Inspection on 04/09/07 for Ashling Lodge

This inspection was carried out on 4th September 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 Lodge 09/11/05

Ashling Lodge 20/04/05

Ashling Lodge 04/01/05

Ashling Lodge 13/07/04

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 Lodge 20 Station Road Orpington Kent BR6 0SA Lead Inspector Wendy Owen Unannounced Inspection 09:30 September 4th 2007 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 Lodge DS0000006918.V339085.R02.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 Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashling Lodge Address 20 Station Road Orpington Kent BR6 0SA 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) 01689 877946 01689 819315 ashlinglodge@tiscali.co.uk Chislehurst Care Limited Ms Sally Ann Perry Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2006 Brief Description of the Service: Ashling Lodge is a large detached two-storey house converted to provide care and accommodation for elderly people who are physically frail. The home is situated on a busy main road accessed by a steep drive with some off street parking. The home is within a short walking distance of Orpington Town centre with its range of shops, leisure facilities and public transport links. The building has two floors with service user accommodation on both floors, accessed by a stair lift. There is a large conservatory built on the front. The laundry and further storage is located in a wooden framed structure in the back garden. There is wheelchair access to both the front door and the fire exit leading directly onto the rear garden. Central heating is provided to all area of the home and the radiators are guarded to lesson the risk of an accident. There are handrails in the corridor areas with grab rails provided in toilet and bathroom areas and specialised bathing equipment available. The manager also manages another one of the organisation’s homes, Heatherwood, located on the other side of the main road. Information is provided to prospective residents in the form of a Service Users Guide. Contracts are provided and details of the fees are included in this information. Information on fees was not provided. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. The visit included a tour of the building, written feedback from 10 residents, 2 relatives and one health professional; verbal feedback from two relatives and two residents; viewing of records and discussions with the manager and staff. Prior to the inspection the home sent in the required information regarding the service, the AQAA. This service is generally good, although has been judged adequate due to the recruitment practices. What the service does well: Ashling Lodge provides a warm friendly, caring and supportive environment for those living there, ensuring they feel safe, secure and valued. It is “ a happy friendly living environment with a range of activities to meet the needs of the residents” said one relative. Another relative “The staff at Ashling Lodge make time to talk to and care for individual residents. They always keep residents clean and make sure they eat and drink enough. It is an excellent care home.” There is a sound system for ensuring residents’ needs are being met through assessment, care planning and assessment of risk with residents and relatives involvement. The health needs of the residents are generally well met with feedback from the GP stating “……… the care service is excellent provided it residents are within residential care framework.” They also commented on the way the home manages medication through “a carefully thought out medicines management policy.” The quality of food provided is of a good standard with sufficient choice and amounts for those living in the home. The routines of the home are flexible and meet with residents’ individual wishes. Visitors are made very welcome and there are good relationships between families, other agencies and the staff in the home. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 6 Residents are provided with a environment that is comfortable, homely and which is decorated in a domestic style with residents’ own rooms personalised. Staff are provided with training and qualifications to ensure they are able to meet the needs and ensuring the safety of those living in the home. Residents are kept safe through the monitoring of the equipment and services used by the home. There are systems in place for continually improving the care that includes the views of those living in the home and their relatives or representatives. This process is used in conjunction with the regular supervision of staff and a management that is open and inclusive that means any issues or concerns are listened to and acted upon. What has improved since the last inspection? What they could do better: Information provided to residents must be improved to ensure they are in receipt of the full information about the home. Contracts must be developed for those who use the service for respite care only. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 7 The care planning process has improved although there are a few gaps that must be addressed to ensure staff are fully aware of residents’ needs and how they can be met. The procedures for managing prescribed medication are good, although the home should encourage residents to manage their medication, where this is safe. The manager has worked to improve the activities and stimulation for residents, although there is need to progress this further. The home’s adult protection procedures should be supported with guidance from all Local Authorities who have arranged placements in the home. Where the organisation are making changes to any aspect of the home residents should be involved in the decision making process. Recruitment practices must be more robust to protect vulnerable people living in the home. Whilst there is evidence of training being provided, the way in which this training must be reviewed to ensure staff receive the training from a competent and qualified person where this is required by the regulatory authorities. Training records would benefit from being kept in a more organised way and from the development of individual training and development programmes. The systems in place to minimise the risk of fire must be more rigorous. 