Inspection on 23/05/07 for Ashridge House

This inspection was carried out on 23rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Ashridge House 08/04/10

Ashridge House 29/04/08

Ashridge House 17/12/07

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 Mrs Ann Block Key Unannounced Inspection 23rd May 2007 9:15 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.V336713.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.V336713.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.V336713.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. 11th January 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 £322.40-£450.00 per 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.V336713.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection was carried out by Ann Block which included an unannounced visit to Ashridge House on Wednesday 23rd May 2007. This is the third inspection of 2006/2007 and will continue to determine the frequency of visits/inspections hereafter. The commission is committed to inspecting for improvement, this inspection was based on reviewing areas of concern raised at previous inspections and acknowledging areas where quality of life for residents has improved. The day was spent talking to residents and staff and looking at a sample of records including residents care plans and daily records, concerns records, staff recruitment records, accident and incident records. Three residents were case tracked which included talking to the resident concerned, talking to staff about their care and looking at a sample of associated records. Judgments have also been made using observation of practice. Where judgments made at previous inspections remain the same, these have been included in the assessment of standards in this report. Due to timescale limitations surveys to residents, relatives and professionals were not used as part of this inspection. Staff on duty and visiting staff gave their full cooperation to the process of inspection. The owner drove down from Croydon and joined in the later part of the site visit. Feedback was given to the owner during the visit. At the time of the inspection and site visit the manager and deputy had effectively left the service but were reported to continue to ‘pop in and out’ and carry out certain tasks such as assessment of prospective residents. Residents and staff were unclear as to the current management structure and considered there was a need for the home to be properly managed. This lack of clear management significantly affected current standards in the home which at the time of this inspection were poor. What the service does well: Residents like the homely atmosphere where they can sit and chat with friends. They like having their own rooms which they can make their own or to have a room they can share with a friend if they wish. They appreciate the way their rooms are kept clean. Because they were able to bring their own possessions with them it made moving in to a new environment easier. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 6 Residents value the core staff team who they like and look forward to being on duty. They like having an owner who they feel at ease with and who they can talk to. One resident said ‘Staff do treat us respectful’. Residents like to have the freedom to come and go when they please if they are able to do so. They appreciate that in this way they can keep contact with friends and groups in the local area. Residents like the food, those who have special dietary needs have their needs met. Residents like the way their clothes are looked after and returned to them safely. What has improved since the last inspection? What they could do better: Since the last inspection, the manager and deputy have effectively left the service. This is the second change of manager in a short period, neither had obtained registration with the commission. It is a requirement that a suitable manager is appointed who has the capacity, skills, knowledge and experience to manage the home. Failure to do this will put the owners’ fitness to run the service in question. In order to improve services to people receiving care the commission have directed that requirements made through the inspection process will not be carried forward but will result in enforcement action. It is the judgement of the commission that until a manager is recruited enforcement action on a number of requirements will not benefit residents’ quality of life at the moment. However, continued failure to meet the requirements identified at this and previous inspections will result in enforcement action being taken. Accurate, comprehensive information on the home and services it provides must be available to all interested parties to inform any prospective resident’s choice of home. Residents should then have a contract/statement of terms and conditions which underpins their rights as detailed in the statement of purpose and service users guide. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 7 Residents have been admitted whose needs cannot be properly met in the home at the time of admission. Care documentation, including preadmission assessments and care plans, are of poor quality and must be improved to ensure residents receive appropriate care that meets their assessed needs at the time of admission and thereafter. Individual and environmental risk assessments must be set up in response to activities of daily living, including falls and accident records, which provide staff with guidance to maintaining residents safety. Residents are at risk from unsafe medication practices. Medication must be stored and administered as directed by the prescriber and in line with Royal Pharmaceutical Society guidelines. Staff administering medication must have training to ensure they are competent and have the knowledge to do so. Further attention needs to be given to providing appropriate entertainment and activities to ensure individual recreational and leisure needs of residents are met. The suitability and safety of the environment must be addressed to ensure there are suitable toilet and handwashing facilities and a laundry which can be maintained to