Inspection on 02/06/05 for Ashmead Care Centre

This inspection was carried out on 2nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashmead Care Centre 28/08/07

Ashmead Care Centre 15/02/07

Ashmead Care Centre 09/10/06

Ashmead Care Centre 31/05/06

Ashmead Care Centre 07/03/06

Ashmead Care Centre 13/12/04

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 Ashmead Care Centre 201 Cortis Road Putney London SW15 3AX Lead Inspector Janet Pitt Unannounced 2 June 2005 10:35 nd 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. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashmead Care Centre Address 201 Cortis Road Putney London SW15 3AX 020 8246 6430 020 8445 3624 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) Life Style Care Plc Vacancy Care home with nursing (N) 110 Category(ies) of Dementia (DE) registration, with number Old age, not falling within any other category of places (OP) Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 Nursing Unit Ground Floor - Staffing A minimum of two qualified 1st level nurses and six carers must be available on the ground floor nursing unit on each of the morning and afternoon at all times. A minimum of one qualified 1st level nurse and three carers must be available at all times during the night shift. 2 Nursing Unit First Floor - Staffing A minimum of two qualified 1st level nurses and six carers must be available on the first floor nursing unit on each of the morning and afternoon at all times. A minimum of one qualified 1st level nurse and three carers must be available at all times during the night shift. 3 Nursing Unit Second Floor - Staffing A minimum of two qualified 1st level nurses and four carers must be available on the second floor nursing unit on each of the morning and afternoon at allt imes. A minimum of one qualified 1st level nurse and two carers must be available at all times during the night shift. 4 Each unit of the home must be co-ordinated as a separate unit and staffing levels must not fall below those stated above for each unit at any time. The qualified nurses must not have any management responsibilities for the home other than within the unit in which they are working. 13th December 2004 Date of last inspection Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Ashmead Care Centre is a purpose built care home with nursing, that provides care for persons who may have dementia. The home is able to accomodate up to 110 service users. The home is organised into six units, each containing communal areas,comprising of a lounge and dining room. Residents have single room with ensuite toilet and washbasin facilities. Bathroom, shower and other toilet facilties are situated at intervals in the units. In addition to communal lounges the home has quiet lounges. The accomodation is situated on the ground, first floor and second floor, with the kitchen, staff rooms and some offices on the second floor. Ashmead Care Centre is situated in Putney, close to the main A3 road and has access to local bus routes within walking distance. There is provision for car parking on site. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Ashmead Care Centre was undertaken by two inspectors and commencing at 10:35am and finishing at 4:50pm. Records relating to residents’care, staff files, medication records and polices were examined. A tour of the premises was undertaken. During the course of the inspection the inspectors spoke with nine residents, two relatives and four members of staff. What the service does well: What has improved since the last inspection? What they could do better: Residents’ assessment and care planning should be improved to reflect care needs identified and how the care is carried out. Staff need to be more aware of maintaining the privacy and dignity of residents, as there were situations detailed in the body of the report, when residents were treated in an undignified manner. Residents should be appropriately dressed and presented, as it is undignified for a person to have unkempt hair and soiled clothing. Interactions between staff and residents differed in consistency and staff should be aware that the residents are entitled to maintain independent living Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 7 skills. Ashmead Care Centre is classed as the residents’ home. Staff need to be aware that it is their role to promote the health and safety of residents. 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. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 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 Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 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, and 3 Resident assessments should be consistently completed to ensure that care needs are identified. The assessments should evidence involvement of the resident or their representative. EVIDENCE: Residents are provided with sufficient information regarding the service provided by the home. A Service Users Guide is freely available for residents to access. The Statement of Purpose is available in the main entrance. Prospective residents are assessed by the manager or deputy manager prior to admission and these assessments were available on residents’ files. Residents are reassessed on admission, but the quality of information was not consistently recorded, which potentially places residents at risk of not having care needs identified. Assessments of continence, nutrition, skin integrity and mental health but these were not always consistently completed, in particular mental health assessments. There were details of past medical history and contact with family. Information on social history was in place, but not fully completed. Some assessments contained information on religious needs, but this should be in place for all residents. Lack of detail on assessments could potentially place residents at risk of not have needs identified. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 10 There was evidence of residents and their representatives’ involvement in the assessment process, however this needs to be consistent. The home should evidence that residents’ are actively involved in the process. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 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) 7,8,9,10 and 11 Residents care plans need to be completed consistently and include specific details of care required and care given. EVIDENCE: Residents care plans were noted to be developed in relation to specific issues, which indicates that staff are able to identify and plan care according to residents needs. However, some aspects of the care planning, such as continence care and personal care lead from the assessments, but actual care recorded did not reflect the care planned. In total ten care plans and assessments were examined. Residents’ health care needs were identified and in the majority of residents were met. There was information on other health professionals input. However the home needs to ensure that continence programmes are recorded as being implemented and specific details on personal care given are recorded reflecting the timescales within the care plan, to ensure that it is evidenced that residents needs are fully met. Residents who required blood sugar monitoring had detailed entries on the care given in relation to their condition, which protects them from risk of becoming ill. Manual handling assessments and wound assessments were in the residents files. The Waterlow pressure sore risk assessment was noted to be done on Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 12 admission and reviewed monthly, which ensures that there is ongoing review of care needs. Wound documentation has improved and there is evidence of when dressing changes occur, but the details of the condition of the wound were not routinely recorded, which means that residents condition is not always monitored consistently, placing them at risk. Staff do ensure that specialist advise in obtained form tissue viability nurse if required, which is evidence of good practice. General risk assessments were in place and when required specific individual assessments. The home uses cot sides, after a risk assessment has been completed, but must endeavour to ensure consent forms are in place. Risk assessments should contain specific details on how risk is to be minimised, e.g. number of people required, type of equipment, to ensure residents are protected from harm. Residents’ wishes on death and dying were noted to be recorded sensitively in the majority of care plans, but this needs to be noted for all residents. The inspectors observed differing levels of staff interactions with residents. Negative interactions observed included one resident not being given sufficient time to walk from the lounge to the dining room and being hurried by staff, one resident being assisted to eat by a carer who was standing up and residents being served afternoon tea, with the milk already in the teapot. One resident was noted to be wearing trousers with tea stains on, their hair was unkempt and their shirt was unbuttoned. One resident’s care documentation name was incorrectly documented. One residents was seen with a blue plastic apron on at lunchtime, instead of a more suitable napkin. These actions do not promote independence and demonstrate that staff were treating residents with respect and preserving their dignity. However, some good interactions were observed, e.g. knocking on doors before entering rooms, residents being offered a choice of drinks and time allowed to finish meals. Residents’ medications were noted to be stored securely, which reduces the risk of harm. However, there was overstocking of a topical cream. There is not a clear audit trail, so residents are at risk of not receiving medicines as prescribed, as there were discrepancies in medicines received and medicines given. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 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 and 15 Residents are able to access activities and pursue interests of their choosing. Staff need to be aware of the need to treat residents with respect. EVIDENCE: The home has made improvements in the activities provided and are developing the programme to reflect residents choice. There is currently one activities co-ordinator at the home who commenced employment one month ago. Activities co-ordinator said that carers assist with the delivery of the programme to residents and there are plans to recruit another activities coordinator to further enhance the range of activities available. The activities coordinator aims to provide ‘ a broad range of activities, which include social, creative and physical stimulation’. Residents’ profiles are being developed by the activities co-ordinator to identify their preferences and capabilities. To further develop the activities programme an allocated budget, access to transport and a computer are required. Plans have been made for summer activities, such as barbecues and garden parties. One to one visits are made for residents who wish to stay in their rooms. On the day of inspection the activities co-ordinator was doing group craft work with some residents. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 14 Identified religious needs of residents are met by liaison between the activities co-ordinator and leaders of several denominations, services are usually held weekly. Lunchtime was observed in two of the dining areas. Staff should ensure that nutritional needs are met. Three residents had their lunch served, but were not seen to be eating after five minutes and staff did not prompt them to eat. Condiments were available for residents and comments overheard by the inspector included ‘not enough food’ and the ‘food was tasty’. One resident commented that they food was ‘OK’ and another said that the food provided was ‘not great’. The deputy manager was made aware of the amount of time staff were spending in the kitchen rather than assisting residents, there were two members of staff queuing with trays at one point, whilst residents were not being attended to. The observation points to staff being more intent on serving the food and finishing the task quickly, than on ensuring the residents have a pleasant and unhurried meal. This was particularly noticeable during afternoon tea when three members of staff were preparing the tea trolley, whilst residents were left unsupervised in the lounge placing their safety at risk. The displayed menu did not reflect the meal served, as the pie filling had been changed. Food was of an adequate portion size. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 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 Residents can be confident that concerns will be addressed and action taken if required. EVIDENCE: Examination of the complaints log indicated that complaints are dealt with in an appropriate manner and outcomes of investigations were present. The home has received one complaint since the previous inspection. Residents can be confident that any concerns they have will be addressed in an appropriate manner. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 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, 20, 21, 22 23, 24, 25 and 26. Residents are provided with a safe environment in which to live, however attention to detail when cleaning is required to maintain this environment. EVIDENCE: At the time of inspection only two of the floors were open to residents and plans were being made to admit to the second floor. Residents are able to personalise their rooms and the communal lounges have televisions and a range of comfortable seating. Beds provided for residents are hospital types, which enables staff to assist residents and alter their positions easily. The home and bedrooms were noted to be clean, bright and tidy, but attention must be paid to ensuring high dusting is done routinely to prevent cross infection. Residents are enabled to move around the home independently as able, as there are grab rails in toilets and handrails in the corridors. Each unit has a small kitchen for the preparation of snacks and drinks. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 17 Residents are able to access bathrooms easily as the bathrooms are situated along corridors. Residents have access to a walk in shower, which offers choice of bathing facilities. A cupboard was found to be unlocked and contained hazardous substances, which places residents at risk of harm. The environment is safe and maintained by a permanent handyperson. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 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) 27, 29 and 30 Residents are not fully protected by the recruitment procedures in place currently. Residents are supported by staff that have access to relevant training. EVIDENCE: Residents are looked after by staff that have access to relevant training. The deputy manager reported that training is provided in Control of Substance Hazardous to Health, manual handling, dementia and food hygiene. Training will be examined further at the next inspection, as the home was still in the process of recruiting the staff team. The deputy manager stated that when agency staff are used, the agency is requested to supply staff on a regular basis, to maintain continuity of care. Staff meet monthly and trained staff meet on a weekly basis. Residents are not always protected from harm by the adherence to recruitment policies in place. There was evidence within the six staff files examined of appropriate recruitment procedures; each file contained an application form, evidence of interview and two references. However, one file did not contain a Criminal Records Bureau disclosure. In addition, not all staff files provided evidence of appropriate contracts of employment, induction or supervision. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 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) 36 Residents should be supported by staff that are appropriately supervised to ensure they are protected from harm. EVIDENCE: Residents are not always cared for by staff that are appropriately supervised, which potentially places residents at risk of harm. The homes ‘Appraisal and Supervision’ file listed dates of planned appraisals and individual supervisions. Records on this file indicated that eight staff appraisals had been completed since January 2005 and that twenty-three appraisals were overdue at the time of inspection. The list of staff that had supervision between April 2004 and May 2005 indicated that the majority of staff had had one recorded supervision and one member of staff had had two supervision sessions during this period. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 1 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x 2 x x Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 21 yes 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 3 Regulation 14 Requirement The registered person must ensure that resident assessments are completed fully and the there must be evidence of resident/representative involvment in the process (previous timescale of 30/3/05 not met.). The registered person must ensure that care plans lead from the assessments of residents and specific details of care given are included in the daily records (previous timescale of 30/3/05 not met.). The registered person must ensure that there are consent forms in place for the use of cot sides. The registered person must ensure that wound care is acurrately documented (previous timescale of 30/3/05 not met). The registered person must ensure that risk assessments contain specific details on how risk is to be minimised. The registered person must ensure that there is no over stocking of medication and there is a clear auditable trail of Timescale for action 30th September 2005 2. 7 15 30th September 2005 3. 8 13 (8) 30th September 2005 30th September 2005 30th September 2005 30th September 2005 Page 22 4. 8 Schedule 3 (3) (k) 13 (6) 5. 8 6. 9 13 (2) Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 7. 10 12 (4) (a) 8. 11 12 (3) 9. 15 12 (1) (a) 10. 11. 12. 25 26 29 13 (4) (a) 13 (3) Schedule 2 and Schedule 4 (6) 18 (1) (c) 18 (2) 13. 14. 30 36 medicines. Each tablet must be able to be accounted for. The registered person must ensure that the privacy and diginity of residents is protected and promoted at all times. The registered person must ensure that residents wishes on death and dying are recorded (prevoius timescale of 30/3/05 not met.). The registered person must ensure that residents are appropriately supervised at meal times and that meals are served in an unhurried manner. residents should have a choice in the meals served and are given the correct information on the menu for the day. The registered person must ensure that hazardous substances are kept securely. The registered person must ensure that high dusting is routinely carried out. The registered person must ensure that all staff files contain the information required in the Schedules. The registered person must ensure that there is evidence of induction training The registered person must ensure that staff are appropriately supervised at regular intervals. 30th September 2005 30th September 2005 30th September 2005 30th September 2005 30th September 2005 30th September 2005 30th September 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. Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 23 Refer to Standard Good Practice Recommendations Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Ashmead Care Centre G54-G54 S60799 Ashmead V211791 020605 Stage 4.doc Version 1.30 Page 25 - 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. 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