CARE HOMES FOR OLDER PEOPLE
Ashley Park The Street West Clandon Guildford Surrey. GU4 7SU Lead Inspector
Mrs M McHugh Announced Inspection 17 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ashley Park Nursing Home Address The Street, West Clandon, Guildford, Surrey. GU4 7SU 01483 222296 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited Mrs Ladan Roxanna French CRH (N) 47 Category(ies) of Old age, not falling within any other category registration, with number (OP) 47. of places Physical disability (PD) 1. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1) The home may accommodate service users from the age of 60 years. 2) Up to one (1) service user may be a person with physical disability from the age of 50 years. Date of last inspection 17 November 2004 Brief Description of the Service: Ashley Park is a large, attractively presented detached property set in pleasant grounds in the village of West Clandon. The home is owned by BUPA and the service is registered to provide care, accommodation and facilities for up to 47 older persons requiring nursing care. The accommodation and facilities are set over three floors with a passenger lift access to all floors. However, there are two bedrooms that require service users to negotiate two sets of four stairs from the lift to the rooms. These rooms are reserved for respite care or people who are independent and mobile. The communal areas are all found on the ground floor and consist of a sun lounge, a drawing room, a large dining room and a very large activities room that is also used as the hairdressing salon and physiotherapy room. The home has very large gardens that run down to the neighbouring golf course. The grounds closest to the home are well maintained, with many seating areas around the house and a sun gazebo in the grounds. There is plenty of parking to the front and around the side of the home. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out over six hours and forty-five minutes. A tour of the premises was undertaken and staff and care records were sampled during the day. Staff were spoken with during the course of their duties and five of the twenty-eight residents were spoken to in depth. A number of other residents were spoken with in passing or during the lunchtime meal. Three visitors also talked with the inspectors and gave feedback about the service. What the service does well: What has improved since the last inspection? The home has started a supervision programme and all staff have received some supervision in the last few months. This is an ongoing programme and will be monitored to ensure that staff receive at least six sessions of formal supervision in twelve months. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 6 Residents spoken with were aware of their right to complain and it was clearly stated in the complaints procedure that they and visitors to the home have the right to complain to BUPA or to CSCI at any time. It was noted and residents commented on the sweet trolley which has been introduced at mealtimes, to display the desserts and to take around to show residents what is available. This was a popular event following lunch and created much conversation in the dining room. The home has completed the annual quality audit survey of residents and relatives and a summary was made available of the feedback. It was positive to note that the manager has been addressing issues that have been brought up in the feedback and action is being taken. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5 Residents have access to information about the home to enable them to make an informed choice about the service. This includes information about the level of needs the home can cater for and any specialist equipment available. Contracts were in place for all residents. People are invited to visit the home prior to making a decision about admission to the home. EVIDENCE: The home’s prospectus and residents guide was available and contained information about the home, activities, meals, staff and more. The prospectus is due to be reviewed shortly and the manager stated that a photographer was coming to the home to take new photographs in the coming weeks. Residents files sampled contained contracts between the home and the resident and/or the funding authority. These contracts included the room that the person was to occupy and information about any additional costs that are not covered in weekly fees. There was also a terms and conditions of residence in each file that was signed by the resident or their representative. All residents are assessed by the home or by the social care team prior to admission. The resident then has a comprehensive admission assessment
Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 9 completed which looks at physical, emotional, social, health and nutritional needs. These are reviewed as part of the care planning process each month. Any needs that are identified as requiring specialist equipment are provided through the home or the occupational therapist. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8. 