Inspection on 29/04/08 for Ashridge House

This inspection was carried out on 29th April 2008.

CSCI found this care home to be providing an Good 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 17/12/07

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Ashridge House 132 Dorset Road Bexhill-on-sea East Sussex TN40 2HT Lead Inspector June Davies Unannounced Inspection 29th April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashridge House DS0000062830.V361222.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.V361222.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.V361222.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. 17th December 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 26 single rooms and one double room. Two bathrooms are fitted with standing hoists. 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 and £470 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 (at cost). 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.V361222.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection took place on the 29th April 2008 over a period of 7.5 hours. During this time the inspector spoke with the new appointed manager, the registered provider, residents and staff. Documentation relating to the key standards inspected was also viewed. The inspector carried out a partial audit of medication, observed lunch being taken in the dining room and carried out a tour of the home. Information was also considered from the homes Annual Quality Assurance Assessment. There was one requirement from the previous three inspections that has only been partly met, and is related to staff mandatory training. What the service does well: What has improved since the last inspection? There have been major improvements in the home since the last key inspection in December 2007. The newly appointed manager has ensured that a pre-admission template is in place that requires detailed information about a prospective resident, so ensure that the staff will be able to meet the prospective residents assessed needs. Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 6 Care plans are now kept electronically and in paper form and provide much more detailed information regarding each individual residents care needs, both physical and social, good risk assessments are in place, some are generic and other are pertinent to each residents, needs, interests and choices. There is good recording by staff regarding personal hygiene care and nutrition. Residents and or relatives/representatives are involved in signing up to the pre-admission assessment, care plans, reviews and risk assessments. There are good policies and procedures in place for the receipt, administration, storage and return of medication within the home. For those residents who are self-medicating, there are policies and procedures in place, together with risk assessments and recorded monitoring forms. The privacy and dignity of the residents is observed by providing privacy curtains around beds in the shared bedroom. The newly appointed manager is a ‘Skills for Care’ induction trainer as has compiled a good ‘Skills for Care’ induction programme for new staff employed to work in the home. At least 75 of staff now have NVQ level 2 and above qualifications. A new quality assurance system is in the process of being put in place and the manager has already given surveys to residents, relatives/representative, and visiting professionals. Systems used in the home are monitored weekly and each room in the home now has a health and safety and fire risk assessment. The manager is in the process of checking the exterior of the building and the gardens to ensure they are safe for residents to use. All staff are now supervised on a regular basis, and this ensures that staff are knowledgeable in respect of the philosophy of the home, the written policies and procedures and are able to take up further training which will enable them to use improved knowledge and skills to meet the assessed needs of the residents. A professional Legionella check has been carried out on water systems in the home and the registered provider is now aware of the improvements that need to be made in this area to ensure that residents are not placed at risk. What they could do better: While the administration of medication has improved further work needs to be done to ensure that all liquid medicines, eye drops, eye ointments are dated on Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 7 the day of opening on the bottle and tube, as this ensure that a good audit trial can be kept of liquid medications and eye drops and eye ointments do not go out of the 28 day use by date. Staff must be observant and ensure that residents are sitting comfortable to eat their meal. Residents with small appetites should be offered smaller meals, with seconds available if required. Any resident who needs their food to be liquidised must have their meal presented to them in an appetising manner by ensure that each item of food is liquidised separately. The back garden of the home must be made safe, so that residents are able to have free access to this area, in safety. Waste bins with swing lids must be provided in communal toilets and bathrooms to ensure that the risk of cross infection is kept to a minimum. The appointed manager must review her staffing levels to ensure that staff have time to spend one to one with residents and that residents are able to obtain immediate staff attention should they need to do so. These staffing levels will need to be reviewed at regular periods as the home begins to take in more residents. A requirement was made at the last two key inspections that all staff must receive mandatory training, while the new manager has gone a long way in meeting this requirement there are still staff who need to complete all their mandatory training. The manager must ensure that all staff receive this training as well as work related dementia training. The appointed manager must ensure that she applies to CSCI for registration. The registered provider must ensure that risks identified in the professional Legionella check are rectified to ensure resident are not placed at risk. Ashridge House DS0000062830.V361222.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.V361222.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.V361222.