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Inspection on 15/05/07 for Ashmount Residential and Nursing Home

Also see our care home review for Ashmount Residential and Nursing Home for more information

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a good atmosphere in the home, and staff and managers are seen as caring and supportive. People are supported to access the health services they need, and can expect their health needs to be met in the home. People living at Ashmount generally believe they have a lifestyle which suits them, and are able to maintain contact with family and friends, the local community and their faith.People receive meals they enjoy, and have a varied and nutritious diet. All areas of the home visited, including bathrooms, laundry areas and the kitchen were found to be clean, hygienic and odour free. The views of people on how the service can be improved is being listened to and acted upon.

What has improved since the last inspection?

All outstanding requirements were found to have been met. Care plans, health care assessments and risk assessments have been reviewed and updated. Improvements to the premises have included building repair shortfalls identified at the random inspection visit, and the fitting of a radiator guard. There have been improvements to the system for administering medicines, and the handling of residents` money, which have increased safety for residents in these areas. Equipment recently purchased to improve moving and transfers has improved the service for people accommodated.

What the care home could do better:

It is recommended that risk assessments be carried out as part of the assessment of ability for residents who wish to hold and administer their own medicines.

CARE HOMES FOR OLDER PEOPLE Ashmount Residential & Nursing Home 10 Southey Road Worthing West Sussex BN11 3HT Lead Inspector Mr E McLeod Unannounced Inspection 15th May 2007 08:30 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 Ashmount Residential & Nursing Home DS0000024106.V336101.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. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashmount Residential & Nursing Home Address 10 Southey Road Worthing West Sussex BN11 3HT 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) 01903 528500 01903 528502 ashmount@btconnect.com www.guildcare.org Guild Care Miss Alison Lynne Wiles Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2006 Brief Description of the Service: Ashmount is registered to provide personal and nursing care for up to fifty people aged 65yrs and over. It is a large detached property situated in a residential area of the seaside town of Worthing. The sea front and shopping areas are a short walk away. There is a private car park at the front of the home and a garden at the back. Accommodation is provided on 3 floors. A passenger lift allows access to all floors. Large communal sitting and dining areas are available on the ground floor. Fees are between £259 and £460 per week. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was arranged to carry out an assessment of how the service is meeting key national minimum standards for care homes for older people, and to assess progress on previous requirements made. Since the previous key inspection, a random inspection visit was carried out on the 3rd March 2007, and planning for this visit included a consideration of shortfalls identified during the previous key inspection and the random visit. An update on service provision was requested from the provider, and this information was sampled during the inspection visit and has been used in this report. We visited on the 15th May 2007. We spoke with six people living at Ashmount, five members of staff, two visitors, and Ms Wiles the registered manager. Five sets of care plans were sampled, including records relating to risk assessment and the review of care plans. Three sets of staff recruitment records were sampled, which included training records. A breakfast and a lunch were observed, and throughout the visit interactions between staff and people accommodated were observed. Policies and procedures, including those relating to the protection of people being cared for, and health and safety, were sampled. A partial tour of the premises was carried out. What the service does well: There is a good atmosphere in the home, and staff and managers are seen as caring and supportive. People are supported to access the health services they need, and can expect their health needs to be met in the home. People living at Ashmount generally believe they have a lifestyle which suits them, and are able to maintain contact with family and friends, the local community and their faith. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 6 People receive meals they enjoy, and have a varied and nutritious diet. All areas of the home visited, including bathrooms, laundry areas and the kitchen were found to be clean, hygienic and odour free. The views of people on how the service can be improved is being listened to and acted upon. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Ashmount Residential & Nursing Home DS0000024106.V336101.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 Ashmount Residential & Nursing Home DS0000024106.V336101.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Before being admitted to the home, people are receiving an assessment of their needs. People living at Ashmount are being provided with a contract or terms and conditions of residence, which sets out their rights and responsibilities. EVIDENCE: Five sets of admission records were sampled, which indicated that people’s needs are being properly assessed before they are admitted to the home. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 9 The registered manager, Ms Wiles, said that all people living at Ashmount have a contract or terms and conditions of residence, and we sampled copies of these contracts and terms and conditions of residence. Ms Wiles advised that the home is contracted to provide some accommodation for people in need of respite short stays. The home does not provide specialist intermediate care. Ashmount Residential & Nursing Home DS0000024106.V336101.