Inspection on 31/08/06 for Ashton Grange

This inspection was carried out on 31st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashton Grange 09/05/07

Ashton Grange 04/10/05

Ashton Grange 03/05/05

Ashton Grange 12/08/04

Ashton Grange 19/04/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOMES FOR OLDER PEOPLE Ashton Grange Ashton Grange 3 Richmond Road Horsham West Sussex RH12 2EG Lead Inspector Miss Helen Tomlinson Unannounced Inspection 31st August 2006 10:15a 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 Ashton Grange DS0000024107.V310409.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. Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashton Grange Address Ashton Grange 3 Richmond Road Horsham West Sussex RH12 2EG 01403 257263 F/P 01403 257263 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) Ashtonleigh Nursing Home Limited Mrs Carmel Rigby Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (25) Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 25 service users may be accommodated. Date of last inspection 31st July 2006 Brief Description of the Service: Ashton Grange is a privately owned care home registered to accommodate up to twenty four older people with dementia who are over the age of sixty five years. The property is a large detached, converted, two-storey period house, situated in a quiet residential area of Horsham. It is opposite a school and close to local shops and public houses. There is car parking to the front of the home and a spacious, well maintained garden to the rear. Accommodation is provided in twenty-two single rooms and one double room. Seven of the rooms have en-suite facilities. There is a passenger lift connecting the two floors. Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at the home at 10.30am and left at 6.15pm. The registered manager was present throughout the inspection. At the time of this inspection twenty four residents were accommodated. The inspector met all residents living at the home during the visit but, due to their level of mental health ability, none of the residents were able to express an informed opinion of what it was like to live at the home. The inspector spoke with five relatives and one health professional, who were visiting, and all discussed their experiences of the home. Prior to the visit to the home information was gathered, from previous inspections and information received, regarding the service. During the inspection a full tour of the premises took place, the inspector spoke to the residents, staff and manager. Care practices were observed, care plans examined and other documents seen as necessary throughout the inspection. Following the last inspection two requirements were made. These were met at this inspection and four further requirements were made. What the service does well: Residents were not accommodated in the home without an assessment of their needs being carried out. This and other health care needs and risk assessments formed the basis of a comprehensive plan of care. These were kept up to date. Relatives spoke highly of the staff team, saying they were polite, friendly and very approachable. They discussed how they were included in their relatives care, should they wish this, and kept informed of any changes. They were welcomed into the home and felt part of the team with one relative saying when her Mother had been admitted she had “gained an extended family.” They praised the organised activities which took place and the enthusiasm shown by the activities co-ordinator. The home was clean, tidy, well maintained and free from offensive odours. The environment was homely, safe and suitable to meet the needs of the residents accommodated. An attractive, fully enclosed and well maintained Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 6 garden was available for residents and relatives. Equipment needed to meet the needs of the residents was available. Relatives and staff spoke highly of the manager saying she was approachable, helpful and knowledgeable. Staff described how they worked as a team in the best interests of the residents, and were encouraged to improve their knowledge and skills. 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 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 the following standard(s): 3 Residents needs were assessed prior to them being accommodated in the home. It was confirmed, in writing that their needs could be met. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The files seen contained assessments of the resident’s needs which included all aspects of physical and health care and personal information. The manager confirmed these had been carried out prior to the resident becoming accommodated in the home although they were not signed or dated. Some basic information from one resident’s previous home was included. Since the last inspection a letter confirming that the home could meet the needs of the resident had been developed. Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 7,8,9 and 10 All residents had a plan of care which was drawn up from health needs assessments and risk assessments. These were regularly reviewed and kept up to date. The storage and administration of medication was safe for the residents. An issue of incorrect practice and recording with controlled drugs was discussed. Residents’ privacy and dignity was protected by the staff. One bathroom, when used for immobile residents, did not afford them privacy. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: All residents had a plan of care documented. This included personal, physical, mental and some social information. A variety of needs assessments and risk assessments were used to obtain information about the resident’s individual needs and devise an appropriate plan of care. These included falls risk assessments, bed rail risk assessments, risks of developing a pressure sore, manual handling assessments and since the last inspection nutritional assessments had been introduced. Since the last inspection the pre-printed Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 10 care plans had become more individualised and were regularly reviewed and kept up to date. A visiting health professional commented that information regarding residents’ health was easily accessible and staff were knowledgeable and helpful. It was discussed that an increased amount of necessary equipment had been purchased, to meet the health needs of the