Inspection on 09/10/06 for Ashmead Care Centre

This inspection was carried out on 9th October 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 31/05/06

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 11:00 9 , 17 and 23 October 2006 th th rd 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.V314923.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 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 ManagerAshmead@lifestylecare.co.uk 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.V314923.R01.S.doc Version 5.2 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. 31st May 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 in the basement. 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.V314923.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken over three days. Two inspectors visited the home on two separate days, with a third inspector on the second day. The inspecting pharmacist visited on one day. Residents care documentation, staff records and training files were examined. Surveys were sent to thirty-one residents and thirty-one relatives, and thirtyone members of staff. Eighteen resident surveys, fifteen relative surveys and fifteen staff surveys were returned. Comments from these have been included throughout the report. Minutes of staff and relative/resident meetings, duty rotas and pre inspection information were examined. Discussions took place with social workers, visitors, residents and staff. The site visit by the three inspectors lasted a total of twenty-five and a quarter inspector hours. Fees range from £581-44 to £750-00 per week dependent on needs and funding. What the service does well: What has improved since the last inspection? Handling and administration of medications has shown greater improvement since the previous inspection however requirements have been made in relation to this. There is some evidence of improvement in care planning and staff spoken with at the time of inspection showed more awareness of resident centred care. Food provided is of good quality and well presented. However, further work is required to make sure that ‘finger foods’ are available and mealtimes are pleasant and enjoyable for residents. All staff need to monitor meal times and consideration is given to ‘protecting’ these times, to make sure that the event is resident focussed. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 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.V314923.R01.S.doc Version 5.2 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): 1, 2, 3 and 5 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. The admission of residents is process driven and there is little consideration of the skills, ability or knowledge that staff will be caring for them. Some prospective residents may feel pressurised to make a quick decision rather than receive a thorough assessment of individual need. EVIDENCE: Residents are generally given a contract on arrival which details their terms and conditions. 16.67 of residents who responded to surveys indicated that they had not received a contract. 5.5 of respondents did not know whether a contract had been issued. The majority of residents, 86 of those surveyed, thought that they had received enough information about Ashmead prior to moving in. Comments from 16.5 of surveys suggested that there had not been sufficient information gained prior to moving into Ashmead. For example: ‘Placed here by social services as an emergency measure.’ ‘After [the resident’s] recovery Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 9 from a stroke we were told by the hospital that she would be moved to the home. I managed to make a preliminary visit prior to [the resident] being taken there.’ Residents and their relatives are able to visit the home before moving in. This was supported by comments on surveys: ‘I visited the home prior to [the resident] moving in.’ and ‘I visited it and received a brochure. The home had just opened.’ Assessments of residents are done before and on admission to Ashmead Care Centre. There is a lack of consistency across the units in completing assessments fully. Incomplete information on residents’ assessments could put them at risk of not having needs identified. Residents were asked about their preferences for male or female carers, but this was not always respected: ‘wants a male carer- but to have female as well.’ Assessments contained limited phrases such as: ‘can feed herself’, ‘can do some crosswords’, and ’she is able to feed himself’ One assessment had ‘two step children, close links with family’, and ‘had three step children’ later in the same assessment. This does not make sure that staff have correct information about important aspects of residents’ lives. One resident was assessed, as not being able to communicate in English, yet further in their care documentation we found an entry stating there were no issues. We found the structure of the assessments provides good guidance for information to be obtained. However, as staff do not fully complete all sections, then valuable information on how residents wish to be care for is not documented. There was very little information in care documentation on social needs and life history. Information was available in the pre admission care management and health professional assessments but had not been added to the assessments or care plans. Involvement of resident or their representatives in the assessment process was inconsistent, in all units. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 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, 9, 10 and 11 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. Although improvement has been made in the auditing, ordering and recording of medication administration significant errors were found in giving medication that were not discovered and could have had an effect on the health and welfare of residents. Residents care plans are poorly developed and may be out of date. They are written by care staff and professionals and do not include the residents contribution or active involvement. There is evidence that staff in the home treat residents in a way, which does not respect their privacy and dignity. EVIDENCE: Lack of consistency in the units leads to these Standards not being met. We found reasonably good guidance in place but question if staff follow guidance available (see below). 