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Inspection on 28/08/07 for Ashton Grange Residential Home

Also see our care home review for Ashton Grange Residential Home for more information

This inspection was carried out on 28th August 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff are friendly and approachable and work hard to meet the needs of the residents. Staff are able to respond satisfactorily and offer support to residents who have behaviours that challenge. Most areas of the home are nicely decorated and homely.Tables are nicely set with cloths, placemats napkins and condiments. And a good choice of meals is available to the residents. Menus are varied and a good selection of fresh ingredients is available.

What has improved since the last inspection?

There have been few improvements in the service other than the systems for managing personal allowances for residents have been changed. This now ensures that money being held is audited once monthly and is managed appropriately. The home has responded positively to family`s complaints and where necessary have worked with other agencies to resolve concerns.

What the care home could do better:

The written plan of care and the assessment documents which are used to write the care plan must be improved to ensure that all staff know how to deliver consistent care to residents. Care must be offered based upon the assessment of need and should be individual to the resident. The assessment documents must be kept under review and updated to reflect any change in residents needs. Any changes must then be recorded in detail to demonstrate how staff will meet these needs. All records that relate to care must be kept up to date and information must be obtained about a resident`s previous lifestyle in order to help with meeting social and psychological needs. When keeping records staff must not use inappropriate terminology especially for those people who have been diagnosed as having mental ill health. Statements such as " no problems", "slept well", "ate well" should be replaced by a more accurate description of what this means so that a full account of any progress being made by residents is recorded in their written plan of care. Nutritional assessments and assessments that deal with pressure care must be carried out monthly for those residents who have been identified as being at risk.More detail must be included in the daily records to ensure an accurate account of life in the home and how residents spend their day. Staff still require training in challenging behaviour to ensure that they deal with it appropriately and recognise triggers to help avoid it. A programme of stimulating activities for residents must be developed with sufficient staff being available to arrange this on a regular basis. Improved standards of cleanliness must be in place and staff practices must ensure that residents are not at risk of infection. Crockery and cutlery must be thoroughly cleaned after each meal and items must not be stored in bathrooms. The dishwasher and hot water boiler must be repaired or replaced. The unpleasant odour in the upper corridor of the home must be addressed to ensure the home is clean, hygienic and odour free. Steps must be taken to ensure that information that is on display on notice boards on the first floor is kept up to date but also placed at a height that residents can read. Other information that is on display in resident`s bedrooms about the manager and staff must be updated and also placed at a height at which it can be read. Staff awareness of safety risks must be improved so that residents are safe at all times. Staffing levels must be reviewed in order to provide more consistency with care. The designate person in charge at any time must be supernumerary to the care staff so that they have sufficient time to carry out management tasks. Staff must not be employed in the home unless all gaps in employment have been explored and a satisfactory explanation of this is recorded in the staff file. All staff must receive formal supervision from the manager and this should focus on their individual career development needs and any training they require to do their work effectively. Accident records should always contain an account of the action taken by staff and also the outcome/follow up to confirm that staff are dealing with accidents appropriately.Ashton Grange Residential HomeDS0000015762.V346320.R01.S.docVersion 5.2Page 8

CARE HOMES FOR OLDER PEOPLE Ashton Grange Residential Home St Lukes Road Pallion Sunderland SR4 6QU Lead Inspector Mr Clifford Renwick Key Unannounced Inspection 10:00 28 & 30th August 2007 th 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 Residential Home DS0000015762.V346320.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 Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashton Grange Residential Home Address St Lukes Road Pallion Sunderland SR4 6QU 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) 0191 567 4003 0191 567 4690 ashtongrange@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Homes No 3 Limited Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (9), Old age, not falling within any other category (40), Physical disability (3), Physical disability over 65 years of age (10) Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two places within the PD category relate to current service users only. 5th September 2006 Date of last inspection Brief Description of the Service: Ashton Grange provides care to 40 older people over the age of 65 years who may have dementia or mental health needs. It provides personal care only and any health needs are dealt with by the Community Nursing Services. It is also registered to provide care for a maximum of 10 people with a physical disability. The home is purpose built and is located in the Pallion area of Sunderland. The building has two storeys, with accommodation provided on both floors. It has its own drive with parking area and a fully enclosed garden. All areas are accessible to people who use a wheelchair. It is adjacent to the local church and community centre and it is only a short walk to a busy shopping parade, which has a range of facilities. It is on a bus route offering easy access to the city centre as well as the surrounding areas. Fees range from £361 - £447 per week. