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Inspection on 05/09/06 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 5th September 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

All residents had their needs fully assessed prior to being accommodated in the home. Residents said the staff were polite, kind and helpful. They said they were respected by the staff and their dignity was protected. Visitors said they felt very welcome in the home and could visit at any reasonable hour. Resident`s choices and preferences were explored and respected by the staff. They praised the quality and variety of meals served. They said they had plenty of food and their individual likes and dislikes were catered for. Residents and visitors said they could approach any member of staff should they be unhappy about any aspect of life in the home. They felt they would be listened to and their comments acted upon. The home was clean, tidy, airy and free from offensive odours. It had a homely atmosphere with fixtures and fittings being domestic in nature. There was a variety of communal space available for residents, including a safe and accessible well maintained garden. The recruitment procedures and staff training protected the vulnerable adults accommodated. A comprehensive training programme was in place which ensured all staff kept up to date with statutory training and that more specific to the needs of the residents accommodated. A system of reviewing the quality of service and providing continuous improvement was in place.

What has improved since the last inspection?

The records for the administration of medication were accurately kept. The residents were very complimentary about the range and number of activities available in the home. Since the last inspection two activities coordinators had been employed who assisted residents to join in organised group activities and also provided a one to one service, taking residents out to use local amenities. The numbers of care staff had increased which had lead to a change in working practices and the residents and staff said this had improved the care at busy times of the day.

What the care home could do better:

The identification through assessment, recording of needs and the plan of how these are to be met should cover all aspects of care given. The records seen did not provide evidence that staff were meeting all the documented needs of the residents. The number of qualified nurses was insufficient, at certain times of the day, to ensure the resident`s health needs were fully met.