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 Lodge DS0000006918.V339085.R02.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 Lodge DS0000006918.V339085.R02.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): 1,2,3,4,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents or their representatives have the information they need to make an informed decision about coming into the home. The pre-admission processes ensures staff have the information to meet residents’ needs and that they can plan their care prior to admission. EVIDENCE: A Statement of Purpose has been developed and is in the written format, although large print is available on request. It contains information as required by the Regulations, although this is not quite up to date. For example: the organisation structure does not have the correct managers in post. The organisation has also developed a Service Users’ Guide and a copy is available in the hallway for residents and other people interested in what the Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 10 home has to offer. Residents also have a copy in their bedrooms and two people were able to point to the “blue book” as containing information on the home. The “Guide” includes a copy of the terms and conditions and a number of other areas required by the Regulations, including complaints procedures and a copy of the inspection report. However, the manager needs to view the standards and Regulations, as many of the areas are not included in the Guide and would be beneficial to residents and families. (See requirement) It is positive to note the improvements in the pre-admission processes with information, including a template of the contract being sent out prior to a resident’s admission. There is documented evidence of this, including visits to the home by family or the individual. Discussions with two residents and a relative gave me an understanding of the process for a resident being admitted to the home. In the one case the residents had been in hospital and a care home had been the only option for their continued safety. The family and resident wished to be admitted to another home but there were no vacancies and therefore Ashling Lodge had been decided upon by the family. They visited the home on the resident’s behalf and the manager visited the resident in hospital asking about her needs and discussing these with the family. The manager also provided information about the home to the individual and their family member. The relative was “very impressed” with the fact that the manager had already arranged District Nurse input when the daughter went back to the hospital the next day. She also told me that she had received a contract and was aware of the information guide in her mother’s room. During the second day of the inspection another resident was being admitted to the home. I viewed the pre-admission records and found details of the resident and family visit to the home at the end of August and the Care Manager’s assessment and the assessment undertaken by the manager during the individual’s visit to the home. Two other files were viewed in relation to recent admissions both contained assessments by the home and the Care Manager’s assessment, where appropriate. The manager also ensures that she makes enquiries to hospital staff as to the acquiring of infections whilst in hospital, especially as this information is not always forthcoming. This is good practice and allows the manager to ensure sound infection control practices are in place. The organisation has developed terms and conditions and a copy of these included in pre-admission information. Discussions with two residents/relatives and written feedback shows there is a mixed response as to whether contracts are received. In the past copies of these have been maintained by Head Office and therefore could not be viewed. However, this has now improved and those that received permanent care have copies of their contracts. However, those who are on respite care in the home do not. There is evidence that those whose placement was arranged by Social Services receive the Local Authority Placement Agreement from the boroughs responsible. (See requirement) Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff have the information they need to ensure residents’ individual health and personal needs are being well met. There are sound practices for ensuring residents receive access to the healthcare they require which meets they are kept safe and well. EVIDENCE: The feedback provided by residents, relatives and health professional showed the home to provide a supportive and caring environment for those living there. All residents have a care plan developed and, where possible, each person signs the records to show their agreement and involvement. The care plan system in use is the standex system and covers long term needs assessment, care plan and risk assessment. Those viewed were generally satisfactory with areas of need and risk documented to ensure staff know how to provide the appropriate support. There were some gaps in these. For Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 12 example where a person had a waterlow score of 16 (high) there was no corresponding care plan entry. The care plan in relation to nutrition was not very detailed considering the poor nutrition of the individual. Neither did the home detail the activities undertaken by the resident. However, the care plans documented the individual