CARE HOMES FOR OLDER PEOPLE
Ashlyns Residential Home Chesham Road Berkhamsted Hertfordshire HP4 2ST Lead Inspector
Yoke-Lan Jackson Unannounced 8 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ashlyns Residential Home Address Chesham Road, Berkhamsted, Hertfordshire, HP4 2ST 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) 01442 870565 01442 861601 Colley Care Limited (Trading as B&M Care) Mrs Diane Delicate CRH Care Home 58 Category(ies) of DE(E)-19, OP-39 registration, with number of places Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: There are no additional conditions of registration. Date of last inspection 9 February 2005 Brief Description of the Service: Ashlyns, provided by B & M Care, is a purpose built residential care home for 58 service users in the older people category. The home has a Dementia Unit (for 19 service users) and a Residential Unit (for 39 service users). The building, part of a large country estate, is situated on the outskirts of Berkhamsted, close to the A41. There are ample parking spaces nearby. The home has a front driveway and the main entrance to the building is security locked. Both units have ample communal spaces. All the bedrooms have ensuite facilities and they are all of single occupancy and they are accessible to wheelchair users. The Dementia Unit has 19 bedrooms, two lounges, a small nurses’ station, a kitchenette and a dining room. Overlooking the lounge is the ‘sensory garden’. The interior décor and furnishing are designed to provide a homely and comfortable atmosphere. Security locks are in place at both ends of the Dementia Unit for the safety of the service users. The corridor extends into the Residential Unit, with 39 bedrooms, two lounges, a laundry room, a main kitchen and two dining rooms. The building is generally well maintained, both externally and internally. In the centre of the building is the courtyard that is well designed with an ornamental fountain, attractive potted and climbing plants and comfortable garden furniture. There is a large sun lounge overlooking the back garden, which is well kept and accessible to wheelchairs.
Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection (unannounced) for the year 2005. The registered manager and the deputy manager were present. The inspection began with general observation of the lunchtime routine, including observation of staff performance and staff interaction with the service users. Several service users were interviewed. Additional feedback was obtained from relatives and a health care professional. All those interviewed made positive remarks about the staff and their caring attitudes. The premises inspected appeared clean and well maintained. (Please see below the inspection findings). What the service does well: What has improved since the last inspection?
The home has recently appointed a new activity coordinator to fill the vacant post. There is further improvement in the provision of facilities for recreation. The communal space leading to the sun-lounge (in the Residential Unit) is being converted into a permanent activity room with suitable and improved recreational facilities for all service users to access. The patio and garden next to the sun-lounge have been redesigned to provide better access to service users who wish to participate in gardening activities. Plans are underway to construct a large medication storage facility to replace the two existing ones. The CCTV has been installed to improve security. It does not intrude on the service users’ privacy.
Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5. Prospective service users and their relatives are given the opportunity to visit and assess the facilities and suitability of the home. A comprehensive assessment is carried out before the prospective service user is admitted into the home. EVIDENCE: The registered manager ensures that a comprehensive assessment is carried out and proper documentation is kept in the care plan file of the respective service user. One service user has been readmitted to hospital on several occasions. Each time, the manager ensures that her needs can be met before her readmission into the home. Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11. The care planning system ensures that the service user’s health, personal and social care needs can be met. Service users are treated with respect and their wishes and preferences are respected. Medicines are administered in accordance with legislation and the home’s policy and procedures. However, the home is experiencing problems with the supplier pharmacist. EVIDENCE: The plan of care for the individual service user is reviewed regularly and when necessary. The home has the support of the healthcare professionals. Currently a district nurse visits the home on a regular basis to see to the health care needs of respective service users who require their service. It was noted that the members of staff were gentle and patient with the service users during the teatime gathering (in the lounge) in the Dementia Unit. All the service users appeared clean and relaxed. Two visitors gave very positive feedback about the care and services provided. One service user
Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 10 volunteered and was seen assisting the care worker with the washing up in the kitchenette. She appeared to enjoy herself. This is good therapy for someone with dementia. Members of staff have bereavement training to enhance their skills in offering care and support to the service users and their relatives during this sensitive time of their lives. The medicines are administered to the respective service users by trained staff. The home may replace its current supplier pharmacy. The service users have not been affected and all medicines have been administered appropriately. Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15. Service users are encouraged to maintain links with family and friends. The activities provided are varied. Service users are given choices and their preferences are respected. The meals provided are wholesome and nutritious and there is a choice of menu. EVIDENCE: There were visitors present throughout the day of the inspection. One relative interviewed said that she is “very pleased with the care workers”. The activities provided are both stimulating and varied but not all the service users participate on the day. The registered manager believes that the activities and facilities can be improved. The home is in the process of creating a permanent recreational and activity room as well as provision of a section of the back garden for those service users who are interested in gardening activities. Seven service users enjoyed their recent trip to a local garden centre. Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 12 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, 17, 18. Service users and their relatives are aware of the complaint process. Their complaints are taken seriously and acted upon. Service users are protected from abuse and their legal rights are protected. EVIDENCE: The home has had two complaints since the last inspection. These were dealt with within the time specified in accordance with the home’s complaints policy and procedures. The home keeps a complaint log containing details of all complaints received and action taken by the home in response. The members of staff are aware of the Whistle Blowing Policy and Procedure. There is a copy of the Hertfordshire Adult Protection Procedure in the office. The staff of the home are not involved with the financial affairs of the service users. Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26. The home and the surrounding grounds are kept to good standards of cleanliness and attraction. There are ample communal spaces and the facilities provided are adequate for the service users. EVIDENCE: The premises appeared homely, clean and well maintained. The bedrooms inspected were odour-free and tidy and there were personal items on display. A CCTV system has been installed and it was operating clearly on the day of the inspection. The device does not intrude on the daily life of the service users. The home was designed with built in fire compartments to obviate the need for electronic hold/open door devices on bedroom doors and other doors. However, the manager has agreed to install an electronic device to the hairdressing room to avoid the use of wedges to keep this door open. (The hold/open electronic door device was installed on 10/08/05).
Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30. The home has an effective staff team. Service users’ needs are met by the staffing level and skill mix of the staff. The recruitment and selection process is thorough and complies with legislation. EVIDENCE: The staff present on the day of the inspection have demonstrated their skills and dedication to the work they have been assigned to perform. Only positive remarks were received from the service users and the visitors about them. All members of staff have the appropriate training to meet the assessed needs of the service users. There is an on-going training programme. All the staff recently attended in-house fire evacuation training that was provided by a specialist company. New staff commence employment subject to clearance by the Criminal Investigation Bureau. The Protection of Vulnerable Adult (POVA) check is done. The staffing level was adequate on the day of the inspection. Agency staff are used when necessary. Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, 35, 36, 37, 38. The health, safety and welfare of the service users are promoted and protected. The administration and management of the home is consistently maintained. EVIDENCE: The registered manager ensures safe working practices. All the maintenance and servicing programmes are updated and they comply with legislation. The records for the protection of the service users are kept up to date and stored securely in accordance with Data Protection Act 1998. The home has a range of policies and procedures to provide guidance to staff who are supervised as part of the normal management process. Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 4 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 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x 3 3 3 3 3 Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 17 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation None 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. Refer to Standard None Good Practice Recommendations Ashlyns Residential Home I52 s19271 Ashlyns v243935 080805 Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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