CARE HOMES FOR OLDER PEOPLE
Ashton Lodge Ashton Road Dunstable Bedfordshire LU6 1NP Lead Inspector
Dragan Cvejic Unannounced Inspection 14th September 2005 07:30 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 Lodge DS0000014990.V250437.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 Lodge DS0000014990.V250437.R01.S.doc Version 5.0 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.V250437.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 08/08/05 Brief Description of the Service: The home is situated in a residential street, close to the town centre. Since the last inspection the home has made some major changes. The number of bedrooms has been increased from 36 to 54 and the admission procedure for the newly built bedrooms was done in phases. The home now provides 54 en-suite bedrooms, 4 lounges, and a number of communal toilets. This now exceeds the required amount. The kitchen was extended, and also the laundry room. The home is arranged in a domestic style, with bedrooms on three levels and communal areas on the ground floor. For operational reasons the home is divided into 3 units, grouping service users according to their conditions, but still respecting freedom of movement throughout the home. The garden was reduced in size following the extension, but it was landscaped and arranged in a pleasant way. It is easily accessible and is already well used by the service users. Ashton Lodge DS0000014990.V250437.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and the report reflects on the four previous visits, carried out on 16/04/05, 24/05/05, 29/07 and 08/08/05. The last inspection was carried out on 17/05/05 and the immediate requirements issued than were carried out fully and the outcome exceeded the required expectation. This inspection was carried out during one working day and lasted 10 hours. The methodology used was a partial case tracking, a tour through the house with the emphasis on the new bedrooms and communal shared areas, also gathering information from 3 staff members and 18 service users and reading the service users documentation. The extension to the home was almost finished, with only final touches left, such as fitting a new carpet in one of the lounges. The number of bedrooms was increased from 36 to 54. The category of service users accommodated remained the same and the number of users with similar conditions remained well balanced. There was a new arrangement with social services to open 8 interim care beds, whereby service users would be temporary admitted while waiting for beds elsewhere. What the service does well:
The home was carrying out very comprehensive assessment prior to offering a place to a prospective service user. They visited users either in their home, or in hospital. The home asked everyone involved for brief details and from gathered information and the user’s comments they drew up an initial care agreement. This was reviewed regularly during the trial period and a proper care plan was drawn. The plan had a short description on each user and this was a very informative and an excellent document. Service users knew their plans and agreed to them. The staff team were stable, staff supported each other and felt valued and respected. There were extra staff members employed to minimise the effects and disturbances caused by the building work and they stayed as permanent members. Apart from minor, non-finished jobs, such as laying the carpet in a quiet lounge or fitting one radiator guard, the home offered a pleasant and comfortable environment. Service users commented: “this is lovely lounge, it is so bright”. A service user with mobility problems was much more motivated to walk and walked in front of the inspector to the newly landscaped garden, stating: “It is worth walking when I can come to this lovely place”. Ashton Lodge DS0000014990.V250437.R01.S.doc Version 5.0 Page 6 A visitor could not find the words to describe her satisfaction with care offered to her mum. She stated in her written comments: “I am even thinking to apply to come in here myself”. 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 Lodge DS0000014990.V250437.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 Lodge DS0000014990.V250437.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): 3,4,5 The home provided effective procedures and information to allow service users to choose the home. The home’s assessment was comprehensive and was used to create a care plan that was realistic and agreed to by the service users. It allowed staff to offer good care. EVIDENCE: The initial assessment carried out by senior staff, it was comprehensive and was well recorded on the form. The home used it to create an initial care agreement with a service user. The home collected information from family members too and provided a textual, informative introduction to each individual. The introductory visits and a trial period were well used to ensure that the home was capable of meeting all assessed needs and implementing the initial care agreement. Service users were assured that the home would meet their needs. Visitors commented that they had enough information about the home prior to making a decision and that the initial period showed them that the home was meeting the needs of their relative.
Ashton Lodge DS0000014990.V250437.R01.S.doc Version 5.0 Page 9 Ashton Lodge DS0000014990.V250437.R01.S.doc Version 5.0 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): 7,8,9,10,11 Service users’ files, that included a care plan and risk assessment, were well produced documents and provided clear information and instructions on how the users’ assessed needs were met. Service users were well looked after and treated with respect. EVIDENCE: Files kept about the service users contained well organised information and necessary instructions. A descriptive way of presenting each individual, with characteristics, preferences, dislikes and history was the leading document. The care plans and risk assessments were organised and well written. The risk assessment in particular, was well written, it related to the care plan in all six checked files and clearly indicated the actions to eliminate or reduce the risks. It exceeded standards in relation to reassessments and the proposed best actions to take. The risks assessed included physical and emotional hazards. The notes of professional visits demonstrated that the home worked closely and cooperatively with GPs, district nurses, dietician, opticians and other health care professionals. The home had a new medication walk-in cupboard and the medication was well organised and recorded.
