Inspection on 31/05/06 for Ashmead Care Centre

This inspection was carried out on 31st May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 07/03/06

Ashmead Care Centre 02/06/05

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 Inspection 31st May 2006 10:10 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 Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 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. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashmead Care Centre Address 201 Cortis Road Putney London SW15 3AX 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) 020 8246 6430 020 8445 3624 Lifestyle Care PLC Mr Moise Jennah Care Home 110 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (50) of places Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 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. 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. 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 all times. A minimum of one qualified 1st level nurse and two carers must be available at all times during the night shift. 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. 7th March 2006 2. 3. 4. Date of last inspection 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 accommodate up to one hundred and ten residents. 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 facilities are situated at intervals in the units. In addition to communal lounges the home has quiet lounges. The accommodation 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 DS0000060799.V293602.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by an inspector and Regulation manager and involved case tracking residents files, examination of staff records, a tour of the premises, with observation of staff interaction and conversation with residents and relatives. Surveys were sent to twenty staff, twenty relatives and thirty residents. One staff, six relative and eight resident surveys were received. Information from Protection Of Vulnerable Adults and complaints investigations has been included within the scope of this inspection. The site visit lasted a total of six hours. What the service does well: What has improved since the last inspection? There is now an enthusiastic activities co-ordinator employed who is gathering information on residents’ interests to develop the activities programme. The activities co-ordinator would benefit from specific training. More equipment, would ensure that there is something personal available for all residents. Improvement has been made in the recording and auditing of medication handling and administration. Training of all staff giving medication has been arranged. There has been improvement in choice of food offered, but this requires further work to make sure that residents’ personal preferences are catered for. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 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 Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 7 contacting your local CSCI office. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 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 Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 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 the following standard(s): 1, 2 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The admission of new residents is process driven but not particularly personalised, with little consideration of the individual needs. EVIDENCE: Prospective residents and their representatives are able to visit the home prior to admission. Comments received from relatives included: ‘I went to Ashmead three times before [the resident] moved in it was brand new….There were a few teething problems but now I think the home operates well.’ However, choice of which care home is not always apparent as other comments included: ‘there really wasn’t much choice in Putney.’ and ‘[The resident] was being moved from hospital……. and this was the only care home place offered.’ Six residents indicated that they had received a contract, but one person said that they had only received a Service User Guide, which does not contain a contract. Staff must make sure that any documentation given to residents is Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 10 clearly explained, to make sure that residents are fully informed of what they can expect. Residents are assessed prior to and on admission. There has been some improvement in involving residents and their representatives in the process, but residents are still being placed at risk of not having care needs identified, by assessments not being consistently completed. One assessment had ‘likes and drinks anything offered.’ There was some evidence of preferences being recorded; one resident had requested a female carer and this was noted on the assessment. The home admits residents from differing cultural and ethnic backgrounds and must make sure that this is reflected in the assessments, with regard to personal care needs and dietary preferences. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a site visit to this service. Health care is reactive rather than proactive, ongoing monitoring of health is poor. There is evidence that staff treat residents in a way, which does not respect their privacy and dignity. For example, residents are not dressed correctly and staff do not have a thorough understanding of Dementia care. Residents had not received their medication as prescribed. Putting the health and welfare of the residents at risk. EVIDENCE: Residents care needs are not evidenced fully on care plans, which lead from assessments. However, surveys received indicated that care outcomes were generally adequate, with five residents surveys indicating that care and support was usually available. Comments received from both residents and relatives included: ‘Just occasionally there is a problem with the buzzer when I need help.’ ‘Yes, sometimes, but it is often different people, staff.’ and ‘The staff are always polite and appear to work hard. They however, have little time to spend talking or interacting with the residents. This could be improved on.’ Another Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 12 comment stated that: ‘Nowadays everyone is very caring. …[the resident] is changed regularly and made as comfortable as possible.’ This implies that there have been issues around care practices which have now been addressed, as evidenced in another comment:’[the resident] found it hard to adjust initially, but is now happy as [they] now know the staff.’ Residents are placed at risk of potential harm, due to interventions from other health professionals, not being sought in a timely manner. Examination of care documentation showed that two residents had lost weight, but there were no referrals to dieticians, or monitoring of nutritional intake. Although one resident had been commenced on weekly weights. This alone is not sufficient to make sure that residents’ nutritional needs are met and they are not put at risk of malnutrition. Even though residents and their relatives think that care is adequate, observations made on the site visit do not evidence that this is consistent. Comments from surveys also indicate that there are areas of care which must be improved i.e. ‘there have been occasions where new medication had been prescribed and I have not been informed. In one unit it was observed that residents looked unkempt and dishevelled. Three female residents had not had their hair brushed and did not have tights or stockings on. Nail varnish was chipped and old. One male resident had his jumper pulled up and a lady had her skirt on back to front. This lack of attention to detail does not protect the privacy and dignity of residents. Resident and relatives’ surveys indicated that there are diverse views on whether medical attention is sought quickly. Comments such as:’[the resident] has had recurring infections and the general practitioner has been slow to prescribe medication.’ And ‘the doctor does not always come out straight away to get a prescription.’ All records relating to receipt, storage, administration and disposal of current medication were examined for four units. The deputy manager and four staff member were interviewed. A sample of the current medication in stock was compared to the current records and medication not supplied in the monitored dosage system was counted and compared to the records. All medication was stored securely and in the correct conditions. Alterations to medication were clearly documented. Records of training for staff indicated that training in medication handling has taken place. An external person is coming to check the competency of staff in handling medication. The actual amount of medication given had not been recorded on the administration record for three items. It was clear from the amount of medication that the medication had been given correctly and the health and welfare of the resident had not been put at risk. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 13 All other records relating to receipt, administration and disposal of medication had been completed. The details showed any allergies and non-administration of medication. Most medication is given from a monitored dosage container (MDS). Staff are able to check if medication has been given or not. When medication is not supplied in the MDS there is a clear audit trail to check whether medication has been given correctly. The amount of medication currently in stock agreed with the records of administration. Ten residents had not been given their painkillers for periods of two- to sevendays. This was because the medication had been out of stock. The records for one resident showed that they had either not been given one of their medications or had received the incorrect dose of the medication for a period of two months. The resident was also being given another medication from an unlabelled container. The care notes indicated the dose of medication had been changed, but no clear records were seen as to when or how the dose had been changed. Residents’ wishes for end of life care and death were not consistently recorded. One plan indicated that the next of kin should be contacted, but no details regarding any religious or other rituals that the resident would like. One staff member thought that there was a barrier of a resident’s age to enable death and dying to be discussed. The member of staff said that this also created a barrier in discussing sexuality. Residents must have the opportunity to discuss specific details of their lives, in order that they are respect. Staff must work on effective communication, to make sure that residents are able to discuss intimate issues if they wish. The home is registered for dementia care, but care plans do not convey that staff have a good understanding of this condition. One care plan related to a resident who displayed inappropriate behaviour and the term ‘abuse them sexually’, was used. There was a lack of understanding that this can be a symptom of dementia and needs to be handled sensitively. Daily records of residents did not consistently indicate what care had been given. Phrases such as ‘[the resident] remains out of touch with reality’ and ‘[the resident] was washed and dressed according to the weather.’ were noted. Specific details of care need to be recorded to evidence the condition of residents. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Improvements have been made to mealtimes and the choice of food available, but more development is required to enable all residents to have a choice. The activities programme is starting to reflect residents’ wishes and choices. EVIDENCE: Relatives’ surveys indicated that they were made to feel welcome in the home and were able to visit when they wished. The activities co-ordinator indicated that she has started to gather information on residents’ social interests and hobbies and is trying to include these in the activities programme. Surveys from residents indicated mixed views on the activities provided within the home.eg ‘I don’t often want to go but I would go to bingo if someone really encouraged me.’ ‘The activities co-ordinator regularly comes in to speak to [the resident].’ (written on behalf of a resident who chooses not to attend activities), ‘but no-one tells me about them [activities] they say they have activities, but I haven’t seen any here.’ and ‘The activities staff are often around and inventive and lively.’ Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 15 Communication is not consistently effective within the home. Resident within the home are predominantly White British, but there are a few West Indian and Sri-Lankan residents and staff spoken with did not seem aware of specific religious and cultural needs, of any of the residents. This is obvious when it comes to meal choices. The chef has worked hard to gain information on likes and dislikes of residents. One comment received from a resident stated: ‘I’m a vegetarian so cannot eat everything but [the chef] does special things for me.’ The staff must ensure that correct information about dietary preferences are given to the kitchen staff, in order that residents have choice and their dietary needs are met. One comment was that: ‘No, the food is poor not enough meat, no curry, my daughter has to make my food. If I complain they sometimes bring me different food.’ Monitoring of mealtimes has begun since the previous inspection, but there was little evidence of action taken in response to what had been recorded. One comment involved a resident who was ‘shouting for more porridge’, the nurse was recorded as saying that ‘ [the resident] was diabetic and tends to eat a lot which could lead to increase in sugar level. [The resident] had already had a cup of milk, tea and a bowl of porridge already.’ It is not known whether the resident had any other diagnosis, but this demonstrates the lack of understanding of giving residents choice. If a resident who is diabetic wishes to eat more than a member of staff think is necessary, then it is the resident’s choice and staff must make sure that this is respected. Advice can be sought from other health professionals on monitoring of diabetic status. Lunchtime was observed on one of the units. A carer was noted to be sitting with residents talking about the food, which had been served. Food was presented well and was of a suitable portion size. One resident spilt their drink and was told by a member of staff ‘Don’t do it again.’ this type of remark is unacceptable. There was some evidence of choice, but residents were not always asked whether what they had ordered previously was still correct. Condiments and drinks were available and effort had been made to dress the tables, to provide an attractive setting in which to eat. In order to maintain the dignity of residents at mealtimes large napkins must be used, as the use of ‘bibs’ detracts from the efforts made with table presentation and does not show due to respect to the residents who are all adult. One comment indicated that there are issues with the evening meal: ‘Sometimes there are a strange mixture of meal for tea (hot meal) e.g. just mash and sweet corn, but usually a choice of sandwich and soup is served in the evening.’ Staff must be made aware that the sandwiches are for supper and residents must be given the published hot meal on the menu. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a site visit to this service. There is little evidence of the service being proactive or open in the area of adult protection. Staff do not have knowledge of what is happening with residents. Residents and their representatives have knowledge of who to make a complaint to. Other agencies do not necessarily have the confidence that action will be taken consistently, with the involvement of the manager. EVIDENCE: Relatives surveys received indicated that the majority of people knew who to complain to at a local level if they had any concerns. The majority of residents also knew who to discuss any concerns with. Comments included: ‘speak to the unit staff nurse or the deputy manager’ and ‘Yes, Abba, Sharma or one of the nurses.’ CSCI is concerned that the registered manager of the home did not feature in survey responses, as he is legally responsible for the running of the home. It has also been noted that reports when requested by CSCI are provided by the deputy manager, without evidence of input from the manager. A member of staff was able to tell the inspectors what action they would take if there was suspected abuse. However, there have been two serious Protection of Vulnerable Adults investigations since the previous inspection, which were not handled appropriately. Issues arising concerned manual handling technique of staff, staff not being aware of or noticing injuries when they occurred, a resident not receiving Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 17 adequate care, supervision of residents, staff attitude towards residents and the way that residents were spoken too. Other issues regarded care documentation relating to a residents condition and accuracy of monitoring changes. An articulate resident had stated that they had been handled inappropriately and staff denied this. Concerns were raised relating to informing other health professionals in a timely manner. On the day of the site visit, one resident was noticed to have bruising to the face and wrist. Staff when questioned indicated that they had faxed the doctor the day before and the resident had not yet been seen. Another member of staff said that they had not been on duty. Care records relating to this resident did not indicate whether there had been any incidents. A report was requested from the home, but the information supplied was inadequate and further information was requested. CSCI was later informed that the resident had sustained a fractured wrist. Staff must make sure that residents are protected from harm and any injuries receive attention without delay. It is not acceptable for staff to use the excuse of not being on duty for not having knowledge of a resident’s condition. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 18 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 the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a site visit to this service. Carpeting and chairs are not adequately cleaned, posing an infection risk. Minor repairs to décor are not carried out in a timely manner, leading to a poor presentation of the home. EVIDENCE: There were differing views on the cleanliness of the home. Comments included: ‘Clean tidy rooms’, and ‘sometimes smells (FOOD/URINE), room is not cleaned, but it is done when relatives tell staff.’ One common concern that was highlighted in the surveys was the cleanliness of the day rooms and chairs: ‘ Staff do not clean spillages etc. immediately. Carpets especially in corridors and day rooms are dirty. [the resident] is bed ridden but her room carpet is dirty and [the resident] doesn’t make the mess!! Chairs in the day room soiled and very dirty.’ and the home could improve ‘cleanliness-carpets and chairs in day rooms very soiled.’ The staff survey indicated that attention was not paid to ensuring cleaning was done thoroughly, this poses and infection risk to residents. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 19 On the site visit one resident’s room had a sticky floor and a lounge smelt strongly of urine. Residents do not live in a home where pride is taken in the appearance of the décor; wallpaper was missing from a wall in a lounge. High dusting must be carried out routinely to make sure residents are not placed at risk of infection. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a site visit to this service. The home employs adequate numbers of staff, but sometimes residents are waiting for care needs to be met and are poorly supervised. Training provided tends to be internal and there is a lack of willingness to seek external providers to deliver specialist training. Recruitment procedures are not consistently followed, which places residents at risk of harm. EVIDENCE: Residents are supported by an appropriate number of staff, however poor supervision of residents puts them at risk of harm. Interactions between staff and residents must be improved to make sure that residents feel supported. Comments on residents’ surveys included:’ Weekends sometimes staff shortage.’ ‘Too many different staff, some haven’t got time for me.’ ‘perhaps more encouragement/time spent with the residents.’ and ‘Staff change regularly so difficult sometimes to know who the key/named worker is.’ However, this may only affect certain parts of the home, as there was a positive comment from a relative who stated that: ‘Nowadays everyone is very caring. The staff stay pretty consistent and there are plenty of them around and they always seem kind and gentle.’ A review of the way staff are deployed and supervise residents must be undertaken to make sure that residents and their representatives feel supported by the service. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 21 Training of staff requires improvement, as training records indicated that this has not been consistent. Training is available for staff, but the records show that some staff have not received training for more than six months and in some cases only three days since October 2004. Particular attention must be paid to making sure that there is good quality dementia care training from an external source, which has expertise in this area. Staff spoken with said they had received four hours training on dementia, which is not satisfactory to enable them to have sufficient knowledge of the condition. Residents cannot be confident that the homes recruitment and disciplinary procedures do not place them at risk of harm. One staff file did not have the required documentation and it was noted that a reference had not been obtained from the previous employer as required in the Regulations. Disciplinary procedures for staff misconduct have not always been followed correctly, one member of staff was found sleeping whilst on duty, but still remains working at the home. However, a member of staff who was underperforming has been given appropriate supervision and objectives set to improve their performance. Nurses who have undertaken a three-month adaptation course with Life Style PLC are employed at the home; care must be taken to make sure that they are competent according to Nursing and Midwifery Council guidance. Three months is a short timeframe for a nurse from another country to be fully coherent in being licensed to practice in the United Kingdom. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a site visit to this service. Training and development of staff is inconsistent and on occasion staff lack visible leadership. A residents/relatives forum has been introduced, but issues raised must be acted upon and the privacy and dignity of residents needs to be respected. The forum should complement a Quality Monitoring system. EVIDENCE: A Residents’ and Relatives Co-ordination Committee has been formed in the home to improve communication and make sure that their views are heard by the management and staff of the home. Meetings are held regularly and minuted. Minutes from a meeting held in February 2006 were examined. These evidenced that staff have been instructed to speak English when addressing residents and the needs of deaf residents were also discussed. There were notes made on ‘toileting of residents ‘ and ‘ getting them ready for Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 23 bed but then to sit in the lounge until later.’ These are not appropriate subjects to be discussed in such a forum, and must be dealt with discreetly with residents and their representatives at care planning reviews, in order that residents own wishes are known and respected. Also, individual residents must not be discussed in these meetings. It is concerning that a ‘troublesome resident’ in one unit was discussed as follows: ‘[the resident] is being given things to do to distract [the resident] from wandering.’ It was noted that action points were made at the meetings, but there was no evidence of follow up. The manager of the home must make sure that he takes responsibility in the home. The inspector is concerned that at Protection of Vulnerable Adult meetings, it has taken time for the manager to accept that there have been errors in the way the staff have responded, for which he is ultimately responsible. Records showed that staff supervision has been planned for the coming year in accordance with the standard. As shown in previous sections residents are not protected from harm due to lack of staff supervision. The environment that residents live in was noted to be free from obstructions, but attention needs to be paid to cleaning routines to make sure that residents are not placed at risk of infection. Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 24 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 12 (2) Requirement The registered person must ensure that prospective residents have enough information to make an informed choice about moving into the home and this information is explained clearly to them. The registered person must ensure that each resident has a statement of terms and conditions. The registered person must ensure that resident assessments are completed fully and the there must be evidence of resident/representative involvement in the process (previous timescales of 30/09/05 and 30/05/06 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 30/09/05 and 30/05/06 not met). The registered person must ensure that care is delivered consistently according to the DS0000060799.V293602.R01.S.doc Timescale for action 30/08/06 2 OP2 5 (1) (b) & (c)& (2) 14 30/08/06 3 OP3 30/08/06 4 OP7 15 30/08/06 5 OP7 15 (1) 30/08/06 Ashmead Care Centre Version 5.1 Page 26 6 OP8 13 (1) (b) 7 8 OP9 OP9 13 (2) 13 (2) 9 OP9 13 (2) 10 OP10 12 (4)(a) 11 12 OP10 OP11 12 (4) (a) 12 (3) 13 OP12 16 (2) (n) 14 15 OP14 OP14 12 (4) (b) 12 (5) (b) 16 OP14 12 (4) (b) care plan. The registered person must ensure that other health professionals are involved in resident care in a timely manner. The registered person must ensure that supplies of medication are maintained. The registered person must investigate why the resident did no receive the correct medication. All medication must be given from an appropriately labelled container. The registered person must ensure that administration of medications is recorded accurately. The registered person must ensure that the privacy and dignity of residents is protected and promoted at all times. (previous timescale of 30/09/05 and 30/05/06 not met) The registered person must ensure that residents are well presented in their appearance. The registered person must ensure that residents’ wishes on death and dying are recorded (previous timescale of 30/09/05 and 30/05/06 not met.). The registered person must ensure that the activities programme is developed in line with resident choice and the coordinator is given appropriate equipment, support and training. The registered person must ensure that residents’ culture is respected and promoted. The registered person must ensure to promote good, effective communication between staff and residents. The registered person must ensure that staff are supported DS0000060799.V293602.R01.S.doc 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 Ashmead Care Centre Version 5.1 Page 27 17 OP15 12 (1) (a) 18 OP15 10 19 OP16 10 20 OP18 10 21 OP18 13 (6) 22 OP18 13 (5) 23 OP18 10 24 25 OP19 OP26 23 (2) (b) 23 (2) (d) 26 OP26 23 (2) (d) to discuss intimate issues with residents, such as death and dying and sexuality, in order that residents retain autonomy. These wishes must be acted upon where necessary. The registered person must ensure that residents have a choice in the meals served and food is presented according to the menu. The registered person must ensure that issues arising from mealtime monitoring are acted upon and outcomes recorded. The registered manager must ensure that they are actively involved in addressing concerns about the home. The registered manager must ensure that there is a proactive approach to Protection of Vulnerable Adults investigations. The registered person must ensure that residents are appropriately supervised at all times. (previous timescale of 30/05/06 not met). The registered person must ensure that residents are handled and moved safely at all times. The registered person must ensure that full and informative reports are produced in response to requests. The registered person must ensure that the standard of décor is maintained. The registered person must ensure that high dusting is undertaken routinely, to prevent spread of infection. The registered person must ensure that communal areas are cleaned thoroughly routinely, in particular carpeting and chairs. DS0000060799.V293602.R01.S.doc 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 Ashmead Care Centre Version 5.1 Page 28 27 28 OP26 OP27 16 (2) (k) 12 (1) 29 OP28 12 (1) 30 OP29 Sch 2 and Sch 4 (6) 31 OP29 19 (1) 32 OP30 18 (1) (c) 33 34 OP30 OP31 18 (1) (c) 9 35 OP33 24 36 OP33 24 The registered person must ensure that the home is free from offensive odours. The registered person must ensure that there is effective deployment of staff within the home, in order that residents do not have to wait unnecessarily for care needs to be met. The registered person must ensure that residents are supported consistently in their care needs by. The registered person must ensure that all staff files contain the information required in the Schedules. (previous timescale of 30/09/05 and 30/05/06 not met) The registered person must ensure that adaptation nurses are recruited appropriately and have the competency and skills to meet residents’ needs. The registered person must ensure that mandatory training is undertaken at least yearly and recorded. The registered person must ensure that training in dementia care is given to staff. The registered manager must be responsible for leading and developing staff, and development of service provision. The registered person must ensure that there is an effective quality monitoring system within the home, which seeks the views of residents and respects their privacy and dignity. The registered person must ensure that action points arising from resident/relatives meetings are acted on and outcomes recorded. DS0000060799.V293602.R01.S.doc 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 Ashmead Care Centre Version 5.1 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashmead Care Centre DS0000060799.V293602.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection SW London Area Office 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 DS0000060799.V293602.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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