reduce the risks of cross infection. The procedure for investigating and recording complaints needs to be improved to ensure there is evidence that all complaints are taken seriously and properly dealt with. Suitable staffing arrangements must be put in place to ensure staff are able to fulfil their identified roles effectively. This will include staff who have the skills and training to hold responsibility for shift leadership and staff who have the skills and training to carry out regular formal 1:21 staff supervision. Staff have been allowed to work in the home without having the appropriate checks completed, staff must only be employed subject to POVA/criminal records bureau checks being completed and written references obtained to ensure residents are safeguarded. Staff should have secure private space to store their belongings which does not encroach into areas used by residents or present a risk of cross infection. Records as required by regulation to evidence that staff have the skills and qualifications to carry out their duties, must be available in the home at all times for inspection. Quality assurance measures that respond to resident’s views need to be established and reported on. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 8 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.V336713.R01.S.doc Version 5.2 Page 9 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.V336713.R01.S.doc Version 5.2 Page 10 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): 1,2,3 & 4 Quality in this outcome area is poor. Current and prospective residents are at risk due to poor assessment and admission procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A statement of purpose, service users guide, certificate of registration and the last key unannounced inspection report were on a table in the entrance hall. The statement of purpose and service users guide were dated January 2007 but remain inaccurate. For example, the management structure includes staff no longer fully employed at the home. The description of the facilities refers to ‘two lounges’ with one used as a smoking room. There is one combined large lounge diner and residents are asked to smoke outside. The category of residents accommodated is unclear. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 11 Two residents have been admitted recently. The former manager had carried out the assessments of each person. The assessments were brief and did not take into account sufficient information to allow a proper judgment to be made whether the home could meet their needs at the time of admission. One person with a physical disability and of significantly younger age than the majority of residents had been placed by Social Services. No care management assessment or service delivery order had been obtained. Any impact of the admission of this resident on an already reduced staff team had not been considered. Facilities are not suitable for people who need a wheelchair to mobilise as the lift is too small to safety take a resident, wheelchair and Zimmer as seen during the site visit. As the lounge/dining room is on the lower ground floor anyone with mobility problems has to use the lift to get there. The toilet facilities on the lower ground floor are not suitable for wheelchair users to use in private. In respect of another resident admitted the previous evening there was a very basic care assessment but nowhere recorded sufficient information to advise staff how the home would meet her needs. The resident had been in the home for respite care for a few days earlier in the year, before a significant change in her health. Information from that stay had not been used to aid the assessment, admission or settling in process. The resident was clearly unfamiliar with routines of the home and staff didn’t evidence that they were aware of her particular needs. There had been no procedures put in place to help the resident settle into the home. Earlier in the year a group of 8 residents with learning disabilities had moved in from a local home which was stated as being closed. Residents and staff said that when they first moved in it was ‘horrific’, the group were very noisy, anxious and disruptive causing some residents to complain. Most agreed that things had settled down now. One of the residents who had moved in said the home was ‘very pleasant, treat me well the staff do, no complaints at all’. Of concern is that staff do not have the specific skills to work with people who have a learning disability and no training is planned. Again there was no structure in place to help these residents settle in or to consider the what the impact would be for current residents, those moving in and staff capacity by admitting 8 people at one time. One resident spoken to said she hadn’t had any contract and spoke of promises she believed had been made at the time of admission but which weren’t being provided. The owner thought that the resident had a contract but couldn’t find one on file. None of the files seen contained a contract or statement of terms and conditions. Intermediate care is not provided in the home. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 12 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 & 10 Quality in this outcome area is poor. Residents are at risk from a lack of understanding of their care and health needs and poor recording. Medication is not stored or administered safely. Privacy and dignity is not reliably maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some residents have a care file. Two recently admitted residents had a very basic assessment which was also termed a care plan but did not give sufficient evidence of health, personal and social care needs. For example, one resident was seen to have difficulty managing her lunch. Staff were not aware of this. The care plan held very brief detail of her physical limitations but did not direct staff how to support the resident in her daily life even though it was known at the time of admission the resident had had a stroke. The care plan gave no Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 13 information which would help the resident settle in the home and