100 of the survey respondents indicated that their needs were at least usually met, but there are concerns about staff interactions. ‘ I sometimes find Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 11 some staff not very sensitive to some issues, this does surprise me and usually I do comment at the time.’ Issues regarding poor manual handling have been made known to CSCI. Examples were observed on the site visits. Please see under Health and Safety section for further details. Staff have started to document the religious needs of residents, but more improvement is needed. For example, the home has persons who are Christian, Buddhist and Jewish, but the only information available was on a general printed sheet in their care documentation, details were noted to be brief. A resident with terminal diagnosis, who had specific religious needs, had no information about their personal wishes. The resident has not been asked whether they were aware of their prognosis or if they wished to discuss end of life care. Entries on care documentation relating to end of life care and residents wishes tended to be limited to ‘inform family’. This does not enable residents to make choices and ensure that their wishes will be respected. Communication needs of residents are not consistently addressed. We were concerned that choice was not always evident at meal times. (See under Daily Life and Social Activities for examples). We are concerned that persons who have dementia and may exhibit challenging behaviour may not be appropriately supported. Care documentation detailed statements such as: ‘If [the resident] becomes aggressive, do not argue with her but calm.’ ‘Orientate …. to time,… surroundings.’ ‘[the resident] is able to communicate but [they] are very negative and demanding due to [their] confusional state.’ Residents’ continence and personal hygiene needs were not fully detailed in care documentation. On all care plans sampled residents were ‘offered a daily wash and weekly bath as required.’ Continence plans did not consistently evidence details of maintaining residents’ independence and adequate programme to promote continence. Specific details for the amount of fluid to be consumed were not available. There must be good evidence of fluid intake and output, if staff are required to monitor this. This does not evidence individualised holistic care. Daily records need to include actions taken by staff. One entry stated complaining of pain left leg swollen …but the record did not state what action staff had taken. There was a lack on information on whether residents had received a bath or shower. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 12 Wound care records could be improved by the purchase of a digital wound care camera, to make sure staff are able to record wound condition accurately. Overall, care plans should include more details of the exact care and how it should be provided. Also cultural needs must be included. Two of the files examined were about residents who are not originally from England. Language and culture could become an issue as their dementia deteriorates. However the nurse was aware of both residents’ religion and background but no special requirements had been noted. Daily records should detail visitors and activities. The person providing care must write daily records. Entries were being made by nursing staff who did not evidence well, what carers had done. Care plans must be used as a working document. The inspecting pharmacist examined medications on 23rd October 2006, his report is detailed below. All the current records relating to receipt, storage, administration and disposal of medication were examined on a sample of units. The person in charge of each unit was interviewed and the administration of medication on one unit observed. A sample of the current medication in stock was counted and compared to the current records and to the amount that should be in stock. Only trained nursing staff administer medication. All medication was stored securely and under the correct conditions. Most medication is supplied in a monitored dosage container enabling staff to see if medication is given correctly. The amount of each medication in stock is recorded on a daily basis on the administration record and the amount of medication carried over from one month to the next is recorded for all items not in the monitored dosage system. This enables a good audit trail for the use of all medication. No residents had missing entries on the current administration record and changes to medication were clearly identified. The records clearly show any reason why medication has not been given to a resident at a particular time and this includes if a resident does not wish to have their medication. Two residents had not been given the correct dose of medication for a considerable period of time. This could have a significant impact on the health and welfare of these people. One other resident had the wrong dose of medication on two occasions in the last month. The doses were checked on the day and the correct dose to be given was confirmed. These had not been picked up as part of the routine audit process. A new audit tool is to be introduced that will help identify these issues in the future. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 13 None of the residents looked at had gone without medication because it had been out of stock. This was a major concern on the last inspection. All medication is disposed of appropriately and is recorded accurately. In instances where large amounts of medication are deposed of the reason for disposal is not recorded. In all instances staff explained that there was a genuine reason for these amounts. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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 is poor. This judgement has been made using available evidence including a visit to this service. Routines in the home are rigid and staff are not prepared to change their way of working to meet residents individual choices and wishes. Residents are not routinely consulted on individualised activities. Little consideration is given to supporting their faith needs or social preferences. Residents’ wishes to develop or maintain personal relationships with privacy for intimate contact is not respected. Residents do not have a choice of hot or cold drinks. Food served is of good quality, but improvement is required in meeting the needs of persons with dementia. Mealtimes are chaotic and disorganised. EVIDENCE: Residents’ mealtimes were observed on both site visits. We inspected both lunchtime and the evening meal. Some improvements had been noted in presentation of the dining areas and food, but require further improvement to make sure that residents can have a relaxed meal. Lunchtime in one of the units was observed and the overall organisation was chaotic. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 15 Staff were observed to be trying to attempt many tasks at the same time, such as medications, assisting residents with meals and checking residents not in the dining area. Staff must make sure that mealtimes are protected and clinical tasks are timed not to interfere with ensuring that residents receive proper nutrition. Residents were not consistently asked what beverage they would prefer with their meal, and all were given orange squash. A resident commented that they only had ‘cold drinks in the morning.’ (this occurred during the period just prior to lunch, when an inspector was offered a hot drink, but the residents were not.) When the staff were assisting residents to go to the dining room, on this unit, comments by staff such as: ‘Start sitting them in the dining room’ and Yes, take them in now.’ This suggests that residents are not respected for being individuals. Condiments and paper serviettes were available, however residents still had ‘bibs’ put on them, this practice is degrading to an adult person. Residents were left unsupervised during the meal whilst staff left the room to attend to other tasks. The home must make sure that residents are appropriately supervised at all times. We were concerned when this occurred as one resident was restless and was standing and could have fallen. At suppertime on another unit, staff were heard to ask residents in an abrupt manner if they wanted something to drink. Again no choice was offered. During this meal the television was switched off and the radio put on, but none of the residents were asked if this was their preference. One incident occurred when a resident requested a cup of tea for another resident. The member of staff to whom this request was made was reluctant to fulfil the request. Residents were told they were ‘going for supper’, prior to being assisted badly to move. (See under Health and Safety for further issues relating to moving and handling.) Residents were noted to be sitting for ten minutes prior to the meal being served. Some people were in wheelchairs, it was not clear whether this was their choice. One resident at the end of the meal requested coffee, but was given tea. A carer noted this error and changed the drink. One member of staff was seen on two occasions standing over a resident, with their hands on the edge of the resident’s chair. This looked overbearing and the resident did not appear comfortable with this invasion of their personal space. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 16 Delays were observed in assisting residents when meals had been served, which meant hot food was cold by the time staff were able to help residents. On another unit when supper was served only one person was taking their meal in the dining room. Staff said that most people take their meals in their room. This issue should be looked at, as the home needs to know why residents do not wish to eat in the dining area. Staff were seen to serve meals in rooms. Improvement the presentation of meals on trays is needed, it was noted that there were no condiments or tray cloth. The majority of residents spoken to liked the food, one person said: “too much food at times but that is better than too little”. Staff on this unit were seen to assist in considerate manner. One off duty member of staff had come in to help. This was their own choice. One resident said she did not like the food; it was not what she would normally eat. This was discussed during feedback to the management team. At lunchtime on one unit most of the residents were using the dining room. A large percentage of residents ate their meal in a wheelchair. This was discussed with the senior on duty; no evidence was available to indicate if this was the residents’ choice. Staff were observed to give everyone a bib. A member of staff stated that napkins they were provided with were not in keeping with the décor and they had ordered new ones. This indicates that some staff are aware of the need to take care over presentation. A social worker visiting one resident said everything was fine, but the resident felt quite isolated in their room. The home must support residents to make sure they have opportunities to socialise and take part in meaningful activities. Residents who choose to smoke are not supported; care is not taken to make sure that there are cigarettes available. Suppertime on another unit was observed. All residents were seated in the dining room. Tables were well presented with tablecloths, serviettes, salt and pepper. One table did not have a tablecloth or condiments as the resident tended to pull this off and it could cause an accident. Staff also stated that it reduces conflict between the resident and the staff, as they do not have to ask the resident to leave the cloth alone. It was not possible to verify whether the resident was happy with this decision. Six residents were noted to be seated in wheelchairs for their meal, again there was no evidence to support if this was the residents choice. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 17 The meal served reflected the menu written on the board in the dining room. Everyone got offered a cup of tea at the beginning of the meal and salt and pepper pots were on the table. The sugar bowls were moved off tables once the tea was poured. Food was served nicely to individuals on a tray with soup to begin with and then a sandwich. A choice of quiche or vol-u-vent was also available. On another unit staff were uncoordinated with serving the meals and making sure that residents were supported. At one point three residents were shouting or hitting out at the person next to them, as a result two of the residents were moved to another table. Mealtimes were discussed with the nurse in charge of the unit and the need for the staff team to review how meals can be relaxed and socialable. A review is required of the types of food provided. As the home has a high number of persons with dementia there must be the provision of ‘finger foods’ that enable residents to maintain independence and wander if they chose. One issue that arose was of maintaining contact with significant others. A married couple had been accommodated in separate units, as had two sisters. The nurse in charge of the unit was unable to explain why this had occurred. Activities have shown some improvement, but there needs to be a focus on the individual. Records of activities undertaken must be kept with the residents care documentation, to make sure that activities are provided in line with the residents’ choice. All staff need to be involved in providing activities. It was noticeable on one unit that staff only started to interact with residents when an inspector was in the lounge. The activities programme was well displayed throughout the home, but staff need to make sure that residents are reminded what is on offer. Staff were observed sitting in the lounge with residents. The residents were seated around two walls, the staff sat facing them. The staff looked like they were on guard. There was some positive interaction taking place. One of the ancillary staff was talking to a resident in their first language. Again the inspector on this unit thought that some of the interaction was for their benefit, as staff came from outside the lounge to offer books and magazines. This was not happening when the inspector first went in the room. We have general concerns that staff do not have knowledge of the individuals they care for. Staff, in particular qualified staff must get more involved in what is going on for residents. There was a lack of empathy with residents e.g. nurse laughing when an inspector said someone, who had just returned Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 18 from Chemotherapy, had had a hard day. The home must to improve communication with families. The inspector spent more time reassuring this resident’s relative than the member of staff did. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 19 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 is poor. This judgement has been made using available evidence including a visit to this service. The service has a weak complaints procedure, due to the policy not being adhered to. There is little evidence of the service being open and proactive in the area of protection. EVIDENCE: The complaints procedure is on display in the home but it is not particularly accessible to residents, the small typed print document, needs to be more accessible to all residents. We are concerned that there have been a significant number of Protection of Vulnerable Adults investigations at Ashmead, which have not been handled proactively. Minutes of meetings and the management attitude do not give the reassurance that these matters are dealt with effectively. Minutes imply that staff are aware of abuse occurring, but where concerned about naming suspects. We are extremely concerned that residents are not being protected from harm and all staff at Ashmead are failing to take responsibility for protecting residents. There must be an open and transparent manner of dealing with allegations or known abuse. All staff have a responsibility to report bad practice and make sure that residents are safe. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 20 The management team must enable to staff to make sure that they are confident that their concerns will be heard and acted upon. The home has also had a serious outbreak of an infectious disease, possibly linked to poor practice. The investigation in ongoing and is being lead by the Health Protection Agency. The disease has affected current residents and previous residents, as well as some staff members. Although training in infection control has been given, as a result of this outbreak, it is clear that this has not been implemented. One member of staff was seen cutting fingernails of one of the residents. The member of staff said ‘tissue was used to clean them [the nail clippers] after’. Another member of staff commented that normally residents had their nails soaked and brushed before being cut. When ask why this had not occurred on this occasion they were unable to give a reason why. There was no evidence available to indicate that the equipment was cleaned between each resident. It was observed that one resident had their nails cut, directly after another one. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 21 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, 24 and 26 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. The service provides a homely environment. Residents can personalise their rooms, but need to be encouraged to do this. The home is generally clean and tidy. EVIDENCE: The home was purpose built; it is separated into six units, each with a dining room, lounge, bathrooms, shower rooms and toilets on each unit. Bedrooms are single with ensuite toilet and wash hand basin. Some bedrooms have been personalised with residents’ pictures, photographs and ornaments, with other bedrooms more stark, it was not evident that this was the residents’ choice. The extractor fans in two ensuites were not working and the fan in one ensuite needed cleaning. This task should be added to cleaning schedule and a regular check devised for extractor fans. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 22 Surveys sent to relatives and residents all stated that the home is generally clean and tidy. There have been issues with unpleasant odours, but these have been quickly dealt with. Minutes of meetings indicate that chairs and carpets are cleaned regularly, but there are problems with the material that makes staining difficult to remove. Plans are in place to replace these items. On the site visits the home was clean and tidy. Bathrooms and equipment was noted to be clean. There is adequate provision of pedal operated bins and clinical waste bins. It was noted in the kitchens on two units that food had not been covered or labelled. Food must be handled correctly to make sure that residents are protected from harm. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 23 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 is poor. This judgement has been made using available evidence including a visit to this service. The service does not support or encourage the development of a competent staff team in key areas. Training provided is not always targeted appropriately and implemented when undertaken. Staff are task orientated and not resident focussed. EVIDENCE: Staff levels seen to be appropriate to meet residents needs. However, we are concerned that staff are task orientated rather than resident focussed. Evidence detailed in Health and Personal care and Daily Life and Social Activities sections indicate that meeting of residents needs tends to be for the benefit of staff rather than residents. Residents need to be confident that they are supported by staff that are aware of how to meet their needs in a holistic individualised way. The published rotas identified adequate numbers of staff on each unit and ancillary staff. However, we are concerned that units are left short staffed when training occurs. A random sample was examined from training records provided. It was noted that four people had undertaken infection control training on the same day, but there was no time noted for when this training had occurred. Two of the members of staff were scheduled to work in the morning and two in the afternoon. It can be assumed from this that the units are left short staffed. The home must make sure that units are covered with Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 24 the prescribed number of staff at all times. Provision must be made for training to occur at suitable times. Times of training sessions must be recorded, along with evidence that staff had attended. Records do not show evidence of staff attendance, as the records are computerised and staff have not signed to say they have attended. Two members of staff had received training on days that the rota indicated that they were not working. If training occurs on a workers scheduled day off, this must be noted on the duty rota. One social worker informed us that they had concerns that whilst reviews of residents were being carried out, the named nurse had to continually leave to attend to other residents. The social worker appreciates that reviews can take time, but was concerned about the apparent lack of staff and organisation of the units. Examination of training records provided showed that staff need to have regular mandatory training. The majority of staff have received manual handling training and infection control training. However, the requirement was for all staff to receive this training. It was noted that a high proportion of kitchen staff have not received food handling training. Fire training has been carried out, but not twice yearly as required. There was no evidence that staff had recently received Protection of Vulnerable Adult training and training in Death and Dying. Control of Substances Hazardous to Health (COSHH) training needs to be updated for all staff members. One nurse, one day care staff and two night care staff have completed the sixweek dementia and Alzheimer’s course. The nurse reported that this training was very valuable. However, the majority of staff have not received training in dementia care, which is concerning as a high proportion of residents have this condition. Dementia training must be given to both care and non-care staff, to make sure that resident needs are met. A resident and their visitor commented that they felt that staff did not have a good understanding of communication with people with hearing difficulties. This was observed, senior staff on the unit were seen to try to communicate with a resident without facing the person and using a loud high-pitched tone. All staff must be provided with training on effective communication. Requirements relating to staff files have been met. Examination of a sample of files showed that relevant checks and information was in place. The home must make sure that the full employment history of staff is explored as required by the amendments to the regulations. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 25 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 and 38 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. Training, development and supervision of staff is inconsistent and staff lack leadership. Residents’ interests are not safeguarded as evidenced by poor record keeping. The home is drifting and lacks purpose and direction. EVIDENCE: We are concerned that although the residents and relatives surveys do not raise any issues regarding the management of the home, negative quotes appeared on staff surveys, concerning the attitude of the manager, ideas from staff not being listened to and staff not being treated on a professional manner. Residents and staff must be supported by suitable management practices and enabled to express concerns or ideas in an open fashion. They must be able to contribute to the running of the home. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 26 There is a relative/resident committee, but examination of the minutes raises concerns that issues which are not appropriate for the forum are being discussed, such as staff behaviour. Care must be taken that this forum does not replace the responsibility of the management team for the running of Ashmead. The structure and content of this forum must be reviewed to make sure that it focuses on issues that are relevant. We have concerns about poor manual handling practices. Evidence from POVA meetings, social workers and observation by inspectors’ leads to this conclusion. Two inspectors saw a resident using a Zimmer frame; a member of staff was seen pulling the frame along from the front. The deputy manager who did not intervene also witnessed this. Residents were seen to be pulled underneath their arms to move them from one chair to another. Staff when they did use the correct equipment failed to inform the resident of what was happening. Residents need to be confident that they are not put at risk when needing assistance with moving. Bad practice must be stopped. A social worker raised concerns about residents who have limited mobility, not being able to maintain independence. Staff tend to leave residents in bed and do not actively encourage them to mobilise short distances such as to the toilet. There is no evidence of passive limbs exercises being carried out to prevent muscle wastage, which compounds the issue. Staff do not demonstrate professional awareness when dealing with emergency situations. Review of Regulation 37 notifications shows that on occasion the on call doctor is faxed with information, rather than a telephone call being made. Also, persons who are nearing the end of their lives are taken into hospital, as there is a lack of information on their wishes and some conditions should be able to be managed at the home, to make sure that death is dignified. We are concerned that staff do not have an awareness of how wounds or injuries are caused. A request was made for care plans relating to persons who had wounds or pressure sores, but the nurse did not immediately provide information on one resident who had a large bruise and a dressing on their face. Contracts are in place for monitoring and checking of equipment used in the home. However, there was no indication whether identified faults had been remedied. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 27 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 3 3 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 1 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 X X X X 2 X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X X X 1 Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 28 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 timescales of 30/09/05, 30/05/06 and 30/05/06 not met). The registered person must ensure that assessments of residents include specific details on continence care, social history, life history and communication needs. The registered person must evidence that the resident or their representative is involved in the assessment process. The registered person must ensure that special food and fluid requirements are detailed in care plans and this is evidence as being given. The registered person must evidence that there are clear directions for continence care. The registered person must DS0000060799.V314923.R01.S.doc Timescale for action 30/01/07 2 OP3 12 (1) (a) 30/01/07 3 OP3 12 (3) 30/01/07 4 OP7 17 (1) (a) & Sch 3 (m) 17 (1) (a) & Sch 3 (m) 15 30/01/07 5 6 OP7 OP7 30/01/07 30/01/07 Page 29 Ashmead Care Centre Version 5.2 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, 30/05/06 and 30/08/06 not met). 7 OP7 12 (3) The registered person must evidence that residents or their representatives are involved in the care planning process. The registered person must ensure that all medication is given as directed unless a clear reason for not giving it is recorded The registered person must ensure that residents are well presented in their appearance. (previous timescale of 30/08/06) The registered person must ensure that staff are competent in dealing with challenging behaviour and have a good understanding of specific needs of persons with dementia. The registered person must ensure that staff proactively communicate with residents and have an understanding of different communication needs. 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, 30/05/06 and 30/08/06 not met) The registered person must ensure that religious needs of residents are recorded and acted upon. The registered person must ensure that staff are professional towards residents. The registered person must ensure that residents’ wishes on death and dying are recorded DS0000060799.V314923.R01.S.doc 30/01/07 8 OP9 13 (2) 30/01/07 9 OP10 12 (4) (a) 30/01/07 10 OP10 18 (1)(c) 30/01/07 11 OP10 12 (5) (b) 30/01/07 12 OP10 12 (4) (a) 30/01/07 13 OP10 12 (4) (b) 30/01/07 14 15 OP10 OP11 12 (5) (a) 12 (3) 30/01/07 30/01/07 Ashmead Care Centre Version 5.2 Page 30 (previous timescale of 30/09/05, 30/05/06 and 30/08/06 not met.). 16 17 OP12 OP12 16 (2) (n) 16 (2) (m) & (n) The registered person must ensure that all staff are involved in the provision of activities. The registered person must ensure that activities are developed to ensure that all residents benefit and have individual time. . Residents who tend to stay in their rooms must be provided with choices about how to spend their day and be supported in this. The registered person must ensure that residents are able to maintain relationships with significant others and this is evidenced. The registered person must ensure that staff are supported 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. (previous timescale of 30/08/06 not met) 30/01/07 30/01/07 18 OP12 16 (2) (m) & (n) 30/01/07 19 OP13 16 (2) (m) 30/01/07 20 OP14 12 (4) (b) 30/01/07 21 OP14 12 (1) (a) 22 OP14 12 (2) 23 24 OP14 OP14 16 (2) (i) 12 (3) The registered person must 30/01/07 ensure that residents are enabled to use the dinning facilities, if they wish and are not isolated in their rooms at mealtimes. The registered person must 30/01/07 ensure that residents who smoke cigarettes are not deprived of this and must make suitable arrangements to ensure that a supply is available. The registered person must 30/01/07 ensure that appropriate foods are provided for all residents. The registered person must 30/01/07 DS0000060799.V314923.R01.S.doc Version 5.2 Page 31 Ashmead Care Centre 25 OP14 26 OP15 27 OP15 28 OP15 29 OP15 30 31 OP15 OP15 32 OP16 33 OP16 34 OP18 OP16 ensure that residents are not seated in wheelchairs for meals, unless this is evidenced as their choice. 