Inspection on 04/10/05 for Ashton Grange

This inspection was carried out on 4th October 2005.

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

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

Other inspections for this house

Ashton Grange 09/05/07

Ashton Grange 31/08/06

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 3 Richmond Road Horsham West Sussex RH12 2EG Lead Inspector Helen Tomlinson Unannounced Tuesday 4 October 2005, 13.00, V248133 th 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 H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 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 Post Vacant CRH 24 Category(ies) of DE(E)-24, MD(E) registration, with number of places Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 3rd May 2005 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 garden to the rear. Accommodation is provided in twenty-two single rooms and one double room. Seven of the rooms have ensuite facilities. There is a passenger lift connecting the two floors. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 1pm and left the home at 6.30pm. At the time of this inspection the manager had applied to the Commission to be registered. She had been working at the home for approximately eighteen months and was familiar with the residents and staff. The manager and deputy manager were present throughout the inspection. Over the course of the inspection 8 residents, two visitors and five members of staff were spoken with. Staff were observed giving support and assistance. One resident’s files was examined in detail and other records were seen as was necessary. A tour of the premises took place. Staff files were examined What the service does well: Staff treated the residents with dignity and respect. They spoke calmly and patiently with the residents when any interaction was taking place. Staff were aware of the residents past lives and talked with them about their family members, places they lived and their working lives. They were able to answer questions, engage in social chat and share a joke with them. Residents were assisted to maintain their personal appearance with, for example, clean and tidy clothes and hair. Staff were seen to assist the residents to maintain their dignity by closing bedroom and bathroom doors when assistance was being given. The home was clean, tidy, bright and free from offensive odour. The house and gardens were well maintained and fully accessible to the residents. Residents were walking around the home, with supervision if necessary, and were not restricted to stay in the lounge or communal areas. Some residents said they preferred to stay in their rooms and this was respected by the staff. Staff had received training on the protection of vulnerable adults. They said this was very informative and they were aware of their duties and responsibilities in protecting the residents in their care. Relatives were consulted and involved in the care and services provided in the home. Residents financial interests were protected by the management of their monies by staff at the home. Residents benefit from staff who receive regular and relevant training. Visitors said the staff were able to assist their relatives in a manner which showed they had been trained appropriately. Residents had activities and pastimes organised, should they wish to take advantage of these. Staff were assisting residents to do board games and engage in social interaction. One member of staff is employed for three hours twice weekly to assist residents to enjoy social activities. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 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 H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 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) 3 and 6 Residents were not accommodated at the home without an assessment of their needs having been carried out. Residents should be assured, in writing, that the home can meet their needs. Ashton Grange does not provide intermediate care. EVIDENCE: The file examined contained an assessment of need which had been sent from the resident’s previous address. The resident had come from another nursing home, some distance away. A visit by the manager at Ashton Grange had not been possible. The manager confirmed that she had spoken with staff at the resident’s previous home to gain more information. An ongoing assessment of need had continued with the resident once they had become accommodated at Ashton Grange. It was not confirmed with prospective residents or their relatives that their needs could be met, prior to them being accommodated in the home. This should be done for all residents. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 and 10 All residents had a plan of care. This contained a large amount of information, some of which was not relevant to that individual resident. Health care needs were met. Residents were protected by the practices of the staff when administering, recording and storing medication. Residents were treated with dignity and respect by the staff. EVIDENCE: Since the last inspection new documents had been introduced for recording the plan of care for the resident. These covered all areas of the resident’s physical, mental, emotional and social wellbeing. These contained some preprinted information and some which was added for each resident. Some of the pre-printed information was not relevant to the individual resident whose plan of care was examined. Examples of this were the skin management care plan which stated skin should be examined more frequently when splints were in use. This resident did not have splints. There was a care plan included for the impaired range of motion, which was not a problem for this resident. Whilst not losing any of the comprehensive information contained in the plans the relevance of some of the pre-printed information should be reviewed on an individual basis. A very thorough assessment and plan of care for hearing loss was included. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 10 The health care needs of the residents were assessed and a plan of care recorded. These included assessments for the prevention of pressure sores, risk assessments for various activities, hazards and falls and moving and handling risk assessments. In the care plan examined the information recorded on the moving and handling assessment did not correspond with the plan of care. There were no specific assessments for the risk of using bed rails. There was a letter of consent for their use, however this did not show that alternatives had been considered. Pressure relieving equipment was in use. A plan of care for adequate nutrition was present. This had not been drawn up from a specific assessment and it was advised this be done. The manager stated the residents and relatives were invited to read and comment on the plans of care where they were able and wished to do so. Staff said they used the care plans to understand the care needs of the resident. The medication was administered to the residents by the qualified nurses in the home. The storage of medication was safe and met with current guidance. Clear records of medication administration were kept. The relevant policies and procedures were in place. The manager was advised to gain the consent of the G.P. to administer homely remedies. Staff respected the privacy and dignity of the residents. Bedroom and bathroom doors were closed when care was being given. Staff spoke to residents calmly and respectfully, using their preferred name and engaging in appropriate social chat and jokes. The residents personal appearance was maintained by the staff. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 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 standard(s) 12 and 14 The lifestyle in the home was designed to match their social and recreational needs. Residents were assisted and encouraged to make choices about their lives. EVIDENCE: Staff were aware of the resident’s family lives and talked to them about relatives and friends. Staff used resident’s own photographs to orientate those with memory loss to remember their families. Staff were seen to engage in one to one activities with the residents including board games and gentle physical activity. Various pastimes were encouraged and residents had access to well maintained and safe gardens. Social events like bar-b-ques, where family and friends were invited, did take place. Staff knew the individual interests of some residents and talked to one about their favourite football team and discussing matches which could be watched on television. Religious preferences were documented in the plans of care. Staff were seen to encourage residents to make choices about where to spend their time. They took non-verbal clues, such as a residents becoming restless, to indicate that they no longer wished to be in the lounge, but would rather spend their time alone in their room. This resident was assisted to do this in a safe manner. Residents choices about their preferred name and routines were recorded in their individual plans of care. Staff understood that in some instances advocates would be used on behalf of those residents who were unable to express their own wishes and choices. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 12 Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 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 standard(s) 18 Residents were protected from abuse. The recruitment procedures in the home did not protect the residents. (see standard 29) EVIDENCE: Staff had receiving training in the protection of vulnerable adults. Those staff spoken with said this was thorough training and an “eye opener” in terms of what could constitute abuse. It had made them aware of their roles and responsibilities in protecting those in their care. The manager said that the few staff members who had missed this training through holidays etc, were booked onto another course shortly. Staff were aware of the whistleblowing policy in the home. Staff who may be in charge of the home were aware of the reporting procedures should an allegation of abuse be made. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 14 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, 20,23 and 26 The home was clean, tidy and well maintained. One risk to the safety of the residents in the case of a fire was discussed with the manager. There was a range of communal facilities and access to a safe, well maintained garden. The residents own bedrooms were suitable for their needs. Staff were aware of the measures to prevent the spread of infection. EVIDENCE: The home was clean, tidy and well maintained. The individual bedrooms and communal areas were nicely and appropriately decorated. The garden was well maintained and safely accessible to the residents. Staff were aware of the fire procedure and notices were appropriately positioned in the home. Fire safety training took place and followed the guidance of the fire service. Some resident’s bedroom doors were wedged open by items of furniture. It was discussed with the manager that these are fire doors and must be kept closed, or held open with a device which meets with the guidance of the fire authority. Doors in the corridors and communal areas were held open with appropriate devices or closed. The fire exits were clear. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 15 Communal facilities consisted of one well used lounge and a quiet lounge, which residents used less frequently. These had large comfortable leather sofas and chairs with other domestic furniture. They were decorated in a domestic way. One large dining area was available. This was a congenial place for residents to enjoy their meals. There was a large well maintained garden to the rear. This provided safe and accessible outdoor space for the residents. Social events took place here in suitable weather. The inspector did not see all resident’s bedrooms. Those which were seen had personal belongings and furniture present, of the resident’s choosing. They were domestic in nature, providing comfortable seating and had televisions, radios etc, as the residents wished. Staff wore appropriate protective clothing when carrying out care duties. Plastic aprons and gloves were worn. Waste was appropriately disposed of and staff were aware of the risks of cross infection. Staff had received training on the control of infection within their work environment. There was no hand washing sink or paper towels in the laundry. This should be provided in this high risk area. The appropriate clothes washing facilities were present. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 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) 27,29 and 30 The staff numbers and skill mix, as shown on the rota could be inadequate, at times, to meet the needs of the residents. Resident’s were not protected by the recruitment procedures in the home. Residents benefited from staff who had been trained for their job. EVIDENCE: There was one qualified nurse and three care staff on duty at the time of the inspection. The manager said there was one extra care assistant employed to provide additional numbers over the mealtimes. The manager was additional to these numbers. One of the care staff was on their first day of employment and was working under the supervision of a more experienced care assistant. At night the staff numbers reduced to one trained nurse and two care assistants. It was discussed with the manager that there was no allowance, in these numbers and skill mix, for the unpredictable behaviour some residents could have. The manager was advised to use the Department of Health staffing tool as a guide. She must make sure the numbers and skill mix of staff are adequate, at all times, to meet the resident’s needs. Two staff files were examined. One was for the new care assistant who was working their first day at the home. For this care assistant none of the required information, to make sure the person was fit to work with vulnerable adults, had been obtained. There were no references, no record of previous employment, no Criminal Record Bureau check, no check against the Protection of Vulnerable Adults register and no form of identification. The manager confirmed this person had been working under the supervision of an experienced care assistant for that day. Following discussion about the safety of this person working with the residents, without any checks in place, the Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 17 manager decided to suspend their employment, until all satisfactory information had been obtained. The second file examined showed that this care assistant had begun work at the care home without a satisfactory check with the Criminal Records Bureau and the Protection of Vulnerable Adults register having been obtained. Only one reference was on file. This was dated 20th May 2005, but was written in May 2004. The work permit on file was not pertinent to the current employment. It was discussed with the inspector that some care assistants were employed through an agency and the manager was not involved in this recruitment. The manager must be involved in the recruitment of staff for the home, to ensure they are fit and competent to work with the residents accommodated. Staff had received training appropriate to the work they had to perform. A training company was used or in house training was provided. Staff had completed fire safety training, infection control, food hygiene, protection of vulnerable adults and training sessions regarding the specific mental health needs of the residents. Staff said they felt the training they received was relevant to their work and helped them to meet the needs of the residents. They were complimentary about the support and advice they received from the manager and other qualified staff members. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 18 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) 31,33,35 and 38 The manager of the home had the necessary skills, knowledge and experience to do so. The home was run in the best interests of the residents. The financial interests of the residents were safeguarded by the procedures in place. The health and safety of the residents was promoted by staff and working practices at the home. EVIDENCE: The person who was in the position of manager at the home had not yet registered with the Commission for Social Care Inspection. An application was ongoing at the time of this inspection. She did have the necessary qualifications, skills and knowledge to manage the service in the best interests of the residents. Staff and visitors said they found the manager and other staff approachable and helpful. They described an open and inclusive atmosphere within the home. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 19 The manager discussed how there was consultation with the residents, as they were able and the relatives or friends, regarding the general running of the home. Relatives meetings were held every other month, with records kept and suggestions acted upon. Sometimes a relevant speaker, such as the advocacy service, is invited to speak to the relatives. At other times the relatives set the agenda dependant on what they wish to discuss. The staff discussed how the residents choices about the day to day life of the home were understood and respected. These choices were not always made verbally, due to the impairment of the residents, but staff understood their individual behaviours which may indicate the choices they wanted to make. The manager looked after small amounts of personal money for several residents. Any use of this money was well documented and it was securely stored. The accident book was examined. This showed that accidents were recorded correctly with an audit of accidents taking place on a monthly basis. Should any pattern emerge the manager would take remedial action. The inspector raised no concerns regarding the health and safety of the residents, other than that of the fire doors wedged open, which is addressed in standard 19. Staff were due to receive health and safety training in the near future, but showed an understanding of their role in ensuring the residents were safe. The manager confirmed that all equipment was serviced as necessary. Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION 2 3 x x 3 x x 2 STAFFING Standard No Score 27 2 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 x 3 x 3 x x 2 Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 21 YES 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. 2. Standard 19 29 Regulation 23(4)(c )(i) 19 and Schedule 2 Timescale for action Fire doors must be closed or held 31/10/05 open with a device which meets guidance of the fire service. The registered person shall 30/11/05 ensure that persons working in the care home are fit to do so. This requirement remains unmet since the inspection of 13/05/05. The timescale given of 31/8/05 has expired. Requirement 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. 2. 3. 4. 5. 6. Refer to Standard 3 7 8 8 26 27 Good Practice Recommendations It should be confirmed in writing, to all prospective residents, that the home can meet their needs. The information contained in the pre-printed care plans should be relevant to the individual resident. Risk assessments for the use of bed rails should be in place. Nutritional risk assessments should be done. Hand washing facilites should be provided in the laundry. The staff numbers should be adequate to meet the needs of the residents at all times. Staffing guidance tool should be used. H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 22 Ashton Grange Ashton Grange H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 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 H60-H11 S24107 Ashton Grange V248133 070905 Stage 4.doc Version 1.40 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. 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