Inspection on 17/12/07 for Ashridge House

This inspection was carried out on 17th December 2007.

CSCI found this care home to be providing an Poor service.

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

Other inspections for this house

Ashridge House 08/04/10

Ashridge House 29/04/08

Ashridge House 23/05/07

Ashridge House 20/07/06

Ashridge House 09/12/05

Ashridge House 23/06/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ashridge House 132 Dorset Road Bexhill-on-sea East Sussex TN40 2HT Lead Inspector June Davies Key Unannounced Inspection 17th December 2007 09:00 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 House DS0000062830.V356812.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 House DS0000062830.V356812.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashridge House Address 132 Dorset Road Bexhill-on-sea East Sussex TN40 2HT 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 222200 01424 222300 ashridgehouse@hotmail.com Sarojini Sivayogarajah Vacant Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users that can be accommodated is twenty nine (29). Service users must be older people aged sixty five (65) years or older on admission. That one named service user under the aged of sixty five (65) can be cared for in the home. 23rd May 2007 Date of last inspection Brief Description of the Service: Ashridge House is registered to accommodate up to 29 older people in receipt of personal care, the registered provider is Mrs Sivayogarajah. Ashridge House is a large detached property situated on the outskirts of Bexhill on Sea. The town centre with its shops and access to bus and rail routes is approximately a mile and a local shopping centre is approximately half a mile. Accommodation is provided on three floors and a shaft lift is fitted to assist those service users who may have mobility problems. Bedroom accommodation is provided in 25 single and two double rooms. The home provides care and support to residents who are both privately funded and those who are funded by Social Services. The home’s fees as of 01 July 2006 range between £335.30-£441.50per person per week depending on the room to be occupied and the care needs of the individual. Additional costs are charged for chiropody (approx £10) hairdressing, newspapers and magazines. The homes literature states that the objective of the home is that residents shall live in a clean, comfortable and safe environment and be treated with respect and sensitivity to their individual needs and abilities. Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out on the 17th December 2007 over a period of 9 hours. During this time the inspector spoke with six residents, four members of staff, the manager and registered provider. Documentation relevant to the standards inspected was also looked at and a tour was carried out of the home. The pharmacy inspector also attended this key inspection and a full audit was carried out of medication receipt, administration, storage and returns. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. What the service does well: What has improved since the last inspection? The statement of purpose and service user guide has been reviewed, and now gives accurate information to prospective service users. The residents now have a far greater choice regarding activities, and their views are sought regarding these activities. The toilet and bathroom facilities have undergone refurbishment ensuring the privacy and dignity of the residents. The laundry room has been redecorated Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 6 and a new washing machine and tumble drier are on order. been ordered for the communal sitting room. A new carpet has Staffing levels have improved and there is a more stable staff team that the residents can get to know the staff who are caring for them. Recruitment practices have improved ensuring that new staff employed to work in the home are properly vetted and residents are not placed at risk of abuse. The registered provider has recently employed a full time manager and deputy manager, both have been in post for three and half weeks. Temperature control valves have been fitted to all hot water outlets, thus reducing the risk of scalding to the residents. A new boiler has been fitted, and this has made the central heating system far more effective. What they could do better: Pre-admission assessments must be improved upon to ensure that the home can meet the needs of the prospective resident and that sufficient detailed information is obtained about the resident to ensure that an informative care plan can be drawn up. Care plans need to be more detailed in that they give staff clear information on all aspects of the physical, mental, and social needs of the resident, and that the information gathered is correct and in line with the resident’s wishes and not contradictory. These plans of care need to be regularly reviewed and agreed by the resident and or their relative/representative. Risk assessments must be drawn up for each individual resident and should not be generic. Medication procedures in the home need to improve to ensure that the residents’ are not placed at risk. Staff need further training in the administration of medication to ensure that medication is handled in line with The Royal Pharmaceutical Guidelines for Care Homes. The privacy and dignity of residents sharing a bedroom must be considered and privacy screens/curtains should be fitted to ensure that personal hygiene and other tasks can be carried out privately. Staff mandatory and resident specific training must be improved upon to ensure that the staff have the skills to meet the