residents. An issue was raised regarding the resident’s safety when staff were busy and there was no supervision of residents in the lounge. This was particularly the case following meal times. It was discussed with the manager that currently the residents accommodated were highly dependant on the staff to meet their physical and mental health needs, with almost half requiring the use of a hoist for moving and handling. This had implications for the deployment of staff and supervision and safety of the residents. The manager stated she would review the current staff numbers and work practices within the home to take into account this high level of dependence. The medication in the home was safely stored and administered with records kept. All medication was administered by the qualified nurses in the home. An issue was raised regarding the recording of Controlled Drugs in the home and the retention of such medication following the death of a resident. The manager was asked to review practices which had led to incorrect procedures taking place. Observation of care practices showed the staff treated the residents with respect and dignity. They spoke to them in a friendly, polite and appropriate manner, using their preferred term of address and showing an understanding of the individuality of each resident and how they liked to be treated. The resident’s had been assisted with their appearance and privacy was assured during care practices taking place. One bathroom used to bath residents had limited space which resulted in the door not being able to be fully closed during transfer of dependant residents onto the bath seat. Staff showed the inspector how they protected the privacy of the residents, but agreed it was insufficient and an alternative bathroom should be used. Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 12,13,14 and 15 Social activities do take place which meet the needs of the residents. There are, however, periods of little interaction with staff. Visitors are welcomed into the home and involved in the care should they wish. Some choices and preferences of the residents were understood by staff, but not all, for residents who could not verbally discuss this, were recorded. The meal served was nutritious but was unappealing when pureed. No choice of meal was offered. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: The residents accommodated were unable to discuss life in the home with the inspector. Some relatives said although organised activities did take place there were long periods of the day when residents were sat in front of the television with little interaction from staff. This was observed during the inspection. An activities co-ordinator came into the home five days per week and carried out organised activities, on these afternoons, such as music and games. Relatives who had been present at these sessions said they were “very good” with residents being encouraged to join in. An enclosed, safe and Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 12 attractive garden, with appropriate seating and shade, was available for the use of residents and visitors. Some of the resident’s past social history was included in the plans of care. This did not give a thorough picture of this aspect of the resident’s life. Visitors spoken with said they were very pleased with the care and attention given to their loved ones. They could visit at any reasonable time, stay as long as they liked, were included in the care and kept up to date with any change in condition. They said they received a warm welcome and one visitor described the staff as “an extended family”. They said should there be anything they were not happy with they could approach any staff member and it was resolved. The residents accommodated were unable to verbally express to staff their individual likes and dislikes. Some of these were documented, but not all aspects of the daily routine, such as rising times, were included. Staff showed an understanding of the resident’s non-verbal communication, such as becoming restless, and the meaning this had for their care. Residents received three meals per day with snacks between and supper if desired. A record of food eaten was kept for those residents who had nutritional problems. Residents were weighed monthly and gains or losses noted and a care plan initiated. On the day of the inspection all residents were given the same meal at lunchtime. The cook and staff said a choice was available, should they know a resident didn’t like the main meal, but these were not listed on the menu or actively offered. The main meal of salad was pureed and liquidised for those residents who required a soft diet. This was not appealing when served, which was also commented on by relatives. There was no evidence that the needs of residents with dementia, such as difficulty remaining seated and settled for a whole mealtime, or attention to colour, had been considered. Some residents ate in the dining room whilst others had their meals in their bedrooms. Those who required assistance were given this on a one to one basis and staff did not rush the resident, but offered gentle persuasion to have sufficient. Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 13 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 the following standard(s): The service provider had not responded to a complaint in the timescales within the home’s procedure. Relatives said they could approach any member of staff with concerns and were assured they would be dealt with. The procedures for reporting allegations of abuse had not protected the residents. The manager accepted mistakes had been made and had reviewed training and the procedures with all staff. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: One complaint had been received by the service provider since the last inspection. This was not related to care issues. The provider had not responded to the complainant in a timely fashion or within the timescales in the home’s procedure. This issue was now resolved. Relatives spoken with said the staff were very approachable and they would speak to any senior member of staff should they have any concerns. Where they had done this the issue was quickly resolved to their satisfaction. The complaints procedure was on display in the home. Since the last inspection an allegation of abuse had been made against one member of staff. This staff member was suspended whilst the inter-agency investigation proceeded. There was no conclusion to this investigation at the time of this inspection. When the allegation was initially made to a senior staff member it was not dealt with according to the correct procedure. The manager also failed to follow the correct procedure and potentially residents were put at Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 14 risk. All staff had since received training in the protection of vulnerable adults and the correct procedures to follow. A new procedure had also been produced and the manager and other staff were fully aware of their responsibilities and the actions they must take. Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 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 the following standard(s): 19,21,22 and 26 The home was clean, tidy, well maintained and free from offensive odours. The environment was homely, safe and suitable to meet the needs of the residents accommodated. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The home was clean, tidy and free from offensive odours. The communal areas were homely in nature, with domestic fixtures and fittings. A well maintained, enclosed and attractive garden was available for residents and relatives. Resident’s bedrooms were personalised with their own belongings. Since the last inspection some devices which meet the guidance of the fire authority were in place, to hold resident’s bedroom doors open. Some remained wedged open, but the manager said more devices would be fitted. A concern had been raised with the Commission regarding the access to bathrooms when the hoist was needed. This was discussed with the manager Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 16 and staff. The bathroom most in use did not have adequate space and presented moving and handling and privacy issues, since the door could not properly be closed. An alternative bathroom was identified as more suitable and the manager agreed practices would be reviewed. The equipment needed to meet the needs of the residents accommodated was available in the home. Staff had received training in infection control procedures and wore protective clothing when appropriate. Since the last inspection a hand washbasin had been purchased for the laundry, but this had not been fitted. Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The staff numbers were inadequate to meet the needs of the residents during the night and early morning. Staff received training appropriate to the work they were doing. The recruitment procedures safeguarded the residents. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: At the time of this inspection the residents accommodated were highly dependant on the staff to meet their daily personal and health care needs. Many residents required the help of two care staff to meet their needs. During the day the staff numbers and skill mix was adequate to meet these needs. The numbers of staff reduced at night and these staff also assisted a large number of residents to get up in the mornings. There was concern that residents would remain unsupervised, for long periods, during this time. The staff numbers should be reviewed and increased as necessary. Staff received training appropriate to the work they were to perform. All staff received training in the protection of vulnerable adults on the day of the inspection. All statutory training was carried out on a regular basis. Some staff had received training in the care of people with dementia and other mental health issues. The manager was advised to ensure all staff had Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 18 received adequate training in this area. Thirty two per cent of the care staff had completed NVQ to level two or above. This does not meet with the recommended 50 . At the time of the last inspection an immediate requirement regarding the incorrect and unsafe recruitment of staff was issued. At this inspection two staff files were examined and all information required was present. Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The home is run in the best interests of the residents. A more robust system of reviewing the quality of service provided should be implemented. The health and safety of the residents was protected Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The registered manager has the qualifications, skills and experience to manage the home. She is a trained nurse with her qualification being in the care of people with mental health problems and has completed a management qualification. Staff and relatives described her as approachable, very helpful and running a good home. Some quality assurance measures were in place such as relatives meetings and questionnaires. It was discussed a more robust system of quality review Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 20 was needed which included a continual programme of review and improvement. The manager confirmed no resident’s personal finances were managed by staff at the home. Staff had received training in health and safety. The manager confirmed all equipment was serviced. The insurance certificate on display had expired. The manager was requested to obtain an up to date certificate from the service provider. Accidents in the home were recorded. It was discussed that where unexplained injuries were found by staff these must be recorded with a detailed account of an investigation into how they occurred. Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 21 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 17 X 18 2 3 X 2 3 X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13(2) Requirement Timescale for action 30/09/06 2. OP15 16(2)(i) 3. 4. OP27 OP33 18(1)(a) 24 The procedures regarding the receipt, recording and disposal of controlled drugs must meet the current legal guidance. Varied meals must be properly 30/09/06 prepared so as to meet the nutritional needs of the residents and be appealing. The numbers of staff on duty at 30/09/06 nights and early mornings must meet the needs of the residents. A system for reviewing and 31/10/06 improving the quality of service must be implemented. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Worthing LO 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 © 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 Ashton Grange DS0000024107.V310409.R01.S.doc Version 5.2 Page 24 - 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. 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