it was clear that she was unaware of routines in the home. Staff were more aware of the needs of residents who had been at the home for longer. There was evidence of good relationships and mutual understanding between the directly employed staff and longer term residents. Those residents spoken to said that care was good and staff knew what they needed. A number of residents spoke highly of three of the care team who they felt offered stability and consistency for them. As is often the case, staff directly employed by the home had far more knowledge of each of the longer term residents than was recorded in a care plan. There is no structured system for care planning. Files seen held miscellaneous formats, some included information from a previous care setting which itself was ill prepared and gave little detail of how care and support would be provided. Some files held risk assessments, some of these related to falls, nutrition and skin integrity. There was no logic in why certain assessments had been made for individuals and there was inconsistency in what information was included for the individual. Risks which were noted quite quickly by the inspector during the site visit had not been recorded in care plans. The accident book recorded a number of falls. The accident record noted how the accident could be prevented but these were not reliably incorporated into a risk assessment or care plan. As the accident records are held separately from the care files staff are unlikely to actively use this information. One general care folder is put in an understairs cupboard near the lower ground floor lounge. The folder contains sheets for daily records, activity records, bath lists and weights. Most residents have a photo there, but not all. Records were made daily but contained very limited information usually being of the slept well, had a good day nature. There was no clear system to link daily records, or any other records, to care plans. Some care plans had elements which were dated as being reviewed but little evidence of how the review affected the care provided. In the absence of a clear management structure, core staff felt there was no one with key responsibility for care planning or sharing information, they used staff handovers to pass on any essential information. Medication is mainly administered via monitored dosage Nomad system. Some medication remains in its original packs. Medication administration records are handwritten by staff and do not contain details of which medication is to be taken as required or guidelines of when to take it. There are no accurate up to date records of medication received or returned to the pharmacy. The drug cupboard was dirty, the Nomads were dirty. Out of date medication, uri sticks and needles were in the cupboard. There was medication which was out of its packet but not named. One resident who moved in some months Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 14 earlier had brought with her a pack of osteoporosis therapy medication. None had been administered and none was recorded on the medication administration record. There was no evidence of whether or how this medication had been discontinued. Other medication which had been brought in with a resident on admission had not been administered as prescribed. No system had been identified or set up as part of the admission process how anti coagulant therapy and medication would be continued. Medication for another recently admitted resident had no system to record administration. Observation of practice at lunchtime showed unsafe systems with medication left unattended and not signed for at the time of administration. There are no secure systems to take medication round to residents. Some staff who administer or handle medication have had medication training. Two residents spoken with administered their own medication. A risk assessment had been carried out for each but there was no detail of who had carried out the assessment, whether they had the skills to do so and whether others such as the general practitioner had been part of the decision. One resident said there was no system to check whether they were taking their medication but felt she ‘knew what she was doing, she’d been doing it for long enough.’ Residents’ privacy is only partially maintained. Some residents said that staff always treat them with dignity. One carer made sure the curtains were drawn when personal care was given. Two residents complained that the personal hygiene of one resident was carried out in view of other residents. There is no phone which can easily be used in private. Staff and residents use an extension phone in the kitchen which presents a health and safety risk. The main phone is in the ground floor office and has two portable handsets. A payphone has been disconnected since the change of ownership some two years ago. Some residents have their own private phone lines. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 15 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 & 15 Quality in this outcome area is adequate. Residents make choices about their lives and have some interests to occupy them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Throughout the site visit residents were relaxed and at ease in the home. There was good use of the lounge and patio with friends able to sit near each other and have a chat. Those spoken with all valued having companionship when they needed it but also valued having their own room for privacy. A few residents prefer to stay in their room and this is acknowledged. Those residents who like to help with tasks such as helping set up the tables or assist others with drinks were pleased to be able to do so. Some residents like to go out unaccompanied and this is encouraged where appropriate. A resident spoke of going out regularly into the town to meet friends and do some shopping and was getting ready in the afternoon to go Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 16 out to one of her ‘groups’. Residents said they could order a taxi or Dial a Ride if necessary. Posters were on display in the passage way to the lounge/dining room giving details of activities which took