needs of the residents in the home. All new staff should complete both initial induction and ‘Skills for Care’ induction, to give them a basic knowledge to meet the residents needs. The quality assurance system needs to be further developed to ensure that the views of the resident’s relatives/representatives and external professional stakeholders are sought regarding the care that is given to the residents. The Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 7 quality assurance system should also include thorough health and safety and fire risk assessments of the whole building including all external areas. Regular monitoring of all the systems used in the home should be carried out by the manager. Staff must receive regular two monthly formal recorded supervisions, to ensure that they are aware of practice, philosophy of care, and to ensure that the correct training is available for each individual member of staff. Systems must be put in place to ensure that the risk of Legionella is prevented. 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 House DS0000062830.V356812.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 House DS0000062830.V356812.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): Standards 3 and 6. People who use this service experience poor quality outcomes in this area. The homes statement of purpose and service user guide provides prospective resident with the information they need to make a decision about moving into the home. Pre-admission assessments do not contain sufficient information on which to base a plan of care but are under review to ensure that each resident moves into the home knowing that their needs can be met and that their independence will be maximised and promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guide has been reviewed and now contains all relevant information relating to the category of residents that can be admitted to the home and the staff structure. Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 10 While the format for the pre-admission assessment is good and covers all aspects of personal, health and social care, the information contained within these pre-admissions assessments, was not always clear and would not give sufficient information on which to base a care plan. The prospective residents had signed none of the pre-admission assessments and therefore there was no evidence that they had agreed to the level of care they required. None of the care plans viewed contained a Local Authority Care Manager assessment or plan of care. The new manager employed by the provider is in the process of changing the pre-admissions assessments to ensure that sufficient information is contained within these documents. The manager also stated that in future, prospective residents and or their relative/representative will be asked to sign up to this pre-admission assessment. This home has received no new residents admission since February 2007 therefore the pre-admission assessment forms were based on admissions to the home prior to this date. Ashridge House DS0000062830.V356812.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): Standards 7, 8, 9 and 10 People who use this service experience poor quality outcomes in this area. There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet the resident’s needs. The health care needs of the residents need to be clearly recorded to ensure there is evidence of good multi disciplinary working taking place. Medication in this home is not well managed and could place residents at risk. More needs to be done to ensure that resident’s privacy and dignity is adhered to at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 12 From the three care plans viewed there is no consistency in the information contained within these care plans. Risk assessments do not give clear guidelines to staff as to how risks can be reduced and in some cases where risk assessments would have been relevant to a particular residents activity this was not in place. Some information contained within these care plans is contradictory for example in two care plans the impression was that these two residents are fully independent with personal hygiene, but the manager stated that both need help and supervision. It was also difficult to assess if the care plans have been reviewed on a monthly basis, some paperwork within individual care plans had been dated, but it was not clear if this related to a care plan review. Care plans do contain evidence that residents have access to a variety of external health care professionals, but external health care matrix is not always kept up to date. There is no evidence in the three care plans viewed that residents who need assistance with continence are visited by the continence nurse, or where there are concerns regarding mental health care, that a referral is made via the G.P. to the mental health team. None of the care plans viewed show visits from the district nurse team. All care plans need to be checked with each resident to ensure that they contain the correct plan of care, and that appropriate risk assessments are written which are relevant to each individual resident and not written generically. These care plans then need to be signed by the resident and or their relative/representative. From discussion with the new manager, she stated that she is in the process of re-arranging care plans to ensure that they are more user friendly and give clear instructions to staff and that staff have access to all residents care plans as soon as there is a lockable cupboard in the staff room. Medication audit carried out by Pharmacy Inspector J.D. Medication was stored securely at