Inspection on 20/02/07 for Ashling House

This inspection was carried out on 20th February 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

Ashling House 10/11/08

Ashling House 14/10/05

Ashling House 26/04/05

Ashling House 10/12/04

Ashling House 01/09/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Ashling House 119 Elmhurst Drive Hornchurch Essex RM11 1NZ Lead Inspector Mr Roger Farrell Unannounced Inspection 20th February 2007 12:15 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 Ashling House DS0000027834.V334759.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. Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashling House Address 119 Elmhurst Drive Hornchurch Essex RM11 1NZ 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) 01708 443709 Ms Beverley Holmes Ms Beverley Holmes Care Home 14 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (14) of places Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) place for a service user with dementia can be accommodated. Date of last inspection 14th October 2005 Brief Description of the Service: Ashling House is a privately owned care home for 14 older people. It is in a pleasant residential area in Hornchurch, about half a mile away from shops and public transport links of the town centre. First opened as a care home in 1981, Beverley Holmes became the owner in March 2001, and also the manager in day-to-day charge. She takes great pride in providing high quality facilities, including thorough attention to cleanliness. Considerable improvements to the building have been carried out over the past two years. This has included a new wood-panelled dining room, creating new single bedrooms, and giving the garden a major make-over. The lounge is a large conservatory. The assistant manager spends his time maintaining the home, carrying out building improvements, and overseeing the contractors doing the conversion works. Fees are between £420 and £500 per week. Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection started with an unannounced visit between 12:15 and 4pm on 20 February 2007. The inspector returned for six hours on the following day to complete his checks. He appreciates how the manager and assistant manager responded to the visit, including working around welcoming the new resident, meeting with a GP, and carrying out some staff interviews. At the end of 2005 Beverley Holmes bought another established care home, Arran Manor, situated just over a mile away. It was agreed that she could manage both homes for six months. A new manager for Arran Manor was registered in September 2006, but left in January 2007. The deputy post at that home is also vacant. Beverley Holmes was reminded that being responsible for the day-to-day management of two homes is a short-term interim agreement. She is expected to submit an application to register a new manager at Arran Manor within a reasonable time. She gave an undertaking to keep the inspector up to date on this important matter, and is aware that having a dedicated registered manager is an important consideration when the Commission assesses a service’s ‘quality rating’. The inspector gave an overview of the changes being introduced in the way care homes are regulated, using a point-by-point chart. This includes placing increased emphasis on the registered person keeping the Commission informed, including notifications of accidents and incidents; returning a main service assessment each year. These ‘AQAA’ forms will be sent out later this year; arriving at a ‘quality rating’ for each service, and making these public early next year; and the different types of inspections, the regularity of which will be decided according to the home’s rating. The Commission has introduced better forms to get the comments of residents, their families, and others who know the home. The manager was reminded that she must include in her annual return to the Commission contact details for each resident’s next of kin or main link person. She was also asked to keep an up-to-date staff matrix, including listing individual qualifications and training. The inspector is grateful to those who provided comments, and to the residents who gave their views during the visits. These largely favourable views have influenced the positive conclusions set out in this report. This included asking a number of people if the manager covering two homes at times had affected this service. One reply from a regular visitor was – “I can’t see that it has been a problem. Staff know that she is only a phone call away at anytime, and she could be back here in under ten minutes if needed. I know she keeps in touch when she is away on holiday. (The assistant manager) is still about and can check that things are running smoothly.” Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 7 The headline conclusion of the recent inspection is that positive ratings are entered for all the areas tested at this visit. The quality of the facilities and level of care is confirmed by the fact that the inspector has not had to set any requirements on this occasion. The excellent household standards, including cleanliness is again acknowledged by being scored at the ‘commendable’ level. The top rating is also awarded for safety monitoring, including having all the required building safety certificates. The lead inspector has found that if the right advice is given, Beverley Holms takes on board the need to make changes and introduce improvements. One such idea currently being considered is the possibility of having an activities coordinator. Underlying the positive findings is the practical and legal requirement for each home to have its own manager. Beverley Holmes needs to consolidate the management cover for the two homes she owns. 