Inspection on 20/04/05 for Ashton Lodge

This inspection was carried out on 20th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashton Lodge 06/02/09

Ashton Lodge 27/10/08

Ashton Lodge 10/10/06

Ashton Lodge 11/10/05

Ashton Lodge 04/10/04

Ashton Lodge 14/05/04

Ashton Lodge 30/01/04

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Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Ashton Lodge 3 Daneshill Road Leicester Leicestershire LE3 6AN Lead Inspector Bhavna Keane-Rao Unannounced 20 April 2005 9:30am 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 and Care Homes for Adults 18 – 65*. 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Ashton Lodge Address 3 Daneshill Road Leicester Leicestershire LE3 6AN 0116 2620065 0116 2620065 None Mr Ramesh D. Seewooruthan 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) Mr Ramesh D. Seewooruthan Care Home 27 Category(ies) of MD(E) - Mental Disorder -over 65 (27) registration, with number of places OP Old - age (27) DE(E) - Dementia - over 65 (27) PD(E) - Physical disability - over 65 (27) Ashton Lodge Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 4 October 2004 Brief Description of the Service: Ashton Lodge Residential Home is a care home offering accommodation for twenty seven older people. People moving to live at Ashton Lodge Residential Home have dementia and/or mental disorder. The home is located near to the centre of Leicester. Off Fosse Road South. All main bus routes and roads are immediately accessible. The building itself is situated in a residential area. Ashton Lodge Residential Home is a large Victorian property which has been converted and extended. It has a large rear garden which is well maintained. Accommodation is provided on the ground and first floors. There are fifteen single and six shared bedrooms. Bedrooms are located on both floors. All areas on the first floor are accessible via a slow moving lift Ashton Lodge Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during Wednesday morning and early afternoon. A number of residents were spoken with, but detailed discussions were only held with three of them. One resident asked not be disturbed. A tour of the premises was undertaken and opportunity was taken to view residents daily records, menus of meals, fire records, a staff rota and staff records. The registered owner/manager and the deputy manager, spent time discussing many issues that arise in the running of a residential home, facilitated this inspection. What the service does well: What has improved since the last inspection? What they could do better: The owner/manager and his staff should use their guidance on safe handling of medication. This will reduce the types of error that are occurring due to carelessness. This issue has been raised at the last inspection and again this time. This issue must be addressed with urgency. Ashton Lodge Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashton Lodge Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Ashton Lodge Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,5 and 6 Information about the home is provided from the earliest opportunity and at regular intervals. The admission process is well managed and reflected in the records. Resident entering the home are always assessed and so that their needs are fully met. EVIDENCE: Examination of the Statement of Purpose indicated that the document accurately describes the services provided in the home. The admission procedure is adequate in that assessments of individuals are carried out by health and/or social care professionals, as part of the referral process. Three service user files viewed, detailed the specific care needs of service users, identifying the needs that would be met by heath and/or social care professionals. Ashton Lodge Version 1.10 Page 9 It was not possible o have a detailed discussion with the residents due to their care needs. However it was noted that the notice board has all relevant literature with regards to the provision of care and residents rights. Comment Cards received, ten from relatives/friends and nine from residents, indicate satisfaction with the provision of care. One resident commented that the ‘girls are very good’ referring to the care staff and the level of care given in attending to their personal hygiene and social care needs. Two staff members on duty were spoken with and two were observed, including one kitchen staff. They were able to give an accurate account of the residents’ assessed care needs and what duties they needed to carry out to meet those care needs, referring also to the residents’ care plans and recent dementia training. Ashton Lodge Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are 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 and 10 Residents are well looked after having their health and social care needs generally met. Management of medication in the home is not satisfactory and so must be reviewed. The guidance on administration of medication procedure is not followed. Residents’ records are accurate and clear. Residents’ privacy is upheld and they are treated with respect. Ashton Lodge Version 1.10 Page 11 EVIDENCE: Recording in the residents’ plans of care was detailed setting out clearly preferences and assistance required for residents to continue living as independent as possible, depending on care needs. Residents who were spoken with said they were involved in the provision of care and the review meetings. All the residents are on electoral register and have now received their voting cards for the forthcoming elections. Medication is stored in a locked medical trolley, chained to the wall, in the hallway and administered by staff that are trained. Administration of medication and recording was seen and is considered to be unsafe. On a number of occasions it was noted that on the MAR sheets ‘o’ had been inserted after they had been signed. Discussion was held with the registered owner/manager as this indicates that staff are actually signing records prior to giving out the medication. Another area of concern was that ‘o’ is used as per the key symbols at the bottom of the MAR sheets. However no further explanation is given, against the home’s own administration of medication guidance. On another residents MAR sheets it was noted that medication was to be given at 1700 hours this was changed four days later to 2200 hours without further explanation. All previous entries had been erased using correcting fluid. Records showed that staff have been trained by the district nurse to give out insulin injections. Observations in the lounge and the dining areas showed that staff have a good awareness of how to speak with residents with curtsey and kindness. Staff were also heard discussing provision of care for residents