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): Standards 1, 3 and 6 People using this service experience good quality outcomes in this area. The homes Statement of Purpose and Service User Guide are good. They provide prospective residents with the information they need to make a decision about moving into the home. New residents move into the home knowing that their needs can be met and 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 are kept under constant review and present copies of these documents show all relevant information is contained within them. Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 11 The home has a new pre-admission assessment, which incorporates all details as outlined in National Minimum Standards 3.1. The appointed manager stated that she would visit prospective residents prior to admission, and gain as much information from them as possible this would then be checked with relatives/representatives, and she would seek any gaps in information, further information would be gathered via the residents Care Manager, G.P. or other professional bodies that know the prospective resident. The appointed manager stated that she would need as much information as possible to ensure that the home would be able to meet the needs of the prospective resident, and that her care staff team have the skills and knowledge to meet the resident’s needs. A completed pre-admission assessment could not be viewed, as the home has had no new residents since the last key inspection. Ashridge House does not offer intermediate care. Ashridge House DS0000062830.V361222.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): Standards 7, 8, 9 and 10 People using this service experience good quality outcomes in this area. Residents know that their own personal wishes are reflected in their individual care plans and that potential risks are managed. The health needs of the residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for medication in the home have improved, but further work needs to be done to ensure that residents are not placed at risk. Personal care is offered in a way to protect the residents’ privacy and dignity and promote independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 13 The inspector viewed three care plans these had been updated into the new format, and are kept securely, electronically as well as in paper form. The new format for care plans is very good and from the three care plans viewed there was detailed information regarding the care needs of the three residents, this gives staff clear information as to the level of care the residents require and what each residents preferences are. Each care plan is signed either by the residents and or their relative/representative. Care plans are reviewed on a monthly basis, and any changes in care are recorded in detail. Residents and or their relative/representative sign the review to say they agree to any changes in care. General risk assessments are completed relating to mobility and individual risk assessments are drawn up relating to the residents activities, interests and wishes, these too are signed by the resident and or their relative/representative. Each care plan contains a personal hygiene matrix, which staff complete after carrying out these tasks, this ensures that all aspects of personal hygiene are carried out including oral care, shaving, hair care etc. None of the residents’ have pressure areas or sores at the present time. Should concern arise about tissue viability the deputy manager of senior carer would report this immediately to the district nurse. There was evidence on the day of this key inspection that any concerns regarding continence are reported immediately to the continence nurse who will visit the resident to carry out an assessment. While many of the residents’ in the home have differing degrees of dementia, none of them have follow up visits from community psychiatric nurses. The manager did state that should she have concerns regarding a resident’s mental health she would contact the G.P. in the first instance and ask for referral to the consultant psychiatrist. Every two weeks the residents’ receive an activity from an external motivation exercise person, and every week another external visitor does music to movement with those residents who wish to participate. Residents are weighed on a regular monthly basis, most of the residents maintain a stable weight, but again if the manager or staff have any concerns this would be referred directly to the resident’s General Practitioner. There was evidence within the residents care plans that they have access to a variety of health care professionals as and when required. Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 14 The receipt, recording, administration and return of medication has improved since the last key inspection. Good records are kept of medication coming into the home. For a resident who is self medicating there is a good policy and procedure in place as well as risk assessment and monitoring sheets in place, signed by the resident. There is a list of medication, trained staff with their initials. The policies and procedures for the administration of medication are placed in the front of the monthly administration record file. There is a double check by staff at each medication round, in that one member of staff takes responsibility for administering medication, and when this has finished the deputy or senior carer checks the monthly administration record for each resident to ensure that all medication has been signed off. It was noted that at lunch time on the day of this key inspection, there were several gaps on the MAR sheet that were being checked by the senior carer, these mainly related to ‘as required’ medication, discussion took place with both the member of staff and the manager as to how this could be rectified. It was also noted that eye drops and liquid medication is not dated on the bottle on the day of opening, and therefore a requirement is being made to ensure that this takes place. There are no controlled drugs kept in the home, but there is a controlled drugs cupboard. Medication fridge and medication room temperatures are recorded daily. The returned medication book shows that medication is returned to pharmacy on a regular basis. Both the medication trolley, medication cupboard, medication fridge and medication room were in a clean and hygienic condition. The inspector observed that staff talk to residents in a friendly manner. Where personal hygiene tasks are being carried out staff ensure that residents privacy and dignity is maintained, by ensuring that doors are closed. Staff knock on doors prior to entering the bedroom or toilet. Where a resident needs to see their General Practitioner the consultation takes place in the resident’s bedroom. Residents are able to entertain their visitors in the communal lounge or in their own bedrooms as they wish. The residents have access to a telephone in a vestibule close to the communal lounge, or the resident and or their relative/representative can make arrangements for the resident to have their own private telephone in their own bedroom. One resident is waiting for the telephone engineer to call to fix up a private telephone for him. There is only one shared bedroom in the home at the present time, and this has now been fitted with privacy curtains around the beds. Ashridge House DS0000062830.V361222.