CARE HOMES FOR OLDER PEOPLE
Ashton Grange 3 Richmond Road Horsham West Sussex RH12 2EG
Lead Inspector Marie McCourt Announced Tuesday, 3rd May 2005 V220212 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 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. Ashton Grange Version 1.10 Page 3 SERVICE INFORMATION
Name of service Ashton Grange Address 3 Richmond Road, Horsham, West Sussex, RH12 2EG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01403 257263 01403 257263 Ashtonleigh Nursing Home Limited Post Vacant Care Home 24 Category(ies) of N Care Home with Nursing registration, with number of places Ashton Grange Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12 August 2004 Brief Description of the Service: Ashton Grange is a privately owned care home registered to accommodate up to twenty-four services users with dementia who are over the age of sixty-five. The registered provider is Ashtonleigh Nursing Home Ltd, and Mr Chaytansing Gopal is the responsible individual. Mrs Carmel Rigby is acting as manager whilst her application to register as the new manager is being processed. The property is a large detached two-storey period house, situated in a quiet residential area near to the town centre of Horsham. There is a spacious and well-maintained garden to the rear of the house. The accommodation is provided in twenty-two single rooms and one double room, and seven of the rooms have en-suite facilities. There is a passenger lift connecting the two floors. Ashton Grange Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection at the home took place over a period of eight hours. Pre-inspection planning and the reading of various materials, including comment cards took approximately two days. A full tour of the building took place and included the observation of Health and Safety matters, hygiene issues, decorative order and general overview of the atmosphere created within the home. Three visitors, three staff members and five residents were spoken to. Case tracking was carried out by examination of relevant records and information held on the staff and residents spoken with during the course of the inspection. What the service does well:
There is a good assessment process in place, which includes risk assessments that help to identify suitability to the home. The needs of residents are well met and staff work in a respectful and positive way with both them and their relatives. One relative said that there are always lots of staff around who are willing to assist in any way they can to make the quality of life as comfortable as possible for people living at the home. Social activities are encouraged, with residents being able to access the local community on request, aided by staff if required. In-house activities are also offered by an employed activities co-ordinator. All residents spoken to reported that the food was satisfactory and that the meals were varied and plentiful. Staffing levels are considered to be high and it was noted that agency staff are never used at the home. There was positive feedback from all of the people spoken to regarding the manager and the way in which the home is run. Staff and residents were very complimentary of Mrs Rigby and gave examples of how issues are dealt with in a professional manner and without delay. Ashton Grange Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashton Grange Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ashton Grange Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3. A good standard assessment process is in place, which includes risk assessments, to ensure that the home is able to provide adequate care to prospective residents. EVIDENCE: Assessments are carried out prior to admission to the home. The manager arranges a visit to prospective residents before admission, and using a scoring system, individual needs are assessed. Risk assessments are also carried out and a similar scoring system used to define levels of risk. One resident and their relative confirmed that they had looked at several homes before accepting Ashton Grange and that an assessment had been carried out by the home. On admission to the home residents and/or their relatives are required to agree and sign a contract. Individual records inspected confirmed this. Ashton Grange Version 1.10 Page 9 The manager is in the process of implementing a new care plan. There is one up and running and on inspection it was far easier to read and much more user friendly. Health sections are in a less complex format, are easy to understand and are far more relevant to individuals than the older style card-ex system. Ashton Grange Version 1.10 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8. Health care is regularly reviewed and any changing needs are re-assessed with prompt changes implemented when necessary. EVIDENCE: Individual plans of care do record health, personal and social care needs, although currently the manager is in the process of updating these, so that they are more user-friendly and relevant. Residents and relatives spoken with confirmed that their needs are being well met. One relative who spoke with the Inspector described how when her Mother was ill and required hospitalisation, the home provided staff to care for her additional needs at the hospital. Staff were able to advocate on behalf of the resident and ensure her basic needs and comfort were attended to at all times. The Inspector was told that the home responded very quickly to her poor health, and had her admitted into hospital promptly. Whilst the resident was in hospital, her needs were re-assessed by the home and she was moved into a more suitable and private room on the ground floor. This was decorated prior to her admission, despite the family believing it to be nicely decorated before hand.
