Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Ashley Manor Nursing Home 17 - 19 Cambridge Road Waterloo Liverpool Merseyside L22 1RR The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Claire Lee
Date: 0 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home
Name of care home: Address: Ashley Manor Nursing Home 17 - 19 Cambridge Road Waterloo Liverpool Merseyside L22 1RR 01519282249 01519200094 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): A.C.G. Management Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 75 Number of places (if applicable): Under 65 Over 65 45 30 dementia old age, not falling within any other category Additional conditions: 0 0 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 Brief description of the care home 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 Care Homes for Older People Page 4 of 33 0 3 1 1 2 0 0 8 Brief description of the care home 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 428 pounds to 565 pounds a week. Care Homes for Older People Page 5 of 33 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An announced visit took place as part of the inspection and this was carried out for a duration of two days for approximately fourteen hours. Two inspectors were present for the second day. Forty eight residents were accommodated at this time. The term resident is used in this report as this is what the people staying there like to be called. During the time spent at the home different areas were looked at and a number of care, staff and health and safety records were checked to see what care the residents living there received. Discussion took place with five residents, three relative, five staff, the manager and operations manager. The last key inspection took place on 17th and 18th May 2007 and there was a pharmacy inspection on 31st December 2008. Requirements and recommendations from these inspections were examined at this Care Homes for Older People
Page 6 of 33 time. During the inspection four residents were case tracked (their files were looked at and they were asked for their views of the home). Other residents also took part in the inspection and all the key and other standards were assessed during the visit. Reference is made to them in the report. To find out more about the care provided at the home survey forms called Have your Say About.... were distributed to a number of staff and residents prior to the inspection. Both were also given out during the inspection. Only staff surveys were returned and a number of comments from them have been included in this report. An AQAA (annual quality assurance assessment) was completed for the inspection. The AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. Reference to this document is stated under the section, what the home could do better. What the care home does well: Residents appeared comfortable with the staff. Good interaction was noted between them and the staff. Staff were seen to spend time talking with residents and also offering help to them in a patient and gentle manner. A relative commented that the staff had a good understanding of their mothers needs and they attended to her promptly. Staff were seen to use aids to help residents with their independence in a safe way. Residents are encouraged to join in with the social activities of the day and visitors were seen arriving at different times of the day. Residents interviewed said they were happy with the care and they enjoyed the staff company. Comments included Very good care, I am fine living here and The staff are very nice. New resident care plans have been introduced and these contained good detail regarding the health and social care needs of the residents and any risk to them that would affect their health, safety and welfare. Instructions to staff on how to deliver the care was recorded and the care documents had been looked at regularly to ensure they accurately reflected the care and support given. Feedback from the residents regarding the food was good and the manager has introduced a snack menu and breakfast menu along side the main menu. This offered residents a good choice of meals at various times of the day. Lunch was served in the main dining rooms and two sittings enables residents to take their time and not feel rushed. An activities organsier sorts out the social arrangements for the residents. The AQAA reported that activities have been improved and this was seen at the time of the inspection. The musical entertainment is popular and also the old films shows. A relative commented that there is a lot going on each day and that staff do their best to encourage everyone to join in. There is now a dedicated activities room which can be used. The activities organiser had completed a record of participation and enjoyment by the residents to ensure the social programme was to their liking. The home has lounges on each floor which can be used for residents who would like to meet their relatives in private or would like some quiet time. Staff were observed to provide quiet time for residents who had become agitated due to the nature of their dementia. Staff demonstrated a good knowledge of their individual needs and how to reduce agitation and provide reassurance. The home was found to be clean and pleasantly decorated. A maintenance person makes sure repair jobs are undertaken and carries out general decoration. A number of rooms have been decorated and there was new flooring in the dementia lounge which has brightened up the room. Security locks on doors help to keep the residents safe, however residents were seen to wander round freely with the support of the staff. Residents had brought items in from home to make their rooms feel homely and a resident said, My room is just fine. The lounges had comfortable arm chairs and pictures to make them feel homely. Care Homes for Older People Page 8 of 