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All care plans and risk assessments have been reviewed and updated, and these set out the health, personal and social care needs that are to be met. People have access to the health care services that they need. Staff are supporting the person’s capacity for self care and independence. Arrangements which are safe for residents are in place for the administration of medicines. People feel they are treated with respect and their right to privacy is upheld. EVIDENCE: Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 11 We looked at five sets of care plans. The filing system for care plans has been improved, and all care plans and risk assessments seen had been reviewed and updated. Care plans seen included information on how the person wished to be cared for, and where possible care plans were being discussed with the person and people had signed to indicate their agreement with the care plan. We case tracked care plans and health care plans for the five persons selected, and found that a consistent approach to meeting people’s care and health care needs was being followed. We interviewed the care supervisor, whose role in monitoring and improving standards of care in the home is being developed as part of the service’s future improvement strategies. Staff interviewed gave examples of how they help people retain privacy and dignity when they are receiving personal care. During the visit, no records were seen or interactions noted which might indicate that people in the home was being discriminated against on the basis of their race, disability, gender, age, religion or sexuality. Arrangements for the setting of pressure mattresses were discussed with the registered manager and nursing staff. Assessments to determine the proper mattress settings are in place. Medicines are administered by registered nurses and senior carers, and staff competency assessments are carried out. Medicines are stored securely and administered separately according to the floor on which the person has their bedroom. Medication records were sampled and discussed with the nurse with responsibility for medicines. Medication records were found to be in order, and the previous requirement in respect of this is now assessed as met. Staff interviewed provided examples of how the person’s capacity for self care and independence is supported. One of the residents interviewed selfmedicates, and another said she holds and administers her own eye drops. The national minimum standards for care homes indicate that people’s wish to hold and administer their own medication should be supported where an assessment of the person’s abilities indicates that this is safe and practical. In the home this has been done by seeking the written agreement of the G.P. for Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 12 this. It has however been recommended that the service also carry out their own risk assessment in respect the self administration of medicines. The most recent pharmacy inspection visit record was seen, and the recommendations from that visit were noted to have been acted upon. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities provided by the service are appropriate to the social, cultural, recreational needs of people accommodated at Ashmount. Staff support people maintaining contact with family, friends, advocates, and the local community. People are helped to exercise choice and control over their lives. People enjoy the food provided, and receive a varied, appealing, wholesome and nutritious diet. EVIDENCE: Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 14 Two activity coordinators are employed, who can provide one to one activity time, shopping trips and theatre trips. One person interviewed said she had greatly enjoyed a recent evening out at a local theatre. The week’s arranged events were displayed on the dining room tables – quiz, a party, bingo, and an outing. People interviewed said they felt generally well cared for, and that the activities provided suited them. On the day of the visit, a quiz was taking place in the morning, and there was a bingo session in the afternoon at which prizes were being won. People said they got up and went to bed at a time of their choosing, and that staff were helpful. A local church visits every Sunday for anyone who wishes a visit, and there is a monthly church service. One visitor said “I like this home. Staff are really kind and considerate, and very polite to visitors”. At breakfast and at lunch people who needed help with eating or cutting food were receiving this. Both meals were taken at a relaxed and unhurried pace, and people were arriving for breakfast at different times. People said they could choose to have breakfast in their room if they wished. We visited the kitchen and spoke with the chef. There are good facilities for the storage of fresh and frozen foods, and clear records are held to ensure that people with specialist diets are being catered for (which includes a separate menu for people requiring soft food). Menus seen indicated that meals are balanced and nutritious, and fresh fruit and vegetables are being served. People interviewed said they enjoyed the food provided, and records of residents’ meetings seen indicated that people were being asked what they would like added to the menu. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A concerns and complaints procedure is in place, and any concerns or complaints made are being investigated and considered fairly. Arrangements are in place, including staff training, to ensure that people living at Ashmount are protected. EVIDENCE: A system in place for people to make known their concerns and complaints and to investigate these. The record of complaints was seen and this indicated that complaints and their investigation are being recorded, and that the response given to the complainant is also recorded. Where incidents or accidents are recorded, a follow up record which assesses the incident and recommends any action to be taken is made. We sampled these records, and found appropriate action was being taken in response to incidents and accidents. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 16 Staff are receiving training in protecting vulnerable adults, and the registered manager and care manager each advised us that they had attended briefing sessions with the local authority on changes to local procedures for protecting adults investigations. Further to concerns at the previous visit concerning records for the handling of residents’ money, no cash is now held for residents. Instead, the service pays for expenses such as chiropody treatments and hairdressing, and then bills the nearest relative on a monthly basis for the amounts paid. This previous requirement is now assessed as met. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises continue to be improved for the comfort and safety of people living there. Communal areas and bedrooms provided meet the needs of people accommodated. The home is clean and hygienic, and free from odours. EVIDENCE: A partial tour of the premises was made with the registered manager. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 18 Recent improvements to the premises include new kitchen equipment, the replacement of soft furnishings in the sitting rooms and conservatory, and some redecoration. The main communal facilities are two sitting rooms, a dining room, a conservatory, and a visitor’s room. New ceiling blinds have been provided in the conservatory. There is a system in place for the continuing maintenance of the premises, and some needs for repairs identified at the previous visit have now been put right – such as the provision of a radiator guard and new wash hand basin. Damage to a bedroom wall noted at the previous visit has now been made good. The requirement in respect of this is now assessed as met. The garden is well maintained and accessible for people living at Ashmount. There are ramps for wheelchair access at the front of the building. To reduce the damage to walls and doors through the use of hoists and wheelchairs bumpers have been introduced. Six bedrooms were visited, one of which had been redecorated and had a new carpet. Bedrooms visited were equipped and furnished to meet the needs of people accommodated, and had been personalised by the resident. The kitchen was found to be clean and orderly, with systems in place to ensure that the appropriate checks and records for food safety and maintenance of kitchen facilities are carried out. The laundry room was found to be clean and orderly, with suitable equipment and arrangements in place. We discussed with the registered manager some areas of the ground floor where damage caused by wheelchairs and hoists had not been recently attended to, and we were advised that this remedial work will be undertaken within the current year. As the provider has ensured similar remedial work in other parts of the building have been attended to, we took the view that the word of the manager on this was good, and no requirement was made. All areas of the home visited were clean, hygienic, and free from odours. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 19 The premises were found to be decorated to a good standard, homely and comfortable. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing numbers and the skill mix of qualified/unqualified staff are appropriate to the assessed needs of people accommodated. People are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. EVIDENCE: There are 41 care staff, 13 of whom have the National Vocational Qualification (NVQ) in care at least at level 2, and a further 11 of whom are presently undertaking this. We have received an annual quality assurance assessment from the provider, which indicates that there is an intention that more staff undertake such qualification training. The service has not needed to employ any agency staff in the past year, which has helped maintain a consistent service for people living there. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 21 A system is in place for the induction training of new staff that meets recommended standards, and induction training records were sampled. Staff training certificates and records which provide an overview of what training has been undertaken by which staff were sampled. These indicated that a full range of training which will assist staff in meeting the needs the residents is being provided. Four sets of staff recruitment records were sampled. These indicated that required references and checks are being obtained before a new member of staff is appointed. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run, and continues to improve the service provided for people living there. The views of people accommodated are sought, and these views contribute to improvements undertaken to the service. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 23 The registered manager for the service, Ms Wiles, is appropriately experienced and qualified, and continues to update her training and skills and to look for new ways to improve the service. Ms Wiles believes that by moving to an office near the entrance on the ground floor this makes her more accessible to residents, their relatives, and other visitors. Meetings for residents have allowed managers to consult with people on the changes in the service they would like to see, and a number of the suggestions made have been implemented. Planned improvements for the service include the refurbishment, redecoration and carpeting of the dining room, and the purchase of more air conditioning in time for the summer months. Comment cards have been introduced to further encourage feedback on the service provided. Staff have made suggestions at staff meetings which have been implemented, such as the use of breakfast trays, and systems to ensure heavy lifting in the home is being shared equally by staff. Further to concerns at the previous visit concerning records for the handling of residents’ money, no cash is now held for residents. Instead, the service pays for expenses such as chiropody treatments and hairdressing, and then bills the nearest relative on a monthly basis for the amounts paid. This requirement is now assessed as met. We sampled health and safety records, including fire safety and monthly environmental safety check records. The provider has advised us of the most recent service checks or tests carried out on equipment and systems in the home. Staff training records and discussions with staff indicated that staff are receiving training in recommended health and safety topics. Staff interviewed gave examples of how the spread of infection is controlled in the home. At the previous visit some fire doors were found to be wedged open. During this visit no fire doors were noted to have been wedged open. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 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 X 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that risk assessments be provided where an assessment of ability for a resident to selfadminister medication has been undertaken. Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Ashmount Residential & Nursing Home DS0000024106.V336101.R01.S.doc Version 5.2 Page 27 - 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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