Inspection on 17/05/07 for Ashley Manor Nursing Home

This inspection was carried out on 17th May 2007.

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 Manor Nursing Home 20/07/09

Ashley Manor Nursing Home 07/05/09

Ashley Manor Nursing Home 03/11/08

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashley Manor 17-19 Cambridge Road Waterloo Liverpool Merseyside L22 1RR Lead Inspector Mrs Claire Lee and Mrs Janet Marshall Unannounced Inspection 10:00 17 and 18th May 2007 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 Manor DS0000069982.V344227.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 Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley Manor Address 17-19 Cambridge Road Waterloo Liverpool Merseyside L22 1RR 0151 928 2249 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) A.C.G Management Limited Mr Rob Blakemore Care Home 75 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (30) of places Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing – code N. to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories:Old age not falling within any other category – Code OP, (maximum number of places: 30) Dementia over 65 years of age – Code DE (E) (maximum number of places: 45) The maximum number of people who can be accommodated is: 75 Date of last inspection New service Brief Description of the Service: Ashley Manor is a large care home situated in Waterloo. The home overlooks a public park and there is access to local transport. Ashley Manor provides accommodation for up to 75 older people and is divided in to 3 categories of care. This includes 30 places for residents with general nursing care needs, 33 places for residents who have dementia and nursing care needs and 12 places for people who have dementia and require personal support. The home is divided into 3 separate areas thus enabling residents to have their own recreational areas and bathroom facilities. There are 55 single and 10 double bedrooms, some of which are ensuite. The home is equipped with a call system with an alarm for the residents and the home has manual handling equipment to assist those who are less independent. There is car parking space to the front and patio areas and gardens. Ramp access is available. CCTV cameras operate in main entrance areas for security purposes only. The fee rate for accommodation is from £389.50 to £550.00 per week. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A site visit took place as part of the unannounced inspection. Two inspectors conducted the inspection over two days for duration of approximately sixteen hours. The home was re- registered this month as a limited company. Mrs Joyce, the owner is now registered as the responsible individual for ACG Management Limited, Ashley Manor Nursing Home. Sixty eight residents were living in the home at the time of the visit. A partial tour of the premises took place and general observations were made. A selection of care, staff and service records were also viewed. The Registered Manager was present and members of the senior management team took part in the inspection process at various times of the day. Interviews were conducted with management, seven staff and six residents. Relatives and visitors views were also obtained as part of the inspection. At the time of the site visit six residents were case tracked (their care files were examined and their views of the home were obtained). This process was not carried out to the detriment of other residents who also took part in the inspection process. All the key standards were inspected. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents at the time of the site visit to gain their views of the service. What the service does well: Residents and relatives were pleased with the service and the standard of care and support provided by the staff. Comments included, “Very good home”, “The staff work hard”, and “It is a busy home however everyone works together for the residents”. Ashley Manor presented as a caring and homely environment. The home was clean, decorated and furnished to a good standard. The people living in the home appeared relaxed and comfortable and staff were observed providing appropriate care and support to residents throughout the day. On the dementia unit a number of residents are limited in their ability to make life choices but when spoken with they said they are listened to and choices made on a daily basis are respected. Relatives and residents interviewed felt that the staff approach to care on all the units was delivered respectfully. Through observation it was evident that there was an understanding on the units of the importance of facilitating good communication. A resident reported, “The staff have time to spend with me which is nice”. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 6 On the nursing unit discussion with residents confirmed that they receive the medical support they need and that staff are appropriately trained and experienced to provide the necessary care. The manager prior to residents taking up residency completes resident assessments. This ensures the home can meet the resident’s individual needs. Care planning is good and care documentation had been reviewed regularly to ensure the information was accurate and relevant. The care plans recorded care and social needs with an aim and nursing intervention for the staff to follow. This information enables staff to understand and deliver the care required. Care files on the dementia unit also gave a good account of the resident’s emotional state with appropriate care interventions by staff. The care documentation on all units is easy to read, organised and includes risk management to protect the health and safety of the residents. Residents being nursed in bed due to frail health appeared comfortable and were visited regularly by staff to ensure they were safe and well cared for. There are good links with health care support services. This is the case throughout the home so that residents’ health care needs are fully met. Residents were complimentary regarding the standard of meals provided. They said that there was always a good