33 Records seen in relation to health and safety were up to date to ensure the safety of the people who use it. What has improved since the last inspection? What they could do better: Resident and/or their familys members agreement and consent to the plan of care should be obtained where possible so that they are full aware of the care being given. All care plans and associated documentation should be written in a way that can be understood by residents and everybody involved in their care. The manager must ensure there is a system in place to check that staff are competent to give out medicines. Assessments completed to check their skills and knowledge could not be found and these must be completed.This remains an outstanding requirement from the pharmacy inspection in December 2008. All handwritten information entered on the medicine sheets should be signed by two people to show the accuracy of the information. It is very strongly recommended that the manager ensures changes made by a GP regarding a dosage are clearly recorded on the medicine chart so that staff are aware of the dosage to be given. When controlled medicines (a medicine liable to misuse which is recoded in a bound book and stored in a special cupboard) are disposed of it is recommended that two staff undertake this task to protect the residents and them. Residents who receive controlled medicines for relief of their pain should have a plan of care which gives details of how the pain is managed to ensure the resident is comfortable. This is an outstanding recommendation from the pharmacy inspection in January 2008. Staff training would be beneficial so that staff are aware of the importance of good pain management for the residents. It would be beneficial to incorporate details of Seftons local guide for protecting vulnerable people with the safeguarding training for staff. The whistle blowing document should be displayed for staff to refer to. This will ensure they know who to contact if they witness an alleged incident. Care Homes for Older People Page 9 of 33 The landings and bedrooms doors should be painted a brighter colour as the wood work is dark. This would brighten up the home for the residents. A Health and Safety inspection took place in November 2008 and the manager has asked for an extension to complete the necessary work in relation to the safe storage of hot water in the home. The Care Quality Commission should be advised when the work required by the Health and Safety Executive has been completed. The work is needed to ensure the ongoing safety of people who use the service. Visual aids should be used to help the residents with dementia to find their way round the home. Broken wheelchairs which are not in use should be repaired as soon as possible so that residents are able to use them. The training plan for the staff should be updated with details of past courses and those planned. The AQAA could have recorded more information regarding the service as it is is the main way the manager will let us know how well the service is delivering good outcomes for them. Advice was given to the manager regarding the need for more information next time one is completed. It is strongly recommended that the fire risk assessment of the building be reviewed and updated in consultation with a fire officer. This will protect the welfare of the people at the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information was provided to residents and their families to enable them to decide whether their needs can be met at the home. Residents needs had been assessed to ensure the staff could provide the care and support they needed. Evidence: Information regarding Ashley Manor was provided in a service user guide and statement of purpose. The documents were on display in the main entrance hall for residents and visitors to see. They are also given out to prospective residents and their families to provide them with enough information to help them decide whether the home is right for them. A relative said that they had been able to choose the room they wanted and the staff had been very welcoming when they arrived. A receptionist is now employed at the home and this helps to provide a good welcome for people visiting. Care Homes for Older People Page 12 of 33 Evidence: The manager completes a care needs assessment for residents prior to their admission. Information regarding health and social care needs had also been obtained from other health professionals, for example social services. The four assessments looked at had been completed in good detail and gave the staff relevant information to help draw up a plan of care. The assessment gave details regarding daily tasks such as, help with washing and dressing and walking. As the home is registered to provide dementia care, the assessment included details of residents behaviour and how to provide the necessary care for residents who may become agitated and need more support from the staff. Intermediate care is not provided at Ashley Manor and therefore this standard was not assessed. Care Homes for Older People Page 13 of 33 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents may be placed at risk if checking systems are not robust for administering medicines and staff have not been assessed as being competent to give them out. Evidence: Residents had a care file with an individual plan of care developed from information taken from their assessment. Staff had been given the necessary information they needed to care for the residents. A new format for care planning has been introduced and this was well presented and much easier to understand than care plans viewed at the previous key inspection. Care files were stored in a locked cupboard to ensure the information held was kept secure. Case tracking took place of four residents to review their care documents. The care plans recorded in detail the care and level of support the residents needed to keep them well. This was seen for areas such as walking, assistance with washing and dressing, eating and drinking and social background. The manager was advised to provide a clear heading to identify the particular area of care and to replace the title
