CARE HOMES FOR OLDER PEOPLE
Ashton Lodge Ashton Road Dunstable Beds LU6 1NP Lead Inspector
Dragan Cvejic Unannounced 17 May 2005 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 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 I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ashton Lodge Address Ashton Road Dunstable Beds LU6 1NP 01582 673331 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Resicare Homes Ltd Georgina Thandi care home 36 (36) (36) (36) Category(ies) of OP - Older People registration, with number DE(E) - Dementia over 65 of places PD(E) - Physical Disability over 65 Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13/01/05 Brief Description of the Service: The building, specially adapted for today’s purpose, had been extended on a couple of occasions in the past and had just been undergoing further extension work. It was in an attractive position, very close to the city centre, but still enjoying a quiet corner in a residential part of town was an advantage the home used to provide all amenities to service users. A number of shops, including services like the library, hairdressing salons, church, social club and coffee shops and bars/restaurants were available to service users. There was a school nearby and the home developed a good relationship with them. At the time of the inspection the building was surrounded by building materials, equipment, vehicles, and parking was not available. Internally, some corridors were dressed in dust sheets on the floor to protect the carpets, and work areas were isolated by chipboards to ensure safety while the work was done. The home had already got a new kitchen, extended and properly and nicely equipped. Five more bedrooms were already in use and further 7 were inspected during this inspection all of which had en-suite facilities. Two new lounges were liked and used by service users. Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during one working day. As the home was undergoing major extension and expansion work, the workmen, builders and other professional structure workers were on site. The building was surrounded by scaffolding, building materials etc in connection with the work. The home was also affected internally, as some areas were cordoned off, some covered with dust sheets and there was visible disturbance to daily life in the home. The inspection was used not only to inspect the premises and care standards, but also to approve some of the finished new bedrooms. The inspection was carried out using a case tracking methodology. The inspector talked to management, to the staff, to the service users and to the builders on site. The inspector made a tour of the house and read documents related to the running of the home, and records related to the care of service users. The inspector joined a handover and listened to verbal reporting on service users’ conditions. The CSCI office had received an anonymous complaint that was partly investigated during this inspection. What the service does well:
The expansion of the home and the demand for rooms from social services showed that the home had a good reputation. The care was very individually focused. Service users were looked after as individuals and their wishes and preferences were respected. A service user said: “My new mattress was hard, but they put a quilt on top of it and it is OK now.” A service user was sitting in the new, comfortable lounge and explained: “ It is nice here, but I would like to see more people walking by. Staff call me in the morning, as I have asked them to. I like company, that’s why I like coming here in the morning and spending time here.” New service users were accepted after their needs showed that they needed help and support in a residential home. A service user admitted as the result of a referral from a GP and on family request, said that: …” My room here is quite all right. Food is good. Staff are good.” The assessment form for a recently admitted service user showed that her preferences were given priority when the plan was drawn up: it stated that she wanted to get up late, that she preferred tea and liked watching TV.
Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 6 When staff were showing bedrooms to the inspector they knocked on the doors. A staff member brought a cup of tea to a service user who preferred to spend time in his bedroom. The manager explained the plan to install a big wide screen TV in the new lounge. Some service users were looking forward to it and commented: “I hope it will have teletext subtitles, as I am deaf and that would let me watch TV the same as the others.” The manager confirmed that the new equipment would have teletext. The home was gradually introducing new bedrooms and admitted new service users through a phased programme. These phases were planned and new staff were employed at the same time when new accommodation was ready to accept service users. Staff were very committed and motivated. Eleven staff were on NVQ programme. What has improved since the last inspection? What they could do better:
The home’s records on medication were not clear. This issue was addressed in an immediate requirement left for the home at the time of the inspection. The home reported back and was inspected on a monitoring visit 3-4 days after the inspection and the requirements regarding medication had been acted upon, and a new, walk in medication storage room was introduced. Although the manager stated that care plans and risk assessments were discussed with service users or their relatives, the missing service users or
Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 7 relatives’ signature on these documents did not prove the that they were consulted. The home needed to record when an alternative meal was served to any particular service user on their request. When the home decided to employ a candidate who was not able to provide a second reference or referee, a risk assessment was needed to be included in the file to show that protection of service users was given necessary attention. The home provided activities, but the work being carried out on expansion affected the activities, in the sense that visiting entertainment happened once a month and a service user rightly commented: “We could do with a bit more entertainment. And teletext subtitles would help when we watch TV.” The environment was the most affected by the work carried out. The inspection included a tour of the working areas and new rooms and the outcomes and comments were provided not only to the home manager and owner, but to the person in charge of the building works. The comments included: o A door in a corridor on the first floor needed to be wider, to comply with the minimum required width of 800mm. o New rooms needed bedside lamps. o Some new bedrooms still did not have curtains hung and one new bedroom did not have a curtain rail fitted at the time of the inspection. o The fence in front of one window needed to be cut and replaced with trellis o A risk assessment was needed for the access to the stairs from the first floor o Ceiling in the dining room would need to be redecorated after the leak was cleared. There was no constructional damage, but the paint work would need to be done. All these comments were recorded by the manager and some by the building workers, and the manager stated that these comments would be answered according to plan and in a very short period of time. 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 I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 3,4,5 The home ensured that service users or their relatives and referring agents had enough information to make an informed decision on their choice of home. The home also ensured that they would be able to meet the needs of service users if they offered them a room. EVIDENCE: The manager was aware that the statement of purpose and the service user’s guide would need to be up dated once all environmental changes were finished and the expansion work was finalised. Therefore these documents were not inspected on this inspection. The manager was also aware of the need to design a different contract for the planned interim care beds that would specify the terms and conditions for this type of accommodation and would be different from the standard contract currently in place. The needs assessments were carried out appropriately and details of any prospective service user were obtained from the referring person, from the manager’s assessment and from the first assessment done in the home during a trial period. A suggested care agreement was a guide for the initial care and
Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 10 the base for the care plan that was drawn up as soon as the home had enough accurate information. The management knew the homes’ abilities and presented them to potential service users in order to make the right decision about admission. Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 7,8,9,10 The home ensured the service users’ health and personal care needs were met. Based on a good of preadmission assessment and getting to know service users well in the home, the staff respected their privacy and dignity. EVIDENCE: A care plan was drawn up based on a well organised and thorough preadmission assessment. The plan was detailed and recorded service users’ preferences about how they wanted to be helped. The care plans were regularly reviewed, but not signed by service users or their representatives in all cases. Risk assessments also were not all signed. The medication was stored in a small trolley and the staff transferred some unused PRN tablets from one box to another, that resulted in the losing track of the dates of expiry, and the number of tablets was not accurately recorded for all PRN medication. The paracematol was correct, but the Adcal D3 tablets were not. The home was issued with an immediate requirement to organise the storing and monitoring of medication. The staff demonstrated knowledge of service users, their conditions, likes and dislikes, preferences and health care needs. Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 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 standard(s) Service users preferences were respected and matched the records. Service users were proud to have control over their lives. Food was very good. EVIDENCE: The service users’ files contained records of their likes and dislikes. The staff spoken to knew about individual preferences and respect for those was seen during the inspection. The activities were affected by the building work, but there was a reasonable amount of understanding amongst service users. The manager explained that activities would be reviewed again once the builders finish their work. A new entertainment plan including a wide screen TV and the engagement of external entertainers, such as the Sally Ann orchestra, would be fully implemented. A new lounge opened new opportunities for structured entertainment. A “Circle of Friendship” – on which service users painted their handprints – was displayed in the main dining room. Four service users commented: “We always have people coming in to talk to us. This new lounge is lovely, they certainly offer good service.” The home arranged for a weekly Holy Communion in the home. They also had a good relationship with their neighbouring school. The manager and the staff had developed a very good relationship with many relatives and welcomed not only their visits, but also their involvement in the care process. A new, extended kitchen was a nice place to work in, as the cook stated, and the outcome of cooking was tasty, nutritious and nicely served food.
Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 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 standard(s) 16,18 The home had an effective complaints procedure and ensured complaints were looked at as suggestions for improving services and provisions. EVIDENCE: The home did not receive any formal complaints but some concerns were expressed by relatives and neighbours. The management team investigated the issues raised and responded by introducing new measures to minimise the effects. An anonymous complaint relating to the environmental and daily routine provision was discussed with the manager and she responded with plans and measures to reduce the negative effects of works on service users lives. The policies and procedures were in place to ensure the protection of service users. The home encouraged relatives to help service users with financial matters and did not control any service users’ money. Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 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 standard(s) 19-26 The environment was hard to inspect due to building work in and outside the home. Individual areas were inspected, such as new bedrooms, the new lounge, extended kitchen and corridors and lavatories and washing facilities. Although standards were not met at the time of the inspection, the general development plan and progress of work gave the impression that the home would significantly improve environmental standards at the end of the expansion works. EVIDENCE: The location and layout of the home was appropriate for service users’ needs. Some carpets had been replaced, but some would need replacement at the end of the works. The building expansion included the creation of a new lounge, that service users liked very much. A smaller, so called quiet lounge was appreciated by a few service users that wanted a quieter place. The paint on the dining room ceiling was damaged and would be re-decorated. Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 15 The garden was not much affected, but due to limited access during the works was not fully utilised. The manager explained the plans for further improvements. New bedrooms were inspected and accepted for use, although some minor elements were still missing, such as bedside lamps and the curtains in some of the new bedrooms. The widening of the door was discussed with the architect. A long, but narrow window in one of the bedrooms was discussed with the manager and the architect, and the home was going to apply for planning permission to change it. There was a plan for relocating the laundry room. The kitchen had already been expanded. All these elements demonstrated the intention of the owner and the manager, as well as the architect, to provide a very high standard accommodation that would meet the needs of service users. The scoring of the environmental standards referred to the findings at the time of the inspection, but were likely to change according to the building timescale and clear plans. Therefore, there were no requirements in this report regarding environmental standards, as they were addressed during the site visits that were carried out on an approximately fortnightly basis. Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-30 The home employed staff in sufficient number and with skills and experience that ensured a good level of care was offered to each individual. EVIDENCE: As the number of bedrooms rose, the home was employing equivalently more staff to accommodate and meet the needs of service users whose number was increasing progressively with the number of new bedrooms. A rota demonstrated the raising staff complement and clearly presented duties and roles. The staff ratio was kept balanced by engaging staff from a “sister” home until the recruitment process was carried out. Eleven staff were on the NVQ programme, in addition to regular mandatory training for all, and TOPSS induction for new staff. The home was also accommodating some young trainees and a student on a placement that were clearly marked on the rota and did not count towards the staff ratio per shift. The recruitment procedure was in process. The staff files demonstrated that the home carefully assessed all new potential workers, but in some cases the second reference was missing. The manager was going to draw up a risk assessment for workers for which the home was not able to obtain a second reference. Their induction was extended and included a close monitoring programme. Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The home was skilfully managed and led through changes by the ownermanager and a proposed new manager, currently on initial induction. The service users were protected and the working practices ensured safety even in an environmentally disturbed environment. EVIDENCE: The manager was experienced, skilled and knowledgeable of service users conditions and needs. The atmosphere in the home was open, inclusive and service users suggestions and wishes were listened to and respected as far as possible. The staff were committed and stated that they were properly supported and motivated to do their jobs. The home displayed a certificate of insurance. The expansion demonstrated the home’s financial viability. The manager explained the development plan for the forthcoming years. The home did not deal with service users’ personal allowances and provided lockable facilities for those who needed to keep their personal allowances or other small amounts of money with them.
Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 18 Staff confirmed that they were well supported and supervised. The regular supervision started three months from the start date, after the induction when supervision was constant. Records, apart from the specifics mentioned in the appropriate standard section, were accurate and up to date. Safe working practices were in place. The new laundry room was not yet operational and temporary laundry was used for the continuity of this service. The lower scoring to this standard was a result of the effects of the current building works. Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 2 3 1 3 1 1 1 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 4 3 3 3 3 3 2 Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 20 yes 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 9 Regulation 13 Requirement Issued as an immediate requirement, the home must arrange appropriate storage for medication to eliminate tranferring tablets from one box to another and keep approriate and accurate records of PRN medication. Timescale for action 24/05/05 2. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 13,16 12 Good Practice Recommendations The service users or their representatives should sign care plans and risk assessments if the risk assessments are kept as separate records from care plans. The home should keep records of alternative food served to individual service users. The home should ensure that service users with sensory impairment and hearing aid can enjoy TV programme supported by teletext and minimise the negative effects of the impairment by introducing appropriate activities for this group of service users. The home should ensure that environmental standards are met as per reccommendations and requirements issued
I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 21 4. 19-26 Ashton Lodge 5. 38 6. 29 during the site visits. The manager must review and up date the infection control policy and procedure once the new laundry room and other environmental changes are finilised as a part of the homes expanssion. The manager must ensure that there is at least a risk assessment drawn up for staff members who did not have two references obtained for them during the recruitment process. Ashton Lodge I51 S14990 ASHTON LODGE V229025 170505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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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