choice and that fresh fruit and vegetables were served daily. A resident said, “The food is fine and we get a choice”. The home provides comfortable areas for the residents to sit and chat to their visitors and relatives. There are plenty of lounges to enable residents to have private meetings if preferred. Areas seen were clean and sufficient numbers of domestic staff were on duty to maintain this good standard. Residents’ bedrooms were pleasantly decorated and they had personal items from home to make the rooms look ‘homely’ in appearance. Recruitment procedures for new staff were robust to protect the residents and staff receive a full training programme for courses in safe working practices. This provides them with knowledge to undertake their work. The manager seeks the views of residents and their relatives as part of an external quality award. Surveys reported positive comments about the care and overall service. The site visit evidenced that the management of the home is effective and the manager works closely with the staff and also senior management. The management team are based at the home and staff stated that they visit the units regularly to talk with staff and residents. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 7 Health and safety checks of the building are carried out and service contracts, for example, gas, electric, servicing of moving and handling equipment, were in date to ensure the ongoing protection of people in the building. Staff said that the new manager had made positive changes to the home and that he was approachable and supportive. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashley Manor DS0000069982.V344227.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 Manor DS0000069982.V344227.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): Standards 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose reflects recent changes to the service and pre admission assessments ensure staff can meet residents’ needs. EVIDENCE: The home’s Statement of Purpose has been updated to include Mrs B Joyce as the responsible individual and Mr R Blakemore as the Registered Manager for the service. The manager was advised to display a copy of the document in the reception area of the home for visitors to view. The home has an entrance hall with large notice board for general information. Feedback from relatives confirmed that they were able to come and look round and were also given written information regarding the service. A receptionist is on duty to greet people at the main door and to assist them with any queries they may have. It was evident that visitors to the home benefited from this. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 10 The manager completes a pre admission assessment for residents who wish to take up residency. This ensures that staff are able to meet their care and social needs in full. Six care files were viewed and assessments were on file for each resident. An assessment was examined in detail for a resident who has recently arrived. The standard of information recorded was good and this included, details of basic needs, for example, hearing and sight that are so important for elderly people. The assessment also included key areas such as eating and drinking, social involvement, mobility, resting, sleeping, personal hygiene and also reason for admission. With regards to assessing sexuality the manager was advised that the words used for assessing this was ‘clinical’ and not clear to follow. This area of the assessment should be reviewed to ensure staff are clear as to the information to be recorded. Residents on the dementia unit also have their psychological needs assessed and relatives are very much involved in collating the information to assist the staff. A social care assessment was on one file and this provided further detail of the resident’s care needs. Intermediate care is not provided and therefore this standard was not assessed. Ashley Manor DS0000069982.V344227.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): Standards 7,8 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care and social needs were identified in a plan of care and medicine administered safely. Staff were observed delivering care and support in a respectful manner. EVIDENCE: Case tracking took place for six residents and this included a resident who had recently arrived at the home. The care files were organised, easy to read and available for staff and residents. Care documentation recorded residents’ care needs in detail and staff were provided with good information on how to deliver the care. Supporting documentation including risk assessments for nutrition, care of skin, moving and handling and communication. Any limitations to freedom and choice had been recorded in the resident’s best interests. This was noted for residents on the nursing dementia unit. There is also a risk that residents on this unit may feel isolated due to their varying degrees of dementia. This had been identified in the care plan with instructions on how to Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 12 provide support and understanding. In the past relatives and residents have been consulted with regard to the plan of care and now the manager has introduced new care documentation their agreement and consent should be obtained. Several care summaries used clinical terminology and there is a risk that not all staff would understand the wording. The use of such words should be reviewed when reviewing care needs. The care summaries are discussed further under Standard 37 of this report. Residents appeared appropriately dressed and assistance was being given to a number of residents on the dementia unit due to their behavioural needs. Residents interviewed on the nursing unit confirmed that they receive a good standard of help with personal hygiene and that staff are around to help. A resident on the dementia residential unit was receiving input from the district nurse service. She confirmed that they came regularly to the home. District nurse notes are available for the staff for their information. It was noted that a resident who was