Ashton Lodge DS0000014990.V250437.R01.S.doc Version 5.0 Page 11 Service users were treated as individuals, as two users spoken to confirmed: “The girls are wonderful, they could not be better”. Another service user stated, ”I can get up and go to bed whenever I want to”. A visitor came to thank the staff at the home, for all that had been done for his relative who recently had died at the home; he also thanked the staff for the help with funeral arrangements. Ashton Lodge DS0000014990.V250437.R01.S.doc Version 5.0 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 Service users enjoyed having a lifestyle that they could choose themselves and lead in a supporting environment. EVIDENCE: The home organised different activities in each lounge, trying the match the users’ abilities and preferences. Visitors were welcome, but the home respected users’ wishes of whom they wished to see. In one example, a visitor was temporary banned from visiting the home as a result of a service user getting upset and anxious. Three other users stated that their visitors were welcome. A service user stated that she enjoyed a visit from the church and a Sunday church service. The home did not handle service user’s money, and their information pack suggested to users to delegate these matters to their representatives, if they were unable to hold the money themselves. Ashton Lodge DS0000014990.V250437.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): 16,18 The home dealt with complaints in a satisfactory way. They investigated complaints and responded to complainants in writing within the set time scale. This procedure demonstrated the home’s ability to offer protection to service users and opened the door to a constructive relationship with service users and visitors. EVIDENCE: The home dealt with a complaint according to the procedure stated in their house manual, the outcome was sent to the complainant and the CSCI was regularly updated during the investigation. The home manager and the manager on induction were exploring training for the two of them on a POVA course. The staff received basic instruction on POVA during their induction, but the manager intended to widen this knowledge through more detailed and extended training onse the two senior managers complete their training. Ashton Lodge DS0000014990.V250437.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): The home went through major changes, due to having an extension built. With all major work now completed and a few minor finishing touches left, the home provided a pleasant and homely environment where service users felt safe and comfortable. EVIDENCE: The home was located near the town centre. The building preserved its natural look with the extension planned and built carefully. Internally, the layout was appropriate for service users’ needs. Apart from the final touches of the more esthetical nature, the home offered a safe and comfortable environment for service users. Any faults were dealt with straight away when they were reported. The home increased the communal areas to ensure that communal space was of the required size for the increased number of service users. “It is so nice and bright in this new lounge, we like it”, two service users stated. All the new rooms had en-suite facilities, and the extension project had included a few more communal toilets, close to other communal areas.
Ashton Lodge DS0000014990.V250437.R01.S.doc Version 5.0 Page 15 Appropriate aid facilities were fitted in the new areas, including a raised toilet seat, grab rails, specialist beds where they were needed and alarm call bell points were installed in all new areas. A toilet seat needed to be placed in a toilet which the service user used during the daytime. There were some problems with the wheelchairs that even the service users had noticed, the manager stated that the new wheelchairs had been ordered. New individual rooms complied with standard requirements; the rooms were furnished in a domestic style. The home was clean and without offensive odours, infection control measures were in place, the extended laundry provided a more comfortable and safe place to work in, as laundry worker confirmed. The home was checking water temperatures in new areas on a weekly basis. Ashton Lodge DS0000014990.V250437.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): 27,28,29,30 The home employed a sufficient number of knowledgeable and skilled staff to meet the needs of service users. EVIDENCE: The home’s rota demonstrated that the home employed staff numbers above the minimum required per shift, the management took into consideration the daily routines and had extra staff working at peak periods. The manager said that they planned to engage an extra domestic staff member in the evenings, when the need for this was identified. The home was considering making a staff member who is currently under the age of 21, to undertake the role of “person in charge”. This person, however, has successfully completed NVQ 2, NVQ3 and the majority of the NVQ4 units, she has had 5 years of care experience and her credentials were admirable. The number of the NVQ trained staff fell due to staff changes and a new policy that was made, instructs new staff to complete first 3 months at the post before commencing the NVQ training. Staff training was comprehensive and staff confirmed receiving appropriate induction based on TOPSS principles. Five service users spoken to commented: “Staff are nice” and the “Girls are wonderful, could not be better”. In addition to a Criminal Record Bureau disclosure for a staff member from another country, the home showed an application for the UK CRB check. Ashton Lodge DS0000014990.V250437.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): 32,33,36 The home was well managed and run, to ensure the service users comfort, safety, protection and to ensure they were treated as individuals with full respect. EVIDENCE: The atmosphere in the home was open and encouraged creativity and initiative. A staff member spoken to by the inspector, confirmed that she received a good level of support and that her request for training was granted and she was able to attend the training course of her choice. The home carried out a quality assurance review and was in the process of analysing results from questionnaires used. The area that was affected by the changes was the supervision process, It was behind schedule and regular formal supervision was not recorded appropriately. The staff felt well supported on an informal basis. The manager
Ashton Lodge DS0000014990.V250437.R01.S.doc Version 5.0 Page 18 stated that the process for recording supervision has just been delegated to a senior member of staff. Ashton Lodge DS0000014990.V250437.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 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X X 2 X x Ashton Lodge DS0000014990.V250437.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 2 Standard OP28 OP36 Regulation 18 18 Requirement Timescale for action 28/02/06 The ratio of 50 of care staff with NVQ must be achieved The supervision programme 30/11/05 must be reinstated, recorded and ensure that staff receive appropriate supervision at least 6 times a year. 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 22 Good Practice Recommendations Wheelchairs that don’t work properly should be replaced as soon as possible. Raised toilet seat should be positioned in the toilet used by a service user who uses the specific toilet close to the lounge. Ashton Lodge DS0000014990.V250437.R01.S.doc Version 5.0 Page 21 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
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