Care Homes for Older People Page 14 of 33 Evidence: problem with need to give a more positive approach to delivering care. Care plans were generally well written although there were a lot of medical terms used to describe certain illnesses and health conditions, which residents had. This has the potential to confuse and intimidate people including care workers, residents and their representative who have the right to access their care plan. Care workers need to fully understand all contents of each persons care plan so that they can fully meet their needs. A staff member commented that the care plans could be difficult to follow. Residents with dementia had a plan of care which looked at the care needed in relation to the symptoms of dementia, for example memory loss and behaviour. Staff had received training in dementia care to help provide the necessary care for residents to continue with preferred activities and to make sure they had a good quality of life. A relative said, The staff are very good at understanding my mothers needs. Likewise a resident reported, The staff know exactly what I need. A good example of monitoring a residents health was seen for caring for residents skin. Staff had recorded the use of special dressings to improve skin conditions and how the areas were progressing. Care plans showed that specialist health care conditions such as diabetes and memory loss were clearly understood, monitored and appropriately supported. Residents who were being nursed in bed looked comfortable and staff were seen to regularly visit them to make sure they were well cared for. Risks to the resident had been identified along side the plan of care. This recorded how staff needed to minimise a risk but also ensuring the resident remains independent where possible. For example, use of equipment to help with walking or if a residents intake was poor and there were concerns regarding weight loss. A relative said they had been involved with reviews of the care and that the staff were good at keeping them informed of any changes. Consent to the plan of care should be obtained where possible and recored in the care file so that the resident and their relative are fully informed of their plan of care and agree to it. This includes consent to equipment used to help protect the residents, for example, the use of bed rails. Other supporting care documents included daily reports of the care given by the nurses and care staff and visits by GPs and other health care professionals. A pharmacist from the Commission for Social Care and Inspection (previous care regulator) visited the home in December 2008 and conducted a pharmacy inspection. This was in light of a controlled medicine error that had been reported. A controlled medicine is a medicine liable to misuse and it is kept in a separate locked cupboard and recorded in a bound book when given. The requirements regarding administering medicines safely and checking that staff were competent to give out the medicines were looked at during this inspection. Good practice recommendations were also
Care Homes for Older People Page 15 of 33 Evidence: reviewed. The manager has a contract with a local pharmacist for supplying medicines to the home each month. A number of medicine charts were looked at and these showed that medicines had been given out by the staff at the required time. There were a number of hand written entries on the medicine charts and these should be signed by two people to show the accuracy of the information. It is very strongly recommended that the manager ensures changes made by a GP regarding a dosage are clearly recorded on the medicine chart, as a dosage for one medicine seen was unclear. This is especially important when giving out a controlled medicine. Residents who receive controlled medicines for relief of their pain should also have a plan of care, which gives details of how the pain is managed to ensure the resident is comfortable. This was made a recommendation at the pharmacy inspection in January 2009. Staff training would be beneficial, so that staff are aware of the importance of good pain management for the residents. When controlled medicines are disposed of it is also recommended that two staff should sign the disposal record as this will help to protect the residents and them. At the pharmacy inspection in January 2009 a requirement was made regarding implementing a system to check that staff gave out medicines in a safe manner. The manager stated that this had been carried out however the assessments completed for the nurses could not be found. The manager must address this with urgency as this remains an outstanding requirement. Regular checks of medicine given out by the staff had been completed by the manager as part of reviewing medicine procedures in the home. The AQAA recorded that the dignity and privacy of the residents is of paramount importance and staff were seen to be polite and helpful in their approach. They had a positive, warm manner and were seen to spend time with residents on a one to one basis and also within a group. They took their time to help the residents with different aspects of care and they spoke slowly and clearly, giving time for the residents to respond. Staff knelt down to talk with residents who were seated thus maintaining good eye contact. Touch was used appropriately to offer encouragement and this was seen in relation to help with walking and assistance with meals. Residents appeared comfortable and relaxed with the staff. Attention had been paid to making sure clothing was appropriate and