appropriate temperatures. A carer said that the room had been recently decorated and a change to the system of supply meant that all medicines in use fitted into one trolley, which could be taken to all floors. Printed medication administration records (MAR’s) were used to record receipt and administration but some inaccuracies were identified. For example an antibiotic dispensed as fifteen capsules, had not been recorded on receipt, thirteen capsules had been administered but none were left. Another antibiotic, prescribed to be taken four times a day, had been given five times a day on three days. For three residents a medicine that should be given 30 minutes before food or other medicines had been given with other medicines. An audit of medication within the home carried out by the pharmacy inspector showed. There was no indication on the MAR’s if medicines not supplied this month, were still prescribed or not. One medicine prescribed to be taken Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 13 every day had been administered only until the end of the previous MAR. Handwritten changes to directions, for example ‘Stopped’ against one medicine, were not dated, signed or referenced to the prescriber. It was discussed with the acting manager that there must be a robust system of stock control and recording prescribed changes. Carers do not record when medicines are given to residents for selfadministration and do not monitor this use. Risk assessments did not identify the risks nor indicate actions to be taken to reduce risk to the resident or others. At lunchtime medication was prepared correctly and residents asked if they wanted their ‘when required’ medicines, but one pot of tablets was left unattended and signed as administered. The carer said that a check would be made later. A carer said that the supplying pharmacist provided training one day in July again in November and was due to give another session in January. Certificates were in three staff files examined. A separate folder had records of four staff being observed assisting with medication. The acting manager agreed to review medication training. During a tour of the home the inspector noted that staff do respect the privacy and dignity of the residents, by locking toilet and bathroom doors, and knocking on bedroom doors before entering. It was noted however that in the two bedrooms that are shared, there were no privacy curtains/screens between beds to ensure privacy to those residents when personal hygiene tasks are being carried out. Three residents spoken to commented – “The staff treat me very well.” “Staff are very friendly, they do respect my privacy.” “You cannot fault the staff here.” Ashridge House DS0000062830.V356812.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): Standards 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. Social activities and community contact is good and enhance the residents social opportunities. The meals in the home are good offering both choice and variety and catering for special diets. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a variety of activities on offer in the home and residents said, “The activities are very enjoyable.” “I like joining in with the activities.” “Some of the activities I join in with, they are very good.” Activities on offer are – Music and Movement, Dominoes, DVD Films, Reading newspapers and magazines, quizzes, bingo, scrabble and other board games. Some of the residents interests are recorded in their care plans, but there was no evidence that residents are consulted regarding they activities they would like in the home. Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 15 The local church visits the home every week for communion. It was unclear as to what choice the residents have regarding getting up and going to bed, it was noted on MAR charts that several residents have their medications at 7.00 a.m. but there was no record within the care plans to suggest that residents have chosen to get up at this time. From information obtained from the notice board outside the communal lounge, residents have entertainment and activities from external sources as well, and this included Cuddle Bunnies, Physical and Motivation Therapists, Pantomime and Carol Singers. A big party has also been arranged for the residents the week before Christmas were all the relatives and friends have been invited. Residents are also able to have their own choice of newspapers and magazines. There was evidence within the care plans and from residents themselves that they are able to go out of the home into the community, to meet up with friends and dc their own personal shopping. Where residents are not able to go out on their own, members of staff accompany them. Two residents said, “I go out nearly everyday, either for a walk or into town to do some shopping.” “I go out on my own, I like to go into town.” The manager is not involved with any of the residents personal finances, where residents are no longer able they have appointed solicitors or their families to manage their finances on their behalf. There was no information available in the home as to how residents and or their relatives could contact an advocacy service. From a tour of the building the inspector observed that residents are able to personalise their own bedrooms with their own personal belongings. All residents have access to their own care plan should they wish to do so, and care plans are kept in accordance with the Date Protection Act 1998. The inspector viewed the menus for the home and these showed that residents are offered choices for each of the three meals. The menus were varied and provided a