Inspection on 07/03/06 for Ashmead Care Centre

This inspection was carried out on 7th March 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 31/05/06

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 7th March 2006 10:30 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.V286358.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.V286358.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 Life Style 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.V286358.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. 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.V286358.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken unannounced by two inspectors and lasted a total of nine hours. Mealtimes care documentation and staff files were examined. During the course of the inspection the inspectors spoke with four members of staff, three residents and two visitors. Standards not assessed at the previous inspection and Requirements made were inspected. What the service does well: What has improved since the last inspection? What they could do better: The inspectors found areas of concern and a letter was sent to the provider to put in place an action plan to address the concerns as a matter of priority. The issues related to requirements made at two previous inspections which have not been complied with and observations made on the day of inspection. These concerns relate to residents assessments, care planning, privacy and dignity of residents, residents’ wishes on death and dying, mealtimes and staff attitude. Further information can be found in the body of the report, under the relevant Standards. One other area of concern was the lack of consistent supervision of residents whilst in the communal areas. Staff must ensure the safety of residents at all times. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 6 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 DS0000060799.V286358.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 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 the following standard(s): 3 Residents’ assessments are not completed consistently. The assessments must evidence involvement of the resident or their representative. EVIDENCE: Residents are assessed prior to admission and on admission. The assessments undertaken on admission are not consistently completed and do not always involve the resident or their representative, which places residents at risk of not having their care needs identified. Entries on assessments included remarks such as:’has complete teeth in [the resident’s] mouth’ and ‘pads used’, but with no further information. Recording of continence needs was poor and did not give sufficient evidence to enable adequate interventions. One assessment indicated that the resident had a catheter, but information about the type of catheter was not detailed in the same section. There was some detail on assessments of needs such as sleeping patterns, but this was not consistent. Attention must be paid to ensuring that the structure of assessments allows all available information to be recorded in a systematic manner, which clearly identifies care needs of residents. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 9 Social history and interests of residents was not consistently documented. Examples found whilst inspecting assessments included: ‘likes listening to music, reading newspapers and likes to whistle’ and ‘watching football’. On both these assessments there was no further detail of how these needs could be met. The poor quality of assessments of residents was highlighted in the letter to the provider. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 10 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, 10, and 11 Residents care plans are not completed consistently and do not include specific details of care required and care given. Residents’ wishes on death and dying must be documented. Residents must be treated with respect by staff. The residents’ privacy and dignity must be maintained at all times. EVIDENCE: Residents care needs were not consistently addressed in the care plans and daily records, which does not indicate fully whether care was adequate. There were some examples of detailed care requirements, but this was not always consistent. The care plans contained risk assessments relating to dependency, nutrition and skin integrity. Information provided by these risk assessments was not consistently followed through on to the care plan. For example a Waterlow assessment for skin integrity indicated that there was a broken skin area, but this was not reflected in the care plan or subsequent evaluation. Continence care was not documented accurately with minimal evidence of toileting programmes. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 11 Daily records contained phrases such as ‘ all care needs met’, ‘toileted regularly’, mentally remains confused’ and ‘incontinence care rendered.’ This is not in line with Nursing and Midwifery guidance on maintaining records of care. One resident was noted to have a catheter in situ on admission, but there was no reference to why it had been removed in the care documentation. There was some good evidence of wound care and involvement of other health professionals such as the tissue viability nurse. Residents wishes in relation to death and dying were not consistently documented and did not provide information of any rituals a resident might wish to participate in at the end of their life. Residents were observed at mealtimes, staff did not protect their dignity and privacy. Some residents looked unkempt, with poorly matched and fitting clothes and unbrushed hair. One resident had stains on their top. One resident was in a wheelchair and had only slipper on; their legs were not covered with a blanket. One resident did not have any shoes or socks on and was sat on a chair for their meal and ‘shoved’ towards the table. There are more details of the mealtimes under Standard 15. One visitor spoken with said that they had witnessed staff ‘taunting’ residents and commented that ‘there are more staff in here because you are here.’ Residents apparently ‘are sometimes calling for help but no staff around you have to ring the bell and hope they come.’ These issues were included in the letter to the provider. Medications were not examined at this inspection; a separate visit will be made with the inspecting pharmacist and reported on. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 12 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): 15 Residents are not able to enjoy their meals in an unhurried manner and are not given assistance in an appropriate manner. EVIDENCE: Residents do not have a choice of meals or where to eat. Mealtimes were hurried and were not social occasions. This does not promote choice and control for residents. The chef was approachable and was visible at mealtimes to make sure food was hot and well presented. The chef demonstrated a good knowledge of the residents’ dietary requirements. Lunchtime, afternoon tea and supper were observed on three units. Food served looked nutritious and appetising. At lunchtime on one unit loud modern music was playing throughout the meal. None of the residents were asked what they wanted to eat and there was limited interaction by staff members about whether the meal that had been provided was satisfactory. Some residents were seated in wheelchairs throughout the meal and were unable to reach the table fully. One resident was left seated away from the table and was unable to reach their food, until a member of staff noted this. One resident was called to come to the dining room for lunch by a member of staff, in the same manner that would be employed to call a child, i.e. clapping of hands and shouting the name. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 13 One member of staff sat down to assist a resident with lunch, but staff did not consistently undertake this action. The serving of lunch from commencement to clearing of crockery took no more than forty minutes. The residents had approximately twenty minutes to eat. After the meal had finished staff started to move the residents to the lounge or their rooms, no choice was given in where they were to go. One resident was heard saying ‘I don’t want to go to the lounge’, but was taken there anyway. A member of staff was seen with her hand on her hip saying: ‘alright sweetie let’s go’, whilst waiting impatiently for the resident to finish their drink. The same member of staff asked another resident: ‘why are you taking so long?’. During afternoon tea on one unit, two staff members were not interacting with residents and were watching television. Tea was being served too hot and a nurse had to make sure that it was cooled down. One member of staff who came into the lounge was seen interacting with residents and demonstrated a caring attitude, by asking how they were and giving assistance in an appropriate manner. The residents were left at one point with no staff supervising them in the lounge. At supper on one unit, there was a choice of soup, sandwiches or vol-au-vents. None of the residents was asked what they wished to eat. Sandwiches were seen being put on the table and residents were ‘grabbing’ them, which meant other residents did not have a choice and less food. Plates were not provided for residents to eat their sandwiches off. Ladies in one unit had vol-au vents, but were not offered sandwiches. Staff were noted to be in the kitchen, rather than assisting residents in the dining room. One resident who kept leaving the table was brought back to their chair, without staff asking if the resident required anything. One resident was observed being moved from their wheelchair to a dining chair after a member of staff had originally indicated that the resident should stay in the wheelchair. The resident was not informed of what was happening. There was a choice of tea or coffee with supper, but not all residents were provided with a hot drink. One resident tried to get a refill and was told to sit down; it was a few minutes before staff fulfilled the resident’s requirements. There was encouragement for residents to undertake independent living skills, such as pouring a cup of tea. One member of staff was overheard to say to a resident: ‘[resident’s name] I am here to feed you.’ In a loud voice, which did not protect the resident’s dignity. Condiments were not available at the tables during any mealtimes, although they were present in the kitchens. Staff seemed more intent on getting the task finished, instead of recognising that Ashmead is the residents home and the resident must be able to enjoy a meal in a civilised manner, with an evidenced choice of what they want to eat and this choice reinforced by staff. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 14 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): 18 Staff do not recognise that Ashmead is the residents’ home and their attitude towards residents is poor. EVIDENCE: Since the previous inspection the home have had one Protection of Vulnerable Adults investigation, which was dealt with, adequately by the home. The concerns were not upheld. One issue arising from the investigation was the use of cot sides and consent for their use. This has been addressed by the home and consent forms are now in place. However, much more work is required to make sure that documentation evidences care given to enable investigations to be thorough. Another issue was of communication between agencies and the home who are involved in supporting residents. This was discussed at length and a transfer letter has been implemented and now used if a resident has to leave the home to go to hospital. Staff attitude within the home puts residents at risk of neglect and does not protect the dignity of the residents. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: None of these Standards were assessed at this inspection but were met at the previous inspection. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 16 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): 29 and 30 Residents are not fully protected by the recruitment procedures in place. Residents are supported by staff that have access to relevant training, but this training must be documented as being received. Residents need to be confident that staff are appropriately supervised to perform their role. EVIDENCE: Residents are not always protected from harm by the adherence to the recruitment policies in place. Staff files examined were well organised with a recruitment checklist at the front of the file. The majority of files examined were complete, apart from one or two pieces of information that are required to be held. It was noted that an audit of information missing in files had been done and there were markers to indicate what information was needed. The home needs to make sure that all relevant information is obtained prior to employment, to protect residents from harm. Residents are supported by the home’s training programme. Staff files indicated that training had been made available in continence, supervision, hazardous substances and food hygiene, in addition to statutory training. Staff had signed to indicate that they had attended. The home has a plan in place for supervision of staff. However, it was unclear from the record how many supervision sessions had taken place. Since November 2005 the record indicates that all staff have received at least one supervision session and that twenty-two staff should have received two sessions. This issue was discussed with the manager. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 17 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): 35 The home needs to implement a formal quality assurance process, to make sure that residents or their representatives views are heard and acted upon. EVIDENCE: A quality monitoring exercise is undertaken monthly and covers numbers of admissions and discharges, deaths, complaints, staff sickness and accidents. There is no formal process for gaining residents or their representatives’ views, which does not promote residents interests. This must be implemented as a matter of urgency. The inspectors were concerned that one member of staff when asked whether they enjoyed working at the home, replied ‘not really’, but refused to be drawn further. Staff attitude was discussed during the feedback of the inspection and it was clarified that staff must take ownership of their work and that Ashmead is primarily the residents’ home. This issue was included in the letter to the provider. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 18 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 X X 1 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 1 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 1 X X X Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 19 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 OP3 Regulation 14 Requirement 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 timescale of 30/09/05 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 30/09/05 not met.). The registered person must ensure that record keeping is in line with Nursing and Midwifery Guidance. 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 not met) The registered person must ensure that residents’ wishes on death and dying are recorded (previous timescale of 30/09/05 DS0000060799.V286358.R01.S.doc Timescale for action 30/05/06 2. OP7 15 30/05/06 3. OP7 17(1)(a) Sch 3(3) (k) 12 (4)(a) 30/05/06 4. OP10 30/05/06 5. OP11 12 (3) 30/05/06 Ashmead Care Centre Version 5.1 Page 20 6. 7. OP15 OP15 23 (2) (h) 12 (1) (a) 8. OP18 13 (6) 9. OP29 Sch 2 and Sch 4 (6) 10. OP30 18 (1) (c) 11. OP33 24 12. OP36 18 (2) not met.). The registered person must ensure that residents are seated comfortably for meals. The registered person must ensure that residents are appropriately supervised at meal times and that meals are served in an unhurried manner. Residents must have a choice in the meals served and are given the correct information on the menu for the day. (previous timescale of 30/09/05 not met) The registered person must ensure that residents are appropriately supervised at all times. The registered person must ensure that all staff files contain the information required in the Schedules. (previous timescale of 30/09/05 not met) The registered person must ensure that staff training files are maintained and specific training in maintaining privacy and dignity is given to staff. The registered person must ensure that there is an effective quality monitoring system within the home, which seeks the views of residents. The registered person must ensure that staff are appropriately supervised at regular intervals. . (previous timescale of 30/09/05 not met) 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 21 No. Refer to Standard Good Practice Recommendations Ashmead Care Centre DS0000060799.V286358.R01.S.doc Version 5.1 Page 22 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.V286358.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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