Inspection on 09/05/07 for Ashton Grange

This inspection was carried out on 9th May 2007.

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 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 31/08/06

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 3 Richmond Road Horsham West Sussex RH12 2EG Lead Inspector Ms J Hartley Unannounced Inspection 9th May 2007 10:50 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.V336148.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.V336148.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashton Grange Address 3 Richmond Road Horsham West Sussex RH12 2EG 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) 01403 257263 F/P 01403 257263 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.V336148.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 august 2006 Brief Description of the Service: Ashton Grange is a privately owned care home registered to accommodate up to twenty five 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. Current fee levels are between £650 and £750 per week. Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit for this key unannounced inspection took place over four hours. The deputy manager was present throughout the inspection and provided the information required. The inspector examined information held on the CSCI service file since the last inspection in August 2006, and read the previous two inspection reports, the Service User Guide and the Statement of Purpose. Evidence was also gathered from the Annual Quality Assurance Assessment completed by the Registered Manager prior to the site visit and from a survey returned by four relatives. During the visit the inspector spoke to four residents, staff and three visitors. The inspector undertook a tour of the premises and looked at three care plans and three staff files. Various record books, policies and procedures were also examined. What the service does well: What has improved since the last inspection? Pre-admission assessments are now being dated. Staffing level and the deployment of staff have been reviewed to enable the home to meet the high levels of needs of residents more thoroughly. Meals are varied and appealing and now meet the dietary needs of the residents. Following an allegation of abuse last year in which procedures were not followed correctly, the home has updated its’ policies and procedures regarding Adult Protection. There is now clear guidance in place regarding the reporting and recording of suspected abuse. Staff have now received training in the protection of vulnerable adults and the correct procedures to follow. Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Ashton Grange DS0000024107.V336148.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.V336148.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are assessed prior to them being accommodated in the home. The home does not provide intermediate care therefore Standard Six does not apply. EVIDENCE: The files seen contained assessments of the individual residents’ needs. They included all aspects of physical and health care and personal information. At the last inspection it was noted that pre-admission assessments were not signed or dated. They are now being dated, but not all the assessments seen had been signed by the person who undertook them. Ashton Grange DS0000024107.V336148.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a plan of care that is drawn up from assessments of need and is regularly reviewed and kept up to date. Medication is stored, administered and recorded in accordance with current guidance. Residents’ privacy and dignity is respected and protected. EVIDENCE: All residents have an up to date plan of care. It includes information on individuals’ physical needs, mental health needs and social interests. A variety of needs assessments and risk assessments are in place including falls, pressure sores, manual handling, and nutrition. Since the last inspection the manager has started to introduce new care plans which she thinks will be more user friendly. Care plans were seen to be individualised, up to date and regularly reviewed. The deputy manager said that residents, (whenever possible), and relatives are involved with drawing up care plans. Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 Page 10 Since the last inspection staff numbers and the deployment of staff within the home have been improved to take into account the high level of dependence of the residents. Each resident is registered with a GP of their choice, a dentist and an optician. All make visits to the home when required. Two residents told the inspector that the doctor visits them at the home if they are unwell. The medication in the home was seen to be safely stored and administered with records kept. Qualified nurses in the home administer all medication. At the last inspection a requirement was made that the procedures regarding the receipt, recording and disposal of controlled drugs must meet current legal guidance. These practices have been reviewed and procedures now meet current legal guidance. Observation of care practices showed that the staff treat the residents with respect and dignity. They were observed communicating with residents 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 residents had been assisted with their appearance and privacy was assured during care practices taking place. A relative commented that; “Despite mum’s dementia problems and inability to move, all the staff treat mum with a lot of dignity and respect her privacy wherever possible.” Ashton Grange DS0000024107.V336148.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make choices in their daily lives. including taking part in a range of activities provided by the home. Visitors are made welcome. The residents are served a nutritious and wholesome diet and are offered a choice of food. EVIDENCE: Residents spoken with during the visit said they are able to exercise choice in their lives in areas such as when they get up in the morning, what clothes they wear and what they eat. The home meets the individual religious needs of residents through assessment to identify needs, care planning and providing information for staff on religious observances. One resident has specific dietary needs in relation to religious practices and these are catered for by the home and her family collectively. On the day of the visit the activities co-ordinator was playing “catch-ball” and doing exercises with residents. She said she talks with residents and finds out their hobbies and interests. One resident likes sewing and she has been supported in making items such as cushions. There is a varied programme of Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 Page 12 activities open to residents to join in if they wish. The programme of activities for the week ahead is put in the residents’ notice board. Resident spoken with said they enjoyed the range of activities available. Visitors spoken with said that they are always made welcome in the home. They said they are able to visit when they like. One visitor said she is also able to join her relative at mealtimes and is offered a meal herself. The home does not have responsibility for residents’ finances apart from keeping amounts of petty cash for them for things such as hairdressing and toiletries. The money is stored in a safe, which only the manager and deputy have access to. All transactions were seen to be accurately recorded. Regular checks on balances are made. The home provides three meals per day with snacks between and supper if desired. A record of food eaten is kept for those residents who have nutritional problems. Residents are weighed monthly and gains or losses noted and a care plan initiated. On the day of the visit the lunchtime meal looked appealing and well balanced. Residents and visitors said that the food was of a good standard. The menu is displayed on the wall in the dining room. Choices are available for each meal. Some residents ate in the dining room whilst others had their meals in their bedrooms. Staff were seen giving assistance to residents with feeding on a one to one basis for those who needed it. Special diets are catered for; including diets to meet religious or health needs and personal preferences. One visitor said that her relative is vegetarian and the home always provides good food for him. At the last inspection a requirement was made that varied meals must be properly prepared so as to meet the nutritional needs of the residents and be appealing. This requirement has now been met. Ashton Grange DS0000024107.V336148.