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Inspection on 15/10/07 for Ashridge Court Nursing Centre

Also see our care home review for Ashridge Court Nursing Centre for more information

This inspection was carried out on 15th October 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 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

Ashridge Court Nursing Centre is a large well-maintained care home, which provides a high standard of care to residents. The home has a high standard of cleanliness throughout which is supported with good infection control practice. The home provides varied recreational activities and takes into account individual cultural preferences, including a well balanced diet that was said to be excellent by a number of residents. The home has a suitable staff team with the necessary skills and experience to the meet the needs of current residents.All residents and relatives spoken with during the inspection were very complimentary of the services and facilities of the home. Comments included `the staff are charming helpful friendly and efficient. They will do anything for me` `It is a great relief to me that my mother is in this home she is safe and looked after well`. Resident`s benefit from a well managed service, which works with other health care professionals to maintain a multidisciplinary approach to care.

What has improved since the last inspection?

Since the last inspection the home has completed an extension and commissioned 12 new rooms. This has increased the size of the home and improved the overall facilities. The registered manager confirmed that the focus of the home has been in ensuring that this increase has been progressed smoothly and this has been well managed. The registered manager confirmed that she was working on developing working systems throughout the home to support the homes practice and development.

What the care home could do better:

The home needs to ensure that all the necessary information required as part of the statement of purpose and service users guide is readily available to all interested parties. This will ensure people are fully informed about the services and facilities that the home provides and what the costs are involved. Although pre-admission assessments are completed the manager needs to ensure that this reflects where and when it is completed and records the multidisciplinary approach that is used. She also needs to ensure that the letter sent out to confirm an admission is appropriate and the terms and conditions of residency refer to the assessment completed. The care documentation would benefit from a more person centred approach with individual risk assessments being completed and reflected within the plan of care. The storage of oxygen must always be safe and individual guidelines for `as required` medicines will ensure these are given in a consistent and wellmonitored way. An improved way of recording concerns would improve the monitoring and auditing of these. The use of a training matrix would improve record keeping. The system for monitoring quality in the home that focuses on resident`s views can be further improved with clear procedures that establish the systems and ways of sharing the information.The home needs to ensure they keep a recent photograph of each resident as required.

CARE HOMES FOR OLDER PEOPLE Ashridge Court Nursing Centre 163 Barnhorn Road Bexhill On Sea East Sussex TN39 4QL Lead Inspector Melanie Freeman Unannounced Inspection 15th October 2007 09:30 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 Ashridge Court Nursing Centre DS0000013956.V351905.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. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashridge Court Nursing Centre Address 163 Barnhorn Road Bexhill On Sea East Sussex TN39 4QL 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) 01424-842357 01424 848570 info@ashridgecourt.com Ashridge Court Limited Mrs Elizabeth Teresa Van Eugen Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53), Physical disability (53) of places Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th April 2006 Brief Description of the Service: Ashridge Court is located on the main road between Eastbourne and Bexhill, approximately half a mile from Little Common Village. Local amenities are accessible by public transport. Ample parking is available at the front of the property. The home is situated in well-maintained gardens that have extensive views to the rear of the property overlooking a large pond. The home is accommodated over three floors, which are accessible by a passenger shaft lift. The home comprises of 51 single bedrooms, 50 of which have en-suite facilities and one double room, with additional toilet and bathroom facilities throughout the premises. The home has specialist equipment including specialist beds, bath and lifting hoists and walking aids. The nursing centre is divided into two wings (East and West), which are staffed separately from each other. The property has recently been extended to provide additional bedrooms and communal facilities this extension has also incorporated the extension and upgrading of existing rooms with the provision of en-suite facilities. The home is registered to provide nursing care to older people as well as those who may have a physical disability. The range of fees charged (at the time of this report) are £750 - £950 per week, with additional charges for hairdressing, toiletries, chiropody, taxi services and daily newspapers. The government contribution towards the registered nursing care of residents is paid to the home in addition to the fees. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Ashridge Court will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health/social care professionals. The allocated inspector spent approximately eight hours in the home and was able to discuss matters with the registered manager and to provide her direct feedback at the conclusion of the visit. During the assessment visits the inspector was able to spend most of her time meeting with the staff, residents and their visitors and observing practice in the home. A brief tour of the premises was undertaken and a range of documentation was reviewed including the homes statement of purpose and service users guide, pre-admission assessment procedures, the systems in place for handling complaints and protecting residents from harm, staff recruitment files, quality assurance systems and some health and safety records. The care documentation pertaining to four residents were reviewed in depth. At the time of compiling the report, in support of the visit, the Commission received survey forms about the service from seven resident and two relatives/advocates. The required Annual Quality Assurance Assessment (AQAA) was being completed at the time of this visit and therefore was not used to inform this report. What the service does well: Ashridge Court Nursing Centre is a large well-maintained care home, which provides a high standard of care to residents. The home has a high standard of cleanliness throughout which is supported with good infection control practice. The home provides varied recreational activities and takes into account individual cultural preferences, including a well balanced diet that was said to be excellent by a number of residents. The home has a suitable staff team with the necessary skills and experience to the meet the needs of current residents. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 6 All residents and relatives spoken with during the inspection were very complimentary of the services and facilities of the home. Comments included ‘the staff are charming helpful friendly and efficient. They will do anything for me’ ‘It is a great relief to me that my mother is in this home she is safe and looked after well’. Resident’s benefit from a well managed service, which works with other health care professionals to maintain a multidisciplinary approach to care. What has improved since the last inspection? What they could do better: The home needs to ensure that all the necessary information required as part of the statement of purpose and service users guide is readily available to all interested parties. This will ensure people are fully informed about the services and facilities that the home provides and what the costs are involved. Although pre-admission assessments are completed the manager needs to ensure that this reflects where and when it is completed and records the multidisciplinary approach that is used. She also needs to ensure that the letter sent out to confirm an admission is appropriate and the terms and conditions of residency refer to the assessment completed. The care documentation would benefit from a more person centred approach with individual risk assessments being completed and reflected within the plan of care. The storage of oxygen must always be safe and individual guidelines for ‘as required’ medicines will ensure these are given in a consistent and wellmonitored way. An improved way of recording concerns would improve the monitoring and auditing of these. The use of a training matrix would improve record keeping. The system for monitoring quality in the home that focuses on resident’s views can be further improved with clear procedures that establish the systems and ways of sharing the information. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 7 The home needs to ensure they keep a recent photograph of each resident as required. 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. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst on the whole the documentation held in respect of the home is informative and accurate it needs to be readily available. The processes in place for the assessment of prospective residents before admission ensures accommodation is only offered to people whose needs can be met by the home. EVIDENCE: When the homes statement of purpose and service users guide was requested these documents were not available. The administrator later produced them and explained that she had been working on updating and reviewing their contents. The need to have these documents readily available was raised with the registered manager. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 10 A review of the two documents provided identified that they were informative but still need to accurately reflect the homes categories of registration and the correct address for the regulating Commission’s office. It was also noted that the new service users guide did not reflect the arrangements for finances accurately and the administrator advised that this would be corrected. The registered manager said that the current contract arrangement for residents is under review and was being changed. A review of the admission process included the review of the last three admissions to the home. The documentation relating to these indicated that in all cases an assessment is completed before an admission to the home takes place, some of which were completed when the prospective resident was visiting the home. Although the assessments documentation was satisfactory it did not document where the assessment was completed and under what circumstances it was completed, it should also be further developed to demonstrate a multidisciplinary approach to the assessment process. The administrator confirmed that a contract is sent to prospective residents before the pre-admission assessment in some cases. The need to confirm in writing following the assessment that the needs of the prospective resident can be met was discussed with the registered manager and the administrator and both agreed that in future a suitable letter would be sent following the assessment as required. Intermediate care is not provided at Ashridge Court. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although not all residents care needs are fully explored within the plan of care residents are offered a good provision of health and personal care by the home, with residents needs being met. Residents are treated with respect and have their privacy and dignity maintained. EVIDENCE: Four residents were case tracked throughout the inspection process. This identified that a full assessment of needs is completed following admission to the home and the main physical care needs of residents are set out within a plan of care. These provide a framework for staff to follow when providing care however they do not record individual preferences and choices and do not Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 12 promote a person centred approach to care. An example of this was reflected in a plan of care for a person’s personal hygiene, which recorded ‘minimal help’. This was discussed with the manager who confirmed that the staff are wanting to provide individual life histories on each resident, which will start a more individual perspective for care. The social and psychological care needs of residents are also not well reported or planned for and again residents would benefit from a more individual approach to care. The care documentation does allow for residents specific care needs to be assessed and included nutritional needs, pressure area risk assessments and moving and handling assessments. Specialist interventions required in response to these assessments is readily available and records indicated that the home works in conjunction with these health care specialists. It was however noted that some assessment of risks did not have appropriate corresponding documentation, and an example of this was evidence of thorough risk assessments for the use of bed rails or care plans for when the risks of developing pressure sores is high. Staff said that residents have a choice of GP and can retain contact with professionals such as dentists and opticians whom they had visited before coming to the home. The home also utilises the services of a private Physiotherapist and Occupational Health Therapist. Residents in the home have varying needs and levels of dependency some being very dependent and others being very independent. Clearly many residents are making a choice to live at Ashridge Court although their nursing needs are not high. All contact with residents, relatives and visiting professionals indicated that the standard of care and nursing care was provided at a good standard. Comments received included ‘the care is excellent’ ‘The care is very good nothing is too much trouble’ ‘I thank my lucky stars that my mother is in this home’. The home has good procedures in place for the monitoring and recording of all drugs entering and leaving the home and drugs being administered. Medication stores and dispensing facilities were viewed and it was evidenced that these were maintained in a clean an orderly manner. Administration practice observed during this visit was found to be appropriate and safe. The home has regular contact with their supplying pharmacy that provides a visiting pharmacist to review the practice and facilities in the home. During the inspection it was noted that oxygen cylinders were being stored in three separate areas in the home and only one area had the necessary safety signs in place. This concern was raised with the registered manager who immediately ensured that all oxygen was stored in the area with the appropriate signage and confirmed that one of the cylinders was awaiting collection. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 13 A review of the medicine records indicated that some residents are on medicines as required and it was recommended that individual guidance is provided for each resident in respect of these medicines. Residents spoken with confirmed that staff treat them at all times with dignity and respect. Indeed this was evident on the day of the inspection with everyone knocking on doors before entering. Each of the residents are addressed by their preferred term and have all personal care needs carried out in the privacy of their own rooms or bathrooms. Residents were found to be well dressed and one relative commented on how good the laundry service was. Ashridge Court Nursing Centre DS0000013956.V351905.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides good social, cultural and recreational facilities, including a balanced diet to residents, which responds to individual preferences and needs. EVIDENCE: Resident’s benefit from the homes planned activities that are organised by a designated activities co-ordinator. The staff were noted to be flexible in allowing residents to choose the level of activities they wish to attend. A published list of activities is made available to residents, with residents being informed of special events being held in the home’s three monthly newsletter. During this visit to the home residents were involved in a morning quiz with staff and in the afternoon the activities co-ordinator spent time with a small group of resident discussing history and interesting events and facts. This was seen to be a very positive interaction where resident’s contribution was central to the activity. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 15 Residents spoken to said that they enjoyed the activities although comments received within the surveys indicated some residents are not able to join in many of the activities due to their disability and one visitor said that they felt arranged outings would be beneficial. Entertainment is also provided from external sources and a beautician is now visiting the home. The home takes into account resident’s specific cultural/religious and spiritual beliefs with the input and links with local churches being encouraged and facilitated. The home believes in promoting an equal and diverse culture among staff and residents. Contact with family and friends is very important to the residents and is encouraged with visitors able to stay for long periods in the home and able to have a meal if they wish. Residents are encouraged to remain independent and those who are able to attend events or visit relatives are given assistance to do so. All feedback received about the food was very positive with comments from residents including ‘the food id very very good’ ‘Definitely very good always a choice’ ‘The food is excellent and menus are varied’. On the day of this visit the main meal included a soup and a choice of either