ladies were wearing make up and jewelery. A resident said, The girls are very good indeed, they are polite but we can have a joke. Likewise a resident reported that the staff knock on the bedroom door before coming in as a mark of respect. Care Homes for Older People Page 16 of 33 Evidence: To ensure good standards of privacy were maintained in the lounge and adjoining WCs, the existing curtains were removed and replaced with doors at the time of the inspection. Care Homes for Older People Page 17 of 33 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are well managed and to ensure residents enjoy their day. Evidence: An activities organsier is now employed and she has introduced a more formal social programme for the residents to enjoy. This included musical entertainment, baking, DVDs, film shows, bingo, quizzes and reminiscence therapy. A lounge has been converted into an activities room and this had comfortable arm chairs and light therapy equipment, which could be used for relaxation purposes. The residents enjoyment and participation was recorded and the activities organiser said that one to one time was also spent with residents in their own rooms if preferred or if needed due to frail health. The care files seen had good information regarding what the residents enjoy taking part in and also family background. This helps the staff to get to know the residents in more detail and to ensure maximum enjoyment of their day. It was evident that staff knew the residents well and that their individual wishes were taken into account, for example, time of getting up, what time visitors arrive and foods they enjoyed. A staff member said, Carers encourage residents to take part in activities to improve their
Care Homes for Older People Page 18 of 33 Evidence: health. The manager expands any ideas for the residents and encourages them to interact with other residents. Visitors were seen at various times of the day and they were able to meet residents in the lounge or in their private rooms. A relative made the following comments, I do not have any worries about what time I visit. The dementia unit lounge is spacious and provides room for residents to wander round safely and to take part in various activities. There are two sittings at lunch time so residents can spend time enjoying their meal. The dining room tables had been laid for lunch and the main meal of the day was served at this time. The menu was set over four weeks and changes have been made as a result of listening to residents and relatives. The menus now include a snack and breakfast menu and these were displayed in the dining rooms for residents to choose what they would like. A resident said, The food is very good, I have no complaints. Fresh fruit and vegetables were on the menu to help ensure residents received a good well balanced diet. Care Homes for Older People Page 19 of 33 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident their complaints will be listened to. Policies and procedures in place help to keep the residents safe. Evidence: The complaint procedure was displayed for residents and their visitors to see. The manager is aware that the document should be updated with the Care Quality Commissions contact details. The AQAA said that four complaints had been received and three upheld following an investigation. The Commission for Social Care Inspection (previous care regulator) received one safeguarding referral and one anonymous complaint. Following investigation only part of the anonymous complaint was upheld. When discussing complaints, staff interviewed said they would speak to the manager right away if a resident had a worry or concern. Residents and relatives interviewed said they were happy with the care at this time. A number of staff had received training in safeguarding vulnerable people from abuse and this was last given to staff in March 2009. Staff interviewed were able to describe what abuse was, however they were unsure of contact details for the agency that must be contacted if they witnessed an alleged incident. Seftons local guide for protecting vulnerable people was available and all staff should be made aware of the document. It would be beneficial to incorporate the guide within the training and display the whistle blowing document for staff to refer to. This will ensure they know who to
Care Homes for Older People Page 20 of 33 Evidence: contact should they witness an alleged incident. Care Homes for Older People Page 21 of 33 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in safe, clean and comfortable accommodation which contributes to their quality of life. Evidence: The home was found to be warm, airy, bright and clean. Residents had access to all areas by a passenger lift and there is disabled access. CCTV cameras are in operation in certain areas. Security locks were on the doors to keep the residents safe and they were seen to be able to wander around with the support of the staff. The external grounds include a patio, which residents enjoy during the warmer weather. The home was found to be maintained and plans were discussed regarding painting the landings and bedrooms doors a brighter colour as the wood work is dark. This will brighten up the home for the residents. Visual aids should also be implemented as this will help residents with dementia to find their way round the home. The AQAA reported on the improvement which include new carpets, curtains, blinds and flooring in the dementia lounge. This was seen whilst having a look round the home. A Health and Safety inspection took place in November 2008 and the manager has asked for an extension to complete the necessary work in relation to the safe storage of hot water in the home. The work is needed to ensure the ongoing safety of people