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident that their complaints will be listened to and acted upon. As far as possible, they are protected from abuse by the home’s policies, procedures and staff training. EVIDENCE: Residents spoken with during the visit said that they would speak to a senior member of staff if they had a complaint. They said that they thought they would be taken seriously. Relatives said that the service always responds appropriately if they raise a concern. One relative said, “Any concern I have raised has always been dealt with promptly to my total satisfaction.” The complaints procedure is displayed prominently in the home. Following an allegation of abuse last year in which procedures were not followed correctly, the home has updated its’ policies and procedures on Adult Protection. There is now clear guidance in place regarding the reporting and recording of suspected abuse. Staff training records seen show that all staff have now received training in the protection of vulnerable adults and the correct procedures to follow. Staff are fully aware of their responsibilities and the actions they must take. Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home is suitable for its stated purpose and provides a safe, well maintained environment for residents that is clean, pleasant and hygienic. EVIDENCE: On the day of the visit the home was clean, tidy and free from offensive odours. Residents said that the home is always kept clean and tidy. The communal areas are homely with domestic fixtures and fittings of good quality. Rooms are decorated when they become vacant. A well maintained, enclosed and attractive garden is available for residents and relatives. Residents’ bedrooms are personalised with their own belongings. The equipment needed to meet the needs of the residents such as grab rails, raised toilet seats and hoists were available in the home. Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 Page 15 Staff have received training in infection control procedures and were seen wearing protective clothing when appropriate. Infection control policies and procedures are in place and give clear guidance to staff. The laundry is sited away from food preparation and storage areas. At the last inspection a hand washbasin had been purchased for the laundry, this has now been fitted. Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ needs are met by the numbers and skill mix of staff, who are well trained and competent to do their jobs. Residents are protected as far as possible by the home’s recruitment policy and practices. EVIDENCE: At the last inspection it was found that during the day the staff numbers and skill mix was adequate to meet the high level of needs of the residents, however the numbers of staff reduced at night and there was concern that residents would remain unsupervised for long periods during this time. A requirement was made that the numbers of staff on duty at nights and early mornings must meet the needs of the residents. Since then staff numbers have been reviewed and increased as necessary. There are now three carers and one trained nurse on duty at night. Other staff employed by the home include a chef, domestics, a gardener and a maintenance man. Staff receive training appropriate to the work they perform. All statutory training is carried out on a regular basis. Some staff have received training in the care of people with dementia and other mental health issues. Fifty per cent of the care staff have now completed NVQ to level two or above. All new staff receive induction training on the principles of care, safe working practices, their role and the needs of the residents. Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 Page 17 The home has a thorough recruitment procedure in place. Three staff files were examined and found to include all the required documentation, including an application form, two written references, and Criminal Records Bureau, POVA and NMC register checks. Comments received from relatives about the standard of care provided by the home were all positive and included; “They look after mum’s physical condition very well. She is always clean and always appears smart and well dressed. They keep a constant check on her health needs.” “The staff and management are always friendly and willing to help.” “Ashton Grange is certainly very caring, and looks after all the patients – I really do not think there is anywhere more caring.” Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has the qualifications and experience needed to run the home and meet it’s stated objectives. The home has some quality assurance and monitoring systems in place. Residents’ financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The registered manager has the qualifications, skills and experience needed to manage the home. She is a trained nurse with her qualification being in the care of people with mental health problems and she has completed a management qualification. Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 Page 19 Some quality assurance measures are in place including relatives meetings, monthly audits in line with ISO9001 and questionnaires. These should be formalised and the results published. The deputy manager confirmed that resident’s personal finances are not managed by staff at the home. Staff have received training in safe working practices including moving and handling, fire safety, first aid, food hygiene and infection control. Electrical equipment hoists, boilers and other equipment are maintained and serviced regularly. Accident records were seen during the inspection and found to be clearly recorded. Risk assessments regarding safe working practices are in place. Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 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 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 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 3 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 3 28 3 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.V336148.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action 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.V336148.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Ashton Grange DS0000024107.V336148.R01.S.doc Version 5.2 Page 23 - 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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