being nursed in bed received regular visits from the staff and was made comfortable before leaving the room. Screens were used in double rooms to protect residents’ privacy. Feedback from residents and relatives was positive regarding the care. Comments included: “Good care” (relative) “The staff are very good” (relative) “Nice people to help you” “I get a bath each week and a good wash each day” “I think the care is fine” Care documentation had been reviewed regularly to ensure accuracy and daily report sheets for the week of the site visit recorded the care provision and any other relevant information. Weight records were in place and also care files evidenced appointments with GPs and other health professionals. A relative commented that staff were prompt in seeking medical advice when needed. The clinical room on the nursing unit was unlocked on the first day of the site visit; this was brought to the attention of the nurse in charge. On the second day the door was locked. The clinical room was clean and not cluttered. The medicine trolleys are stored in this room and it is also used for clinical procedures. The medicine trolleys and medicine fridge for the nursing unit were locked and medicines appropriately stored. The administration of medicines policy was available and a list of staff signatures for those responsible for administering medicines was on file. Medicines are administered using a monitored dosage system, which was dispensed by a local pharmacist. Medication Administration Records (MAR) viewed had been correctly completed to record the details of medication received and Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 13 administered in the home. Staff signatures for medicine to two residents were missing on one day however overall the administration was good and the correct code was being used for medicines not taken by residents. The controlled drug register was viewed in relation to a controlled drug being administered. This evidenced an accurate record with staff signatures. Two staff members also check the medicine Temazepam as it is liable to misuse. It is recommended that the manager review the administration policy regarding administering medication to residents who leave the premises, as they may need to take their medications with them. This was discussed in relation to a resident who did not receive a lunch time medication. Non administration of the medicine may affect their general health. No residents are currently administering their own medications. Suitable systems had been established to account for medication returned to the pharmacist. A resident who has recently arrived at the home received a visit by an external health professional regarding prescribed medicines as part of a health review. Discussion with residents and relatives confirmed that staff were respectful in their attitude and were aware of the importance of promoting privacy. Staff interviewed were able to give examples of how this is respected within their day-to-day practices. A relative said, “The girls are always polite and speak nicely”. It was noted however that one member of staff did not knock on a bedroom door before entering and one staff member was talking loudly to another member of staff with regard to an aspect of personal care. This however was not observed at any other time; other staff were seen knocking on doors and talking quietly in the lounge to residents. Both incidences were brought to the manager’s attention as an induction and training issue. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 14 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): Standards 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily life, activities and meals were flexible and varied to meet the wishes and care needs of the residents. EVIDENCE: On the day of the site visit residents enjoyed a singer/ guitar player who performed on the dementia and nursing unit. Staff interviewed stated that the home has various activities going on and this included, bingo, DVDs, pamper time, music and films. Residents are encouraged to participate, dependent upon their wishes and interests. A number of residents prefer to main in their rooms and not join in; staff were observed to respect this. Residents confirmed that they see a hairdresser and chiropodist regularly. Holy Communion is offered which, enables residents to take part in their chosen faith. A resident said this is offered once a month. One resident stated that she goes out for lunch regularly but also joins in with the entertainment. A record was kept of social activities undertaken by each resident with also a life history and a record of individual preferences. This included detail such as preferred name, resting after lunch and preferred time of retiring. Staff have good information to ensure individual wishes are taken into account where possible. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 15 Resident activities had been recorded and this included some personal details. The information must not be displayed but kept secure in line with the Care Standards and Data Protection. This is discussed under Standard 37 of this report. Having personal information displayed compromises the resident’s right to privacy and dignity. The manager was advised and the information was removed at the time of the site visit. It is recommended that the activity record be kept in the resident’s care file. On the dementia unit staff were observed to spend a great deal of time on a one to one basis with residents. Residents were observed to be able to walk freely around the lounge with plenty of staff to offer support and guidance. Staff were observed assisting residents with jigsaws and playing cards Residents on the dementia care unit who require personal support are able to attend the day care centre situated at the rear of the main home. The centre is staffed by the home. A resident said, “The centre is just wonderful and I love the staff”. Residents interviewed were satisfied with the routine of the home and did not have any concerns as to the time of going to bed in the morning, times meals were served or time of