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • Information we have received since the last visit in February 2007. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on the 28th August. An announced visit was made on 30th August 2007. During the visit we: • Talked with people who use the service, staff and the deputy manager. • Observed life in the home. • Looked at information about the people who use the service & how well their needs are met. • Looked at other records, which must be kept. • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. • Looked around parts of the building to make sure it was clean, safe & comfortable. • Checked what improvements had been made since the last visit. We told a representative for the company what we had found. The people who live in this home prefer to be known as residents therefore this term of reference is used throughout the report. What the service does well: Staff are friendly and approachable and work hard to meet the needs of the residents. Staff are able to respond satisfactorily and offer support to residents who have behaviours that challenge. Most areas of the home are nicely decorated and homely. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 6 Tables are nicely set with cloths, placemats napkins and condiments. And a good choice of meals is available to the residents. Menus are varied and a good selection of fresh ingredients is available. What has improved since the last inspection? What they could do better: The written plan of care and the assessment documents which are used to write the care plan must be improved to ensure that all staff know how to deliver consistent care to residents. Care must be offered based upon the assessment of need and should be individual to the resident. The assessment documents must be kept under review and updated to reflect any change in residents needs. Any changes must then be recorded in detail to demonstrate how staff will meet these needs. All records that relate to care must be kept up to date and information must be obtained about a resident’s previous lifestyle in order to help with meeting social and psychological needs. When keeping records staff must not use inappropriate terminology especially for those people who have been diagnosed as having mental ill health. Statements such as “ no problems”, “slept well”, “ate well” should be replaced by a more accurate description of what this means so that a full account of any progress being made by residents is recorded in their written plan of care. Nutritional assessments and assessments that deal with pressure care must be carried out monthly for those residents who have been identified as being at risk. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 7 More detail must be included in the daily records to ensure an accurate account of life in the home and how residents spend their day. Staff still require training in challenging behaviour to ensure that they deal with it appropriately and recognise triggers to help avoid it. A programme of stimulating activities for residents must be developed with sufficient staff being available to arrange this on a regular basis. Improved standards of cleanliness must be in place and staff practices must ensure that residents are not at risk of infection. Crockery and cutlery must be thoroughly cleaned after each meal and items must not be stored in bathrooms. The dishwasher and hot water boiler must be repaired or replaced. The unpleasant odour in the upper corridor of the home must be addressed to ensure the home is clean, hygienic and odour free. Steps must be taken to ensure that information that is on display on notice boards on the first floor is kept up to date but also placed at a height that residents can read. Other information that is on display in resident’s bedrooms about the manager and staff must be updated and also placed at a height at which it can be read. Staff awareness of safety risks must be improved so that residents are safe at all times. Staffing levels must be reviewed in order to provide more consistency with care. The designate person in charge at any time must be supernumerary to the care staff so that they have sufficient time to carry out management tasks. Staff must not be employed in the home unless all gaps in employment have been explored and a satisfactory explanation of this is recorded in the staff file. All staff must receive formal supervision from the manager and this should focus on their individual career development needs and any training they require to do their work effectively. Accident records should always contain an account of the action taken by staff and also the outcome/follow up to confirm that staff are dealing with accidents appropriately. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed before they move into the home, to ensure the home is an appropriate place which provides the care that they need. EVIDENCE: Care records for the most recently admitted residents were examined. They showed that a full assessment was carried out before people moved into the home. A comprehensive assessment is provided from social services. These detail the level of support people will need and any existing health problems. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 11 The home uses this information to decide that they are able to provide the correct level of care to the person. Prior to admission prospective residents and their relatives are invited to visit the home to have a look around and ask any questions about the services provided. Staff use these visits to gain further information from the resident and their relative/representative so that they can complete their own assessment document. Though the home do not provide intermediate care they have provided short breaks for older people who have had to move out of their house while the council carry out essential modernisation works. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and social care needs are generally met but there is insufficient information in the written care plan confirming the actions carried out by staff. However suitable medication procedures are in place that ensure residents receive their prescribed medicines and therefore their welfare is promoted. Residents are treated with respect and their rights respected, though at times their dignity is compromised by poor staff practices. EVIDENCE: Care records for three residents were examined. These contain admission information, pre admission assessments, physical assessments, and mental state examinations. These also include weight and nutritional assessments, assessments of pressure sore risk (sometimes called bed sores), falls risk, and moving and handling assessments. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 13 As noted in a previous inspection report (2006) the standard of these varies from file to file, with some containing more detailed information than others. Dates are often missing, making it difficult to tell how up to date the information is. A number of the forms had not been completed so it could not be determined what needs residents had. Assessments for one person indicated that they required someone to sit with them and offer support with eating. However there was no record to confirm that this was being carried out. The nutritional assessment indicated a need for this persons weight to be checked monthly but this was not happening. Another resident was identified as being at risk of developing pressure sores but there was no record to show how this would be prevented. The care plan in use for a resident who has behaviours that challenge does not contain sufficient information of what strategies staff use to deal with this. Yet observed staff practices confirmed that staff do work in a positive way with this person. One resident spends most of the waking day in their bedroom and has a range of needs that require one to one staff support. Though staff are dealing with these needs there is no information in the care plan to confirm how staff are supporting the resident. Some of the terminology being used in the care records is inappropriate and words such as, “split personality”, “no problems” and “slept well” do not give a thorough account of what this means. The “life history “ document that is used by staff to record resident’s interests and previous lifestyle is not fully completed therefore staff have insufficient information to help them with the care process. It was noted that the care plan for the person identified by staff as presenting the most challenging behaviour, due to their dementia, had no detailed care plan in place to deal with their daily distress. This was identified at the previous inspection and no developments have taken place. Observations made confirmed that staff are meeting this residents needs. However the absence of a written plan of care means that the care being offered is not consistent. Advice offered in previous inspections was that social assessments, which include information about resident’s previous lifestyle and interests, should be in place. As previously stated no work has been carried out in this area. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 14 The previous report inspection report indicated that the manager in areas of record keeping was making a number of improvements. However as the manager is no longer employed in the home the quality of record keeping has become inconsistent. There is currently no manager in the home, the Deputy is acting manager, with support available from an experienced manager from a nearby home that is owned by the company. Both acknowledged the shortfalls in the care plans and supporting documentation in discussion with the inspector. Records are in place that confirm the residents have good access to health professionals. Advice has been sought by staff from health professionals on dealing with pressure care. However staff have not updated the care plans to demonstrate how they will act on this advice. Medication records were examined and were satisfactory. Senior staff are responsible for administering medication and have received training appropriate to this work. Records are maintained for medicines that have to be stored in a fridge and controlled drugs storage is good. The upstairs medication storage room is fitted with a carpet, which was badly stained, and sticky causing your feet to stick to it. This was discussed with the deputy manager. Privacy, dignity and respect of residents are generally upheld. Staff knock on doors before entering bedrooms. Personal and intimate care tasks are carried out in the privacy of resident’s bedrooms. However some basic care tasks, such as, making sure residents food trays that they use in their bedrooms are clean are being overlooked. One resident was using a tray that was heavily soiled with dried up food but this had gone unnoticed by staff. The inspector had to ask staff to remove this tray for cleaning. Staff are pleasant in their manner and a number of observations confirmed that they have a good rapport with the residents and their families. Discussions held with families during the inspection confirmed that they are satisfied with the services in the home. Though they did say that the absence of a manager and insufficient staff being available did have an impact on the service being offered. For example they spoke of the lack of activities and how things such as the regular bingo sessions and chair aerobics were no longer being carried out. Relatives went on to say that “ the girls” were working extremely hard but there were to few of them to organise any activities as all of their time was spent carrying out care tasks. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are usually helped to exercise choice and control over their lives. Nevertheless there are no activities to take part in due to insufficient staff therefore there is little stimulation offered. However arrangements are in place for residents to maintain contact with family, friends, and representatives. This enables them to keep in touch with people from the community. A good range of meals is available which ensures that resident’s dietary needs are met. EVIDENCE: On the 2 days of the inspection, residents spent their time watching television listening to music or sitting in their bedrooms. There were no planned activities and insufficient staff on duty to organise something to keep residents stimulated. No drivers are available to drive the homes minibus so outside activities are not taking place. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 16 Discussion with the staff confirmed that the activities coordinators post is vacant and currently advertised. The home is hoping to recruit someone for 20 hours per week to solely be responsible for organising activities. A weekly church service is carried out in the home from the neighbouring church and residents said they looked forward to this. There are no restrictions on visiting the home and relatives may take people out into the local community. One family who visit the home everyday said that the staff always make them feel welcome and keep them up to date with what is happening in the home. Residents are offered choices throughout the day and one person often goes out to the local shops unaccompanied. Some residents prefer to spend time in their bedrooms and staff keep popping in to ensure they have what they need. Staff take refreshments and snacks around the rooms so that residents receive regular drinks. And some residents have expressed their choice to have all of their meals in their bedrooms. The inspector joined the residents for lunch in the first floor dining room. A varied menu is available which offered two choices for the main course and the dessert, although menus are not displayed for people to see. It was confirmed by staff that residents are asked what they would like to eat from the choice menu. This information is then shared with the cook. Discussion with families confirmed that they have been in the home when meals are served and found the standard of food to be good. The mealtimes are staggered between ground and first floor in order that people do not have to wait too long for food being brought up from the kitchen. The residents who live on the first floor have dementia type needs and as such require assistance and support during mealtimes. Staff provided good support to residents during the meal. However as there was only two staff on duty on this floor not everyone was able to receive the support that they needed. One resident who eats their meals in their bedroom would have benefited from staff spending time assisting them with their meal. The current staffing level of 2 is insufficient to meet the needs of the residents during mealtimes. The food was nice and well presented and tables were well set with all of the necessary condiments. Observations and discussions with residents confirmed Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 17 that they enjoyed the meals and many said that they looked forward to meal times. The cutlery and crockery in use at lunchtime was marked or stained. This was discussed with the deputy manager who stated that the dishwasher was broken and had been for 6 weeks. Consequently staff were washing all items by hand. During the meal residents were served cold drinks in plastic cups, the type of cup that you normally would see in a vending machine. As a result two residents were experienced difficulty in gripping them, which caused them to spill their drinks. Staff were asked why they were using these cups and the inspector was informed that they were left over from a barbeque so they had been told to use them up. Signs and information on the first floor which informs residents who is on duty were not completed and due to being placed too high, could not be read by everyone. Clocks in residents bedrooms were not working therefore it was difficult for residents to know what time it was. This combined with the lack of information does not assist residents with orientation to time and place. Posters of old pubs that used to be in Sunderland are on display throughout the corridors, but due to their size and the small text were difficult to read. Information on posters in bedrooms that informs people of the name of the manager and key worker are out of date. In addition to this the height they have been placed at makes them again, difficult to read. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their family and friends are confident their complaints will be listened to and acted upon now that the manager has ceased to work in the home. Appropriate procedures are in place to ensure that residents are protected from abuse. However families state they are not always fully informed of the outcome of any investigations. EVIDENCE: Discussion with the residents confirmed that they have no complaints but if they did they would tell staff or their families. In the past they have said when they have made a complaint it has been addressed to their satisfaction. There is a suggestions box in the entrance lobby of the home and also information is on display advising people how to make a complaint. In discussion with families they said that in the past they had complained to the manager about the care being offered to their mother but the manager had taken no immediate actions. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 19 The families had persisted with their complaint and the company responded appropriately. As a result of the complaint safeguarding adults procedures were implemented and representatives of the company and social services carried out an investigation. This resulted in two staff being dismissed for poor care practices. The manager has also ceased to work in the home. The family confirmed that they had been invited to meetings during the investigation and felt that the matters of concern had been investigated thoroughly. However they did say that they had not received any formal notification from the company of the final outcome. This was discussed with the deputy manager who was advised that discussion should be held with the family in order that this matter can be closed. The monthly residents and relatives meetings, which were used to discuss a range of matters, as well as any concerns, are no longer being held. Consequently residents and their relatives no longer have a forum to meet as a group. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most parts of the home are generally safe and well maintained but some areas are not satisfactorily clean, pleasant, or hygienic. EVIDENCE: Since the introduction of the new smoking legislation this year a designated smoking area for residents has been provided on the ground floor. All residents who smoke regardless of where they reside in the home use this area to smoke. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 21 Most of the resident’s bedrooms, all communal areas and bathing facilities were seen during the inspection. A number of repairs were needed in order to maintain safety within the home. The bath panel in a ground floor bathroom was broken and loose and could be hazardous for residents. The flooring in the en suite in one bedroom was heavily stained and needed a professional clean or replacement. Most of the extractor fans in all areas of the home have been cleaned but realigned incorrectly to the ceiling, which is causing them to make excessive noises. One when touched caused the light in the toilet to go off and this needs to be rectified. One bedroom door was sticking and requires attention to the door thresh otherwise fire safety will be compromised if the door does not fully close into the frame. Items such as mops and buckets were being stored in the shower room, which not only causes a hazard but also can have an impact on infection control. Other items such as the lids of plastic rubbish bins and chairs were being stored inappropriately. The dishwasher was broken and had been for 6 weeks so staff were washing dishes by hand. And as reported in section 12 – 15 of this report crockery and utensils were stained. The hot water boiler that is used for making hot drinks was also broken so staff were using kettles to boil water. There was strong unpleasant odour in part of the upstairs corridor and this was present all day despite the area having been cleaned. Steps were taken by the second day of the inspection for further work to be carried out in getting rid of this unpleasant smell. A fire extinguisher was standing on the floor as the bracket to secure it to the wall was missing. This caused a hazard as it was outside someone’s bedroom door, as well as compromising fire safety in the home. The flooring in an upstairs bathroom was stained with what appeared to be rust from a pedal bin. A thermometer in one bathroom that is used to check hot water temperatures was broken but staff had not noticed this. Similarly the mirror door wall cupboard in the bathroom had a large crack to one of the doors. The inspector advised that this was immediately removed from the wall in order to avoid a potential accident to staff and residents. The lock on the toilet door on the first floor was broken which meant that resident’s privacy was being compromised. Another toilet on this floor had no Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 22 sign to indicate it was a toilet. This was confusing for residents who have poor orientation skills due to their dementia. In a number of bedrooms and bathrooms the emergency call cords were tied up and out of reach of the residents. The deputy manager was advised to rectify this immediately and instructed not to tie call cords up. Overall the deputy manager who is responsible for managing the home in the absence of the manager is not maintaining a satisfactory standard of safety, cleanliness or hygiene. Despite the above, a positive aspect of the home is that residents doors have now been painted and fitted with door numbers and fake letterboxes to assist with orientation. There is also evidence that the home tries to adapt the environment to make it easier for people to manage, for example, handrails in toilets are painted blue so that they stand out from the walls and are easier to see. Tactile discs, which are circular three-dimensional textured circles, are on the walls in the dementia unit. These can be removed and taken to people or they can explore and touch them as they pass. Bedrooms are personalised and homely. Bedding is usually coordinated. And many of the residents have personalised their bedrooms with furniture and personal effects that they have brought from home. The dining rooms are fitted with laminated flooring, which have brightened up these rooms, as well as making them easier to keep clean. The décor in the home is of a good standard and the home is generally kept clean. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 23 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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Resident’s needs are not always met by the numbers and skill mix of staff and not all staff are adequately trained and competent to do their jobs It cannot be guaranteed that residents are in safe hands at all times as information required as part of recruitment is not always obtained. EVIDENCE: Discussion with the deputy manager confirmed that the training matrix was not up to date and neither was it available for examination. Therefore it could not be determined what training staff had been involved with or what was planned. It was confirmed in discussion that staff had undertaken training in the safeguarding of adults. And 95 of the staff team had attended a one-day course on “challenging behaviour”. At the time of the inspection there were 4 staff on duty to care for 24 residents. Eleven residents were residing on the ground floor and thirteen people with dementia were living upstairs. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 24 Of the four staff who was on duty, one was the deputy manager who was working in a carers role and had no time to deal with the management of the home. Staff were kept busy throughout the inspection and there was little time for engaging them in conversation due to the needs and demands placed on them by the residents. It was clear that this current staffing level was not satisfactory due to the level of service user needs and also the size and layout of the building. The staffing numbers would also be reduced further should it be that a resident needed to be accompanied to the hospital. The deputy manager who is responsible for managing the service in the absence of the manager should not be working as part of the staff team of four but should supernumerary. This is discussed more fully in section 31 – 38 of this report. Since the last inspection was carried out two staff have been employed in the home. Their files were looked at and it was confirmed that for one person insufficient information had been obtained about their previous employment. There were two gaps of two years in their employment history but no record to show that this had been discussed with the employee. Other important information that is required as part of recruitment including the criminal record check was in place. However any gaps in employment must be explored and a written account kept in the employees file. In order to demonstrate that only staff that are suitable to work in the home are employed. As there is no manager in the home, the administrator has sole restricted access to staff records in order to maintain security and confidentiality. In addition to the care staff on duty, there was also a cook, kitchen assistant, a housekeeper and the person who is employed to carry out maintenance work. The inspector was informed by the deputy manager that due to staff holidays the home was a little short of domestic cover. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is currently no manager to ensure that the home is run in the best interests of the residents. Staff are not receiving formal supervision to ensure that best practice guidelines are followed. Health and safety of the residents is at times being compromised as night staff are not receiving regular periods of fire instruction or taking part in fire drills. However, resident’s financial interests are safeguarded. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 26 EVIDENCE: There has been no appointed manager in the home since March 07. The deputy manager is responsible for managing the home and in her absence any senior staff member carries out the management role. By working as part of the staff team the deputy manager could not take a full part in the inspection as she was needed to carry out care tasks with the carers. In order to complete the inspection and not impact upon the care of the resident’s arrangements were made for the manager of another service to spend time with the inspector. Support and advice is available from this manager and the deputy manager can telephone this person at any time. In addition to this, the company’s area manager visits the service at least three times a week The deputy manager confirmed that in her absence senior staff have been instructed to call her if there is an emergency in the home or if they have any queries about the work. The deputy manager confirmed that her role was not supernumerary to the care staff. She is working on the rotas as part of the staff team to make up the minimum staffing numbers of 2 persons working on each floor. The deputy manager had also worked a nightshift due to staff shortages. It is unacceptable for the deputy manager to be working on shifts as part of the care team. At times there has been no designated person taking responsibility for the management of the service. The deputy manager stated that any senior person on shift would take responsibility for the management but it would not be a designated supernumerary management role, as they too would be working as part of the staff team. A number of the standards within the home particularly those relating to the care records, the building and fire safety have deteriorated since the last inspection. From discussion and observations it was noted that the management of the service is not what it should be. Good standards of record keeping are not maintained and the building is not kept in good, safe order, which means that residents are exposed to unnecessary risks. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 27 The incomplete care records and assessment documents do not reflect how residents make individual choices or express their preferences of how they wish to spend their day. However staff have a good knowledge of residents individual interests and try to support them as best as they can. The absence of a permanent manager and insufficient staff numbers on each shift is having an impact on the quality of life for residents, as only basic care tasks can be carried out and there is little time for staff to spend any quality time with residents. Staff do not have time to engage in conversation or take part in organising stimulating activities for the residents. On the second day of the inspection a manager had been appointed but all of the necessary employment checks such as obtaining the full criminal record certificate had not been completed. He will not commence work permanently in the home until this has been obtained. At the time of the inspection the manager who is giving oversight to the home and who was taking part in the inspection process was supervising the newly appointed manager. The new manager did visit the home during the inspection and spent time introducing himself to staff. Examination of the fire logbook and discussion with the deputy manager confirmed that staff who work on nightshift are not receiving 3 monthly fire instructions. Neither are they taking part in 6 monthly fire drills. This is required by the fire authority and also by the Commission in order to ensure that well-trained staff care for residents. A recent event in the fire logbook indicated that on one evening night staff had to evacuate the building as they had heard a loud bang and all of the lights had gone off. The emergency fire services were called out to investigate. Though records indicated that the staff had successfully evacuated the building there is no record of what happened after the event or what had caused the lights to go off. Record keeping in this area is poor. Other staff who work in the home during the day are receiving appropriate and regular fire instruction and taking part in fire drills. Standardised forms are in place for the recording of any accidents involving residents and staff. Recent entries made by staff contained only basic details of accidents and did not confirm what actions staff took. Some of the forms were not fully completed, despite guidance being available on what to include on the form. The form also asks staff to record what the outcome of any accident was (follow up) this too was incomplete. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 28 The homes administrator deals with records that are used to record monies held on behalf of the residents. These are audited monthly to ensure that any expenditure is recorded correctly and appropriate receipts are obtained. As reported in section 19 –26 of this report the kitchen equipment is not being maintained satisfactorily. The dishwasher has not functioned for 6 weeks and no evidence is available to confirm when it will be repaired. Similarly the boiler used for heating hot water for refreshments is not working but no one was aware of when this would be repaired or replaced. Infection control is being compromised, as well as safety, due to poor staff practices. And as already noted in the report, bathrooms are being used inappropriately to store items that should not be there. The deputy manager is not monitoring health and safety and safe working practices for staff. Staff are not receiving formal supervision and there is no process in place to do so until the new manager takes up his post on a permanent basis. Therefore until this takes place staff are not always following best practice guidelines in their work. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 29 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 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 (1) Requirement Residents care plans must continue to be developed using information obtained from assessments. Individual assessment of needs must continue to be updated. Residents who have been identified at risk of developing pressure sores or have nutritional needs. Must be monitored on at least a once monthly basis. The written plan of care must demonstrate how staff responds appropriately to pressure care and what equipment is in use to support residents. Care records must contain information about resident’s interests and previous lifestyle. In order that a programme of stimulating activities can be developed. All areas of the home must be kept in good order, safe, clean and free of unpleasant odours All areas relating to the premises as discussed in this report must DS0000015762.V346320.R01.S.doc Timescale for action 31/12/07 2. 3. OP7 OP8 14 (2) (a) & (b) 14 (2) (a) 31/12/07 31/10/07 4. OP8 15 (2) (b) 31/10/07 5. OP12 15 (1) 31/10/07 6. OP19 7. OP19 23 (2) (d) & 13 (4) (c) & 16 (2) (K) 23 (2) (d) 31/10/07 31/10/07 Ashton Grange Residential Home Version 5.2 Page 31 8. OP19 23 (2) (c) 9. OP27 18 (1) (a) 10. OP27 18 (2) 11. 12. OP29 OP30 7,9,19 & Schedule 2 18 (1) (c) (i) 18 (1) 13. OP30 14. 15. OP36 OP38 18 (2) 17 (1) (a) & Schedule 3 23 (4) (d) be dealt with. Suitable facilities must be provided for washing crockery and cutlery and providing hot water for refreshments. Staffing levels must be reviewed in order to provide increased staff cover to meet residents needs. Any person who is designated in charge of the home during the working day must be supernumerary of the care staff team. (Immediate) Any gaps in staff employment must be explored and a written record kept. (Immediate) Training records for all staff must be available to confirm what training has been achieved and also what is planned. Staff must receive training to enable them to respond more appropriately to challenging behaviour (Previous timescale 01/04/07) Staff must receive formal supervision at least 6 times a year. Accident records must include an account of the action taken by staff and also the outcome. 31/10/07 31/10/07 30/08/07 30/08/07 31/10/07 31/12/07 31/12/07 31/10/07 16. OP38 Fire records must confirm that 13/09/07 staff who work in nightshift role receive at a minimum, 3 monthly fire instructions and take part in 6 monthly fire drills. (Within 14 days) Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 32 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 OP12 Good Practice Recommendations Notice boards and signs in the home must contain information that is accurate. And be sited in such a way that they are easily read by residents. Ashton Grange Residential Home DS0000015762.V346320.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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