place during the week. A carer said that there would normally be something arranged for the afternoon when it was quieter. Reference was made to an exercise class, magician, quizzes and music afternoons. An activities record is held for each resident. Many activity records referred to ‘stayed in lounge’, ‘watched TV’. There was some evidence that residents had ‘enjoyed the music’, ‘attended the exercise class’. There is a TV in the lounge and some residents shared the control as they needed it. As there is only one lounge, whether the TV is on or off affects anyone using the lounge. Staff mentioned an excellent Christmas party the previous year where the owner had bought presents for each resident. One resident said she had had her birthday the day before and had been bought presents and had a birthday cake. There was evidence throughout the site visit that the group of people who moved in together remained close to each other. Two are long term partners and are able to share a room and sit at table together. There was little evidence for this group that the need to keep contact with previous friends is promoted or for residents who need assistance to do personal shopping to have opportunities to do so. The owner offered to purchase some clothing on a resident’s behalf. Other residents mentioned maintaining contact with friends and family, some referring to regular visits and of being taken out. One resident said keeping contact like this meant a lot to her. There is no separate visitors or quiet room. The carer on duty said that normally visitors liked to sit in the residents room or happy to join in with others in the lounge. Residents are encouraged to being in personal possessions. One resident spoke of the things he had brought with him including his music and TV. For a number of residents being able to make their room their own had helped the transition between their own home and being in a residential home. The use of advocacy services was not explored at this inspection. The weekday cook recently resigned but at the time of the site visit was helping out by cooking at weekends. A former domestic was cooking the weekday meals. She said she had been trained in catering and had a basic food hygiene certificate which was due to be updated. She said she enjoyed cooking and had already spent time talking to the residents about the food they would like. The owner said the cook was looking at changing the menus to reflect new choices. The morning staff take breakfasts round by tray to each room and wash the dishes up afterwards. This restricts time for personal care at a peak time of day. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 17 One resident spoke of having a very restricted diet due to health issues and that the home managed this ‘excellently. Another resident is a diet controlled diabetic, this was also being well managed. The current menus do not routinely offer a choice at lunch time. A kitchen assistant comes in between 5 and 7.30 to assist with supper. During the site visit each resident was being asked what they would like for supper and it made clear to them what the options were. There was no similar system to offer any form of choice to the majority of residents at lunch time. Drinks and biscuits are provided in between main meal times. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 18 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 & 18 Quality in this outcome area is poor. Residents can complain but records do not always evidence this. Residents are put at risk by inadequate recruitment checks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaint procedure and a file to hold any complaints with blank records sheets ready for use. An inaccurate complaint procedure was removed from display. The correct complaint procedure is on display in the entrance hall. From talking to residents, not all complaints are recorded. Residents said they felt they could talk to certain care staff and they would listen. One resident said he had ‘no complaints, I like it here’. Written complaints are recorded and responded to. Due to the limited number of staff employed by the service and the lack of training records it was not possible to verify that all staff have had adult protection training as stated by the owner. A senior carer said that an external trainer had come to the home to provide adult protection training. The adult protection policy was not explored in depth at this inspection. No adult protection alerts have been raised. There have been no protection of vulnerable adults (PoVA) alerts made. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 19 Residents are potentially placed at risk as at this inspection and previous inspections it has been found that staff have been working at the home before a criminal records bureau certificate has been applied for and without a Protection of Vulnerable Adults (PoVA) first check being carried out. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 20 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): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is adequate. Resident live in a homely environment but where there are risks of cross infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ashridge House is converted from a domestic property to provide accommodation for 29 people over four floors. Each floor can be accessed by a shaft lift. A large lounge diner is situated on the ground floor with one end having large windows and patio doors leading onto a patio. At the time of the site visit the handles from the patio doors were missing. A short ramp leads from a side door onto another patio. The step down to the patio is marked with white edging but there are no railings to promote safety. A ramped path Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 21 with railings leads down to the lawn. The gardens are maintained to a basic level but required some attention to grass cutting and weeding. One resident has her own garden area outside her room which she loves and was proud to show off. A fire risk assessment has been carried out. The handyman appointed earlier in the year is a retired fire officer and has the skills