retiring at night. They said that staff were pretty good and would be flexible. Bedrooms seen had been personalised with pictures and personal possessions and a relative said they he was encouraged to make the room as homely as possible. Visitors were seen popping in at various times of the day and offered refreshments. Some resident preferred to see their visitors in the privacy of their own room and this is respected. A relative self-help group meets once a fortnight and during the site visit the inspector gave a talk regarding the role of the Commission. The group is open to all relatives and the dates of the meetings displayed. Minutes are not taken as the group wish to remain informal however feedback is given to the manager. Relatives feel the meetings are very beneficial and the manager willing to act on their suggestions where possible. There is a small dining room in both units and the tables were laid for lunch. Menus viewed offered residents a balanced, wholesome and nutritious diet. A copy of the daily menu was displayed for residents and alternatives are provided at each meal time. Pureed food was served individually to ensure it retains colour and staff were observed to offer assistance to residents in an unhurried manner. Residents were offered drinks, biscuits and fruit at various times of the day. The kitchen was well stocked with fresh produce and strawberries were being prepared for the evening meal. Hazard charts for recording food temperatures and fridge/freezer temperatures were up to date. Comments regarding the food include: Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 16 “Tasty meals” “Very nice meals” “Meals are brought to me hot” “I like the food which is cooked” “Food very good, get what you want even if it is not on the menu” One resident requires a special diet and a relative stated that on occasions the family member and other residents had been served incorrect foods. This is not the norm however, as this tends to occur when agency staff are employed. A list of dietary preferences should be made available for staff to refer to. This information was recorded in the care files and kitchen. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were confident their concerns would be listened to and systems were in place to safeguard and protect vulnerable people from abuse. EVIDENCE: The home had a complaints policy and complaint leaflets were placed on display in the main entrance hall at the time of the site visit. Two documents are currently being used for recording complaints and one should be implemented to ensure consistency. The complaint log should also evidence in more detail the action and outcome of complaint received. Previous complaints are not stated in this report, as the home has been re-registered. Residents and relatives interviewed stated that they would speak to the manager if they had any worries and that he would listen to them. The relatives self help group also enables relatives to voice their opinions of matters that concern them. A staff member said, “I would report anything to the nurse in charge and tell her the complaint”. A copy of the Liverpool and Sefton’s Adult protection procedures was available and there was also an abuse policy. Policies and procedures provided guidance to staff regarding what to do in response to suspicion or evidence of abuse. Staff also receive adult protection training as part of their training programme. This was last given in March 2007 and the manager reported that training would be arranged for staff that did not attend at that time. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 18 A staff member was able to describe the action to be taken should they witness an alleged incident. They also gave good examples of what constitutes abuse. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 19 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): Standards 19, 20,21,22,24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and clean environment, which contributes to a good quality of life. EVIDENCE: Ashley Manor has maintenance men who attend to the general upkeep of the home and who undertake health and safety checks of equipment and services. They check different areas of the home each day however a maintenance book is recommended to record work undertaken and for staff to make entries for work that needs attention. The accommodation was found to be very clean; there were no unpleasant odours and domestic staff had sufficient equipment to enable them to undertake their work. The exterior of the premises was well maintained and CCTV cameras operate in main entrance areas for security purposes only. The home has car parking space at the front and rear and there is wheelchair access. The day care centre is managed from a separate building however this is not regulated and therefore was not inspected. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 20 Lounges seen were furnished with comfortable armchairs and small tables. The dining tables were laid for lunch and flower arrangements were evident. There is a patio area outside the dementia care unit, which is used in warmer months. The relative group have requested that the patio be used more and for residents to have a quiet lounge on the ground floor as the main lounge can become very busy due to the nature of residents who are cared for. The use of such an area would benefit residents at various times of the day and this was passed to Mrs Joyce for her attention. The home has stairs, a passenger lift and assisted bathing and toilet facilities for the residents. Mobility aids are provided subject to an individual moving and handling needs assessment and the aids to be used were documented in care files seen. During the site visit it was noted that on the nursing unit the two shower curtains, which divide the toilet area from the lounge were soiled. They were taken down to be laundered and the manager was advised to give serious consideration to providing a more appropriate furnishing/fitting to protect the resdients’ privacy. One room had a telephone with large push buttons to assist the resident with its use. Bedrooms had