Care Homes for Older People Page 22 of 33 Evidence: who use the service. The Care Quality Commission should be advised when the work required by the Health and Safety Executive has been completed. The lounges had comfortable arm chairs and the dining room tables were nicely laid for lunch. The structure of the coffee tables were found to be flimsy and this posed a health and safety concern as hot drinks and foods could be spilled. New coffee tables were ordered at the time of the inspection to reduce this risk. Bedrooms were pleasantly decorated and residents had brought items in from home to make their rooms feel cosy and homely. Care files showed that residents had been offered a key to their room to respect their privacy. Residents who were being nursed in bed as their health was frail had been given special mattresses and other aids to provide comfort for them. Call bells were available for residents to ring for help. A resident said, My bedrooms is fine, it is always kept clean and tidy. The bathrooms had equipment to help residents bathe safely. The temperature of the hot water had been recorded to ensure it was at a safe temperature for residents to use. Staff raised a concern regarding the use of a hoist in one bathroom, as limited space posed difficulties with moving the hoist. The manager agreed to move the bath to allow easy access of equipment. The bathrooms and toilets were clean and there was liquid soap and paper towels. Staff wore glove and aprons when needed and all these measures help to reduce contamination. The infection control nurse has visited to help the staff maintain good standards of hygiene. Equipment to help the residents with getting round the home includes wheelchairs. A number of them were not in use as they needed foot rests and general repairs. The manger should have them repaired as soon as possible so that residents are able to use them. Care Homes for Older People Page 23 of 33 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by staff who are recruited safely and are trained to undertake their job role. Evidence: Sufficient numbers of staff were on duty to care for the residents at the time of the inspection. A staffing rota showed the staff on duty and the hours they worked. A registered nurse is on duty twenty fours a day for each unit with the care staff. A number of care staff hold a senior carer role and they are able to give out medicines following relevant training. On the morning of the inspection, four care staff were on duty for each unit with domestic and kitchen staff. A relative commented that the home was busy however staff were always available to help when requested. Four staff files were looked at and these showed that staff had been recruited safely. The checks included police clearance and references. New staff had received a formal induction, which is in accordance with Skills for Care induction standards. This helps to provide formal learning for the staff in accordance with their NVQ (National Vocational Qualifications) in care. A staff member commented that on induction health and safety and fire precautions were gone through. The AQAA recorded that of the thirty nine permanent staff, nineteen have achieved an
Care Homes for Older People Page 24 of 33 Evidence: NVQ in care at Level 2 and above. Staff had also received training in safe working, for example, moving and handling, infection control, first aid and food hygiene. Dates were provided for further training and the training plan should be brought up to date to evidence the courses undertaken and those planned for the staff. Dementia care training is given to staff to promote an understanding and awareness of the disease, its associated illnesses and their management. Staff records also showed training in care planning and medicine awareness and continence management. These courses are all relevant to promoting the well being of the residents to ensure good outcomes for them. The manager has undertaken training which looks at residents who have a disorder or disability such as dementia and because of this may lack capacity to agree to their treatment and how this is managed. The manager is providing training for all the staff regarding this. Care Homes for Older People Page 25 of 33 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ashley Manor is being run in the best interests of people who live there and their welfare and that of the staff is promoted and protected. Evidence: The manager is Ms N Gorman and she was appointed as manager for the home earlier this year. Ms Gorman previously held as position as a registered nurse at the home and has many years experience caring for older people. Ms Gorman has commenced the necessary NVQ management course as part of her development. She should now apply to the Care Quality Commission for the registered managers position. Residents, relatives and staff interviewed commented that the change in manager had not disrupted the home. Resident and relatives meetings have been planned for next month which will enable them to meet the manager in a formal setting and to raise any questions they have regarding the home. The AQAA could have recorded more information regarding the service as it is is the
