Inspection on 11/05/06 for Ashton Lodge

This inspection was carried out on 11th May 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 Lodge 26/09/08

Ashton Lodge 12/02/07

Ashton Lodge 14/09/05

Ashton Lodge 17/05/05

Ashton Lodge 13/01/05

Ashton Lodge 27/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Ashton Lodge Ashton Road Dunstable Bedfordshire LU6 1NP Lead Inspector Vanessa Rumball Unannounced Inspection 11th May 2006 13:00 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 Lodge DS0000014990.V293988.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 Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashton Lodge Address Ashton Road Dunstable Bedfordshire LU6 1NP 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) 01582 673331 01582 673284 Resicare Homes Limited Mrs Georgina Thandi Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Old age, registration, with number not falling within any other category (54), of places Physical disability over 65 years of age (54) Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th September 2005 Brief Description of the Service: The home was situated in a residential street, close to Dunstable town centre. The home was extended in 2005 and now provides 54 beds in single and double rooms, 4 lounges, and a number of communal toilets and bathrooms. The home was arranged with the bedrooms on all three levels and communal areas on the ground floor. For operational reasons the home was divided into three areas, grouping service users according to their needs, but still respecting freedom of movement throughout the home. A pleasant garden was easily accessible and was well used by the service users in the summer months. The home charges between £425 and £495 per week depending on how much care and support the service user requires. This rate was effective from 1st May 2006 and will be reviewed on 1st May 2007. Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by Mrs Vanessa Rumball, Regulations Inspector, on 11th May 2005 from 1pm – 8pm and 23rd May 2006 from 9am – 11am. The methodology used was case tracking the care of four service users in detail, a tour of the home, discussion with five staff, six service users, two family members and the reading of documentation. This report should be read in conjunction with the National Minimum Standards for Care Homes for Older People. The Inspector would like to thank all those involved for their assistance during this inspection. What the service does well: What has improved since the last inspection? The home provided equipment to assist service users to move, including hoists and wheelchairs. Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 6 Staff were receiving regular supervision from a manager. This provided an opportunity for the care worker and manager to raise any concerns they had or talk over any difficulties. It also provided an opportunity to identify any training needs and plan how these can be best addressed. 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 Lodge DS0000014990.V293988.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 Lodge DS0000014990.V293988.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, 2, 3 & 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home did not make available sufficient written information to service users to enable them to make an informed decision about the care offered by the home. Contracts were issued to service users after they had moved to the home and therefore service users were aware of the terms and conditions of residence. Service users needs were generally met. EVIDENCE: Neither the Statement of Purpose nor the Service User’s Guide contained all the information required by the Care Homes Regulations and the National Minimum Standards for Older People. Examples of information not included in the Statement of Purpose is the name and address of the registered provider and manager, any relevant qualifications of the manager and staff, and the organisational structure of the home. Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 9 Information not included in the Service User Guide were the terms and conditions in respect of the accommodation provided, and relevant qualifications and experience of staff. In addition the Guide made reference to appendices, which were not available when requested by the inspector. Neither document was available in ‘user-friendly’ formats. The representative of a service user said they could not remember being given any written information about the home either prior to, or after, the service user came to the home, but did say that staff had been ‘very good’ at telling them verbally all about the home. A contract had been issued to the one privately funded service user whose care was tracked. This was signed by both a representative of the home and the service user. Of the four care records inspected, three had comprehensive assessments on file but the fourth was incomplete. It was, however, evident that ongoing assessment was being undertaken with this service user. In addition to a care needs assessment information was also collated on service users preferences. Ashton Lodge DS0000014990.V293988.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, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The system for administering medication did not protect service users; the opportunity for errors to occur was increased by the practices adopted by the home. EVIDENCE: Where service user plans were completed, these were comprehensive and informative documents that ensure that care workers and service users know what care and support is agreed. Two of the four service users whose care was tracked had a service user plan on file. Both were very detailed and informative documents. However, one of these had not been updated to reflect a recent change in care needs and had not been reviewed within the timescale stated on the plan. Correspondence and records were seen that showed the home worked with other health care professionals. Equipment was available to reduce the risk of pressure sores. Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 11 Only one of the two records for controlled medicines inspected was accurate. All other medication records sampled were satisfactory. The inspector was concerned that tablets were taken from their original containers by a senior care worker and placed in a small pot, labelled with the service user’s name, and then given to a care worker to give to service users. This means that the care worker giving the medication has no way of knowing if this is the medication that is prescribed to the service user and is being given at the right time. In addition the senior care worker is signing to say that they have administered the medication when in fact this is being given to another care worker to do. Service users stated that some care workers were ‘wonderful’. Care workers were observed talking to service users in a respectful manner. Ashton Lodge DS0000014990.V293988.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, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ preferences were sought and respected. Visitors were encouraged and welcomed into the home and there were no restrictions on service users leaving the home unless they would be at risk by doing so. The standard of food provided was very good and well-balanced meals were offered. EVIDENCE: Service users’ files contained information about their personal preferences. Visitors to the home said they felt welcomed and at ease. Service users stated they had been able to bring personal possessions such as picture and ornaments with them to the home. The inspector’s first visit to the home was on a very warm day and a number of residents were sitting in the garden. Glasses and jugs of squash were distributed throughout the lounges and garden and some service users chose to have their meal outside. Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 13 Several service users commented on the good quality of the food. A choice of meal was available and the inspector heard staff offering these choices to service users. The menus were varied and well balanced. Soft diets were well presented and meals generally looked appetising. Ashton Lodge DS0000014990.V293988.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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and investigated. Staff were aware of pova protocols and ensured service users protection. EVIDENCE: One complaint had been made about the service since the last inspection. The local authority had investigated this. Some areas of the complaint were upheld and the manager stated that systems or practice would be reviewed to rectify any shortfalls identified. The manager stated that she prefers that people discuss any concerns or worries they have and therefore resolves issues before people feel they have to complain. Staff were aware of pova protocols when questioned by the inspector. Ashton Lodge DS0000014990.V293988.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, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was clean and reasonably well maintained. The environment was suitable to meet the needs of the service users. However, the safety of those in the home was put at significant risk by fire doors, including those leading onto staircases, being left wedged open and this has resulted in the overall judgement for this area being poor. EVIDENCE: The home was sited close to the town centre. A large extension had recently been added to the building that resulted in a significant increase in the home’s size. The garden was pleasant and easily accessible. There was space for service users to sit outside both in the sunshine and in the shade. Apart from some final touches to the décor, for instance a skirting board needed to be fitted on one landing, and pictures to be hung in one of the lounges, the home offered a comfortable environment for service users. Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 16 The home was clean and without offensive odours. Protective clothing was available to staff to ensure good infection control procedures were adhered too. Hot water was delivered at a safe temperature. During the inspector’s visit to the home, several fire doors were left wedged open, including those leading onto the staircases. There were no risk assessments or evidence to suggest the fire service had agreed to this. A letter was issued after the inspectors second visit to the home requiring that this be rectified quickly. Appropriate aids and facilities were fitted in the new areas, including a raised toilet seat, grab rails, and alarm call bell points. All equipment seen, including wheelchairs, appeared suitable for their purpose. The home is registered to provide specialist care to people with a diagnosis of dementia. Ashton Lodge is a large building with many corridors that can be confusing. In finishing off the décor, following the building works that have been carried out, further thought should be given to how the décor can, for instance, provide signals and help people to find their way around. Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. Recruitment records did not demonstrate that staff were thoroughly checked and found to be suitable to work with vulnerable people before they worked in the home. Staff were trained for their role so that service users are cared for satisfactorily. However the home should ensure that it can provide evidence of the training staff have had. EVIDENCE: As the staff personnel files were not available when the inspector visited the home on 11th May, the inspector returned, unannounced, on 23rd May, but was still not able to see one of the three files requested because this was not at the home. The Care Home Regulations require that such records be kept in the home at all times. The inspector was therefore not able to assess the recruitment process or management of that care worker. Of the other two files seen during the inspection, one care worker had been employed and had commenced work but had only one reference, and the other had been employed and worked in the home for almost nine months before a povafirst check had been obtained by the home. Neither files contained a recent photograph of the care worker. The inspector issued a letter following the inspection requiring that only those people that have been satisfactorily checked, be allowed to work with service users. Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 18 Rosters showed that there were enough care workers, led by a senior who delegated the work, on each shift. However, three service users commented that they had had, to or observed other service users having, to wait before they were given the assistance they needed. During the visit to the home the inspector observed that it was nine minutes before a call bell was answered. When an emergency call was sounded, that was answered immediately. Of the thirty-six staff employed at the home, seventeen were working towards NVQ’s in Care, and five staff had completed either NVQ Level 2 or 3 in Care. Although the standard is not yet met, it was evident that the home was well on the way to meeting the 50 of the staff team and therefore a requirement has not been made. One file, for a fairly new care worker did show a record of a brief induction. The care worker had not yet had formal moving and handling training. A risk assessment had been completed but did not state any restrictions on her work. The person in charge stated that the care worker had been briefed by a senior member of staff and could only participate in limited tasks where service users required assistance with moving. The manager should consider the risk associated with staff, who have not been formally trained, participating in moving and handling tasks and record the outcome of this assessment to ensure that everyone is clear about what that staff member can and cannot do. The second file did not show what training that staff member had had. However, when questioned, the staff member stated that she had attended various courses including statutory training and dementia awareness. The home should ensure that a record of staff training and development is maintained. Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 19 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, 34, 35, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the quality of the service was monitored, this was not formalised. A quality assurance report had not been produced to show that the home was run in the best interests of service users. Notification and reporting requirements had not been met and not all the records required by the Regulations were produced, or available, e.g. the service could not show that staff were properly checked before they worked with service users or that it was safe to prop open fire doors. Those in the building were put at significant risk by fire doors being propped open and a lack of risk assessment. EVIDENCE: Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 20 The manager provided the inspector with a Development Plan for Quality Assurance. However, this document showed that the home plans to monitor the quality of care provided, but did not show any outcomes. The manager regularly reviewed policies and procedures. The provider had taken action to meet requirements from the last inspection. On both visits to the home several fire doors were wedged open, including the fire doors opening onto staircases. The manager stated at the first visit that she was in the process of completing a fire risk assessment for the building. This was not available at the second visit. The home had not displayed the company’s certificate of insurance liability. Nor, at the time of writing this report, had the home provided the Commission with evidence of this. Staff were appropriately supervised to make sure they cared for service users properly. Staff confirmed that they were well supported and supervised by the management team. Service user’s care records were generally accurate and up to date. However, there were some shortfalls as detailed under the specific standards and some records were not dated or signed, or were signed with a care workers first name only. In addition to this the manager had not notified the Commission of deaths, illnesses or other events affecting the well-being of service users, and there was no evidence of any reports of the Provider’s monthly visits. Both of these are required by the Care Homes Regulations. The manager stated that the monthly reports would be introduced at the end of May and that notifications would be provided to the Commission for all circumstances in the future and backdated from 1st February 2006. As mentioned elsewhere in this report the recruitment and personnel file for one care worker was not stored in the home as is required by the Regulations. The manager stated that the home does not hold service users money. If service users require the services of the chiropodist or hairdresser the home pays for this and then invoices the service user or their representative. Records were not checked on this occasion, but have been satisfactory during past inspections. Generally working practices were safe. However as stated elsewhere in this report, fire doors onto staircases were wedged open on both days of the inspection and could put those in the building at significant risk if a fire were to break out, and it had not been clearly documented what a care worker who had no formal moving and handling training could or could not do. Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 21 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 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 1 3 3 1 1 Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 22 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 OP9 Regulation 13 (2) Requirement The registered persons must ensure that medication is administered from its original container and that the person administering the medication signs the record and that all records are accurate. The registered person must ensure that all care workers have a satisfactory CRB disclosure or povafirst check obtained by Ashton Lodge before they are allowed access to service users. AN IMMEDIATE REQUIREMENT WAS ISSUED 3 OP29 19 The registered person must audit 02/06/06 all care workers personnel files and provide the Commission with the names of those staff who do not have a full CRB disclosure. The date of commencement at Ashton Lodge and the date the povafirst was received (or state not received) must also be provided. DS0000014990.V293988.R01.S.doc Version 5.1 Page 23 Timescale for action 31/07/06 2 OP29 19 02/06/06 Ashton Lodge AN IMMEDIATE REQUIREMENT WAS ISSUED 4 OP34 25 (2) (e) The registered persons must ensure that the company’s current certificate for Employers Liability Insurance is displayed and evidence of this insurance provided to the Commission. Ensure all fire doors remain closed and are only propped open after a risk assessment has been carried out and advice sought from the fire safety office. AN IMMEDIATE REQUIREMENT WAS ISSUED 23/06/06 5 OP38 23 (4) (c) (i) & 12 (1) (a) 24/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashton Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Lodge DS0000014990.V293988.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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