Inspection on 26/04/05 for Ashling House

This inspection was carried out on 26th April 2005.

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

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

Other inspections for this house

Ashling House 10/11/08

Ashling House 20/02/07

Ashling House 14/10/05

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 Roger Farrell Unannounced 26 April 2005 15:45 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. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Ashling House Address 119 Elmhurst Drive, Hornchurch, Essex, RM11 1NZ 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) 01708 443709 Ms Beverley Holmes Ms Beverley Holmes CRH - Care Home 14 Category(ies) of OP - Old age - 14 registration, with number of places Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10 December 2004 Brief Description of the Service: Ashling House is a privately owned care home, registered to provide care and accommodation to 14 people aged over 65 years. This converted property first opened as a care home in 1981, and the current owner, who is also the manager, took over in March 2001. It is situated in a pleasant residential area in Hornchurch, about half a mile away from shops, public transport links and other amenities including a library, theatre and park. It is a two-storey building with a passenger lift. The building is not fully wheelchair accessible. There were eight single bedrooms and three double bedrooms. Work is underway to to extend the property to provide improved accommodation – one double and one single bedroom are to be extended and converted into four new singles with en-suite facilities. This includes agreement with the builders about safety assessments and minimising disruption to residents. Last year the dining area was upgraded and considerable work carried out to landscape the rear garden with excellent results both in terms of safety and aesthetics. The Statement of Purpose for Ashling House includes positive commitments to promote the privacy, dignity, independence, rights, choice and fulfilment of residents within a safe environment - and to maintain good links with families. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on Tuesday 26 April 2005. The inspector arrived at 3.45pm, and was later able to join the residents for their evening meal. The manager was away at a meeting. The person in charge was the assistant manager. His main role is overseeing the maintenance and upgrading of the building. This was helpful as one of the main aims of this visit was to check on the current phase of building work, in particular to make sure that safe arrangements were being maintained, and that disruption to residents was being kept to a minimum. As well as covering overall safety, the inspector followed up on the action that had been taken on the small list of requirements from the last report. He would like to thank the assistant manager and senior carer on duty for the helpful response he received – and to those residents who spoke to him over the meal and later in the evening. The manager kindly forwarded copies of a range of documents the inspector had requested. This included an assurance that all residents had been registered to vote in the coming election. Work had commenced six weeks earlier to improve a number of bedrooms and add additional space. Two existing double bedrooms and one single are being withdrawn, and four new singles with en-suites are being created. The overall number of places will remain as fourteen, but will mean that all but one bedroom will be single occupancy. Currently, a married couple have the remaining double room. The assistant manager said that he was happy with the ‘site-safe’ arrangements of the building contractors. He explained how the work was being phased, and showed the inspector the sections that had been knocked through. The inspector was satisfied with the conditions he saw, including screening off the work areas, the scaffolding erections, and how exit routes were being guaranteed. He has also been sent copies of the safe-site risk assessments. This involves work not starting in the mornings until the contractors have checked with the senior carer that residents in that area are out of their bedrooms. There was no evidence that the occupied areas were being unduly affected, including being dust free. None of the residents spoken with raised concerns, including when asked about the noise. The main restriction is that there is use of the garden at present. The estimate is that the work will be completed by early July. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 6 What the service does well: What has improved since the last inspection? What they could do better: High standards of hygiene and safety were found. However, in the absence of the manager a small range of documentation could not be located. Therefore a small range of requirements have been set to make sure that all safety records are available to show to the inspector, including at unannounced visits. The Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 7 three recommendations to do with improving practice notes are also carried over in this report. The next phase of improvement will be to upgrade bathrooms. The inspector will discuss this at the next visit. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, and 5 The manager deals with all enquiries, and carries out the assessments to see if the home can meet the needs of prospective residents. As nearly all residents are private, discussions are generally with family members. Since the manager took over, there has only been one person who has chosen to move on to another home. One relative wrote to the inspector last Autumn 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. residents and relatives. EVIDENCE: A copy of the home’s statement of purpose and ‘service users’ guide’ are available. These documents are made available to service users and their representatives in a folder which contains the last inspection report. The inspector was told that the brochure is due to be updated, describing the improved garden, dining and bedroom facilities. Nearly all the residents who move into this home pay their own fees. As private residents, social workers are not usually involved in making the arrangements. Normally it is a prospective resident’s family who visit first, having made an appointment to see the manager. She then visits the person, Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 10 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 background report from a social worker. The files seen at the last announced visit had adequate assessment information, including a ‘kardex’ profile sheet with photo, an assessment form and a onepage tick and comment sheet. 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. There had been no recent admissions as it has been necessary to keep two places empty due to the building work. The sample of personal files seen at the announced visit also 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. Last year she had difficulty getting one council to issue a contract, but this was not currently a problem. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8. The inspector has had a lengthy discussion with a relative of a resident whose needs increased significantly. She said that the family were very grateful that the extra help could be provided, such as encouraging food intake and preventing bruising. She said - ”We do attend reviews and discuss Nan’s needs. Beverley has been very good, and the (senior carer) is always helpful. The family dreaded the effect a change (of home) would have had on Nan.” Such examples show that this service can be flexible and caring in meeting individual needs. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 12 EVIDENCE: The manager takes a lead on completing the main practice files for all residents. It was agreed that a more thorough discussion of care plan files would take place when she was present, and that the recommendations from the last report would be carried forward. At the last announced visit the inspector looked at a sample range of practice documentation, including those of the most recent resident, and the person with the highest dependency needs. The ‘personal files’ and daily records are set out in a methodical manner. In addition to the assessment material, these include a three page ‘care profile’ under a range of useful headings; two page ‘care plan sheets’ covering practical and social needs, and how these can be met; and minutes of reviews. Where there are higher dependency needs, such as diet or continence management, there was evidence of involvement from health care workers. The inspector gave advice on three areas that would help strengthen the system – 1) To include more specific instructions in the ‘action’ section of the care plans, being more precise about the type of help an individual needs; 2) To consider having individual tracking sheets for health care professional that is individual sheets for the GP, optician, dental care and so on. This provides a useful ‘at a glance’ resume of contacts and treatments; 3) Records of reviews need to refer to the care profile and care plans. It is helpful to use the same headings, as the purpose of reviews is to report, discuss, and agree if there is a need to change any aspects of the care and facilities being offered. These recommendations have been carried forward, though the manager has said that they have been introduced. At this visit the assistant manager said that it would be best to discuss how practice files have been improved in more detail with the manager at the next visit as she acts as ‘key-worker’ for all residents. The assistant manager gave an overview of current GP and community nursing support. As most residents lived locally they tend to stay with their own GP’s. The assistant manager spoke of problems that were experienced with one GP around one person’s dressings. A local pharmacist supplies medication in blister packs with printed recording sheets. Supplies are kept in a locked cupboard in the dining room. The Commission’s pharmacy inspector last examined the home’s medication arrangements on 20 January 2004, and a report was provided. The inspector has followed this up with the manager – and she was able to describe and demonstrate how she has taken suitable action on all points, including improving security for the medication cupboard keys, having the most up-todate guidance; and having available the required range of policies and procedures. Staff training includes covering the NVQ medication module, and using the test paper. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. Residents who gave an opinion about activities at this visit said they were satisfied. Discussions in residents’ meetings conclude that inviting outside entertainers is not popular. Going out tends to be trips with family. The inspector again found consistent satisfaction with the standard of catering and arrangements for meals. EVIDENCE: At the time of the last announced one relative wrote - “We are very happy with the care provided by Ashling House. {My relative} is better both physically and mentally than she was previously. The only comment I would make is that the residents could perhaps benefit from a more structured programme of activities….small things like 10 mins per day of simple physical exercise which could be done whilst still sitting down.” When the inspector arrived a group of four were playing cards, which they said was their regular afternoon activity, along with board games. Cake making was also mentioned. There were photos on display of a recent dance evening arranged by the senior carer. She said that the other main popular activity was sing-a-longs to cd’s. However, a couple of other planned social events had been cancelled – including a ‘silver– service’ meal with guests from another care home, and a visiting