Inspection on 05/09/06 for Ashton Grange Residential Home

This inspection was carried out on 5th September 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashton Grange Residential Home 23/12/09

Ashton Grange Residential Home 22/12/08

Ashton Grange Residential Home 17/01/08

Ashton Grange Residential Home 28/08/07

Ashton Grange Residential Home 06/12/05

Ashton Grange Residential Home 16/06/05

Ashton Grange Residential Home 18/01/05

Ashton Grange Residential Home 20/07/04

Ashton Grange Residential Home 11/03/04

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The Highlands

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Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashton Grange Residential Home St Lukes Road Pallion Sunderland SR4 6QU Lead Inspector Aileen Beatty Key Unannounced Inspection 5th September 2006 09:30 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.V309128.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.V309128.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@highfield-care.com www.cshealthcare.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.V309128.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. 6th December 2005 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.V309128.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 7 hours on Tuesday the 5th of September. The inspection involved a tour of the premises, discussions with residents, relatives and staff, and a review of records. The inspector ate lunch with residents. Service user satisfaction surveys were received from sixteen people, fourteen were from relatives and two were from residents. Comments from these surveys will be included in the body of the report. The overall standard of care is adequate. What the service does well: What has improved since the last inspection? A number of areas of the home have been redecorated, making it more homely in appearance. New curtains have been provided and a new fireplace has been put in the upstairs lounge to provide a focal point. New armchairs have been provided in lounges, which was a requirement from the last inspection. Social assessments have been developed and are available for some residents, which list past interests and information to help inform activity planning. Ashton Grange Residential Home DS0000015762.V309128.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. Ashton Grange Residential Home DS0000015762.V309128.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 Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, intermediate care is not provided so standard 6 was not assessed. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the 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. The home manager carries out a pre admission assessment, and a comprehensive assessment is provided from social services. These detail the level of support they will need and any existing health problems. This information helps the home to decide that they are able to provide the correct level of care to the person. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,and 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Resident’s health and social care needs are not sufficiently set out in individual plans of care. Although health care needs are generally met. Medication procedures do not adequately protect residents. Residents are treated with respect and their rights respected some of the time. EVIDENCE: Care records for four 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 Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 10 moving and handling assessments. 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. From these assessments, care plans should be developed describing how staff must care for the person. It is important that these are detailed and up to date enough to enable even a new member of staff to provide a consistent standard of care to the person, in the way that they prefer. Care plans are of a generally poor standard, despite some training in care planning being provided since the last inspection. Again, these vary in standard, but are generally vague and lack detail, some care plans actually only have a heading and are otherwise blank. For example, a care plan to deal with a resident with epilepsy simply says to “lie on their side and monitor”. It does not say what they are actually monitoring or for how long they should do it. The language used is also not appropriate in some care plans. In contrast, another care plan describes how someone preferred to shower, with very specific information about his or her routine. This was an example of good practice. Psychological care plans, especially for residents with dementia, need to be developed. It was very concerning to note 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. Care plan evaluations are equally minimal, often with repetitive phrases saying things like “no change, continue as per care plan”. A requirement was set at the last inspection that social assessments should be in place. These were available in the files and contained information about past history likes and dislikes. This information has not always yet been transferred onto a social care plan, so this must be further developed. There is currently no manager in the home, the Deputy is acting manager, with support from an experienced manager form a nearby sister home. Both reported that they are aware of deficits in care plans and are working with the company training manager to improve the situation. Records demonstrate that people have access to health care. Visits from GP’s nurses and chiropodist are recorded. A number of residents on the ground floor said that they feel well cared for. Six surveys returned said that they did not feel that there are sufficient staff on duty to provide adequate assistance. Additional comments were that “staff do their best, but that there does not appear to be enough of them”. One survey complained that fingernails are often long and dirty, one resident was noticed to have long dirty nails during the inspection, and also had an itchy skin complaint and broke the skin Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 11 through scratching. This was pointed out