CARE HOMES FOR OLDER PEOPLE
Ashton Grange Residential Home St Lukes Road Pallion Sunderland SR4 6QU Lead Inspector
Mr Clifford Renwick Unannounced Inspection 6th December 2005 10:00 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.V254142.R01.S.doc Version 5.0 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.V254142.R01.S.doc Version 5.0 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 Southern Cross Care Homes No 3 Limited Miss Allyson Elaine Smith 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.V254142.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Two places within the PD category relate to current service users only. 16th June 2005 Date of last inspection Brief Description of the Service: Ashton Grange provides personal care to 40 older people over the age of 65 years and some of 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 approximately 6 years old and is located in what can be described as the heart of the Pallion community. The building is of brick construction and 2 storey offering accommodation on both floors. It has its own drive and parking area and an enclosed garden. All areas are accessible to people who may be dependent upon the use of 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. Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by myself and another regulation inspector and took 7.5 hours. Most areas of the premises, which included communal areas and bedrooms, were viewed. Care records were examined as well as records that related to health and safety and social activities and examination of records of new staff employed in the home was also carried out. Discussion took place with the staff on duty and discussion also took place with 10 residents and four relatives and time was spent observing staff practices and how staff spoke to residents. It was established in discussion that the people who live in this home preferred to be known as residents therefore this term of reference is used throughout the report. The judgements made are based on the evidence available at the time of the inspection. What the service does well:
The manager continues to have a positive commitment towards staff training and staff recruitment in order that she can staff develop a staff team that are professional in their work and who also share the same values as the organisation. Observations made confirmed that staff are professional in their approach with residents and this is consistent with the previous inspection. Residents stated that this is a “nice home” and “they like living here”. Discussion with families confirmed that they were satisfied with the home and said that the manager had made a number of improvements. The manager has developed forums whereby residents can actively contribute their views about the service and she has also implemented a weekly slot whereby she is available to families to discuss any matters relating to the home. Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 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.V254142.R01.S.doc Version 5.0 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, 4 The admissions process ensures that resident’s needs are assessed prior to care being offered. This helps to ensure that resident’s are offered the right type of care at the home. The assessment document in use is a standardised model and though this covers all health needs it does not sufficiently cover any social or mental health needs. EVIDENCE: Examination of the case file for the most recently admitted person confirmed that prior to any admission an assessment is carried out. This assessment primarily focuses upon health and physical needs. Assessments, which deal with falls and risks, are also completed and these were good. Some of the terms used by staff when completing the assessment document are vague and staff need to ensure that more detailed comments are made and preferably in plain English. Discussion was held with the manager about the need for the assessment documents to include more detail on resident’s background and also their social interests, as this will assist staff with the care process. The manager stated that the organisation is currently working on how assessment documents can be developed.
Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 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, 9 & 10 A care planning system is in place, however, records are not sufficiently detailed to highlight how residents individual needs are met. The home treats residents with respect, and their privacy is upheld at all times. Medication administration procedures ensure that the resident’s health care needs are addressed. However, some improvement needs to be made in this area. EVIDENCE: Examination of four residents case files and care plans were carried out as part of the case tracking process. The care plans have continued to be developed since the last inspection and the manager stated that senior staff have been involved in these developments. Care plans are in place for each resident, however, they are not sufficiently detailed to show staff how to support people with their individual needs. Fluid charts, which are in use for one resident, were not completed therefore making it difficult to establish whether the resident had received the recommended amount of fluids as part of their care plan. Evidence of observed ‘good practices’ carried out by members of staff is not always reflected in the residents care plans. The daily records which are in use and used to record the actions being carried out by staff have also improved but these too require
Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 10 some further development. Some of the words and terminology used by staff was not satisfactory or did not give a clear picture of events. This was discussed with the manager who was aware of the need for further developments to take place in this area. Discussion held with the manager confirmed that she is currently carrying out audits of residents care files and any shortfalls are addressed with senior staff. The manager explained that developments had been slower than she had wished but this was due to supporting senior staff in making the developments. And at the same time supporting them to accepting responsibility and accountability for their actions. Records used for the administration of medicines are in good order however some minor developments need to be carried out. There is no record of temperature checks being carried out for medicines that are stored in the fridge. Neither are there any records of staff that are authorised to administer medicines. Eye drops and creams when opened should be dated to reflect the date that treatment commenced. During the inspection many positive interactions between staff and residents were observed. Staff were observed respectfully supporting a resident who preferred not to have lunch with other residents. Staff members were observed consulting effectively and supporting individuals in a sensitive manner. Staff were also observed to promote residents independence whenever possible. Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 A planned activity programme is now in place that ensures that residents receive stimulation. People living at Ashton Grange are able to maintain contact with family and friends and are able to visit the home at any time. The home is run in a way that promotes residents to exercise choice regarding their everyday life. Residents receive a well balanced diet in pleasant surroundings and are supported in a sensitive manner. EVIDENCE: Manager has recently appointed an Activities Coordinator who is responsible for organising and developing a structured programme for residents within the home. The Coordinator is employed 20 hrs per week working 12-4 Monday – Friday. Discussion with the Coordinator highlighted that she is developing the activities programme with resident involvement. Activities include making seasonal decorations, bingo, and ‘sing a longs’. An activity board is displayed on the ground floor this also needs to be displayed on the second floor to inform activities of activities on offer. On the day of the inspection the planned activity was ‘chair aerobics’ and making ‘seasonal decorations’. The majority of the residents were observed taking part in this activity.
Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 12 Discussion with residents and staff confirmed that friends and family members have the opportunity and are encouraged to visit whenever they would like to. Links with the local community are maintained with visits from local schoolchildren and entertainers planned in the future. One resident continues to remain actively involved in her local church every Sunday and informed inspectors that she gets transported to the Church every week. The two dining rooms are newly decorated, and new flooring has been provided and also curtains. The rooms are spacious and provide a nice environment for residents to have their meals. The tables were set with appropriate cutlery and condiments. All the tables displayed menu’s that rotated on a 4 weekly basis. The menu’s provided evidence of a wide and varied choice of nutritious meals available. Alternative meals were also available when requested. Lunch was taken with the residents, meals were served well presented, sufficient in quantity and very tasty. One resident throughout her lunch commented on the meals being “lovely”. Staff were observed asking residents if they would like hot or cold drinks. Discussion with staff member throughout lunch indicated that residents could have their lunch at a time that is suitable to them. Staff support residents during the lunchtime meal, sensitively and discreetly. Residents were given the opportunity to have extra portions of food if they required. Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Local adult protection procedures have been implemented and instigated to help contribute to the protection of service users from abuse. EVIDENCE: Appropriate policies and procedures are in place that deals with the protection of vulnerable adults. There have been occasions when the manager has had to use these because of matter that had been brought to her attention by relatives. The procedures work well and the manager has worked well with other professionals in order to seek positive outcomes for residents. Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The home is clean and warm offering residents a homely environment in which to live. However, there were a number of issues relating to decoration, which need to be addressed, as they do not contribute to the well being of the residents. EVIDENCE: A representative number of bedrooms were viewed on both floors and all communal areas were viewed. Decoration to the first floor has been completed and the bedroom doors have been painted different colours similar to what resident’s front doors would have been like when they lived at home. The addition of large numbers on the doors has assisted residents with orientation around the building and this was seen to be positive. Discussion with the manager confirmed that they are also going to paint a mural on one of the walls upstairs that relates to the local area. Corridors on the upper floor also have street names and this too is helping with orientation. The ground floor corridors have been stripped of wallpaper and are awaiting the decorator to return to the home to complete the work. Progress in this area has been slow and it is now some months since the decorator was in.
Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 15 Steps need to be taken to complete this decoration. In addition to this the home are still awaiting delivery of the new armchairs and again progress in this area is not satisfactory as they were ordered over 4 months ago. The building was clean and the decorative works completed so far and new carpets and laminated flooring have “lifted” the building making it a pleasant environment to live in. The odour, which was present in one bedroom at the last inspection, has been eradicated. One bathroom required some remedial work to the tiles and this was discussed with the manager who immediately arranged for the handyman to put this right. Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25, 29, 30 The procedures for the recruitment of staff are robust and provide the safeguards to offer protection to people living in the home. Staff have received or were about to receive training in the area of dementia. This has provided staff with an understanding of this illness so that they can adequately meet the needs of all of the residents living in the home. EVIDENCE: Since the last inspection five new staff have commenced work in the home. Examination of their personnel files confirmed that all necessary documentation required for employment had been obtained. Amendments have been made to the application form which requests that staff sign to state that the information they have provided in support of their employment is accurate and gives a full picture of their health. The home have an active commitment towards staff training and some staff have recently received training in caring for people with dementia. Discussion with staff confirmed that they had enjoyed this training and found it helpful in their work. Staff who have not yet completed this training course confirmed that they are looking forward to starting it. Though staffing levels on duty meet previous agreed staffing standards as set by the local authority these have been in place for over 5 years. This consists of two staff on duty on the ground floor and three on the first floor exclusive of the manager. The manager should review the staffing levels on the ground floor as a number of the residents have now become more aged and a change in needs is evident. This has resulted in a number of them requiring additional support from staff. When reviewing staffing levels the manager should refer to the “residential staffing forum guidance”.
Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 17 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, 38 The manager offers clear leadership and direction to the staff so that they can consistently meet the needs of resident’s. Resident’s are asked by the manager and by staff about how they want their support to be provided so that their rights and best interests are promoted. A well-managed staff team promotes the health and safety of the resident’s. EVIDENCE: The manager is enthusiastic and continues to work hard in developing good practices within the home. The manager in developing care plans is supporting senior staff and training opportunities have been provided to senior staff. Discussion with residents confirmed that the manager is always seeking their views about the service and implementing suggestions that they raise. The manager now holds a “surgery” one afternoon per week whereby residents and their families can have access to the manager to discuss any matters relating to the home. This is a positive development though the manager has stated
Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 18 that so far attendance has been minimal, as families have stated that they don’t feel the need for a “surgery” as they have no concerns about the home. Good records are maintained for fire safety and this confirmed that staff receives regular fire instruction training and fire drills. Records of accidents are maintained and these are satisfactory. There were no noticeable hazards on the day of the inspection other than a trailing cable in a resident’s bedroom and this was discussed with the manager who had plans in place to address this. Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 19 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Assessment tools must be developed to include how residents social needs can be included and also any needs related to dementia and mental ill health. Residents care plans must continue to be developed as advised during the inspection. When developing the care plans a social profile, which lists residents, interests past, and present must be developed. This will assist staff in their work. Decoration to the ground floor must be completed. New armchairs must be provided to the lounges. The staffing levels on the ground floor unit must be reviewed. Reference must be made to the “residential staffing forum guidance” when carrying out the review. Timescale for action 30/06/06 2. 3. OP7 OP7 15 15 30/06/06 30/06/06 4. 5 6 OP19 OP19 OP27 23 23 18 28/02/06 28/02/06 28/02/06 Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 21 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 OP7 Good Practice Recommendations Daily records should be developed as advised. Ashton Grange Residential Home DS0000015762.V254142.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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