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): Standards 12, 13, 14 and 15 People using this service experience good quality outcomes in this area. Activities and links with the community are good and support and enrich the residents’ social lives. The home has an open visiting policy and this ensures that residents are able to have visitors at any time. Residents make their own arrangements regarding the personal finances. The meals in the home are good with residents being offered choices at each mealtime, but staff, need to pay attention to detail to ensure that each resident is able to enjoy their meal. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 16 Residents are able to make choices in regards to their daily living. Evidence of this was seen during this key inspection, where a resident needed to take a medication at least half an hour before eating, this was marked down as being given at 9.00 a.m. each morning when staff were asked what time the resident had breakfast, they explained that this resident does not like to get up too early so they have arranged to give this medication at 9.00 a.m. as this is the time that the resident likes to get up, they then have their breakfast later at around 9.30 to 10.00 a.m. There was evidence that a range of activities are on offer to residents and they are able to choose what activities they become involved in. Some of the activities on offer are arts and crafts, DVD films, world news, quizzes, bingo, scrabble, music to movement and motivation. Each week an aromatherapist visits the home. Residents look forward to this visit, and are able to choose between hand massage, leg and foot massage or both. The appointed manager takes two residents at a time out to the local shops or for a cup of coffee, on a regular basis. When time permits staff take residents out for walks in the local community. The local Church of England vicar visits the home each month to carry out inter denomination communion. At the present time all the residents in the home are of Church of England denomination. The manager would ensure that arrangements are made if a future resident practiced a different religious belief. The home has an open visiting policy and procedure and residents relatives and friends are free to visit at anytime. One resident said, ‘My sister is coming to visit me, she is going to have lunch with me, she is going to sit at this table.’ 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. The inspector spoke to residents in the communal dining room at lunchtime; all but one resident praised the food and said that they were able to have choices. The rotating four weekly menus showed that residents are offered a choice of meals throughout each day. Food offered to the residents gives a varied and nutritious diet. It was noted however that for one resident who requires liquidised meals, this was not delivered in an appetising manner. A requirement is being made that each item is separately liquidised to ensure that the meal is presented attractively and encourages appetite. Through observation the inspector also noted that three residents ate very little, for one particular resident who that day had chosen to eat her lunch in the communal dining room, staff had not ensured that she was sitting comfortably, and was in need of cushions to prop her up to ensure that she had proper access to the table that had been placed in front of her. Discussion took place with the manager regarding these residents having small appetites and being over faced with too much food, the manager confirmed that she will speak to the Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 17 cook, to ensure that a smaller plate is used, with less food on it. At the present time the home only caters for diabetic diet, but other diets can be accommodated as and when required. The inspector noted that residents were able to eat their meal in a relaxed and unhurried manner. Ashridge House DS0000062830.V361222.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): 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 their views are listened to and acted on. Staff have good knowledge and understanding of adult protection issues, which protects the residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy and procedure is up to date and gives timescales of when the complaint will be investigated and responded. The complaints policy is displayed in a prominent position in the home. There have been no complaints since the last key inspection. The manager has a developed a compliments and complaints file. Two residents said – ‘I would talk to the manager or Mrs Sita the provider if I was unhappy.’ ‘I would talk to one of the girls if I was not pleased with something and I know they would tell the manager.’ Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 19 The safeguarding adults policy and procedure has recently been reviewed and has been made available to staff. All but two members of staff have recently completed Safeguarding Adults training. While the home has not recruited new staff since the last key inspection, through discussion with the manager she is well aware that when recruiting new staff she needs to obtain POVA first check and CRB prior to a new employee being deployed to work in the home. The whistle blowing policy and procedure was reviewed in March 20078 and the home has a policy and procedure relating to staff accepting gifts from residents. The manager is in the process of obtaining the Sussex MultiAgency Policy and Procedures for Safeguarding Vulnerable Adults. Ashridge House DS0000062830.V361222.