and qualifications to review the fire risk assessment. The handyman carries out general repairs and maintenance. At the time of the site visit he was redecorating some vacant bedrooms. Residents said they could ask him to do little jobs such as putting up shelves or hanging pictures. The senior carer said it had been a real blessing when he was employed. The lounge/dining room is homely and comfortable with a range of seating and dining tables allowing for social interaction during meal times. Occasional tables are available for use. Residents rooms are well personalised with those seen having items of the occupants own furniture, pictures and mementos. There are two shared rooms currently occupied by residents who have chosen to share. Residents have locks to their rooms, one resident was noted to lock her room and carry her key with her. Another resident said she chose not to lock her room and left her door open during the day but said she felt her belongings were quite safe when she did so. The home is centrally heated with radiators in high risk areas covered for safety. Where it has been necessary to raise the heat levels in a room the occupant has purchased a free standing heater. The maintenance person was reported to check water temperatures each week. There are three bathrooms with in bath hoists, there is no separate shower facility. A number of residents like to take their own bath without staff assistance and mainly use the ground floor bathroom, leaving the upper floor bathroom for those needing assistance. The bathroom on the ground floor has a toilet and bath but no hand washbasin hence presenting a risk of cross infection. There were other indicators of poor management of risk in this bathroom. Residents who smoke go outside where disposal bins have been provided. Two staff spoke of one resident who has oxygen cylinders in his room being a smoker. This was included in the fire risk assessment. All spoke highly of the domestic who currently is employed through a recruitment agency. Residents said not only did they like her, she was good at her job. Some areas of the home needed extra attention. The domestic was also helping with the drinks and washing up. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 22 A laundry is sited on the lower ground floor. Residents said the laundry was carried out well. There are no separate laundry staff, carers do the washing and night staff do the ironing. The laundry contains a sluice facility and the staff toilet is accessed through the room. At the time of the site visit the walls to one corner of the room were flaking badly and together with the dust in other areas of the room present a risk of cross infection. This must be discussed with the local environmental health officer and action taken as directed by them to reduce the risks of cross infection. Some adaptations are provided such as handrails, toilet rails and mobility aids however as mentioned earlier in the report the home is not fully suitable for people who are wheelchair users. The home does not have a hoist other than the in bath hoists, the lift is unsuitable to accommodate a wheelchair user, Zimmer and staff, and the lower ground floor toilets cannot offer privacy for wheelchair users. There are no separate facilities for staff for changing clothes or storing belongings. They have a cupboard to hang uniforms. There is some use of the kitchen to store belongings which presents a risk of cross infection. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is poor. Residents are at risk due to unsafe recruitment practices, lack of staff training and support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose refers to a low staff turnover, however, since the current owners took over there has been a significant change of staff. A core of staff employed by the home are supplemented by agency staff employed by a recruitment agency. The agency staff have been found lodgings locally. This gives better continuity of staff to residents but unfortunately in two cases staff’s fluency of English makes conversation with residents and understanding of tasks asked of them difficult. Residents spoke highly of one of the agency staff who works mainly as a domestic. At the time of the site visit there was one carer employed by the home on duty, two agency carers, a cook, an agency domestic and the handyman. Some staff hold senior carer status as they have been in the home the longest. On the day of the site visit a carer was holding responsibility for the shift but did not hold senior status. Of concern is the lack of a proper management Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 24 structure. A manager and deputy are still employed but are no longer part of the rota. Staff and residents were confused about the status of the manager and deputy saying they ‘popped in now and then’. Whilst staff’s commitment to the role of person in charge of the shift is not in question, this is not a satisfactory arrangement for day-to-day management of the home. Care staff duties include breakfast preparation, taking and collecting trays to rooms, personal care tasks and laundry. As resident numbers have increased, staffing levels have also been increased to provide three care staff in the morning with a domestic, two care staff during the rest of the day and two staff on duty at night, one wakeful and one sleep in. A person has been employed to work between 5 and 7.30 pm to help at suppertime. Whilst basic care needs were being met, staff time does not allow for one to one time or flexibility in meeting individual choice particularly in the afternoon. Residents spoke highly of some of the staff including three carers who have worked at the home for some time. Residents said these were staff they could rely on and how much looked forward to them being on duty. Evidence that staff are suitably trained was not provided. Staff employed directly by the home spoke of some training having been undertaken including moving and handling and adult protection. The last inspection report records good training opportunities. Some staff are undertaking NVQ level 2 in care. No training records, personal learning and development plans or training matrix could be located. Recruitment practices do not provide a safe system to ensure staff are suitable to work with vulnerable people. Staff have been appointed without two written references and in one case no references at all, no criminal records bureau certificate and no POVA first check. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,35,36,37 & 38 Quality in this outcome area is poor. Residents’ rights to live in a safe well managed service are restricted by lack of clear management and staff supervision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was some confusion about the status of a manager As already mentioned, in principle a manager is still employed. She is not on rota yet occasionally visits to do certain tasks. Staff and residents were also confused as to the management structure. The owner said that recruitment was taking Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 26 place for a new manager and spoke of the qualities she wanted from applicants and proposed employment package. The lack of management structure restricts opportunities for planned one to one staff supervision and does not include work based supervision. The owner was a nurse but said she hasn’t maintained her professional qualification. From the findings of the inspection, there is evidence to suggest the owner doesn’t have the skills and experience to manage the home herself hence must recruit a registered manager. What was clear was the familiarity and positive relationship seen between the owner and residents. There were a lot of smiles and people wanting to chat with her. A number of the group with learning disabilities came to her to ask for assistance and she gave them time and attention to their needs. Some meetings are held, including residents meetings. The last inspection report refers to a need to set up a quality assurance system. With the departure of the manager, this hasn’t happened. The owner arranges for any expenditure necessary for the home is response to identified and agreed need. There is no specific budget allocation. A current employers liability certificate was on display. Records of residents’ finances were not reviewed. The last report records good systems in place. The owner spoke of giving some residents an amount for their personal use each week, as she manages their personal allowance. A resident said that he got his money regularly and he had enough for his needs. Two other residents said they handled their own affairs with family help where needed. As referred to in previous reports and earlier in this record, there have been problems with heating and hot water. These problems have been largely addressed by regular hot water temperature checks and radiator covers for high risk areas. A room at the end of the heating system has less efficient supply than other areas. Fire safety is well maintained with staff aware of fire evacuation procedures. Fire training records couldn’t be located. Records of servicing of supplies and equipment were not reviewed but were found to be satisfactory at the last key inspection. Accidents and incidents are recorded in a manner which meets data protection principles. There is no system to formally monitor falls and link these to risk assessments. There was little in the way of generic risk assessments such as accessing the garden. Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 2 1 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 3 1 2 3 3 3 1 STAFFING Standard No Score 27 1 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 2 X 1 Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 and 5 Requirement That the registered person ensures that an up to date accurate statement of purpose and service users guide is available to all interested parties. This is repeated from the last two inspections, action was required by 1 March 2007. Any further contravention of this regulation will result in enforcement action being taken. The home must evidence that the service can meet the residents needs in respect of their health and welfare. This will be done by ensuring that before admitting any residents: Any resident admitted to the home has been properly assessed with a copy of any assessment carried out by another agency such as Social Service obtained Written confirmation is given to the resident stating that the Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 29 Timescale for action 30/09/07 2 OP3 OP4 14 30/06/07 home can meet their needs. The registered person must be able to demonstrate that the home has capacity to meet the assessed needs of individuals admitted to the home. That plans of care are drawn up in consultation with residents or their representatives as appropriate and are reviewed regularly. This is repeated from the last three inspections, action was required by 1 March 2007. Any further contravention of this regulation will result in enforcement action being taken. Residents daily lives must as far as possible be free from avoidable risks. 3 OP7 15(1) 30/09/07 4 OP7 13 (4) 30/09/07 5 OP8 OP9 12 (1) (a) 13 (2) For staff to have access to practices which safeguard residents care plans must contain risk assessments which include assessments made in response to accidents and incidents and information obtained during the course of the day and night. The registered person must 30/06/07 make proper provision for the health and welfare of residents in that: Medication must be administered safely and in accordance with Royal Pharmaceutical guidelines. Medication must be stored safely in a clean and well ordered manner. Medication must be given as Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 30 directed by the prescriber with accurate, contemporaneous records held of such administration. Facilities must be provided which ensure medication is safe and secure when in use, including when staff are carrying out drug rounds. Medication which is required only for occasional use must clearly state it is for use ‘as required’ and guidelines available to direct when it is to be administered. Staff administering medication must have the skills and training to do so which is evidenced by their practice. Any