CARE HOMES FOR OLDER PEOPLE
Ashton Lodge 22 St Michaels Road Maidstone Kent ME16 8BS Lead Inspector
Maria Tucker Announced Inspection 17th October 2005 09:30 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 DS0000023889.V257349.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 DS0000023889.V257349.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ashton Lodge Address 22 St Michaels Road Maidstone Kent ME16 8BS 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) 01622 677149 Mr Ramdass Varathy Ramasawmy Mrs Manoon Ramasawmy Mrs Manoon Ramasawmy Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th May 2005 Brief Description of the Service: Ashton Lodge is a large house has been converted to a residential home, having accommodation on the ground and first floors. The home has ten single and one double room, each room is fitted with a call alarm and television point. The staff work on a roster system and have one waking and one sleeping care staff at night. The care staff and Manager undertake all of the duties in the home including cooking, cleaning and entertainment. The owner is a registered Mental Nurse and has qualifications in management and is an NVQ assessor. The homes aims and objectives are to provide a warm and friendly atmosphere, which reflects service users individuality. Ashton Lodge aims to provide a home for life. The home is located approximately ½ mile from Maidstone town centre with easy access to public transport. The nearest shops, church, pubs, post office are within easy walking distance. The home has facilities for car parking at the front of the building. The home currently has an all female service user group. Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The inspection lasted from 09.35am until 13.10pm. Time was spent meeting the manager and staff going through various records and documentation. About one hour was spent meeting service users individually and as a group. One staff on duty was spoken with. One relative was spoken with. A partial tour of the premises was undertaken. 10 comment cards were received from service users. • “I am happy at Ashton Lodge” 11 comment cards were received from relatives/visitors • “I am more than happy with the care my receives at Ashton Lodge. The staff are all very kind and caring, and it has a calm, happy and really homely atmosphere”. • “My has been here for almost a year and I am very pleased with her care and attention”. • “I feel my relative is extremely happy and well cared for”. 3 comment cards from General Practitioners. 3 from health and social care professionals. 2 from Care Manager/placement officer. The pre inspection questionnaire was received by the CSCI. What the service does well:
Ashton Lodge is a small family type home that provides an individual service in a homely comfortable way. There is a small staff team including the manager who work closely together providing care and support. Service users are supported to be as independent as possible and make choices and decisions about their daily lives, such as where they choose to spend their day; what time to get up and what to eat. Service users medical needs are supported by the home with good working relationships with health professionals. The home is very well run and managed with a competent caring staff team who support the manager in meeting the aims and objectives of the home. Relative and visitors are made very welcome and are encouraged and supported to be included in the well being of their loved one. Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashton Lodge DS0000023889.V257349.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 DS0000023889.V257349.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): 2, 3, 4, 5, 6. Service users are supported to decide if the home is suitable for them and can feel secure that their needs will be assessed and met. EVIDENCE: With the exception of standard 1 all of these were inspected and met during the last inspection. Two standards were exceeded. The manager continues to operate good practice in assessing prospective service users and in supporting newly admitted service users in making the decision to stay at the home or not. The manager is very conscious of the needs of the current service users and the ambience in the home, which is considered carefully when new service users are admitted. A visitor spoke of how service users are “all treated as individuals as it is small enough here to do that”. Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 9 A comment received from a Care Manager stated, “Placed at Ashton Lodge, held a review. Manager is very responsive and caring towards I have no concerns”. The home does not provide intermediate care. Ashton Lodge DS0000023889.V257349.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, 10 Service users can expect a high standard of care, which supports them in promoting and maintaining good health and well-being. EVIDENCE: Comments from the comment cards include “The standard of care has always been very good”. Service users spoken with during the inspection were aware of their care plans one service user stated, “Yes they have got a care plan and we have discussed it”. A staff member has taken over the responsibility for the care planning system and discussed this during the inspection. The care plans were very informative and up to date with regular recordings and entries made. It was recommended that the likes and dislikes and personal preferences to be recorded formally. The current staff are very aware of preferences and automatically accommodate these. The health and well being of the service user are promoted and maintained through regular visits and appointments with health professionals.
Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 11 A district nurse said, “if we ask them to do something they do it, they are very good at accommodating and will try everything to help us”. A service user spoke of how they had always had “trouble for years with my legs” stating that they “put that cream on although … does it at night and staff do it in the morning”. The district nurse confirmed that they have improved with the care and support given. Extra equipment has been provided for the promotion of tissue viability. Assessments have been conducted by the manager into the dental needs of service users. The manager is currently trying to seek a service to meet these needs. The pharmacy inspector will visit the home to inspect the medication policy procedure and practice. Ashton Lodge DS0000023889.V257349.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, 14, 15. Service users have a relaxed comfortable lifestyle and the pleasure of home cooked meals and snacks. EVIDENCE: From the comment cards received 2 service users ticked to say that they would sometimes like to be more involved in decision making within the home. Service users spoken with during the inspection said the manger often sat and discussed things with them and consulted them about what they would like. Service user are encouraged to make as many choices in their everyday lives as possible this includes food, where they want to spend their time and who visits them. There has been an increase in the activities on offer in the home a recent BBQ and male guitarist was spoken about with great enthusiasm. Service users spoke of how they had plenty of entertainment including music and videos, but quizzes remain the favourite. One service user who is able attends church. It is recommended that the home look into the possibility of having a visiting clergyman as currently service users spoke of how they watch “songs of praise” on a Sunday but did
Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 13 used to go to church. This is something that they had not mentioned before to staff. Visitors spoke of how they often visit the service user in their room and that they are made very welcome by the home with refreshments offered. Without exception all service users spoke of the quality of the food overall the consensus of opinion was, they had plenty of choice; it was good quality; they were consulted on what they wanted and offered and alternative. Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 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, 17, 18. Service users can feel safe in the home and secure in the knowledge that staff would take the appropriate measures to ensure this. EVIDENCE: All of the comment cards received from relatives/visitors had ticked to say they had never had to make a complaint. One comment stated, “I have had no complaints. The staff and management have always been very helpful. The pre inspection questionnaire stated that no complaints have been made. No adult protection alerts have been raised. Staff receive adult protection training. Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 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, 26. Overall the service users live in comfortable surroundings and can make the most of the space provided in the lounge, dinning area and garden. EVIDENCE: The home is very well maintained and decorated to a good comfortable standard. It is very clean and had no odours. Service users private rooms are very individual and have plenty of personal possessions and equipment. One service user spoke of how they liked to watch television in their room and received their visitors in there. The home has had a professional fire safety assessment conducted and carried out all of the recommendations made. An asbestos assessment found no asbestos to be at the home. Evidence was seen that the environmental health officer is aware of the home policies and procedures in relation to the laundry and sluicing facility. Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 16 There are equipments in the home to assist service users physical needs i.e. grab rails and bathing aids. Individual advice is sought from district nurses and occupational therapists when required. Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 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, 29, 30. The home provides a range of staff to meet the needs of the service users. EVIDENCE: The staffing levels have increased in the mornings to provide a housekeeper. This has given staff more time and opportunity to support the service users on a one to one basis. Staff spoke of how this enables them to spend extra time to have “a little bit of a chit chat when doing stuff” and that “residents and staff are happier” as a result. The staffing levels are 2 care staff am and pm; 1 housekeeper am; 1 waking and 1 sleep in staff. The manager works supernumerary on some shifts. There is a staff-training matrix, which records all training undertaken and identifies when refreshers are required. The home provides a good level of training opportunities. The induction training is comprehensive and thorough. Rigorous recruitment policies and procedures are in operation. Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37, 38. Service users benefit from a well managed home with a pleasant welcoming atmosphere and staff who are given clear direction and leadership. EVIDENCE: The manager is a qualified nurse and has had many years experience in managing the care home and working with this service user group. It was not inspected on this occasion if she has completed the NVQ level 4 managers award. The home is a small establishment with regular competent staff who work with the manager as part of a team. The home is open and transparent in its management and has good lines of communications between staff, service users and the manager. There has been 1 Regulation 26 visit report received by the CSCI.
Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 19 The records and documentation viewed was as far as it is reasonably practicable to ascertain accurate and up to date. Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 20 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 3 3 4 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X 3 3 Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 21 NO 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 OP33OP 33 Regulation 26 (1) (3) Requirement The responsible individual shall visit the home in accordance with this regulation at least once a month. Timescale for action 17/10/05 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 OP7OP 7 OP12OP 12.2 Good Practice Recommendations It is recommended that the care plans record the service users choice and preferences i.e. over a 24-hour period. It is recommended that the home explore the possibility of a clergymen visiting the home. Ashton Lodge DS0000023889.V257349.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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