Cottage pie with fresh vegetables or Spinach and Ricotta Cannelloni with a choice of dessert. The home’s menus are devised on a four-week rolling programme and were found to be varied and displayed within the dining room. All meals are home cooked with an alternative option available for each mealtime. Meals are mainly eaten in the ground floor lounge/dining room although a further first floor communal dining area is available. One couple chose to have their meal in this room where they enjoyed the quieter environment. Some residents also choose to have their meals in their own rooms. The dining areas are attractive and provide a good environment that allows for social interaction. Each table is provided with individual condiments and drinks. Snacks including fresh fruit and drinks are available throughout the day and one relative was impressed by the way the crusts were taken off her mother sandwiches to aid her eating. The afternoon tea was also served with home made cake. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst the home has a complaints procedure and residents and their advocates feel their comments are listened to and acted on, a central record of concerns would be beneficial. The homes procedures and training should ensure that any allegation or suspicion of abuse is responded to appropriately. EVIDENCE: Although the home has a thorough complaints procedure and this has been updated this did not reflect the correct contact address for the CSCI and the registered manager assured that this would be rectified. People spoken to were confident that if they had a concern that the management of the home would deal with it effectively. The registered manager confirmed that there had not been any complaints received that needed to be recorded within the complaints record although confirmed concerns raised had been dealt with and recorded within individual residents care records. The importance of recording such concerns centrally was discussed to promote confidentiality and systems to monitor any themes and responses to issues raised. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 17 Criminal Record Bureau (CRB) checks have been carried out on all existing staff. Both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. The home has an Adult Protection procedure (Safeguarding Vulnerable Adults) and although this was informative it needed slight amendment to record Social Services as the lead authority in these matters. Each staff member is given a useful booklet on Adult Abuse which records the indicators of abuse, and a flow chart that demonstrates in broad terms the action to be taken following an allegation or suspicion of abuse. The registered manager was not aware that the new local policies and procedures on Safeguarding Vulnerable Adults had been published and confirmed that she would source these. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean and safe environment for those living in the home and visiting. Residents are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s preferences. EVIDENCE: Ashridge Court is a large well-maintained care home separated into two wings the East and West wing. The location and layout of the home are suitable for its stated purpose. The home has been subject to a purpose built extension that has provided 12 high quality bedrooms and the upgrading of the existing home has provided extra communal space and extra en-suite facilities. The registered manager Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 19 confirmed that it was the intention to upgrade the rest of the home to the same standard to provide ‘excellent’ facilities throughout the home. There are some attractive garden areas that include some patio and seating areas to the rear and side of the home. Following the building work the garden needed attention to ensure safety and good accessibility, and at this visit it was noted that landscaping of the garden has been progressed and a large pond has been provided. During the visit arrangements for a path to improve the accessibility to the garden and pond was being progressed. The home was found to be very clean and fresh and it was clear the cleaning staff work to a high standard. A visiting professional commented on the homes cleanliness saying ‘the home is spotless’. The registered manager was aware of the new Department of Health guidelines on infection control in care homes and was working on the homes policies and procedures to reflect this guidance. It was however noted that some areas in the new extension did not have liquid soap and paper towels this was raised with the registered manager who said that this would be addressed to ensure suitable hand washing facilities at all hand-washing areas. All residents spoken to said that they liked their rooms and those residents who were accommodated in the new rooms were very impressed with the high quality facilities and the beautiful views afforded. Ashridge Court Nursing Centre DS0000013956.V351905.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): 27, 28, 29 and 30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a suitable staff team with the necessary skills and experience to the meet the needs of the current residents. The home operates a thorough recruitment procedure. EVIDENCE: At the time of this inspection visit 42 residents were living at Ashridge Court. During the inspection visit it was found that for the mixed dependency of residents in the home the staffing levels were found to be appropriate and included two registered nurses in addition to the registered manager. All staff spoken to said that there was enough staff on duty and care was being provided in an un-rushed manner, with staff having time to talk and interact with residents. The recruitment practice was found to be satisfactory apart from one missing photograph and the records relating to two staff members CRB were not available. The administrator assured that these had been completed and was able to confirm this the following day. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 21 Staff training is well promoted and the registered manager explained that all the mandatory training is now being co-ordinated by an outside training consortium. Staff induction training is in place. It was recommended that a training matrix is used to demonstrate clearly the training provided and the training planned, although records held within individual files did demonstrate that training is being maintained some gaps were noted, and the registered manager said that the records were not up to date. Staff spoken to said that training opportunities in the home are good and that they felt well trained to meet the needs of residents. A visiting professional said that staff seemed well informed about the residents needs and were able to meet these. All comments received about the staff working in the home were very positive and comments included ‘staff are always pleasant and courteous’ ‘everyone is brilliant the staff are angels’ ‘the nursing staff are excellent and very kind and caring’. The registered manager confirmed that more than 50 of the carers working at the home have a National Vocational Qualification in care level 2 or above. Although the home did not have any students at the time of this visit it is a training centre audited and accredited by Brighton University to provide adaptation training to overseas nurses. Ashridge Court Nursing Centre DS0000013956.V351905.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): 31, 33, 35 and 38 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management arrangements provide clear leadership and an appropriate management structure. Systems for monitoring the quality of care and services although being developed still need to be fully established. Resident’s financial interests are safeguarded. The health, safety and welfare of residents and staff are generally promoted and protected. EVIDENCE: The registered manager is also the registered owner of the home along with her husband Mr Van Eugen, and has many years relevant experience in caring for older people. She is working towards her Registered Managers Award. Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 23 There is no deputy manager at the home but the manager is well supported by a team of registered nurses that include her two sons, who also form part of the management team. People who expressed their view on the homes management said that the home is well managed and the registered manager was approachable and responsive to residents and visitors views. The home has an annual development plan and the homes administrator explained that a new system of quality monitoring is being implemented. This is based on confidential interviews with residents completed by her with the results being audited and reported on. This practice is not supported by a quality procedure as yet and this was discussed with the administrator and manager. Ways of circulating the results to interested parties also needs to be built into this procedure. Residents meetings are held and satisfaction surveys are available in the home for residents or their representatives to complete. The home is accredited with ‘investors in People’ Award that reflects the homes commitment top staff development. The home does not take any responsibility for resident’s finances any extras paid for by the home are included on the monthly bills. During the inspection process it was noted that a photograph of each residents is not retained in the home. Health and safety matters are addressed by an outside Health and Safety Company that reviews of all the procedures and risk assessments on the home annually. When asked about the Health and Safety records the registered manager confirmed that the homes maintenance man had allocated responsibility for these and that all records were in his possession. She confirmed that these included regular environmental risk assessments for inside and the outside of the home and the regular checks and maintenance completed in the home. She also confirmed that the hot water supplied to taps accessible to residents are checked regularly to ensure hot water is supplied at a safe temperature. Ashridge Court Nursing Centre DS0000013956.V351905.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 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 2 X X X 2 3 Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12 (1)(a) Requirement Timescale for action 01/11/07 2. OP33 24 That individual risk assessments that cover all residents risk are recorded and responded to on an individual basis. These should include the risks associated with the use of bed rails and a clear plan of care if resident’s risk of developing pressure sores is identified. That a thorough Quality 01/02/08 Assurance measures are established based on gaining residents and their representatives views and underpinned with a clear procedure. All results of residents, relatives and visitors questionnaire surveys must be published and made available. This is outstanding from the previous two inspections. That the home retains a photograph of each resident. 01/03/08 3. OP33 24 4. OP37 17 01/12/07 Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 26 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. 2. Refer to Standard OP1 OP3 Good Practice Recommendations That the home ensures that up to date information is readily available to all interested parties to include information on fees. That the assessment documentation is improved to record the multi-disciplinary approach to assessing the prospective resident and includes where and when the assessment is completed. That clear criteria guidelines for medicine prescribed on a ‘when require’ basis is provided on an individual basis. That areas where oxygen is being stored or used are appropriately labelled. That any concerns raised are recorded centrally so they can be audited. That a training matrix is used to plan and record all staff training. 3. OP9 4. 5. OP16 OP30 Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Ashridge Court Nursing Centre DS0000013956.V351905.R01.S.doc Version 5.2 Page 28 - 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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