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): Standards 19 and 26 People using this service experience good quality outcomes in this area. The standard of the environment within the home is good providing residents with an attractive and homely place to live. The manager ensures that the infection control procedures in the home are adhered to, so that residents are not placed at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of this inspection the home was well presented there were no offensive odours. All the furniture is in good order. Residents live in a Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 21 welcoming and homely atmosphere. Some of the vacant bedrooms were in the process of being decorated, and new carpets are due to be fitted and new furniture has been purchased to put into these rooms. Throughout the home was in a good state of repair and was clean and tidy. Doors have been fitted with magnetic fire releases. Three residents said – ‘My room is lovely, I like my bedroom.’ ‘I am very happy in this home and I like my bedroom.’ ‘We like our bedroom and I am pleased with the curtain that goes round the bed.’ The back garden is a large grassed area, with a patio where residents can sit, the inspector did note that from the back path, there is a drop onto the grass, this is an area of risk, and was discussed with both the registered provider and the appointed manager, both stated that they are in the process of ordering some fencing to put up in this area, to ensure the residents have a safe outdoor space which they can use. The inspector observed that throughout the home staff are provided with disposable gloves and aprons. The standard of hygiene was high. The laundry room is in a clean and tidy condition, and a new industrial washing machine and tumble drier have been purchased. The new industrial washing machine has two programmes for the sluicing and disinfection of soiled linen. The appointed manager has purchased individual laundry boxes for each resident, and these boxes have the resident’s names and photographs on the front. 86 of staff have received infection control training, and the homes has recently reviewed policies and procedures in place for infection control. The home has a contract with a waste disposal company for the disposal of clinical waste. The only improvements that need to be made are the supply of swing bins in some communal toilets and bathrooms and the supply of liquid soap and paper hand towels in the staff room. The appointed manager monitors the cleanliness of the building weekly. Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 22 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 using this service experience adequate quality outcomes in this area. Staffing numbers must be reviewed to ensure that residents are not placed at risk, and have their assessed care needs met. Staffing qualifications are good ensuring good quality care. Staff recruitment practices have improved and residents will now receive care from well-vetted staff to ensure they are not placed at risk. Staff training is improving and this ensures that staff that have the knowledge and skills to meet needs safely in caring for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From viewing the staff rota and discussion with the new appointed manager, at the present time the home is using 396 care hours per week. At the present time there are 21 residents at Ashridge House. Four of the residents have high level of needs, nine have medium level needs and 8 have low level needs. The residential forum suggests that the home should be using 528 care hours Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 23 per week. There is only one domestic employed at the home, and two cooks to cover lunch and teatime meals seven days per week. A handyman is employed and he works according to need. There is no laundry assistant employed in the home. A requirement is being made to ensure that the home is staffed appropriately to meet the needs of the residents. The new appointed manager also needs to keep staffing levels under review as more resident’s move into the home. 75 of care staff have achieved NVQ 2 and above, one member of staff is about to complete her NVQ and further staff have recently been recruited onto a NVQ course. This meets the required qualification level of the National Minimum Standards. No new staff have been employed by the home since the last key inspection. The inspector looked at three personnel files and found the all files had an application form, but not a full employment history, the new appointed manager now has an updated application form which requires a full employment history and which she will use when recruiting new staff into the home. All staff have a CRB check, but not all have been POVA first checked, the appointed manager says that she is well aware that new staff must be POVA first checked prior to being deployed to work in the home. Each staff file has a recent photograph and at least two forms of identification, two written references, terms and conditions of employment and job description. There is also evidence of initial induction. These files also contained supervision forms, observation forms in regard to personal care and administration of medication. The new manager now observes staff carrying out their duties to ensure that staff have no further training needs and are working within the philosophy of the home and in line with policies and procedures. All three staff files show that staff now receive regular formal recorded supervisions. From the training matrix for each member of staff the inspector found that the following percentages of staff had completed mandatory training; 75 have Moving and Handling, 83 have Fire Safety, 91 have Food Hygiene, 83 have Infection Control, 58 have first aid, 91 have Safeguarding Vulnerable Adults, 50 have Dementia Care and 83 have completed Diabetes training. The training levels in the home have taken an upward trend since the last key inspection, but this trend needs to continue to ensure that all staff have completed their mandatory training including Dementia Care training. The appointed manager stated that further dementia care training is in the process of being booked and this will take place over a three day period, she is also in the process of finding out about Understanding Dementia Care which is a long term course run over a period of 16 to 18 weeks. The new appointed manager has set up a ‘Skills for Care’ induction pack; she is also a qualified trainer in ‘Skills for Care’ induction. These packs will be used on new staff employed to work in the home in future. Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 24 There is an outstanding requirement from the last three inspections that requires the registered provider to ensure that all staff have received mandatory and job related training, this requirement has been partially met, but failure to meet this completely could result in enforcement action being taken. Ashridge House DS0000062830.V361222.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): Standards 31, 33, 35, 36 and 38 People who use this service receive good quality outcomes in this area. The manager has a good understanding of what needs to improve in the home. A good quality assurance system is being developed by the manager to ensure that all residents receive a high quality of care. All staff receive regular supervision to ensure they are able to deliver care according to the individual needs of the residents. Health and safety issues within the home are addressed appropriately to ensure that neither the residents nor staff are placed at risk. This judgement has been made using available evidence including a visit to this service. Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 26 EVIDENCE: The new appointed registered manager has been in post since April 2008; she has a NVQ level four qualification and has her Registered Managers Award. She has many years experience both in the residential care setting and as a manager in domiciliary care. Both staff and residents spoke highly of the manager saying that she was approachable and how much the home has improved since she has been the manager. From inspecting the work that the manager has done since being in post and through observation the inspector found that there had been significant improvements in the home. The manager certainly has the best interests of the residents at heart and intends to provide the best quality of service that she can. From evidence seen in the appointed manager’s file, she continues to update her skills and knowledge with ongoing training. The manager is in the process of applying to CSCI for her registration, and is awaiting the return of her full CRB check. The appointed manger was able to show the inspector how she is developing the quality assurance system in the home, by requesting residents to complete surveys, some of these had been completed by the residents themselves and some by the residents key workers, surveys have also been completed by some relatives and professionals who visit the home. The manager realises that she has to be more pro-active in encouraging people to complete these surveys to ensure that she gets a true perspective of the care standards within the home. She has also devised quality-monitoring forms to be used for care planning, reviews, medication, cleaning and food management, as well as developing health and safety and fire risk assessments for each room in the home and externally for the garden and external building. The manager has been very pro-active in ensuring that the home is cleared of unwanted items of furniture, aids and rubbish. At the end of the year she will produce a written synopsis of her surveys, monitoring and health and safety and fire risk assessments that she has carried out to ensure that the home is providing the best quality of care of the residents who live in Ashridge House. The manager does not handle any of the residents’ personal allowances. Purchases are made on the behalf of resident within the home, from the petty cash, receipts are retained and these are given to the registered provider who then invoices relatives or representatives for the expenditure. Details of all monies spent on behalf of residents are kept securely within the home. All staff now receive regular formal recorded supervision and the recorded supervision forms are kept on staff personnel files. Supervision covers the philosophy of the home, policies and procedures used in the home, and what further training each member of staff requires to ensure that all the needs of the residents are met. Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 27 The inspector viewed the maintenance certificates for all appliances used in the home and found these to be up to date. A Legionella check has been carried out by a contracted company to meet a requirement from the last inspection, and the report was received back last week, there are issues that need to be addressed, and until these are carried out there is a high risk. From discussion with the registered provider she was able to assure the inspector that these issues will be addressed as soon as possible. All fire points are checked on a regular basis and recorded. Hot water delivery temperatures are checked regularly and recorded. Emergency lighting is checked and recorded monthly. All exterior doors are fitted with number locks to ensure the safety of residents who have dementia. All accidents to residents are recorded in an appropriate accident book, and are recorded to a satisfactory standard by the member of staff on duty at the time of the accident. Policies and procedures relating to health and safety are kept under review and changed in accordance with legislation. Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 29 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 OP13 Regulation 13(2) Requirement Timescale for action 16/06/08 2. OP15 12(1)(a) Schedule 3 (3)(m) 3. OP27 18(1)(a) The registered person must ensure that eye drops, ointments and liquid medication is dated on the bottle/tube on the day of opening, to ensure that medication is not used after 28 days and to ensure a good audit trial for liquid medication. The registered person must 16/06/08 ensure that residents’ requiring liquefied meals have them served in an appetising manner at all times. Each item of food must be separately liquidised to ensure that it is attractively presented to the resident(s). The registered person must 16/06/08 ensure that staff, are employed in sufficient numbers to meet the needs of the residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 30 No. 1. Refer to Standard OP19 Good Practice Recommendations It is strongly recommended that the back garden is made safe to ensure that residents’ have an outside space to use the presents the minimum of risk. Ashridge House DS0000062830.V361222.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone 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.V361222.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!