personal items belonging to each resident and were warm, bright and had attractive décor. A risk assessment had been completed in care files viewed for the use of a call bell system (whether the resident is able to use the call bell safely) and the provision of a door key for their bedroom. A resident described her room as, “Nice room and comfortable bed”. Windows have restrictors in place to ensure they open to a safe width; one room was found to have a faulty catch and the manager was informed. The catch was mended immediately. Records were in place for the temperature of the hot water to the baths to ensure it was delivered to a safe temperature. A spot check also evidenced this. Emergency lighting is provided in the building and subject to an in house monthly safety check and also an annual service contract. Records seen were current. There are two separate laundry rooms for washing and ironing. Staff were observed to use gloves and aprons where needed however one staff member interviewed was unsure of the correct procedure regarding removal of gloves after attending to a resident. This was brought to the manager’s attention as a training need. Laundry was well organised and residents said that clothes are returned promptly. Resident and relatives made the following comments regarding the accommodation: “Nice home to live in” Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 21 “It is kept clean and cleaned each day” “My bedrooms is fine” “Room splendid” “A clean home, which is what we want” (relative) Whilst touring the building it was noted that there were a number of signs displayed in communal areas, bathrooms and in bedrooms. This was discussed with the manager who stated that they were in place as a reminder to staff. Signs should be place discreetly around the home as the accommodation is ‘home’ to the residents and therefore out of respect they should be kept to a minimum. Ashley Manor DS0000069982.V344227.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported and cared for by staff who are correctly recruited. Staff induction is not given in sufficient detail to ensure staff have the knowledge to provide the care and support to residents and to meet their needs. EVIDENCE: The pre inspection questionnaire and staffing rota for the week prior to and the week of the site visit confirmed that sufficient numbers of staff were on duty to provide care and support for the residents. Each unit has their own staffing rota with a registered nurse in charge of the dementia care unit and nursing unit. The dementia residential unit has senior care staff. The manager stated that some staff members have left however six new staff have been employed to boost staffing numbers and that the home is now well staffed. Residents interviewed said that staffing numbers were ‘ok’ and that staff were available to help. One relative referring to the dementia unit reported, “The staff are always on the floor, there are always at least 2-3 staff sitting with residents, nothing is too much trouble”. Likewise a resident said, “The staff are very good, treat me well and staff sit and talk to me”. NVQ (National Vocational Qualification) is ongoing and 41.3 have achieved an NVQ in care. Ten staff members are currently undertaking NVQ Level 2 and Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 23 four staff are waiting to start. NVQ training is to continue to ensure the home has a minimum ratio of 50 of care staff with a qualification. Six staff files were viewed for the purpose of staff recruitment and staff training. This included staff files for three new staff. The files evidenced robust recruitment procedures. There was evidence of completed application forms, details of past employment, two references and a police check – CRB (Criminal Record Bureau) check at enhanced disclosure. POVA (Protection of Vulnerable Adult) checks were also in place for staff who commenced employment prior to the CRB being obtained. One reference could not be located for one staff member however a copy was faxed through at the time of the site visit. One application form had no referees noted however references had been obtained. A photograph was evident in the staff files for identification purposes and staff confirmed that they receive a contract of employment and job description. New staff receive an induction however this is a checklist with emphasis on administrative and organisational information rather than care practices. The manager must implement a more structured induction programme in line with Skills for Care induction standards, which has replaced the Training Organisation for Personal Social Services (TOPSS) induction standards. The induction should to be given over a six week period and include details of care practices to evidence skills and competencies in these areas. Privacy and dignity should be discussed at this time in light of the points raised in their report. Staff interviewed said that they had an induction with the manager however one staff member said it could have been more in depth. A staff member said that they worked with a member of staff for a few days as part of the induction. The manager accesses courses for staff in safe working practice areas, this includes, fire prevention, first aid, moving and handling, food hygiene and infection control. This ensures the staff have the knowledge to provide care and support to the residents and meet their needs safely A wall planner evidenced dates of training and a copy of planned training was provided. A staff member interviewed stated that she had not received any moving and handling training since starting and was unsure of how to use the hoist. This was brought to the manager’s attention and training must be given urgently. A more detailed induction will assist the manager with assessing training requirements for staff. Other courses available include diabetes, catheter, POVA and health and safety. At the time of the site visit a food hygiene course was taking place. When discussing the care of the residents a staff member reported that they would, “Treat residents as I would want to be treated”. The pre inspection questionnaire evidenced a list of personal identification numbers for registered nurses. Their registration was in date to enable them to practice safely. Ashley Manor DS0000069982.V344227.