to staff who agreed to cut and clean them. Personal hygiene records are maintained but are not dated. Moving and handling techniques used on the day of the inspection were poor, and on two occasions staff were seen performing a drag lift (where two staff hook a person under their arms to lift them). This is a banned lift and can cause injury. Staff have received training in manual handling, and hoists are available. Medication records were examined. There were a number of unexplained gaps in records. A code should be entered to say why a medication was not given, for example it was refused or out of stock. There should not be any blank spaces. Large quantities of medication were scattered on benches in the treatment room, and all cupboards are unlocked. Although the room is supposed to be kept locked at all times, medication should be stored in locked cupboards. Medication for people no longer living in the home was stored. These included controlled drugs. These should be returned to pharmacy, and in the event of a person dying retained in the home for seven days in case of a coroner’s inquest. Medication is still provided by Boots, and is supplied in blister packs. A care worker on duty had last received medication training five years ago. The dignity of residents is generally respected. Staff knock on doors and were seen rearranging clothing to cover legs and some were respectful in their manner. On numerous occasions throughout the day, staff were heard referring to a residents challenging behaviour as “kicking off” and this is an inappropriate way to describe this behaviour. Staff must be encouraged to think about how they may view the behaviour differently if, instead of saying “this is the time of day she kicks off” they said “this seems to be the time of day that she gets (upset, angry, distressed, anxious etc) This demonstrates a general lack of understanding and staff were observed to miss several opportunities to avoid conflict. This was most obvious at lunch-time (see standard 15). Training to deal with challenging behaviour is recommended. This should include some training in communication, as on two occasions some staff appeared a little abrupt by saying “no, you can’t come in here” and “don’t do that”. Most of the time staff are pleasant in their manner. A number of unnamed tights were in the laundry, and it was confirmed that although some people have their own, a communal supply is used. The same applies to face cloths. People must wear their own clothing at all times. Staff are discreet when assisting people to go to the toilet. Discreet and sensitive assistance was given at lunchtime to people who needed assistance with eating their food. Staff sat at the same level, and ensured that appropriate assistance was given. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The lifestyle in the home does not always match the expectations of residents, especially concerning the variety of activities available. Residents may maintain contact with family, friends, and representatives if they wish. Residents are usually helped to exercise choice and control over their lives many people agree that a wholesome appealing diet is available in pleasant surroundings. EVIDENCE: On the day of the inspection, residents were having a game of bingo. Upstairs residents were watching a film, and there was a planned trip in the mini bus to South Shields. Residents spoken to on their return said that they had enjoyed the trip and wished the bus was available more often. Seven out of sixteen people in the surveys said that there were not enough activities available. One commented that they felt they had been misled, as prior to admission they were advised that regular activities would be available. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 13 Visitors are able to visit the home at any reasonable time, and may take people out into the local community. One survey reported that on three separate occasions they had left instructions that they would be taking their relative out for lunch. Each time, the person had been given lunch in the home. Residents are offered choices throughout the day. They are able to bring personal belongings into the home and bedrooms are homely and personalised. Residents were joined for lunch. A varied menu is available, although this was not displayed for people to see. A good choice is available for breakfast and lunch. All choices of meals appeared to be enjoyed by residents. Menus were in a small folder, and not displayed. It is recommended that menus are available, possibly in large print, or picture format for some people. Staff provided good support to residents during the meal. Choices for the day are taken around 11 am, which is a good idea; especially as the usual practice of taking them the day before can be hard for people with memory problems. Second helpings are available, although people may need to wait while the trolley is between floors. It was noticed that people were sitting at the table some time before the meal was served. The inspector joined residents upstairs, most of whom have dementia. It is recommended that consideration is given to seating some people as late as possible, due to poor attention span. Staff may also wish to consider carefully who is seated next to whom. For example, it was reported that lunch- time was a potentially difficult time for one resident. They sat at the table for quite a long period before the meal was served. In addition to this, they were sitting beside someone with a tendency to touch other people’s place settings, and this made them angry. Within a few minutes, the person had angrily left the table and walked away. It is recommended that people with very short attention spans are brought to the table with an enticing meal put in front of them. This would maximise the chances of them receiving adequate nutrition, as it is very difficult to encourage someone to come back and eat once they have angrily walked away. If this happens on a regular basis, their dietary intake may be affected and a care plan should be in place to deal with this, for example they may be given regular snacks. The kitchen was inspected and had a very good range of fresh fruit and vegetables available. Dining tables are fully set, and dining rooms are pleasant and bright. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 14 Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents and their family and friends are confident their complaints will be listened to but not always that they will be acted upon. Residents are protected from abuse. EVIDENCE: There have been three complaints since the last inspection. The former manager investigated these. One was not upheld, and two were partially upheld. Complaints procedures are available, but three people surveyed said that they were unaware of how to make a complaint. Most people said that they were aware of how to complain but some people do not feel that complaints are always acted upon. Residents and their representatives must be made aware of the complaints procedures, in particular who they address the complaint to in the absence of the manager. Training in the protection of vulnerable adults was carried out in April. Full training records were not available during the inspection so the numbers of staff who attended the training is not known. There has been one adult protection issue since the last inspection, dealt with in line with the homes procedures. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 16 Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Most parts of the home are generally safe and well maintained and some areas are not satisfactorily clean pleasant and hygienic. EVIDENCE: Externally the home has a large secure garden. It is mostly grass although there are quite a few weeds and it looks a little neglected. Outdoor seating is available. A car park and ramp are at the front of the building. Lounges are identified as smoking and non-smoking. There is a policy that smoking is not permitted elsewhere in the building. Carpets are clean and look new, laminate flooring has been laid in dining areas. Lounges and corridors are generally decorated to a good standard. Some areas have been redecorated Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 18 since the last inspection. Some chair arms are badly marked and scratched. New chairs have been provided and the remainder are due to be replaced very soon. Dining areas are bright and tables are fully set. Southern Cross are currently introducing front door style doors to bedrooms in a number of their homes. Residents are encouraged to choose their own colour, and doors have a brass nameplate, knocker and a fake letterbox. 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. The clock in the upstairs dining room is very decorative and the face is coloured as it is made up from an old fashioned advert. This makes it difficult to tell the time, especially in the unit for people with dementia. Bedrooms are personalised and homely. Bedding is usually coordinated. Some en suites need additional shelving as there is little space for toiletries, and these are often on boxed in pipes close to floor level. This may cause someone to become unsteady as they reach down, and they are in some cases un hygienically close to the toilet. Some mattresses are badly marked. There is currently no rota for replacement, and they all need to be checked to make sure they are comfortable and clean and hygienic (plastic covers not torn). The shower area upstairs is bare and uninviting. A rusty old bath chair is in use even though a new one has been provided. Staff are unhappy with the new chair and prefer the style of the old one. An appropriate chair must be used and the rusty unhygienic one discarded. A large number of towels are stored in the bathrooms. This could cause an infection control problem particularly when they become damp and the bottom towels may not be used for some time. The home is generally clean but there are some problem areas. Some bedrooms have a foul smell and this is unacceptable. The whole upstairs unit smells of urine upon entering from the lift. All residents have their own basket in the laundry. There is an industrial washer and drier capable of reaching temperatures required for the safe laundering of soiled laundry. Red bags are used for soiled linen. These dissolve in the washing machine. Some communal washcloths are used and these should be replaced with named ones. The main kitchen was clean but cereal was being stored in a large cardboard box with no lid, on the floor. This may attract pests and the cereal should be stored in an airtight container to retain its freshness. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 19 Staff received training in March 2006 relating to the use of chemicals. This includes cleaning fluids. Then training is called COSHH (control of substances hazardous to health). The training schedule identifies that infection control training was due to be arranged for August 2006. There is no evidence that this training was delivered. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the 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 Residents are in safe hands at all times and are protected by the home’s recruitment policies and procedures. . EVIDENCE: Surveys found that a number of people did not always feel that there are enough staff on duty. Two people said that there are “usually” enough staff on duty, four said there “always” are, four said there “sometimes” are, and four said there “never” are. Criminal records checks are carried out before staff work in the home. Staff files were checked of two of the most newly appointed staff. They contained all of the required information including two references, identification information and health checks. It was difficult to assess the training that has been delivered. Not all records are available, as the manager left earlier in the year. The company training Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 21 manager is working closely with the home, as training is out of date in some areas. The deputy manager is currently acting manager in the home. They were not in post for very long as a deputy, and discussions revealed that a full and through induction into the role of deputy had not been completed before then being promoted to acting manager. Further training is required to ensure all managerial responsibilities are fulfilled. Training in health and safety awareness and dementia care is required. Training in Fire safety, moving and handling, sensory deprivation, pressure area care, accidents and COSHH are recorded as having been carried out between January and April 2006. Evidence that staff have attended was not available during the inspection. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home is generally run in the best interests of residents, although there is currently no permanent manager. Resident’s financial interests are safeguarded. Staff are not appropriately supervised. The health safety and welfare of residents are not always adequately protected. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 23 EVIDENCE: There is currently no permanent manager. The deputy who is acting up is relatively inexperienced. An experienced manager from a sister home is currently providing support and spending time in the home. This arrangement must be formalised in writing to CSCI, outlining the amount of support being provided by them and the training manager. Staff try to run the home in the best interests of residents. Comments in surveys suggest that staff are well intentioned, and are approachable. One relative spoken to agreed that staff are trying their best but there doesn’t appear to always be enough of them to carry out all the tasks required. The criticism is mainly of the organisation of staffing, and not individual staff. Resident’s personal allowances are held at head office, with a float of cash available in the home. It was confirmed that this never results in people being kept waiting for their money. The company is looking into an agreement with a large high street bank to provide individual accounts. Staff supervision has not been carried out. The training manager is currently assisting with the backlog of supervision. Staff supervision allows managers to meet regularly on a one to one basis with staff. It is very important as part of the process for maintaining high standards in the home, and for making sure staff are well supported. Some systems are in place to keep the environment in the home safe. The handyman carries out regular checks. Fire records include checks of the fire control panel, alarm sounders, break glass units, door releases, extinguishers, and regular tests. Fire doors are checked weekly. Staff call systems are checked monthly, and water temperatures are checked regularly. Accident records are kept, and where an accident is recorded in daily notes, it has been recorded in the accident book also. It was noticed that a number of window restrictors were either missing or broken. These prevent the windows being opened too far, where someone may fall out. It was confirmed that new restrictors had been bought, and that the handyman was in the process of fitting them to each window. Staff confirmed that upstairs windows without restrictors will remain locked until they are fitted. One upstairs room had the window open in the morning to ventilate it due to the serious odour problem. The door was locked while it was open wide and staff confirmed that it would be locked when the resident was in the room. Later in the day, the resident was found to be in the room, and the window was closed but unlocked. The room is on the first floor. An immediate requirement was issued requiring restrictors to be fitted to all high-risk rooms Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 24 the same evening. All other windows had to be restricted within 48 hours. This was carried out. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 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 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 1 X 2 Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 26 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 Requirement Residents care plans must continue to be developed as advised during the inspection. OUTSTANDING Manual handling techniques must be improved. Medication records, storage and disposal procedures must be followed. Staff must receive training to enable them to respond more appropriately to challenging behaviour. Residents must wear their own clothing at all times. A full and varied activity programme must be available to all residents. Instructions to enable residents maintain contact with the community must be recorded. Meal times should be carefully planned to meet the needs of all residents. The replacement of chairs to continue. The garden must be tidied up. Storage must be provided in en DS0000015762.V309128.R01.S.doc Timescale for action 05/12/06 2. 3. 4. OP8 OP9 OP10 13 (5) 13 (2) 18 1 (c16 (2) (d) 05/10/06 05/10/06 05/12/06 5. 6. 7. 8. OP12 OP13 OP15 OP19 16 (2) (n) 16 (2) (m) 16 (2) (i) 23 (2) (a) 23 (2) (0) 05/12/06 05/10/06 05/10/06 05/12/06 Ashton Grange Residential Home Version 5.2 Page 27 9. 10. OP26 OP27 23 (2) (d) 18 11. 12. OP30 OP31 18 (1) (a) 8 13. 14. OP36 OP38 18 (2) 13 (4) (c) suites. Mattresses must be checked routinely with a programme for replacement in place. Malodour in identified rooms must be addressed. Staffing levels must be reviewed following a review of dependency levels in the home. OUTSTANDING Provide an updated list to CSCI of training delivered and planned. Confirm to CSCI the management support provided. Deputy to continue induction into role. Staff must receive supervision at least six times per year. Window restrictors must be on a regular safety audit in the home. 05/12/06 05/12/06 05/10/06 12/10/06 05/12/06 05/10/06 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. Refer to Standard OP12 OP16 OP19 OP19 OP30 Good Practice Recommendations An activity planning tool is obtained to help staff to plan and record activities. Remind residents and their families of the complaints procedure. Replace the dining room clock with one more easy to read. Shower rooms are made more homely. Training in health and safety awareness and challenging behaviour is provided. Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 29 Ashton Grange Residential Home DS0000015762.V309128.R01.S.doc Version 5.2 Page 30 - 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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