Ashton Grange Version 1.10 Page 11 When specialist equipment is required, the Inspector was told that it is provided promptly, with the manager or deputy manger assisting with any necessary paperwork. Individual records show that health is reviewed on a regular basis and in addition the home receives weekly visits from a G.P. to ensure all residents health care needs are up-to-date. Ashton Grange Version 1.10 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15. The environment of the home is welcoming and friendly. Staff are polite and helpful. Social activities are provided both inside and outside of the home and are encouraged and supported by the staff team. Religious interests are respected and maintained. EVIDENCE: Relatives and visitors spoken to on the day of inspection were all complimentary about the home. All confirmed that they could visit when they wished and did not need to agree dates or times with the home, just arriving when it was convenient to them. They were always admitted quickly to the home and staff were said to be polite and helpful at all times. One resident receives regular visits from her grandchildren. The children are able to play in the garden and the inspector was told how it was lovely that the home allowed this, so that their grandmother could see them at play. Residents spoken with confirmed that they are able to access the community as and when they wish, attending cinema, shops and so on. Transport is provided, and residents are accompanied by either a staff member or a relative. Ashton Grange Version 1.10 Page 13 Religious interests are respected and the inspector was able to speak with a visiting Sister from the local Roman Catholic Church. She visits several residents on a regular basis and was complimentary about the home and the staff, informing the inspector that there were always lots of staff around. Five residents were asked to comment on the quality of the food provided by the home. All of those spoken with said that the food was very good and they were happy with the meals in general. One resident requires that her food is pureed, and the home ensures that each food item is blended separately. Meals can be eaten in private or in the communal dining room. Ashton Grange Version 1.10 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16. Residents, relatives and staff are all confident that complaints will be listened to and managed appropriately. There are still problems with laundry, although the home is trying to address this through the ‘Friends and Relatives’ meetings that are held regularly. EVIDENCE: A complaints procedure is in place at the home. There have been no recorded complaints since the last inspection. However, discussion with a visitor and one comment card received by the inspector suggested that there are some problems with the laundry, with residents’ clothing either going missing or being inappropriately washed, causing shrinkage. The manager is aware of this issue and it has been addressed in the ‘Friends & Relatives’ meetings that are held every two months. The inspector was told that any damaged items of clothing could be reimbursed. Relatives, residents and visitors spoken with on the day of inspection all confirmed that they had no reason to complain, but that if they did they would not hesitate to contact the manager. The Inspector was told that the staff and management of the home are always helpful and willing to address any issues that arise immediately. Members of staff spoken with also said that they were able to discuss any issues or concerns with the management of the home. Ashton Grange Version 1.10 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26. The home is clean, bright and in good decorative order throughout. Health and safety records are in place and in good order. EVIDENCE: A tour of the premises found the home to be in good, clean, decorative order. The kitchen was clean and tidy and met the required standard in terms of Health and Safety. An Environmental Health Officer visited the home for an unannounced inspection in February of this year. At that time there were no requirements made. A Fire inspection was last carried out in August 2003. Ashton Grange Version 1.10 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. Staffing levels are good enabling the needs and requirements of residents to be consistently met. The procedures for recruitment are not robust and do not safeguard residents. EVIDENCE: On the day of inspection there were four carers and one trained nurse on duty in addition to the manager to provide care. At night there is one trained nurse and two carers on between the hours of 8pm and 8am. This ratio of staff remains the same over a seven-day period. The home also employs separate staff to cook and clean and an activities co-ordinator to provide structured activities for the residents. Currently there are no staff vacancies. The home does not use agency staff, if necessary they will call on staff to work from the sister home, or offer overtime to existing staff. Seven new staff have been recruited since the last inspection. The Inspector looked at staff files of three staff members spoken with and found that the home has not undertaken all the necessary recruitment checks to ensure the safety and protection of residents. This issue has been highlighted and discussed with the home at the last two inspections and needs to be rectified immediately. Therefore a requirement has been made in respect of this matter. Ashton Grange Version 1.10 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38. Roles of accountability and responsibility are clear and professional within the home. There is a good sense of direction with staff receiving guidance on all matters of care and welfare regarding residents. EVIDENCE: Currently there is an acting manager and a deputy manager who are in day-today charge of the running of the home. The acting manager, Carmel Rigby is preparing to apply to become the Registered Manager. Residents, relatives, staff and visitors spoken with all gave positive feedback about the management of the home. Residents and relatives said that the manager was always available to talk to and was prompt in decision making, ensuring any issues were resolved as soon as possible. Visitors to the home said that they were made to feel welcome at all times, regardless of when they arrived.
Ashton Grange Version 1.10 Page 18 Staff confirmed that the management team were professional and prepared to listen to issues or concerns that arise. The Inspector was told that the manager is very approachable and has made some useful improvements to the structure of the staffing team which enables them to work more efficiently. Inspection of records indicated that the manager is continually assessing, reviewing and implementing various policies and procedures throughout the home. Environmental records and care records are in good order, but as previously highlighted, recruitment records are not up-to-date. Staff confirmed that regular training in core health and safety issues is regularly provided. Ashton Grange Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 4 14 3 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 3 Ashton Grange Version 1.10 Page 20 Are there any outstanding requirements from the last inspection? No 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 29 Regulation 17 Requirement The registered person shall maintain in the care home the records specified in Schedule 4. Timescale for action 31 August 2005 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 Good Practice Recommendations Ashton Grange Version 1.10 Page 21 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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