CARE HOMES FOR OLDER PEOPLE Ashmount Residential & Nursing Home 10 Southey Road Worthing West Sussex BN11 3HT Lead Inspector Miss Helen Tomlinson Key Unannounced Inspection 10:10a 5 September 2006 th 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.V308898.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.V308898.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 538500 01903 528502 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.V308898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2005 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. Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived in the home at 9.45am and left at 6.40pm. The manager was unable to be present for the inspection. The person in charge was fully conversant with the day to day running of the home. Forty seven residents were accommodated at the time of the inspection. Prior to the visit to the home information was gathered from previous inspections and information received regarding the service. During the inspection a full tour of the premises took place, the inspector spoke to the residents, staff and visitors. Care practices were observed, care plans examined and other documents seen as necessary throughout the inspection. Following the last inspection seven requirements were made. Three of these remained outstanding and one new one was made. What the service does well: All residents had their needs fully assessed prior to being accommodated in the home. Residents said the staff were polite, kind and helpful. They said they were respected by the staff and their dignity was protected. Visitors said they felt very welcome in the home and could visit at any reasonable hour. Resident’s choices and preferences were explored and respected by the staff. They praised the quality and variety of meals served. They said they had plenty of food and their individual likes and dislikes were catered for. Residents and visitors said they could approach any member of staff should they be unhappy about any aspect of life in the home. They felt they would be listened to and their comments acted upon. The home was clean, tidy, airy and free from offensive odours. It had a homely atmosphere with fixtures and fittings being domestic in nature. There was a variety of communal space available for residents, including a safe and accessible well maintained garden. Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 6 The recruitment procedures and staff training protected the vulnerable adults accommodated. A comprehensive training programme was in place which ensured all staff kept up to date with statutory training and that more specific to the needs of the residents accommodated. A system of reviewing the quality of service and providing continuous improvement was in place. 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. Ashmount Residential & Nursing Home DS0000024106.V308898.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.V308898.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): 3 Residents needs were assessed prior to them being accommodated in the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The files seen contained assessments of the resident’s needs which included all aspects of physical and health care and personal information. The manager confirmed these had been carried out prior to the resident becoming accommodated in the home although they were not signed or dated. Some basic information from one resident’s previous home was included. Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 9 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 and 10 The documentation regarding health and personal care needs and how these were to be met did not evidence that staff were fully meeting these needs. Medication storage, administration and recording safeguarded the residents. Residents said their dignity and privacy was protected and staff treated them with respect. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Five residents files were examined. These varied in the type and amount of information contained. Whilst some had a plan of how staff should meet their assessed needs, others did not. For residents receiving personal care various assessments identified risks and needs. Some contained conflicting information and for many the needs and risks identified had no plan of management or prevention documented. This included residents with poor appetites, reduced eyesight and one who was confused and leaving the building when they had been assessed as unsafe to do so. For those receiving nursing care there was no plan of prevention or management for those at high risk of developing a pressure sore. Other health needs had a plan of care devised from an Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 10 assessment, although some contained scant information. Notes were not kept on a daily basis but staff said they would document anything of significance. Some issues recorded in the notes had no follow up e.g. the development of red and sore areas of skin. The files seen for those residents receiving personal care, did not contain sufficient information for a member of staff to fully understand all the resident’s needs or how they should be met. It was discussed with staff that there had been no improvement in the information documented since the last inspection. The two requirements regarding the quality of recording health and personal care needs and how these are to be met remain outstanding. Nursing care was provided by registered nurses who knew the residents needs and understood how these were to be met. Since the last inspection the use of care charts had been reviewed and was much improved. Other health professionals visited the home to deliver care as needed. The medication for those receiving nursing care was administered by the qualified nurses. For those receiving personal care trained care assistant carried out this role. All medication in the home was safely stored, administered and records were accurately kept. Where hand written changes had been made to a medication administration chart these were not signed, dated or witnessed. Residents spoken with said staff treated them with dignity and respect. They said they were friendly and informal but polite when assisting them. “Do not disturb” signs were used to indicate that personal care was taking place behind closed doors. Staff knocked on doors and waited for an answer before entering. Staff were seen to treat the residents kindly, speaking to them with patience and assisting them without rushing. Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 11 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 Residents said the social activities and pastimes on offer were what they wanted and they enjoyed the wide variety and being able to visit places outside the home. They could have visitors at any time and they received a friendly welcome into the home. Residents could make choices and preferences which were respected. Residents said the meals were good with a varied choice offered and plenty of food available. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service EVIDENCE: The residents spoken with said there were organised activities they could join in if they wished. These included quizzes, watching DVDs with discussions afterwards and bingo. Activities co-ordinators were employed and they were seen to encourage and assist the residents to enjoy the activities on offer. Some residents had been taken to the local shopping centre and cafes, in their wheelchairs, by staff. Monthly outings in the minibus also took place. Others were able to enjoy their own entertainment such as television, radios and reading. Visitors spoken with said they were welcomed into the home at any reasonable time and could visit their relative in the privacy of their own Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 12 bedroom should they wish. They could also take them out of the home if they were able. A visiting minister said he could visit anyone who wished to see him and was invited and welcomed into the home. Residents said the routines of the home were flexible and their choices and preferences were explored and understood. Some of these were written in the care plans. Residents said they enjoyed the meals served, were offered a choice and plenty of varied food was given. The dining room had attractively laid tables and the meal times were sociable with staff assisting residents to enjoy their meals, should they need this. Residents could have their meals in their bedrooms if they wished. Hot and cold drinks were available throughout the day. Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 13 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 Residents were confident their complaints and concerns would be taken seriously and acted upon. Residents were protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: One complaint had been received by the service. The investigation, response to the complainant and actions taken were fully recorded. The complaint had been resolved to the complainant’s satisfaction. Residents and relatives spoken with said they would be happy to approach the manager or any member of staff with a complaint or concern. The complaint procedure was displayed on the notice board in the home. Staff had received training in the protection of vulnerable adults and were aware of their responsibilities to protect residents in their care from abuse. The person in charge, in the absence of the manager, was not fully aware of the agencies to contact should an allegation of abuse be made. They were however aware of the need to safeguard the residents. Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 14 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): 19,22 and 26 The home was clean, tidy and free from offensive odours. Suitable equipment was provided to meet the needs of the residents. Appropriate infection control measures were in place. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The home is a large converted house, with accommodation on three floors. There are three varied communal areas of a large lounge, seating area in the dining room and a conservatory. A well maintained garden, which was safely accessible for residents, was available at the rear of the home. Residents could choose where to sit and these areas were homely with domestic fixtures and fittings. The home was clean, tidy and free from offensive odours. Since the last inspection several devices to safely hold open fire doors had been purchased and were in use. Other fire doors were closed. At the last inspection, which took place in winter, some areas of the home were cold and Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 15 radiators were not working. The person in charge said these had been repaired. It was a warm day at this visit and the home was kept well ventilated. The home was generally well maintained, however the damage to one bedroom wall, which was required to be repaired at the last inspection, remained the same. Moving and handling and other equipment, to safely meet the needs of the residents, was present in the home. Additional equipment had been purchased, since the last inspection, with an increase in nursing beds and electric hoists. Staff had received training in infection control and used protective clothing and appropriate hand washing during the day. Suitable laundry equipment was present in the home. Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 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): Care staff were employed in sufficient number to meet the needs of the residents. The number of qualified nurses was insufficient, at certain times of the day, for those residents with high dependency nursing needs. Staff had received a good amount of training relevant to the job they were doing. The recruitment procedures protected the vulnerable adults accommodated in the home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: For the residents receiving personal care the numbers and skill mix of staff was sufficient to meet their needs. For those requiring nursing care the number of qualified nurses on duty, in relation to the health needs of the residents, was insufficient at times and should be reviewed. The numbers of care assistants to meet the needs of these residents, had been increased since the last inspection. This improved the personal care practices in the home, since two care assistants could work together to assist the more dependant residents. Two staff files were examined and the necessary information, to ensure they were fit to work with vulnerable adults, had been obtained, prior to them starting work. The Guild Care organisation offer a large amount of training to their staff. This includes all statutory training and additional training specific to the resident’s Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 17 needs. Staff were complimentary about the amount and quality of training provided. Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 18 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): 33,35 and 38 It was not possible to assess standard 31, which is pertinent to the registered manager, since she was not available at the time of the inspection. This standard was fully met at the last inspection. The home is managed and run in the best interests of the residents. Quality assurance systems were in place. The personal finances and the health and safety of the residents were protected by the procedures and practices in the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 19 At the time of this inspection the registered manager was unavailable. The person in charge of the home had sufficient knowledge of the management procedures in the home to run it effectively. Staff and residents were complimentary about the manager of the home saying she was approachable and helpful. There were various systems in place to review the quality of care provided to the residents. These included regular audits, by both the manager and higher management from Guild Care. Residents, relatives and professionals were involved in the quality reviews, by completing questionnaires and having opportunities to attend meetings. The registered manager was involved in the reviews of quality of service and provided reports to Guild Care management to present their progress. Residents said they could approach the manager or any staff informally if they were not happy with any aspect of the service provided. The organisation has an accounting system set up on the computer. Records were kept of the individual residents money and receipts were produced. The resident’s personal money was pooled together and some was held in a bank account, in the name of the organisation, until the individual requested it. Following the last inspection further discussion had taken place and the Commission had agreed that safeguards were in place within this system, which, as far as possible, protected the resident’s money. Staff had received training in health and safety. Accident records were kept and an audit carried out. No issues of health and safety were raised during this inspection. Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 15 Requirement The resident’s plan of care must be kept under review. It must reflect the current situation and be drawn up in consultation with the residents. This requirement remains unmet since the last two inspections of 29/6/05 and 17/11/05. The timescale given of 30/08/05 has expired Timescale for action 31/10/06 2. OP8 14(2)(a) The health care needs of the 31/10/06 residents must be met. Any health care assessments must be kept under review. This requirement remains unmet since the last two inspections of 29/6/05 and 17/11/05. The timescale given of 30/08/05 has expired The hole in a bedroom wall must be repaired. All areas of the home must be kept in a good state of repair. This requirement remains unmet since the last two inspections of 29/6/05 and DS0000024106.V308898.R01.S.doc 3. OP19 23(2)(b) 30/09/06 Ashmount Residential & Nursing Home Version 5.2 Page 22 17/11/05. The timescale given of 30/08/05 has expired 4. OP27 18(1)(a) The numbers of qualified nurses on duty must be appropriate to meet the health and welfare needs of the residents. 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Ashmount Residential & Nursing Home DS0000024106.V308898.R01.S.doc Version 5.2 Page 24 - 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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