entertainer. The inspector was told that these did not go ahead as this was the consensus view given at a residents’ meeting. Residents asked said they recalled the matter being discussed. An activities book is maintained. How activities and Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 14 social events are organised will be checked at the next visit. The assistant manager said that all residents still have active family involvement, about seven going out with their relatives. Again at this visit all comments made about the standard of food was satisfactory. There is a four-week cycle menu, displayed in large print. Each resident is asked in the morning about their choice for the main meal served at lunchtime, with one person again confirming that he can still ask for something completely different from the menu options. The two duty staff were seen to be attentive to individual’s preferences at the evening meal. There is a list of dietry needs on display in the kitchen, including those residents who need a soft diet. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. 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 abuse is also available, with staff saying what they need to do if they hear of or suspect possible abuse. EVIDENCE: Both the ‘service users’ guide’ and the statement of purpose make reference to the procedure for making a complaint and for contacting the Commission. Residents spoken to were aware that they could make a complaint to the manager, should they need to do so. The minutes of the residents’ meetings include reminders about how to make a complaint. The manager has since confirmed that all residents are on the electoral role. Details on using an advocacy services are on display and are included in the ‘service users’ guide’, but have been no known contacts over the last twelve months. On the one occasion in the past when there was contact with Havering Age Concern and Elder Abuse on behalf of a resident this was described as helpful. There is a satisfactory adult protection policy in place, which incorporates a whistle blowing procedure. It is comprehensive in directing staff on the action to be taken if abuse is suspected or disclosed. Staff have confirmed that inhouse 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 are available. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 16 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, 25 and26. Inspections by environmental health officers, independent hygiene consultants, and the Commission continue to confirm the excellent standards of cleanliness and household safety. EVIDENCE: In addition to checks on the building work in progress, general health and safety documentation was examined This included in-house and contractor fire safety checks; gas, electrical, lift and water safety certificates; and general health and safety checks. Three areas need improvement: Have available on site the check schedules completed by the fire alarm contractors; Have available a record of the in-house general health and safety checks. It is advised that these are recorded monthly; At his next visit, ask the fire safety inspector to put in his report his approval of the new dining room arrangements. The catering arrangements were last inspected by an EHO on 13 September 2004 – and satisfactory conditions were reported with no recommendations Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 17 being made. There was an independent infection control audit in June 2004. The overall rating was 83 , with high scores under nearly all headings – the kitchen scoring 92 , and the general living areas rated as 94 . In recognition of this, and the observations made at this visit from looking at communal rooms - the home retains the top ‘commendable’ score for the standard covering hygiene and household cleanliness. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 18 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) 0 This group of standards were not fully checked at this visit. Those areas covered were satisfactory, including vetting the one staff who has started in recent months, and having a CRB certificate for all employees. Four staff have an NVQ at level 2. EVIDENCE: The staff complement is – manager; assistant manager; seven full-time and three part-time care assistants (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) – both excluding the two managers; night cover being one waking person, and one on sleep-in cover between 8pm and 8am. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 19 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) 0 This standard was not covered at this visit. EVIDENCE: Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 4 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 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. 2. Standard 38 38 Regulation 17(2)/ Sched 4; para 14 23(5) Requirement Have available the reports from the fire equipment contractors. Have available a report from the fire authority giving approval for the alterations to the building, including the altered dining room. Have available a record of periodic health and safety checks of the building and grounds. Timescale for action 1 August 2005 1 August 2005 3. 38 13(4)(a) 1 August 2005 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. 3. Refer to Standard 7 7 7 Good Practice Recommendations Include in the care plans more specific instructions in the ‘action’ section detailing more precisely the support necessary to met individual needs. Consider using the care plan and profile headings to structure review meetings and reports. Consider introducing individual tracking sheets fore each type of health care professionals such as GP, optician, dental care and so on. Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford, Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashling House G55_S27834_Ashling House_V225669_260405_Stage 4.doc Version 1.20 Page 23 - 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!