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,35,36,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The general management of the home and key records ensure the health, safety and welfare of the people using the service. A number of records are not being kept secure to protect residents. EVIDENCE: Mr R Blakemore was appointed as the Registered Manager this month. Mr Blakemore is a registered nurse and has many years experiencing working with elderly people as a district nurse and working at Ashley Manor. Mr Blakemore confirmed that he attends training in safe working practices with the staff and is now the trainer for moving and handling instruction. Staff described the manager as, “Fair”, “Good to work for”, “Helpful” and “Professional”. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 25 A staff member said that the manager came round each day to talk with residents and staff and that there was always an ‘open’ door policy to see him. Likewise another staff member said, “The manager has made some good changes to benefit the residents. Mr Blakemore has commenced his induction for NVQ Level 4 in Management. Mr Blakemore and the senior management team work closely together to monitor the overall service and Mrs Joyce completes a Regulation 26 record following he monthly quality check of the home. A report was seen for the month of May 2007. As previously stated a relative self help group meets once a fortnight and points raised from their meetings are brought to Mr Blakemore’s attention. The relatives said they had a good rapport with all of the management team. Staff confirmed they attend staff meetings, which are held every three to four months. An external consultant undertakes an annual quality assurance assessment and satisfaction surveys are completed at this time. Comments received from one survey in January 2007 were discussed as the relative raised concerns. These had been dealt with satisfactorily. A member of the senior management team oversees residents’ finances. At the time of the site visit a financial record was viewed for a resident who was case tracked. The financial record was unclear however further discussion evidenced what was happening with the resident’s finances and bank details. Staff receive supervision and a record is kept of the meeting. It was noted that supervision records were on display in the main office. It is strongly recommended that these be kept secure at all times. Details of residents’ care and social needs must not be displayed. This was evidenced in a number of resident bedrooms and the lounge on the nursing unit. The information included a summary of care and social needs. All documents relating to a resident must be kept secure in line with the Data Protection Act 1998 and the Care Standards Act 2000. Pre-inspection records detailed that equipment within the home was regularly inspected and serviced to protect the residents. A spot check of the certificates for gas, moving and handling hoists and electric supply confirmed this. A health and safety check of the building was completed this month to identify any risks. Fire records were examined. Records confirmed that the fire alarm system was tested on a weekly basis and the emergency lighting on a monthly basis. A certificate was in place to confirm the emergency lights, fire extinguishers and fire alarm system had been serviced. Fire training was last given in November 2006 and is due this month. An inappropriate sign was removed from the fire door in the lounge on the nursing unit as it may prevent residents and staff from using this exit in the event of a fire. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 26 Staff complete an accident record for any untoward incident that affects the resident’s welfare. A record viewed had been completed in good detail with action taken. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 x 3 3 4 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 3 Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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 OP30 Regulation 18 (1) (c) (i) Requirement Timescale for action 17/09/07 2. OP37 17 (1) (b) Schedule 3 Staff must be qualified, competent and experienced to care for the residents. Staff must receive a structured induction to ensure they have the skills and knowledge to provide the care and support to the residents Resident records must be kept 17/08/07 secure in the care home. Care summaries of residents’ care and social needs must be kept secure. 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 OP7 OP9 Good Practice Recommendations Residents and/or relatives should be approached with regard to their agreement and consent to the plan of care. The manager should review the home’s medicine administration policy for residents who leave the premises any may need to take medication as prescribed. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 29 3. 4. 5. 6. OP12 OP15 OP16 OP19 7. 8. 9. 10. OP19 OP20 OP28 OP36 The residents’ activity log should be kept in the care file. A list of resident dietary preferences should be made available for staff to refer to. One form should be used for recording complaints and the action to be taken and outcome of the complaint. Maintenance work should be recorded in a maintenance book when actioned. A more suitable furnishing/fitting should be used to separate the toilet area from the lounge on the nursing unit. Signs place around the home should be kept to a minimum and discreetly placed. The provision of a quiet lounge on the ground floor for the residents on the dementia care unit would be beneficial for ‘quiet’ times and reminiscence therapy. Staff should continue with the NVQ programme to obtain the 50 staff ratio with an NVQ in care. Staff supervision notes should be securely locked away and not displayed. Ashley Manor DS0000069982.V344227.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. 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