9 and 10 The resident’s health, personal and social needs were documented in the care plan and their health care needs were being met. The medication was administered in the correct manner and records were accurately completed. There were no issues identified around privacy or dignity. EVIDENCE: The care plans sampled were comprehensive and contained the individual risk assessments and relevant action plans as well. All plans were reviewed on a monthly basis by staff and the reviews stated the reason for changes or no changes to the care plans. This was good practice and staff were commended. The daily notes were completed during each shift and these were informative about the individual’s care needs met during the day, what activities they participated in, meals taken and emotional needs assessed. The tick boxes for care needs were also completed ensuring that information was documented. Records of external professional’s visits were viewed and showed that the GP, optician and chiropodist make regular contact in the home. Residents stated that they had seen the GP or optician recently and that they only have to inform staff if they are unwell and the GP is arranged to visit them. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 11 The lunchtime medication round was observed and this was carried out according to the Royal Pharmaceutical guidelines. No gaps were noted in record sheets and the relevant symbols were being used when medication was not administered. A random count of controlled drugs was carried out and these tallied with the amounts in the register. No issues of privacy or dignity were brought to the inspectors attention and staff were observed to be knocking on bedroom doors and calling residents by their preferred form of address. The only issue noted was from the quality audit summary and the manager, as stated in the summary, is looking into this further. Also see under standard 20. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Social activities and mealtimes were well managed and provided a choice, daily variation and social contact for residents. Residents had a right to make choices and exercised some control over all aspects of daily living. EVIDENCE: The activities programme was available around the home and in resident’s bedrooms. Residents advised the inspector that there was a fashion show planned for the afternoon activity and that many were looking forward to it. This was also an opportunity for residents to buys clothes for themselves or as gifts for their families. There was a morning activity also arranged and the activities lady and staff were seen inviting residents down to join in the activity. Many residents were very complimentary about the activities lady and stated that she worked hard and visited residents in their bedrooms; especially those who did not want to participate in activities. The manager showed the inspector the posters for the up coming planned activities of an art show and an open air theatre evening in the coming months. Visitors were seen in the home throughout the day and many stated that they were welcomed into the home at any time and were always treated with respect and offered refreshments. A religious service is held on a regular basis at the home and one resident attends a local day centre.
Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 13 Meals were served in the dining room or in resident’s bedrooms, depending on their preference. Residents were very complimentary about the food provided, choices offered and the environment the meals were served in. The lunchtime meal was four courses of a starter, main, dessert and cheese, biscuits and tea or coffee. The desserts are now brought around on a sweet trolley and this was a popular event following lunch and created much conversation in the dining room. Staff were observed to remain in the dining room available to assist any resident and to serve the next course as required. A comment was made to the inspector by a visitor that a resident who sometimes ate meals in their bedroom was not correctly assisted at all times and was not managing with the cutlery provided. This information was passed on to the manager who stated she would look into this situation. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Procedures were in place in respect of the protection of vulnerable adults and training and induction was available for staff. EVIDENCE: Staff receive training in their induction and full abuse training that teaches them how to recognise signs of abuse and what to do if they witness or suspect that a resident is being abused. Residents spoken to stated that staff were caring, kind and polite at all times. Good record keeping of falls and injuries was an effective way for staff to be able to notice any additional bruising or issues to be reported. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The home is safe, well maintained, provides comfortable communal areas and residents have bedrooms to suit their needs. The home has sufficient heating, ventilation, lighting and is clean and free from malodours EVIDENCE: All areas of the home were well maintained and there is a rolling redecoration plan in place. The manager stated that a feedback from the quality audit was that the lift should be replaced or updated. This was being looked into and was likely to be budgeted for in the next year. The home provides a number of communal areas including a sun lounge, activities room, dining room and drawing room. The drawing room has an interconnecting door to the sunroom and previously this was left open to create space between the two rooms. Following the quality audit, it was decided that the drawing room would be made available for private visits or meetings for residents and now the interconnecting door is kept closed. This was of some concern to visitors and residents, although the comments were
Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 16 equally in favour of this as not. The sunroom did look crowded in the morning of the inspection as a number of residents were having their tea and waiting to be taken down to the activities room. Many residents were seated in wheelchairs for the trip and these were placed in front of armchairs, making the space appear smaller and cramped. This was discussed with the manager and she will be looking into the situation further. Those bedrooms that were viewed on the day of the visit, were large in size, many exceeding the National Minimum Standard’s size requirements, and were decorated with residents’ furniture, photos, pictures and ornaments. Residents stated that the staff were helpful in decorating their bedrooms and hanging photos. Many residents stated they liked their bedrooms and that they were spacious. Specialist equipment in the form of handrails, safety rails in bathrooms, specialist baths, hoists, wheelchairs, Zimmer frames and specialist pressure relieving equipment was found throughout the home. The hot water, lighting and ventilation in the home were seen to be satisfactory and the maintenance person carried out regular checks on all equipment. The home employs a dedicated housekeeping staff and they discussed the training they had received and showed a good awareness of COSHH (Control of Substances Hazardous to Health) and infection control issues. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 The staffing levels in the home are satisfactory to meet the needs of the current residents. Not all staff files checked contained the information required as set out in the Care Homes Regulations 2001, as amended. EVIDENCE: The home has maintained the increased staffing levels as requested previously and this was commendable. The inspector received one comment about call bells not being answered swiftly enough. Staff were seen sitting with residents and having the time to spend some extra time talking or doing additional tasks for the residents besides the absolute necessary tasks only. During the fashion show, where some staff had volunteered to model the clothes, there were still staff available in the communal areas and checking on residents who had chosen to remain in their bedrooms. This was very positive to see. The home has an allocation list for each shift and staff are made aware from the start of their shift what jobs they are expected to complete during their shift. Staff files were sampled and two out of the four did not obtain the required information. The manager later confirmed that one of the two staff members was no longer employed by the home. Staff files must include information on proof of identity, details of any criminal offences, two written references and CRB checks. For those staff who require visas to work in the UK, the service should check that these are within the dates specified on the visa.
Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 and 38 The home has good leadership, guidance & direction and the staff are aware of their responsibilities to ensure residents receive consistent quality of care. Residents benefit from the ethos and management approach in the home and their safety and welfare is promoted. EVIDENCE: Records of staff meetings and senior staff meetings were seen. Staff were observed to interact openly with the manager and be at ease in her presence. Residents responded well towards the manager and many were pleased to see her. The visitors spoken with stated that the home promotes good communication and that they are kept up to date with information about their loved ones. A copy of the summary of the recent quality assurance survey was seen and the manager stated that if things were not satisfactory or up to standard
Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 19 according to the returned surveys, actions have been taken to try and amend these problems. For example: Surveys stated that there was no private area for visitors to see residents and therefore the second lounge was converted to the drawing room to be used as a private meeting room. Residents’ finances are dealt with by the home’s bursar and examples of records were seen and found to be satisfactory. The home holds an account and each resident has a separate account within the home’s account, which can now earn them interest as well if they keep their accounts in a positive balance. Families or next of kin are kept informed about the activities on the accounts. All records sampled were accurate and up to date. Supervision has been commenced and the proposed programme means that staff will receive up to six sessions of supervision in a year. Fire testing, maintenance, health and safety checks records were up to date and well maintained. The home promotes the health, welfare and safety of its staff and residents and this was evident through the records viewed on the day of the inspection. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 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 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 3 3 x 3 3 3 3 Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP 29 Regulation 19(4)(b) (i) Schedule 2 23(2)(n) Requirement Staff files must contain all the information required, in the Care Homes Regulations. Staff must ensure that all residents have the correct equipment available to them at mealtimes. For example: large handled utensils, plate edges. Timescale for action 20/05/05 2. OP 15 24/05/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP 20 Good Practice Recommendations The management should review the practice of having the drawing room set aside for private use and/or the seating arrangements in the sunroom to prevent this room looking too crowded. Ashley Park H58 s17588 Ashley Park v215154 170505 Stage 4 ann.doc Version 1.30 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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