needs of the person such as their routines and gave an overview of the individual’s routines and needs. The second care plan viewed was also quite detailed and individualised reflecting their particular needs and routines. In this case the inspector was aware of the individuals allergy to synthetic substances next to their skin yet this had not been detailed in any of the records. As in the previous care plan the staff had not documented in much detail particular risks such as falls and there was a lack of care plan from a pressure risk assessment that had risen from 8 to 13. The third care plan viewed showed the individual to be of Asian origin and of Hindu faith. The spiritual and cultural needs had been paid little attention. On discussing this with the manager and from the assessment, it is clear that the individual does not express any desire to follow religious, dietary or cultural needs associated with their nationality and religion. This may be due to the individual’s dementia. This aspect has been addressed but not in any great detail. For example there is little about the Parkinson’ Disease and Lewys Body dementia and the impact this has. There is information in the records regarding constipation but no action plan, although the medication records show that the individual has prescribed medication. It is also clear from the daily records that there are issues around the care and support for this person that have not been evidenced in the risk assessments and care plans. (See requirement) Discussions with staff and residents and viewing of individual files demonstrate that staff are aware of individual residents’ needs and are able to care for them in a way that supports their individuality although this is not always reflected in the documentation. It is clear from observations and from feedback that residents are treated with respect and dignity by staff who provide care in a warm and friendly way. One relative wrote “staff at Ashling Lodge make time to talk to and care for individual residents. They always keep residents clean and make sure they eat and drink enough. It is an excellent care home.” “From my own experience and the care which my aunt receives I believe the support required is well provide” wrote another relative. Residents’ feedback in the written survey showed that the majority of residents felt they received the care and support required and that they were listened to and the comments by the GP were also favourable saying of the home that, “provided residents’ needs are within a residential care framework the care service is excellent” Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 13 The records in relation to accessing healthcare appointments and treatments are well maintained and show the staff to understand when to contact health professionals and follow the advice provided. Residents have their weights checked regularly and appropriate action is taken where there is cause for concern. The medication procedures and practices were audited and found to be of a good standard ensuring there are full records where residents have been prescribed medication by a health professional. The GP felt that the home has a “carefully thought out medicines management policy” All residents have their medications administered by staff in the home and, whilst this ensures that all residents are safe, it takes away the independence for some. Discussions with two residents showed that they felt they were able to administer their medication, although one resident was happy for the home to take the responsibility away the second residents felt they were able to continue with taking responsibility for administering their medication. The manager should consider this whilst planning individual care and “allow”, where the risk assessment determines, resident to self medicate. (See recommendation) The staff ensure that where new residents are admitted a full record of their medication is recorded and this was observed by the inspector on the day with the manager and staff counting, recording and signing an individual’s medication coming in. Where these records are hand transcribed there are two signatures to confirm the accuracy of the record. There is a also record of staff who are able to administer medication with individuals’ initials as they would be recorded on the medication record. This allows for cross checking where errors may be made or there is a query. Each record also has a photograph of the resident. Staff also record the date of opening of any medication that has a expiry date to ensure the medication is used within the required timeframe. It is positive to note that all staff are registered for the comprehensive distance learning training “Safe administration of medication” organised by a local college. The previous inspection reports identified the need to ensure residents were involved in the day to day running of the home and decisions made about the way in which they live. The recently completed information (the AQUAA) states that the staff now hold review meetings with residents and relatives and that residents’ meetings have been restarted. This was evidenced at the inspection with the minutes from two meetings on record. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a variety of meals that are healthy and nutritious. Routines are flexible and there have been improvements in the activities and stimulation for those living there, although further improvements in the range of activities offered would be beneficial to ensure individual needs are catered for. EVIDENCE: Ashling Lodge provides a homely environment for those living there. A budgie occupies a space in the main lounge giving residents something of interest to watch instead of the TV. Each week the “Pat-a-Dog also visits with his owner and his photograph takes pride of place as you enter the hallway. A hairdresser also visits regularly. There is no activity co-ordinator employed to arrange any structured activities and therefore it is up to staff to become involved in this aspect. Some afternoons have planned activities such as bingo, games and film afternoons. The manager acknowledges that this is an area that needs to improve as does the GP who feels improvements could be made in relation to Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 15 the provision of gentle exercises beneficial in ensuring continued health. The manager has succeeded in using a volunteer to provide some stimulation with Sunday morning craft type activity. She is also looking to increase the number of volunteers to support the home further, particularly in outside activities. Of the surveys received from residents, seven said there were activities for them to take part in, whilst one did not respond and two said usually. One resident spoken to felt, that, the home, whilst lovely, they would prefer a home where residents were more able to communicate so she could socialise more. The resident does not join in games or other activities, although has various other activities and day centres to go to which the home has supported her to attend. One other resident spoken to was not interested in activities whilst another occasionally walks down to the town with staff assisting him on his return. In the survey, when asked: What does the home do well? One wrote back that it is: “A happy friendly living environment with a range of activities to meet the needs of the residents.” (See recommendation) From discussions with residents and staff the routines are flexible in as much as they can be. Meals have fixed times but can be taken outside of these times if the individual wishes. This was noted on the second day where a resident had been to a hospital appointment and therefore missed their lunch. This had been “saved” for them on their return. Another resident spoke of enjoying a “lie in” as she stayed up late, unlike most of the other residents. She also told the inspector of her regular evening “tipple”. As commented earlier mealtimes are set as detailed in the Service Users Guide. There is some flexibility where residents can take meals earlier or later as required. When asked in the written surveys: Do you like the meals in the home? Six residents said yes; three said usually and one, sometimes. So the response is mixed. When I viewed the menus that are placed on each of the dining room tables they looked varied and appetising and the tables were well presented ready for the meal. Two residents spoken to felt the food was adequate, although sometimes the meat is too tough and the potatoes hard. One resident also said that the plates are never heated up and therefore the meals are sometimes cold. Residents take their breakfast in their rooms and this consists of cereal, toasts and a hot drink or juices. This is prepared by night staff as there are no kitchen staff at this time of the morning or in the evening. This means there is little flexibility in what is offered. For example: a cooked breakfast. (See recommendation) All the relatives who provided feedback state that the staff are welcoming and encourage the continuing relationships. Visiting is flexible, although the home prefers people to avoid busy times. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 16 It is positive to note that the manager has, since the last inspection, reinstated residents’ meetings. Two have taken place and the manager is hoping that these will continue. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel safe and any concerns are listened to and acted upon to ensure the service is improved to meet their needs. There are sound systems in place for managing abuse to ensure vulnerable people are protected. EVIDENCE: A procedure for making and responding to complaints has been produced and is on display in the home and included in the Service Users Guide. All the ten service user surveys received said that they were aware of how to make a complaint and knew who to speak to if they were not happy. There is a good relationship between the manager and the residents, with the manager making herself present within the whole of the home ensuring residents have the opportunity to talk to her if they wish. There have been no complaints made over the last twelve months nor have the Commission received any concerns or complaints about the care provided. Both residents and relative spoken to on the day knew who to speak to and had no worries about making a complaint or raising concerns and felt that they would be listened to and issues acted upon by the management of the home, including the deputy manager. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 18 Procedures are also in place to protect residents from abuse with the Bromley Local Inter-Agency Guidelines also available for staff guidance. The manager was advised of the need to obtain the Inter-Agency guidelines from other authorities who have made placements in the home. (See recommendation) Staff spoken to had a reasonable knowledge of what is abuse and what they would do if such a situation arose in the home. Even though the newest member of staff had no care experience and had not received full training in this area, their knowledge was very good and the inspector felt confident that they would take the appropriate action in such circumstances. There was evidence of some staff receiving adult protection training. This report details the shortfalls in the recruitment processes under the staffing outcome group with requirements raised. Around the home there were leaflets advising of independent advocates that could be contacted, if required. One resident has received such support in financial matters. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,2224,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ashling Lodge provides a warm, homely and comfortable environment for people living there. EVIDENCE: Ashling Lodge is a adapted residential house. It has a small lounge and dining room and a number of bedrooms on the ground floor together with a bathroom and WC. Private rooms and bathroom and WC are also located on the first floor. The home is well maintained and reasonably decorated. A tour of the building showed the bedrooms to be of varying sizes and all were very personalised. Some rooms are very small with one resident telling the inspector “it is comfortable” although “there is little room for moving around Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 20 with my zimmer.” The two residents and relative spoken to felt the rooms to be adequate, although one gets very little light. The home has one dining room and one lounge where most of the residents spend most of their day. It is the organisation’s intention to change one of the bathrooms into a shower room. This has not been discussed with the current residents and would be good practice to involve them in changes to the home, in some way. (See recommendation) Alarms calls were viewed in all areas. The home does not use any lifting equipment except for the stair lift. This had undergone a recent examination. Liquid soap and paper hand towels were viewed around the home and a clinical waste bag located in one of the bathrooms. All ten surveys said that the home is fresh and clean. Staff are provided with guidance on infection control through video presentations. Staff spoken to had a basic understanding of this guidance including one new member of staff who has only recently started in the care sector. Since the last inspection the manager has ensured the access to the rear garden is through a secure gate and made ground floor rooms more secure with the fitting of restrictors on the windows. These systems were in response to strangers accessing this area. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 21 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment practices must be more robust to ensure people living in the home are protected. Progress has been made in the number of staff qualified to NVQ and staff are being trained to ensure they are able to meet residents’ needs. EVIDENCE: The home has a consistent workforce with little turnover of staff and little use of agency staff as the organisation uses its own bank staff. There are sufficient care staff on duty during the day with the deputy manager and manager providing management responsibilities. There is one member of night staff on duty who is supported by the on call person in the home opposite. Domestic staff and kitchen staff provide ancillary duties, although kitchen staff prepare and cook lunchtime meals only with care staff taking responsibility for other mealtimes. There has been good progress with staff completing NVQ 2 or above. Nine care staff have successfully achieving NVQ 2 or above and one other currently studying for the award. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 22 Ashling Lodge belongs to the Bromley Training Consortium which provides training in a number of core areas. There is no training matrix or individual training and development plan developed to give a clear record of what training each member of staff has undertaken and what training is currently required. In order to gather the information the individual certificates must be audited and this is very time consuming. There was evidence of staff training, mainly through the DVD/video medium. This includes infection control, food hygiene, abuse, moving and handling. This is not always appropriate as it does not include an element of practice that is required in training such as moving and handling. This is reported on in more detail in the management section of this report. (See requirement) All new staff are expected to go through a period of induction. This was explained to the inspector by a newly appointed member of care staff. Currently the home uses the TOPSS induction and foundation package. The manager was made aware that these have been replaced by the Common Induction standards. Recruitment practices were also audited with two files viewed, one of these being a new care staff and one of a staff member transferred from other home in group. Discussions with the member of staff new to the home on the recruitment process showed the inspector that the systems in place are not robust enough. She explained how she worked for an agency when she first entered the sister home Heatherwood. She told the inspector that she did not have Criminal Records Bureau check (CRB) or other checks when first went in to home and there was no request for evidence that checks had been completed. This is not good practice, as vulnerable people are not protected. When she applied for a job within the organisation she underwent an interview and checks were made. However, when viewing the records the home commenced her employment with POVA First, no CRB or references arriving prior to starting her employment. There was evidence of induction training but not of any supervision by a named member of staff as required by the Regulations. This is also true of the student volunteer who has no CRB check made, although there is evidence that she was not left unsupervised during her time with the residents. (See requirement) Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 23 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): 31,32,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home is meeting the needs of the people using the service. EVIDENCE: The manager has been in post for over a year or so and has relevant experience and qualifications to manage the home. Staff, residents and relatives all provided positive feedback on the manager’s approach and openness and willingness to discuss concerns or ideas for improvement. She is easily accessible, despite also managing a home, “Heatherwood”, located across the road. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 24 It is positive to note that residents’ meetings are now taking place and that regular visits are made by the Area Manager to monitor the quality of care provided. Part of this process is to involve residents and relatives by sending out surveys each month. A review of the service has been undertaken during 2006 with a small sample of individuals. The organisation analysed and evaluated the information producing a report on the findings. A copy was sent to the Commission. The Providers are reminded of the requirement to ensure such a review takes place each year. I have stated earlier that a good deal of the training provided to staff is through the DVD/video instruction. This includes moving and handling and now, first aid. It is the organisation’s aim to provide night staff with first aid training though a competent training provider but for day staff this is to be completed through a DVD. Discussions with the Local Authority Health and Safety advisor says that the home is required to undertake a full risk assessment as to the needs of the home in this respect. This assessment must take into account issues such as layout of the home, number of staff, number of residents and their dependency. The risk assessment must determine the action the home is to take regards ensuring appropriate first aid cover in the home. The practice of providing training through such media is not acceptable in the inspectors view and is disappointing. Staff are not able to ask questions or become involved in the learning process with such instruction. The lack of any practice and competency element not only leaves staff at risk but also those living in the home. (See requirement) The information sent in prior to the inspection shows that the manager is ensuring equipment and services are being maintained appropriately. However, when viewing the fire drills there is no record of the time of the drills. This means that there is no accurate record for day and night staff. The weekly fire alarm testing also had gaps between 26/6/06 - 18/7/07 and 18/7/07 - 9/8/07. It was also difficult without looking through each staff file to determine whether all staff had receive fire instruction. (See requirement and recommendation) The home does not get involved in managing residents’ monies directly, preferring instead the system of invoicing the relatives or other persons who may be responsible for their personal finances. Wherever possible, the residents are encouraged to manage their own finances but many prefer not to do this. Where the home purchases items on the residents’ behalf, including services, such as hairdressing and chiropody, receipts are kept and records maintained to ensure there is an audit trail and all monies spent are accounted for. Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 25 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 2 2 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 3 2 Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 26 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 OP1 Regulation 4&5 Requirement Timescale for action 01/12/07 2 3. OP2 OP7 5 15 The Statement of Purpose and Service Users Guide must include the information as required by the regulations to ensure people using the service have all the information they need. Contracts must be developed for 01/12/07 those people using the service for respite care. The Registered Person must 01/12/07 ensure that care plans fully detail the residents’ identified needs in respect of their health social and personal care. There has been some progress in the development of care plans and this requirement has been partly met. The Registered Person must ensure that recruitment procedures are robust enough and the required checks completed on all employees prior to commencement. This is a repeated requirement. Timescale of 01/2/07 has expired. DS0000006918.V339085.R02.S.doc 4. OP26 17 01/10/07 Ashling Lodge Version 5.2 Page 27 5 OP38 13 6 OP38 13 7 OP38 23 Moving and handling training must be provided by a competent person each year to ensure the safety of residents and staff, unless the risk assessment states otherwise. There must be a person trained in first aid (by a competent person) on each shift to ensure the safety of residents and staff, unless a risk assessment states otherwise. A weekly check of the testing of the fire alarm and fire doors must be made to ensure residents are minimised from the risk of fire. 01/12/07 01/12/07 01/10/07 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 OP1 Good Practice Recommendations The Service Users Guide should include information as detailed in standard 2. This information should be up to date. The manager should review the procedures in relation to the bathing routines to ensure they are flexible and meet individual needs. Residents who are able to self medicate should be given the support to do so whenever possible. The provision of activities should be reviewed to ensure they are varied and meet individual needs. Residents should be involved in any decisions that may affect them. The provision of food should be reviewed to allow for some flexibility at breakfast time. Local Authority Inter-Agency guidelines on the protection DS0000006918.V339085.R02.S.doc Version 5.2 Page 28 2 OP12 3 4. 5 6 7 OP9 OP12 OP8 OP15 OP18 Ashling Lodge 8. OP38 of vulnerable adults should be maintained by the home. The Manager should provide staff with equipment for transporting laundry that minimises moving and handling risks. Training and development plans should be developed for individual staff. There should be an easy to view record of staff training to date. 9. OP30 Ashling Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Lodge DS0000006918.V339085.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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