We have supervision every couple of months” (2 staff members) All statutory required records examined at the time of the inspection were available and kept securely. Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 3 x 3 3 3 x Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Ashley Lodge Residential & Nursing Home H54 S11413 Ashley Lodge V243338 150805.doc Version 1.40 Page 27 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW 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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