nutritious diet. Four residents said, “The food here is alright, neither here nor there.” “The food is nice I enjoy most of my meals.” “The food is quite good, we are given a choice.” “The food is OK, I can have something else if I do not like what is on the menu.” The inspector was in the dining area of the home for part of the lunch time, and residents were given a choice of gammon and pineapple or fish pie, both were service with fresh vegetables, and there was a choice of sweet dishes. The food was attractively presented. It was noted however that some of the food was being returned to the kitchen uneaten. It is important that the manager carries out periodic checks on food wastage, and also seeks the views of the residents regarding menus. None of the residents in the home need to have their food liquidised. The home does cater for diabetic diets and other diets as and when required. None of the residents need assistance with eating. Ashridge House DS0000062830.V356812.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): Standards 16 and 18 People who use this service experience good quality outcomes in this area. The home has a satisfactory complaints system with some evidence that residents know who they would approach if they needed to make a complaint. Staff have a good knowledge and understanding of adult protection issues, which help to protect the residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy and procedure has been reviewed and clearly states what steps can be taken should a resident or visitor wish to complain, clear timescales are given to assure the complainant that their complaint will be noted, investigated and replied to in writing within ten days of the complaint being made. The manager has a complaints file where all complaints made; the outcomes and copies of reply letters are kept. The complaints policy and procedure is clearly displayed within the home. There have been no complaints made to the home since the last inspection. Two residents said. “I do know how to complain I would speak to the Manager or Mrs Siva”. “I have no reason to complain I am perfectly happy here and everyone is very kind to me.” Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 17 The home has an up to date and comprehensive Protection of Vulnerable Adults Policy and Procedure. All staff are aware of this policy and procedure, through their initial induction. There have been no adult protection issues in the home since the last inspection. All staff have completed their POVA training and certificates can be evidenced within each member of staff personnel file. Ashridge House DS0000062830.V356812.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): Standards 19 and 26 People who use this service experience good quality outcomes in this area. Recent investment has significantly improved the appearance of the home creating a comfortable environment for those living there and visiting. The risk of cross infection is kept to a minimum ensuring the residents are not placed at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a warm welcoming atmosphere. One the day of this key inspection the home was free from offensive odours, with exception of a musty smell in the communal lounge, where the carpet is due for renewal within the Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 19 next few days. All bedrooms were pleasant, and three residents spoken to said – “I love my room it is very nice here.” “I was able to bring bit and pieces from my home in here with me, I am very comfortable here.” “I love having this tree outside my room, and watching through the seasons.” One concern that the inspector had was that there were nine bedroom doors that were not closing properly when closing. Through discussion with the manager it was agreed that she would contact the fire safety officer and ask him to visit the home and pass on any correspondence to CSCI regarding these bedroom doors. All requirements made at the previous inspection have been met. Laundry facilities are sited away from the kitchen area. The laundry room has recently been redecorated, and provides a clean and tidy environment. The present washing machine while providing a sluicing facility is due to be replaced within the next few days together with the industrial tumble drier. The laundry room also has a cupboard with a sluice machine fitted. Foul laundry is placed directly into red alginate sacks. There are staff hand washing facilities throughout the home with the provision of liquid soap, paper hand towels and alcohol hand rub. All staff are supplied with disposable gloves and white plastic aprons, which they use for personal hygiene tasks and to clear up spillages. The home has provision for clinical waste, which is placed into yellow sacks and a clinical waste bin. The home has up to date policies and procedures for the prevention of cross infection. Ashridge House DS0000062830.V356812.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): Standards 27, 28, 29 and 30. People who use this service experience adequate quality outcomes in this area. Staffing levels within the home have improved since the last inspection and staff are now able to spend mo0re one to one time with the residents. Since the last inspection the standard of recruitment practices have improved and residents receive care from staff that have been appropriately vetted. Staff training is p9oor, with many staff not receiving mandatory or resident specific training to ensure they can meet the needs of the residents living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels have improved since the last inspection. Four agency staff are employed in the home on a permanent basis. On the day of this key inspection there were four staff on the morning shift including the deputy manager who works alongside the seniors and care staff, two senior care staff and one carer were on the afternoon shift and there are two waking night staff on the night shift, with the Manager, Deputy or a senior on call. Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 21 Two residents said – “There are always care staff here to attend to our needs.” “If we need a member of staff they are always available.” At the present time there are 42 of care staff with an NVQ level 2 or above another member of care staff is in the process of completing her NVQ and another carer is due to start her NVQ. The inspector viewed 3 personnel files. Two application forms do not have a full employment history, the reviewed application forms do require a full employment history and this was evidenced from one of the personnel files viewed. All files had POVA first and CRB checks. Each file contained two references along with two forms of identification. There was no evidence that staff were provided with a GSCC code of conduct when starting employment at Ashridge House. Records of staff supervision were out of date and had not been carried out on a regular basis. All files had training certificates relevant to the training that the staff had undertaken. There was no evidence in the home of an up to date training matrix. Staff files showed that not all staff have completed mandatory training. The manager was able to show evidence, that all staff had recently completed their Protection of Vulnerable Adults training. Staff spoken to also confirmed that while they have done some training they have not been offered all of the mandatory training. Fire training is due to take place on the day following this key inspection. From the staff files viewed two staff had received some initial induction but this had not been completed. None of the staff have received ‘Skills for Care’ induction. From conversation with two members of staff they were not aware of ‘Skills for Care’ induction. Ashridge House DS0000062830.V356812.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): Standards 31, 33, 35, 36 and 38. People who use this service experience adequate quality outcomes in this area. The manager has a good understanding of the areas in which the home needs to improve, but she must ensure that a plan is in place to say how improvement is going to be resourced and managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a new manager who has experience at management levels in other homes and has obtained her NVQ level 4 and RMA. She has only been in post for three and half weeks. Both residents and staff spoke highly of the manager Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 23 and said that she was approachable and there were clearer and direct guidelines for the staff to follow. Staff stated that they were consulted regarding changes made in the home, and recognised why these changes needed to be made. One resident said, “It is nice to have a manager in the home on a more permanent basis.” There is still a lot of work to be done in the home to ensure that residents receive care according to their needs and that methods of written communication improve, to ensure that information is not passed on from staff member to staff member just by word of mouth, it is therefore important that the manager is able to prioritise her work to ensure that residents receive the highest quality of care. The quality assurance system is being developed in the home and there was evidence that the residents’ views are sought regarding the care that they receive, and the results of these surveys have been published and displayed on the main notice board in the home. Further work still needs to be done in seeking the views of relatives, friends and external stakeholders such as the G.P.’s, district nurses, care managers, chiropodists, dentists, opticians and other professional external visitors to the home. The manager needs to develop a recorded monthly monitoring of systems used in the home, which should include medication, care plans, care plan reviews, cleaning, food cooking and presentation, competency of staff after training etc. A health and safety and fire risk assessment should be carried out on a regular basis of every room in the home, and should also include the exterior and external grounds of the home. There was evidence on the notice board that regular residents meetings are held. The registered provider carries out regulation 26 visits on a monthly basis and a written report is drawn up of her findings. The manager oversees the personal allowances for five residents in the home. Each of these residents has their own cashbook, with monies being kept separately in cash folders. Receipts are kept of nay expenditure made on the resident’s behalf. All monies coming in and going out are recorded in individual resident cashbooks. Cashbooks and cash folders are kept in a safe and secure place in the home. With the exception of one staff member none of the staff have received formal supervision. The last recorded staff supervisions were dated in 2004 and viewed via the staff personnel files. The new manager stated that she is setting up a staff supervision programme, but there was only evidence that one member of staff had received supervision in the last month. As mentioned previously in this report there is no evidence to suggest that all staff have received mandatory training for safe working practices and a requirement has been made to ensure that all staff have been trained to work safely. Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 24 During a tour of the building the inspector noted that the COSHH cupboard was kept locked and it was also noted that there is a COSHH file with the leaflets of all chemicals used in the home. All equipment and machinery used in the home has up to date maintenance certificates. There was no evidence that any form of Legionella check takes place in the home, in the form of a Legionella risk assessment, a scheme for prevention, evidence of managing and monitoring control measures or an appointed and competent person to be responsible for these checks. All hot water taps are fitted with thermostatic control valves and these are checked monthly by the maintenance man and recorded. Fire points are checked on a weekly basis and recorded. Emergency lights are checked monthly and recorded. All windows are fitted with window opening restrictors. All external doors are fitted with number locks and doors into the back garden are connected to the call bell system. The home has up to date policies and procedures relating to health and safety and maintaining a safe environment. All accidents are accurately recorded into a HSE accident book, and these forms are kept in accordance with the Data Protection Act 1998. Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 25 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 X 2 Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Schedule 3(1)(a) Requirement The registered provider must evidence that the service can meet the residents needs in respect of their health and welfare. The registered provider must ensure that an appropriate pre-admission system is in place to ensure residents are appropriately assessed prior to moving into the home and where funded by a Local Authority the Care Manager provides an up to date assessment. This requirement was made at the previous key inspection on 23/05/07 with timescale of 30/06/07 not met. The registered provider must ensure that care plans contain the correct information and that they are drawn up in full consultation with the resident’s and or their relatives/representatives and are reviewed with the resident’s knowledge on a regular basis. This requirement is repeated from previous key Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 27 Timescale for action 29/02/08 2. OP7 15 (1) 29/02/08 3. OP7 15 Schedule 3 (1)(b) inspections on 14/10/05, 20/07/06 and 23/05/07 with last timescale of 30/09/07 not met. The registered provider must ensure that the care plan for each resident clearly states the level of care required and the action that needs to be taken by care staff to ensure that all aspects of health, personal and social care needs are met. 29/02/08 4. OP9 13 (2) The registered provider must ensure that the care plans contain risk assessments pertinent to each of the resident’s and that these risk assessments give clear indications to care staff as to how the elements of risk can be reduced. 29/02/08 The registered provider must ensure that medications are given as directed by the prescriber with accurate, contemporaneous records held of such administration. The registered provider must ensure that there is a robust system of stock control and recording prescribed changes. The registered provider must ensure that there a clear risk assessments for people who self administer some or all of their medicines. These risk assessments should clearly identify actions needed to reduce risks, including any risks to other people. Part of this requirement is outstanding from previous inspection on 23/05/07 with timescale of 30/06/07 not Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 28 5. OP10 12 (4)(a) 16 (2)(c) 6. OP30 OP38 17 (2) 18 (1)(c) met. The registered provider must ensure that where residents have chosen to share a room, screening is provided to ensure that their privacy is not compromised when personal care is being given or at any other time. Staff must have the skills and knowledge to carry out their work. This will include mandatory training and resident specific training. There must be evidence that staff have the necessary skills and training. The staffs training needs must be kept under review. Records of training must be available for inspection at all times. This requirement is repeated from the last key inspection on the 23/05/07 and timescale of 31/07/07 have not been met. The registered provider must ensure that all new staff complete a ‘Skills for Care’ induction programme within the first six months of their employment. The registered provider must ensure that the quality assurance system continues to be developed and report on. This requirement was made at the last three inspections on 14/10/05, 20/07/06 and 23/05/07 with last timescale of 30/09/07 not met. 07/03/08 18/03/08 7. OP30 12(1)(a)( b) 18(1)(a) (c) 13(4)(c) 24 (1)(a)(b) (2)(3) 07/03/08 8. OP33 18/03/08 9. OP36 18(2) The registered provider must ensure that regular staff supervisions takes place at least six times per year. These supervisions should include all DS0000062830.V356812.R01.S.doc 07/03/08 Ashridge House Version 5.2 Page 29 10 OP38 13(3)(4) aspects of practice, the philosophy of care in the home and career development needs. The registered provider must ensure that there is a thorough monitoring system in place for the prevention of Legionella. 29/02/08 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 Ashridge House DS0000062830.V356812.R01.S.doc Version 5.2 Page 30 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 House DS0000062830.V356812.R01.S.doc Version 5.2 Page 31 - 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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