Inspection on 02/02/06 for Ashton House

This inspection was carried out on 2nd February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashton House 09/08/06

Ashton House 16/08/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashton House Union Street Stow-on-the-wold Glos GL54 1BX Lead Inspector Mrs Eleanor Fox Unannounced Inspection 09:30 2 and 16 February 2006 nd 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 House DS0000064572.V276667.R01.S.doc Version 5.1 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 House DS0000064572.V276667.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashton House Address Union Street Stow-on-the-wold Glos GL54 1BX 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) 01451 830843 The Orders of St John Care Trust Mrs Maggie Keyte Care Home 45 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (35) of places Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user under 65 years to be accommodated for respite care. This condition will be removed when the service user reaches 65 years of age or no longer wishes to receive respite at the home. 16th August 2005 Date of last inspection Brief Description of the Service: Ashton House is a purpose built well-appointed Care Home, situated within easy reach of the town centre of Stow-on-the-Wold. The Home offers personal and nursing care to the elderly service users; it is managed by The Orders of St John Care Trust. Ashton House has 42 single rooms and a double room, which is currently accommodating one resident, and has homely communal accommodation on both floors. A shaft lift has been installed for easy access to the upper floor; the Home is also well equipped with a variety of disability aids. Part of the ground floor has been converted to provide secure accommodation for ten elderly people who suffer from dementia. Consideration is being given to extending this facility. The residents have secure access to the extensive attractive private gardens that surround the property. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over 2 days in February. On the first visit she selected five residents in a random fashion and then looked at their care records, medication documentation and records of any accidents relating to these people. She visited each person, observed their bedroom accommodation and where possible, gained feedback on the care they were receiving. She observed the service of the mid-day meal, the administration of medications and some of the personal care given to the residents. Quality assurance processes in place were also discussed. On the second visit financial, personnel and training records were inspected. Throughout the process the inspector received full cooperation from a cross section of staff; they provided time and information, as requested. What the service does well: What has improved since the last inspection? Since the last inspection the Manager has ensured that recruitment processes are followed consistently, ensuring that every new member of staff is subject to full screening procedures. There have also been improvements in the standard of record keeping at this home. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 6 The staff are to be congratulated for building on the improvements in care planning that had already been achieved. These now address all the residents’ care needs. 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 House DS0000064572.V276667.R01.S.doc Version 5.1 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 House DS0000064572.V276667.R01.S.doc Version 5.1 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): 1 and 2 The provision of additional information about the Home would enable prospective residents and/or their families to make a fully informed decision regarding their admission and give them assurance that their needs would be met at Ashton House. EVIDENCE: A Statement of Purpose and Service User Guide have been developed for this Home. However these have not yet been fully reviewed and updated to reflect the management changes in the Company early in 2005. These processes are now being undertaken. An information folder is provided at the front entrance, which is readily available to any prospective residents, their families and other visitors to the Home. Some additional details included in this folder are also out of date and require review. Three files relating to residents admitted since the last inspection were read. These contained signed confirmation that residents and/or their advocates had Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 9 received information about the terms and conditions for admission to the home. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 10 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 and 9 The care planning systems in place are consistently maintained to adequately provide the staff with the information they require to care for all the residents’ needs. The medication systems, however, require some minor improvements to ensure that residents are not put at any risk of potential errors. EVIDENCE: The care documentation relating to five residents, one of whom was accommodated in the ‘Sunnyside’ unit, were read in detail on this visit. In each example, explicit specific care plans based on a general assessment of care needs had been prepared. One person had been identified as ‘at serious risk’ of falling; a detailed care plan had been prepared to address this issue. Another person had been admitted with pressure sores. Again, the implementation of appropriate measures to treat the wounds and to prevent any further sores developing was all clearly recorded. Already this person was responding to the care given and one care plan had now been discontinued. The plans seen on this visit were reviewed appropriately and appeared to reflect the residents’ current conditions. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 11 Medication administration was also inspected. A small drug trolley has been obtained for the ‘Sunnyside’ unit. Although a bracket to securely attach the trolley to the wall had not yet been fitted, the trolley was stored in a small locked office for safety. On the whole, medications were administered and recorded correctly. Controlled drugs were managed appropriately. However, in the examples seen, there were three occasions where handwritten drug records either had not been signed at all or not countersigned by a witness. Administration terms, for example ‘four times a day’ should be written in clear English for complete clarity. Terms such as ‘QDS’ and ‘BD’ were seen in the selected medication charts. Carers working in the ‘Sunnyside’ unit have received training in medication administration processes. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 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 and 15 The Home does not consistently provide activities to entertain and stimulate those living at Ashton House. Nevertheless, the Home is managed to enable the residents to maintain social contacts as they wish. The meals are nutritious and balanced, offering both choice and variety to the residents. EVIDENCE: The ten residents accommodated in ‘Sunnyside’ have the benefit of one to one stimulation. Appropriate activities are arranged on a daily basis; these are adapted to address the residents’ special needs. The service user guide in the front hall of the main part of the home advertises a wide selection of activities but the majority of these are not yet provided at Ashton. Plans are in place to provide an activities coordinator within the next few months. According to the planned programme in the main part of the home, the residents were due to have a music and movement session that afternoon. However it was explained that there were insufficient staff on duty to provide this activity. One member of staff did explain that ‘it was not unusual that planned activities had to be cancelled because of lack of staff. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 13 On this occasion, any residents not choosing to remain in their bedrooms sat quietly in one of the sitting rooms or walked around the home. The television was on in one room but no other diversional activity was arranged. Friends and relatives are welcome to visit at any time so long as the resident is content to see them. Two relatives spoke with the inspector during her visit. Both said they were satisfied with the care the residents were receiving. One lady commented that, although her Mother was very confused and could be difficult, the staff couldn’t be kinder to her. She also confirmed that she was normally offered refreshment when she visited her Mother. She said, “All the staff are so friendly”. The majority of residents have their meals in one of the two dining rooms although some prefer to eat in their bedrooms or elsewhere. They were offered a choice of food and were given time and assistance, if required, to eat their meals in a quiet and relaxed manner. A good variety of food is prepared in this home and special diets are provided when required. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 14 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 Further staff training and full implementation of the Home’s robust policies and procedures would give residents the assurances that they may expect to live in a safe environment. EVIDENCE: The Orders of St. John Care Trust have developed comprehensive policies to address all forms of abuse. These are kept in a prominent position in the nurses’ room, readily available for members of staff to read. Whistle blowing procedures are also included in this documentation. It has already been identified that the majority of staff employed at the home now require further training in these issues as they have not been addressed since 2001. Arrangements are being made to provide training on dealing with challenging behaviour and recognising abuse later in 2006. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 15 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 The provision of a safe and reasonably maintained environment ensures that residents may live in comfortable homely accommodation. EVIDENCE: A maintenance man is employed in this home, ensuring that any urgent requirements are addressed when necessary. The home is well designed to meet the needs of frail elderly people. It is equipped with strong supportive furniture and maintained in good decorative order. A replacement carpet was being laid in the administrator’s office. On both visits, the home was clean, fresh and free from any major offensive odours. Laundry systems continue to be well organised; the washing machine has now been repaired. The sluices were also maintained in good working order. They were clean and appeared to be being used within acceptable infection control guidelines. One carer displayed a good knowledge of the correct processes to follow. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 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): 28, 29 and 30 Residents are cared for by experienced staff who have been recruited safely but who would benefit from additional training to ensure that residents’ needs are fully met. EVIDENCE: Of the thirteen carers employed at Ashton House, two have already achieved a National Vocational Qualification, level 3 and one has an NVQ, level 2. However, six people are hoping to start the training later this year, which will ensure that at least 50 of care staff will have an acceptable qualification in care. Four members of staff have been employed at the Home since the last inspection. Personnel files showed that correct employment processes had been followed and full clearances had been obtained. Clear interview notes are maintained. Induction is arranged for each member of staff on commencement of employment. The Manager is aware that, due to operational difficulties, members of staff are now overdue to attend mandatory training. However, the manual handling trainers have now completed their own additional training and are ensuring that the staff are updated in these processes. Other training needs have been identified and will now be addressed throughout 2006. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 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): 33 and 37 There is a programme of self-review and consultations in place at the Home; these require to be developed further to ensure that residents gain full benefit from these processes. Records are stored securely to safeguard the residents’ confidentiality. EVIDENCE: The home does have procedures in place to address quality improvement. Medication administration, any complaints, accidents or adverse incidents, and satisfaction with the provision of food are all monitored closely. The care planning processes now show a marked improvement after these were identified as having shortfalls last year. The Orders of St John Care Trust has just been successfully audited for the ISO 9001 award. However, a quality improvement report has not been provided for Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 18 the Home in the last twelve months, as is required. This is now being developed. All the records seen on this occasion were maintained correctly and stored securely. Residents do have access to their records if they wish. Photographs are provided for each resident. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 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 2 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x x 3 x Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 6(a & b) Requirement The Statement of Purpose and Service User Guide must be reviewed and updated to reflect the changes in the home. A copy must be provided to the Commission The person making the record in the drug administration documentation must sign any handwritten amendments; these must also be countersigned by a second witness. The drug trolley in ‘Sunnyside’ must be stored securely. The Registered person must provide facilities for recreation, having regard for the special needs of the residents Staff employed in the home must receive updated training in abuse and dealing with challenging behaviour Members of staff must receive timely training in the moving and handling of residents (previous time scale 31/10/05 not met) A quality improvement report must be provided for the home Timescale for action 30/04/06 2 OP9 13(2) 01/03/06 3 4 OP9 OP12 13(2) 16(2n) 01/03/06 31/03/06 5 OP18OP30 18(1c) & 13(6) 13(5) & 18 (1c) 24(2) 31/05/06 6 OP30 31/05/06 7 OP33 31/05/06 Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 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 2 Refer to Standard OP9 OP28 Good Practice Recommendations All instructions for the administration of medications should be written in clear English. It is recommended that at least 50 of care staff should be trained to NVQ, level 2 or equivalent. Ashton House DS0000064572.V276667.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 House DS0000064572.V276667.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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