health matters required by the resident as part of their care must be arranged as part of the admission process with detail of how this will be managed. Residents who self administer their medication must be protected by safe systems to ensure their continued competence to do so. Systems and facilities must be in place to ensure that residents’ privacy and dignity is maintained at all times including when carrying out or performing personal hygiene. This will include that suitable toilet facilities must be provided which meet the needs of those residents accommodated in the home. An improvement plan is required by 31 July 2007 Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 31 6 OP10 12 (4) 31/07/07 7 OP12 16 (m)(n) detailing how this will be achieved and timescales. That resident’s social interests are further assessed and an improved to individual need. This is repeated from the last inspection, , action was required by 1 March 2007. Any further contravention of this regulation will result in enforcement action being taken. That the registered person operates a thorough recruitment procedure that includes the appropriate checks being completed before any person is deployed to work in the home. This is repeated from the last two inspections, action was required by 1 February 2007. Appropriate checks include criminal records bureau certificates being obtained and PoVA first checks being made. Any further contravention of this regulation will result in enforcement action being taken. There must be evidence that any complaint made is fully investigated and records held which enables a summary to be provided to the Commission at its request of all the complaints made during the preceding twelve months and the action that was taken in response. Suitable facilities must be provided for residents use. This will include: A toilet accessible to day rooms 30/09/07 8 OP18 OP29 19(1) 30/06/07 9 OP16 22 30/06/07 10 OP21 OP22 23 (2) (j) 31/07/07 Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 32 for use by wheelchair users whilst maintaining privacy and dignity. Handwashing facilities in the ground floor bathroom. An improvement plan is required by 31 July 2007 detailing how this will be achieved and timescales.. Consultation must be made with the local Environmental Health Officer regarding the laundry where there are risks of cross infection, including flaking paint on the walls. An improvement plan is required by 31 July 2007 detailing how this will be achieved and timescales. There must be sufficient staff working in the home to meet the needs of residents at all times. This will include staff with the skills, knowledge and experience to provide management, guidance and supervision in the home. It is unlikely that the current senior structure is appropriate to ensure the health and welfare of residents. An improvement plan is required by 31 July 2007 detailing how this will be achieved and timescales. All people working at the home must have evidence that they are safe and competent to do so through proper recruitment being carried out. This will include: 11 OP26 23 (5) 31/07/07 12 OP27 18 (1) & (2) 31/07/07 13 OP29 19 30/06/07 Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 33 • A criminal records bureau certificate obtained. Unless there are exceptional circumstances, this must be obtained before the person starts work. A satisfactory POVA first check carried out before the person starts work • 14 OP30 17 (2) 18 (1) (c) Two written references received before the person starts work with evidence of the authenticity of these references obtained. Staff must have the skills and knowledge to carry out their work. This will include core training and client specific training. There must be evidence that staff have the necessary skills and training. Their training needs must be kept under review. Records of training must be available for inspection at all times. An improvement plan is required by 31 July 2007 detailing how this will be achieved and timescales. A person must be appointed to ensure the home is managed efficiently. Any person so employed must have the skills, qualifications and experience to do so. The person must be provided with the support, time and • 31/07/07 15 OP31 8 (1) 9 31/07/07 Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 34 capacity to carry out their management responsibilities. An improvement plan is required by 31 July 2007 detailing how this will be achieved and timescales. That an effective quality assurance system is established and reported on. This is repeated from the last two inspections action was required by 1 May 2007. 17 OP38 13 That generic risk assessments are used to ensure resident’s safety. These should include risks presented by the garden and hot water with appropriate control measures being taken. This is repeated in part from the last inspection, action was required by 1 April 2007. Any further contravention of this regulation will result in enforcement action being taken. 30/09/07 16 OP33 24 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations Each resident should have a contract/statement of terms and conditions to include detail as set out in the national minimum standards and by the Office of Fair Trading. A signed copy of any such contract/statement of terms and Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 35 conditions should be held on the resident’s file. 2 OP10 Residents should have use of a phone which is accessible and can be used in private. This is unlikely to be by use of a line or phone that is the main home phone. Residents who are able but need assistance to maintain contact with friends or do personal shopping should have support to do so. Consideration should be given to providing designated secure space for staff to store their belongings without using the kitchen. Staff should receive formal 1:1 supervision not less than 6 times a year. There should be a system to monitor falls and link these to risk assessments. 3 OP12 OP13 4 OP26 5 6 OP36 OP38 Ashridge House DS0000062830.V336713.R01.S.doc Version 5.2 Page 36 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. 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