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. Ashling House DS0000027834.V334759.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 Ashling House DS0000027834.V334759.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): 1, 2, 3, 4 and 5. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to the service. This involved looking at the file and talking to the person who had just moved in. The manager is aware that assessments need to cover all areas listed in Standard 3.3 of Care Homes for Older People - National Minimum Standards’. The assessment section had adequate key-contact details and assessment information, and the care plan had been completed within 24 hours. All five applicable standards are rated as ‘met’, confirming that a helpful and methodical approach is used to help residents move in. One relative said – “We did look at a lot of homes, but have not regretted choosing Ashling. My (relative) has said to me ‘It’s the best thing you did finding me this place.’ We all find it very homely and you are made welcome and kept informed.” EVIDENCE: The manager deals with all enquiries when there is a vacancy, and carries out the assessments to see if the home can meet the needs of prospective residents. Most residents who move into this home pay their own fees. As private residents, social workers are not usually involved in making the arrangements or providing background reports. Normally it is a prospective Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 10 resident’s family who visit first, having made an appointment to see the manager. She then visits the person, who is usually waiting to leave hospital, and carries out an assessment. A further meeting with relatives to gather background information is often needed where there is not a referral report from a social worker. At his last visit the inspector spoke with the most recent resident, who had moved in three weeks earlier. He had transferred from another care homes. He said he was very satisfied with the arrangements, adding – “I am settling very well. I have been messed around in the past. Staff in the last place wanted to do everything for me. The staff here are okay, they give me time to get up myself as I don’t need help. My room is very nice. So far so good, everything’s okay.” At this visit the inspector looked in detail at assessments and move-in arrangements. A new resident was moving in on the first day of this inspection. The inspector saw very good arrangements. This included good attention to the practical details, including welcoming the resident and the manager spending time with a relative to deal with their anxieties. Attention to detail included completing a thorough pre-arrival checklist on the bedroom to make sure everything was in place and in working order. The following morning the inspector checked the new resident’s file. All the necessary sections had been set up. This included - a front sheet of personal details and contact numbers; the in-house assessment, with specific details such as favourite tv programme, preferred bedtime, and food likes and dislikes; a good basic care plan filled out the day before admission, including medication details; additional care plan sections completed on the first day covering the six main areas of support; a manual handling assessment; and a personal belongings inventory. Also, a fax had been sent the person’s GP confirming the move in and verifying medication details. The inspector spoke to the new resident on her second day. She said – “I slept well, so that is a good sign. My room is fine, and I enjoyed lunch…..I had my hair done this morning, and the lady did come back later to ask if I was happy with it, which I am.” Based on the findings at this and previous inspections, the conclusion is that the manager is taking a responsible approach to early stage assessment. The care plan forms and the comments tend to be quite basic, nevertheless there is sufficient attention to personal preferences. Homes have to have two documents that accurately describe the services and facilities they provide. These are the ‘statement of purpose’ and the ‘service users’ guide’. This home’s versions were revised at he end of last year. Based on a standardised version, they cover nearly all the areas required. The home occasionally takes people for short-term respite breaks, but only one person at any one time. The conditions covering these short-stays need to be covered in the ‘statement of purpose’. There is also a glossy brochure. Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 11 There is a standard ‘contract/terms and conditions of residence’, with a copy attached to the ‘service users’ guide’. The sample of personal files seen had a copy of the signed contract. Through her trade association the manager keeps up-to-date with the type of contracts used by local authorities. Copies of inspection reports are available in the entrance lobby. One relative wrote to the inspector last year saying he had checked inspection reports before his relative moved in, but ‘hadn’t felt the need to do so since’ given the resident and family’s level of satisfaction. Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 and 10. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to the service. The manager has gradually improved the way care plan files are kept. These are now better at showing individual needs and the specific help each person requires using a grid format. This includes monitoring physical wellbeing, including linking in with medical services. All residents who gave a view said they are happy with the personal support they receive. Relatives talk about a high level of satisfaction with attention to personal care and medical needs. This positive view was summed up by the view of community nurse who said – “Residents are always nicely presented. Staff always meet and greet me. I would normally see Beverley, but I would be confident that anything important would be passed on…and know that any advice or instructions would be followed. Yes, I always see residents in private and it is always clean. Again I would say it is one of the best homes I visit.” EVIDENCE: At this visit the inspector looked at a sample of care files. This included the ‘personal files’; the ‘care plan file’; and the ‘risk assessment file’. Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 13 As well as that of the most recent resident, the checks included the notes on the highest dependency resident, and a person who spoke with the inspector, who later talked to one of her family. Overall the standard of practice records are brief but adequate. All files seen had all the main elements covering assessment, care plans, monitoring and reviews. In the past the manager has been open to suggestions on improving her documentation and has taken on board advice, such as not using formats designed for use in hospitals. On this occasion the inspector gave advice on three areas, which have been included as recommendations. These are: • The recent introduction of ‘one size fits all’ care plan proformas is a step backwards. The manager agreed that it is pointless repeating the same stock statements for each person. The existing main care plans are much better at describing individual support needs and what assistance is needed. A positive move forward would be to use more main headings, though those seen generally covered between five and ten areas. The manager was able to give details on medical conditions raised by the inspector, and medical correspondence was well arranged on files. However, the inspector repeated his advice that it is a good idea to have medical tracking sheets for each type of practitioner. Improvements include recently introducing ‘care plan review sheets’, some of which were still blank. However, the inspector stressed the importance of dating documents such as the main care plan forms when they are introduced or revised. This had happened in some instances, such as the reviews of the risk assessments. • • Good points included having prominent alerts on the front page, such as a medication precaution; having large clear photos; registrations for postal votes at elections, and starting to introduce life history profiles. Appreciation of the high standard of attention to personal care features prominently in the comments of relatives. One relative with experience of care of the elderly had said – “I had a good idea of the signs to look out for….not just a hygienic building, but how residents appear…is there dignity in their personal appearance….we have not been disappointed with our choice.” Equally, at this visit another relative with experience of managing elder persons’ services commented – “You can’t fault the standard of attention to (personal care) and the home generally. I have been visiting regularly for over four years and can only remember getting an unpleasant whiff once or twice. I took my (relative) to hospital and the nurse commented on how beautifully clean she was, including her clothes.” Equally, comments about ensuring proper medical attention have been mentioned by a number of relatives over the past couple of years. This Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 14 included two quite recent instances where relatives have said that they had more confidence in the care provided at the home because of concerns and deterioration whilst residents have been in hospital. One person said – “My (relative) developed horrendous sores on her heals when she was in hospital. It doesn’t seem logical, but we are convinced that these would be dealt with and treated better once she was back at the home.” Another comment was – “If anything is wrong Beverley is on the phone straight away. She always fights their corner if anything is needed medically.” A local pharmacist supplies medication in blister packs with printed recording sheets. Supplies are kept in a locked cupboard with a handy pull-out shelf in the dining room. Previously the manager was able to demonstrate how she had taken suitable action in response to the last audit by the Commission’s pharmacy inspector. This included improving security for the medication cupboard keys, having the more up-to-date guidance; and having available the required range of policies and procedures. Staff training includes covering the NVQ medication module, and using the test paper. At his last visit the inspector’s checks included watching staff administer the morning and lunchtime medication. Staff made sure each person had a fresh drink of water. When residents are in the lounge, the shift-leader dispenses the drugs from the blister pack into a dose cup and checks it, and then another staff member takes it to the resident. Strictly speaking, the person who signs for the medication should be the person who has actually seen it being taken. Nevertheless, the shift-leader could see the resident from the dining room, only one resident was dealt with at a time, and the person giving the drugs was confirming each time with the shift-leader. The shift-leader said that she had never known an error to occur in the four years she had been at the home. At this visit the inspector saw two rounds of medication administration, mainly given out when residents were in the dining room. The shift leader was again following a safe sequence, making sure each person had been given their drugs before moving on to the next person. The manager confirmed that there have not been any known medication errors since the last inspection. The supplying pharmacist does quarterly checks of the medication arrangements at the home. The last was the previous month, and he leaves a useful checklist report. Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to the service. This involved looking at what in-house activities had taken place, and how residents and relatives are consulted and involved. At present there are no particular cultural considerations. In looking at these standards, the inspector has paid particular attention to the comments made by residents, and his observations over the two days. His previous unannounced visit had been an early morning call starting just before 8am to look at arrangements for getting up and choice of breakfast. In general, residents say they recognise the benefits of having ordered daily routines, one person commenting – “You have to fall in with the way things are done, or nothing will get done, especially for those how need a bit more help. Beverley makes sure what needs doing is attended to.” EVIDENCE: The inspector appreciates the welcome he receives from residents and the chance to listen to their comments on how the home is run. He again asked for views on the choices available, such as if there were any restrictions on going to bed and getting up, selecting meals, and how they spend their time. The general consensus from those who express a view say the benefits of such an ordered regime are accepted and appreciated - the cleanliness of the home and reliable routines being mentioned frequently. Three residents were asked Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 16 about morning routines, and all said these fitted in with their preferences. One person said – “I am woken by staff, but I need that. I call them when I am ready to be helped.” Another person commented – “I get up when I want. I’m okay as my new room has its own wash room (en suite).” The inspector joined a group of residents for lunch. These four residents, and all others who offered a view said they were satisfied with the meals. There is a four-week cycle of menus, displayed in large print. In addition to the two main meal options, there is ‘standing list’ of alternatives such omelettes or sausages. The meals served on both days corresponded with the menu. At the last visit the inspector said that the manager should make sure that residents were being offered alternatives to the main dish, as attention to detail is apparent in so many other ways such as the special dietary considerations being on display in the kitchen. Comments by residents at this recent visit included: • “I am very happy with the food…..Yes, there is always enough and it is served warm.”; • “They know I like porridge every morning, but I do get a fried breakfast if I ask, sometimes at lunchtime. I would also say that I am happy with the food.” • “I have to have mine mashed. I enjoyed that lunch very much. They do say to me what vegetables have been mashed.” • “The tables are nicely set - with the salt, pepper and vinegar. If I ask for salad cream they will bring it around….(Staff) do ask you what squash you want.” Comments from relatives included • “We have had another relatives who lived (at this home) so we knew it was comfortable with very good levels of care…..The food is fine, we know that (our relative) and others prefer their food soft. I see they are patient with one lady who needs help and encouragement.” “I am now able to visit more during the week and am here at lunchtime. I do think they serve what people enjoy. There is always plenty and they are told to ask if they want more. (My relative) says they are mostly satisfied. There is variety, and they are asked if they want what has been served even though they may have forgotten what’s on (the menu) even though they were asked earlier.” • Minutes of meetings held by the manager with residents show a consistent consensus of satisfaction with domestic arrangements, such as the timing of mealtimes and not being allowed to have hot drinks in the lounge. Most residents have lived in the surrounding area, or have family who are local. It is still the case that nearly all residents have regular contact with family. Over the last year two people have spoken to inspectors about staff not accompanying residents to hospital. It was explained that this is not a legal Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 17 obligation, but the home must give accurate written details to ambulance crews, and if possible arrange for a relative to meet the resident at hospital. Also that it is difficult for small homes to release a carer from covering a shift, which might mean a long wait at hospital. This explanation was accepted, and in both instances the callers expressed their general satisfaction with the home. The manager said that she would in future stress this point to relatives at an early opportunity. Comments from residents about the level of organised activities are generally satisfactory. However, objections have been raised in the past about the system of each person signing to say if they have or chose not to join in the afternoon activities such as bingo, and board and card games. Following this visit the manager sent a list of the activities that have been offered. She also said that she exploring the option of having a sessional activities organiser, adding- “It would be essential to have the right person – someone who is enthusiastic, but has patience to engage those residents who are more confused.” The planned activity on the day of the unannounced inspection was taking place. At this visit, as on previous occasions, relatives gave different views on whether there should be more scheduled activities. Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to the service, looking at documents and speaking with residents and visitors. The inspector is satisfied that sufficient steps have been taken to let people know what to do if they have a complaint, including contact details for the Commission. The necessary guidance covering adult protection is available, with staff saying what they need to do if they hear of or suspect possible abuse. At this visit the inspector answered the manager’s queries about ensuring confidentiality if a complaint were raised about a sensitive issue. EVIDENCE: Both the ‘service users’ guide’ and the statement of purpose have details on how to make a complaint, and have contact details for the Commission. The inspector has seen minutes of residents’ meetings that include reminders about how to make a complaint. However, at the last visit the only record asked for by the inspector that the shift-leader could not find was the complaints’ book. At this recent visit the inspector was shown how staff are able to locate the new ‘medipost complaints book’, and the most recent procedure. There have been no complaints logged since August 2004. The inspector did see the range of letters of appreciation, mainly from relatives expressing strong gratitude for the care given to their family member before they passed away. There are details on display about contacting the ‘Care Aware’ advocacy service. The manager had been in contact with this organisation recently asking about getting guaranteed impartial financial advice that may be needed by a resident. On the one occasion in the past when the manager contacted Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 19 ‘Havering Age Concern’ and ‘Action on Elder Abuse’ on behalf of a resident this proved helpful. There is an ‘adult protection file’ that has all the necessary documents. This includes the home’s policy, and a whistle blowing procedure. It is comprehensive in telling staff about the action to be taken if abuse is suspected or disclosed. Staff have confirmed that in-house training is provided on awareness of what constitutes abuse, there being a training video available on this matter which all staff have seen. Copies of ‘No Secrets’ and the local protection guidelines are available, as well as the main national ‘code of practice’, with all staff having been given a copy. Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26. Quality in this outcome area is ‘good’. This judgement has been made using available evidence, including looking at all communal areas, and a sample of bedrooms. This is very well maintained building, with excellent attention to hygiene and safety. Satisfaction with cleanliness and comfort features in comments made by residents and visitors. Comments made by residents and relatives again highlighted their appreciation of the quality of the ‘hotel grade’ facilities. Although some adjustments are still planned – such as enlarging Bedroom 9 and adding an en suite – the upgrading project is now largely complete. Inspections by environmental health officers, independent hygiene consultants, and the Commission continue to confirm the excellent standards of cleanliness and household safety. The consistently good household standards seen again at this unannounced visit are a credit to the team, and deserve repeating the top ‘commendable’ score. One resident who was a retired builder had told the inspector – “You know it would annoy me to sit and look at shoddy work and uneven finishing. I can sit here and look at jobs well done with nice clean lines. My sons are builders and they comment on it.” Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 21 EVIDENCE: Considerable upgrading has been carried out over the past three years. This has included reducing the number of shared rooms whilst increasing the size of bedrooms, and adding en suites. The manager and assistant manager take great pride in providing a well maintained and ordered living environment. The assistant manager takes the lead responsibility for the building. He has skilfully carried out much of the upgrading work himself, such as creating the new dining room. He also oversees works carried out by contractors. This has included excellent attention to safe working during the various phases of adjustment, and good safety standards at all times. This attention to detail has also been apparent where regulators have asked for additional steps to be taken. A good example of this is how he has monitored and improved the temperature control in the conservatory lounge. Also, he has followed the fire officer’s advice to coat the wooden panels in the new dining room with a retardant paint even though he had taken great care with achieving the aesthetic wood finish. Prominent in the inspector’s feedback at the end of his last unannounced visit was praise for the excellent standard of cleanliness and household management found even at 8am, even before the day shift had started their general tasks. Bedrooms show the same high standards of attention to detail found in the communal areas. They also reflect the tastes of individuals, including lots of personal items. The top ‘commendable’ rating has again been given for the standard covering hygiene. Ashling House DS0000027834.V334759.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): 27, 28, 29 and 30. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to the service that involved checking staff files. This confirmed that the required vetting takes place. All comments made by residents were appreciative of the carers. One relative with experience of care services said – “They are lovely. I see them taking time with people. I am confident that if I had a concern and Beverly wasn’t around I could speak to (all the seniors). Things run efficiently, but I don’t see people being rushed.” EVIDENCE: Staff cover at unannounced visits continues to match the details on the rota. At the last early morning visit all staff reporting for the day shift arrived ahead of time and immediately began helping residents. The rota has a code showing who is leading the shift, and which staff are responsible for what sequence of tasks. This was seen to run smoothly over the five hours the inspector was present in communal areas at that visit. The staff complement is – manager; assistant manager; nine full-time, and one part-time care assistant (at present totalling 373 care hours, excluding manager hours.) The normal pattern of cover is two staff on the early shift (8am to 2pm); two on the late shift (2pm to 8pm) – excluding the two managers; night cover being one waking person, and one on sleep-in cover between 8pm and 8am. At present, two of the three designated seniors were doing additional shifts at the owner’s other home. She confirmed that this was a temporary arrangement. The inspector had noted that when he last visited Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 23 when the manager was away on holiday there was an additional senior supervising the day shift. At this visit the inspector checked a random sample of staff files to make sure the right checks were being carried out. These had all the required paperwork, including – an application form; recent photo; references; copies of documents that prove identity; and CRB certificates. They also had copies of the two-stage induction programme based on the ‘Skills for Care’ guidance; a supervision contract; an individual training list; and a copy of their employment contract. Five staff have achieved NVQ at Level 2 or above, putting the team on target for achieving the 50 qualified expectation. The manager agreed to start keeping a ‘training matrix’, that is a table showing when each staff member completes training in the core areas. Ashling House DS0000027834.V334759.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): 31, 33, 34, 35 and 38. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to the service that involved checking safety documents. The home has many signs of a tightly operated service as the owner has firm expectations about maintaining efficient routines. Because of her other commitments over the past year, she stressed the confidence she has in the three main shift leaders, and is encouraging NVQ training at Level 3. The ‘assistant manager’ is mainly responsible for building projects and acts as the on-site maintenance manager. He keeps clear up-to-date records covering safety responsibilities, and this is acknowledged by giving this standard the top ‘commendable’ rating. He is also taking the lead on introducing IT, such as a new quality control programme. EVIDENCE: Part of the new way of assessing homes will be looking at how they carry out quality control audits, including the Commission introducing a standardised audit schedule this year called an ‘AQAA’. This service is gearing itself up to fulfil these expectations. The assistant manager showed the inspector a new Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 25 quality control system. He hoped to use this soon to run a satisfaction survey for residents, relatives and visiting professionals. The manager explained the systems and checks in place to help residents with their personal expenses, and was shown the individual account sheets. These mainly work as a ‘debit account’. This means that the home generally pays for expenses such as hairdressing and chiropody, and relatives or the sponsoring authority settle these periodically. The manager confirmed that neither she, nor any other staff member acts as an appointee or representative for any bank accounts or pensions. No valuables are held for safekeeping at present. Along with the good attention to safety seen around the building and grounds, benefits of an on-site building manager are apparent. The assistant manager was efficient in presenting the health and safety records. This includes fire logs that confirm in-house weekly equipment checks and drills, staff training, and contractor visits. The right certificates are available covering electrical, gas, water and lift safety, as well as contracts covering clinical waste and pest prevention. The last inspection by an environmental health inspector was in January 2006, with a satisfactory report. There is good evidence that all advice given by fire safety inspectors is followed through, such as the extra fire spread precautions in the dining room. In acknowledgement of these high safety standards the top ‘commendable’ score is awarded under this heading. Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 3 3 3 X 3 3 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 X X 4 Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP7 OP7 Good Practice Recommendations Consider introducing individual tracking sheets fore each type of health care professionals such as GP, optician, dental care and so on. Consider having a wider range of support needs in the main care plans, including what help is needed. Make sure the formats used arte dated when they are set up and reviewed. Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI Ashling House DS0000027834.V334759.R01.S.doc Version 5.2 Page 29 - 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. 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