12 (4) (b) The registered person must ensure that residents’ culture is respected and promoted. (previous timescale of 30/08/06 not met) 12 (1) (a) The registered person must ensure that mealtimes are a sociable, enjoyable and wellorganised occasion. 12 (1) (b) The registered person must ensure that residents are given suitable assistance at mealtimes in a timely manner. 12 (1) (b) The registered person must ensure that all staff are actively involved in making sure that nutritional needs of residents are met. 16 (2) (i) The registered person must ensure that a choice of hot or cold beverages are available at all times. 12 (1) (a) The registered person must ensure that meals are presented on trays in an attractive manner. 12 (1) (a) The registered person must ensure that residents have a choice in the meals served and food is presented according to the menu. (previous timescale of 30/08/06 not met) 22 (2) The registered person must &(5) & (6) ensure that complaints policy is available in different formats to meet the needs of residents. 22 (3) & The registered person must (4) ensure that complainants receive appropriate formal responses and a check is made to make sure that the complainant is satisfied with the outcomes and actions. 13 (6) The registered person, the registered manager and the staff DS0000060799.V314923.R01.S.doc 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 Page 32 Ashmead Care Centre Version 5.2 35 OP18 10 36 OP18 13 (5) 37 OP18 10 38 OP18 10 39 OP18 10 (1) 40 41 OP19 OP26 23 (2) (c) 13 (4) (c) 42 OP27 12 (1) 43 44 OP27 OP27 12 (1) 12 (1) team must ensure that complaints and Adult Protection investigations are dealt with in an open and proactive way. The registered person must ensure that full and informative reports are produced in response to requests.(previous timescale of 30/08/06 not met) The registered person must ensure that residents are handled and moved safely at all times.(previous timescale of 30/08/06 not met) The registered person must ensure that staff are able to express their concerns regarding possible abuse of residents. The registered person must ensure that reports required by the CSCI contain all relevant information. The registered person must ensure that when training has been implemented in response to an incident this training is put into practice and staff are reminded routinely. The registered person must ensure that extractor fans are routinely cleaned and checked. The registered person must ensure that food is correctly stored and labelled in accordance with guidance. 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.(previous timescale of 30/08/06 not met) The registered person must ensure that routines in the home are residents focused. The registered person must ensure that adequate time is DS0000060799.V314923.R01.S.doc 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 Page 33 Ashmead Care Centre Version 5.2 45 OP29 17 (2) & Sch 4 (f) 46 OP30 18 (1) (c) 47 OP30 18 (1) (c) 48 OP30 18 (1) (c) 49 OP30 18 (1) (c) 50 OP31 9 51 OP31 12 (5) (a) 52 OP32 12 (5) (a) 53 OP33 12 (3) 54 OP38 13 (5) made available for reviews of residents without interruptions. The registered person must ensure that there is a full employment history on each member of staff and any gaps are explored. The registered person must ensure that mandatory training is undertaken at least yearly and recorded.(previous timescale of 30/08/06 not met) The registered person must ensure that training in dementia care is given to staff. (previous timescale of 30/08/06 not met) The registered person must ensure that all staff received training on fire awareness at least twice a year. The registered person must ensure that training is planned for all staff on POVA, food hygiene, COSHH and communication. The registered manager must be responsible for leading and developing staff, and development of service provision.(previous timescale of 30/08/06) The registered person must ensure that the management of the home is professional and is responsive and enabling to staff. The registered person must ensure that the management of the home is open and transparent and is proactive in response to ideas from others. The registered person must ensure that a review is undertaken on the focus of relative/resident meetings held within the home. The registered person must ensure that manual handling training is given to all staff at DS0000060799.V314923.R01.S.doc 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 30/01/07 Ashmead Care Centre Version 5.2 Page 34 55 OP38 13 (6) 56 OP38 23 (2) (c) 57 OP38 12 (1) (a) & (b) least yearly and put into practice. The registered person must ensure that residents are given opportunities to mobilise and exercises given to prevent muscle wastage. The registered person must ensure that equipment identified as requiring remedial action is repaired in a timely manner. The registered person must ensure that all staff act in a professional manner when taking decisions regarding residents care and Regulation 37 notifications reflect this. 30/01/07 30/01/07 30/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that the reason for disposal of medication be recorded for large amounts of medication. Ashmead Care Centre DS0000060799.V314923.R01.S.doc Version 5.2 Page 35 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. 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