Care Homes for Older People Page 26 of 33 Evidence: main way the manager will let us know how well the service is delivering good outcomes for them. Advice was given to the manager regarding the need for more information next time one is completed. The quality of the service had been looked at in different ways to ensure it was running in the best interests of the residents. This included, formal visits each month by a responsible person for the company. The visit included meeting residents and staff, looking round the accommodation and examining a number of records. His findings had been recorded in a report and the one seen reported favourably regarding the service. Residents and relatives had also been given satisfaction surveys to complete as part of an external quality award. The manager has made improvements to the menu and activities following comments made in the surveys. A relative commented that the social arrangements were better organised. The staff are not responsible for looking after residents monies however a policy was available to provide guidance to staff should they need to undertake this. Staff confirmed that they could look at policy documents at any time and a number are discussed during the induction with new staff. This helps them to work safely. The AQAA reported that there was a need to increase the frequency of staff meetings and one has been arranged for next month. Staff had received supervision of their work and this enables them to talk about care practices and their training needs. The AQAA reported on the safety checks for equipment and contracts such as gas and fire prevention. A spot check of a number of contracts were found to be in date to help protect the residents. Staff had received fire training and fire equipment had been tested regularly to ensure it was in good working order. The fire risk assessment seen was dated 2002 and it is strongly recommended that this be reviewed and updated in consultation with a fire officer. This will protect the welfare of the people at the service. Staff had completed accident reports where an incident had affected the health of a resident, for example a resident falling. Accidents had been audited by the manager and measures had been put in place to help protect residents from further injury. Incident forms should be introduced for recording an event that may affect a residents welfare to help keep them safe. Equality and diversity is looked at through the resident assessment and their care plans. The information recorded showed that staff understand and promote residents individual needs and wishes in respect of their daily life. This ensures that they receive person centred care.
Care Homes for Older People Page 27 of 33 Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 9 18 There should be an effective system in place to check staff competence. This will help make sure they have the skills to handle medicines safely. 05/12/2008 Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 8 13 There must be a system in place to ensure staff are competent to give out medicines. This will ensure staff give out the medicines safely. (This remains an outstanding requirement from the pharmacy inspection. Timescale of 5/12/08 not met. 08/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 7 Care plans should have a clear heading to identify the particular area of care and to replace the title problem with need to give a more positive approach to delivering care. Consent to the plan of care should be obtained where possible and recored in the care file so that the resident and their relative are fully informed of their plan of care and agree to it. Care Homes for Older People Page 30 of 33 All care plans and associated documentation should be written in a way that can be understood by residents and everybody involved in their care. 2 9 It is strongly recommended that the manager ensures changes made by a GP regarding a medicine dosage are clearly recorded on the medicine chart. All handwritten information entered onto the medicine charts should be signed by two people to show the accuracy of the information. When controlled medicines are disposed of two staff should sign the disposal record as this will help to protect the residents and them. When controlled medicines are disposed of it is recommended that two staff undertake this task to protect the residents and them. Residents who receive controlled medicines for relief of their pain should also have a plan of care which gives details of how the pain is managed to ensure the resident is comfortable. This was made a recommendation at the pharmacy inspection in January 2008. Staff training would be beneficial so that staff are aware of the importance of good pain management for the residents. 3 18 It would be beneficial to incorporate Seftons local guide for protecting vulnerable people with the safeguarding training for staff. The whistle blowing document should be displayed for staff to refer to. This will ensure they know who to contact. should they witness an alleged incident. The landings and bedrooms doors should be painted a brighter colour as the wood work is dark in colour. This will brighten up the home for the residents. A Health and Safety inspection took place in November 2008 and the manager has asked for an extension to complete the necessary work in relation to the safe storage of hot water in the home. The Care Quality Commission should be advised when the work required by the Health and Safety Executive has been completed. The work is needed to ensure the ongoing safety of people who use the service. 4 19 Care Homes for Older People Page 31 of 33 5 22 Visual aids should be used to help the residents with dementia to find their way round the home. Broken wheelchairs which are not in use should be repaired as soon as possible so that residents are able to use them. 6 7 32 33 The manager should apply to the Care Quality Commission for the position of registered manager for Ashley Manor. The AQAA could have recorded more information regarding the service as it is is the main way the manager will let us know how well the service is delivering good outcomes for them. Advice was given to the manager regarding the need for more information next time one is completed. It is strongly recommended that the fire risk assessment of the building be reviewed and updated in consultation with a fire officer. This will protect the welfare of the people at the service. Incident forms should be introduced for recording an event that affects a resident and/or staff to ensure their welfare. 8 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