with dementia. This was linked with the recent training provided. Ashton Lodge Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Residents have a stimulating and varied life at the home, with flexibility and are free to receive visitors. There are activities made available for residents to join in with. There are two choices of meals to ensure residents can eat what they like. Residents religious needs are met. EVIDENCE: Staff undertake activities with residents both individually and in groups. The owner/manager stated that there are activities planned everyday. Residents spoken with said that they did ‘things’ in the daytime and also watched television. Once a month there is a sing a long which the residents like. Residents were observed moving freely around the home, some with the assistance from the staff. There are regular residents and relatives meeting held at the home, for those who wish to attend, where information about events and changes to the home are shared and any matters of concern about the home are raised. A number of comment cards were received from both the residents and their relatives. All these were positive about the service provided by the home. Ashton Lodge Version 1.10 Page 13 Menus were viewed and demonstrated that meals provided are nutritionally balanced and appealing. The menu is displayed in the dining area giving a choice of two main meals. One resident will only eat stake and kidney pie every day except on Sunday. This is accommodated. Residents spoken with said the meals were generous and good. Records showed the residents particular preferences and dietary needs. Residents religious needs are met, a priest visits the home on regular bases and one resident visits his local church on Sundays. Ashton Lodge Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents are confident in discussing any issues of concerns with the staff or the manager before it leads to a complaint. EVIDENCE: Residents and visitors comments showed that people feel very comfortable discussing any concerns with the home’s manager. The complaints forms are available in the foyer for residents and visitors. One complaint has been received since the last inspection. There are records of the investigation. This complaint was not upheld. Residents spoken with felt they were safe and protected. The adult protection procedure has been reiterated to all the staff and the staff spoken with showed their awareness of their duty to alert a senior member of staff. One particular staff was able to clearly demonstrate the value of having a whistle blowing procedure. Ashton Lodge Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25 and 26 A comfortable, well-maintained and safe standard of accommodation is provided for the residents. The areas of residents’ dignity must be addressed with regards to continence aids and offensive odour. The atmosphere in the home is warm and welcoming. EVIDENCE: The areas, identified at the last inspection have now been acted upon. Areas in need of work, identified at this inspection are as follows: • In a number of bedrooms it was noted that the continence pads are left on top of wardrobes, under the bed and on chairs etc. In one particular Ashton Lodge Version 1.10 Page 16 • • • • bedroom there were fourteen large bags of continence pads stored in any free space available. Bedroom 7 had strong offensive odour. In bedroom 7 the base of the bed has worn away and needs to be replaced. The carpet in the hallway near the dining area is looking worn and stained. A damaged air vent in the front lounge was repaired while the inspector was on premises. As there are a number of residents who are confused at this home all communal areas are labelled and all the bedrooms have a photograph of the residents on the doors. This is considered to be very good working practice. The residents who were spoken with were pleased with their bedrooms and were observed using the communal areas freely. A number of residents were observed and a few spoken with stated that they liked to sit at the front in the hallway as they could see everything. Ashton Lodge Version 1.10 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well-supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The staff at the home are competent and able to provide for the general care needs of residents at the home. There is ongoing training to ensure that all the staff are providing high quality care. The staff members try hard to ensure that they meet the care needs of residents. EVIDENCE: Since the last inspection two members of staff have left the home. The staff within the home, including the manager, has worked additional hours to cover this shortfall as a short-term measure. New staff have been recruited since then. On the day of the unannounced inspection there were five members of staff on duty to provide care for the residents. In addition to this there is the cook, domestic person, handy person and the owner/manager. At present there are twenty-six residents for whom care is provided. Ashton Lodge Version 1.10 Page 18 The responsibilities of the staff in the home are specific and there are job descriptions for all of these different roles. The staff spoken with were clear about their individual roles in the provision of care within the home. Following training has been provided in the last twelve months: • Moving and Handling. • Administration of medication. • First Aid. • Health and Safety. • Training in supervision • Infection control. • Equal Opportunities. • Awareness of abuse. • Dementia Awareness. • RMA, Challenging behaviour course. • National Vocational Qualification. • Management leadership skills. • Three staff files were viewed, these contained all required checks and paperwork. The residents that were spoken with were positive about the staff employed at the home. One particular resident stated that he was always encouraged to go and to try to be more independent. The observed interaction between the staff and residents was relaxed and friendly. All the staff have now commenced their National Vocational Training level 2. The deputy manager has successfully completed her NVQ level 4 and The Managers Award the owner/manager has commenced his NVQ level 4 training. Ashton Lodge Version 1.10 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35 and 38 Residents are consulted about living in the home. The residents’ finances are safeguarded with a robust system. Residents and staff’s health, safety and welfare are being promoted and protected. The manager and the deputy manager has an ‘open door policy’ which enable the staff and the residents to access the them at anytime. EVIDENCE: The staff and the residents who were spoken with felt that they could go to either the owner/manager or the deputy manager at any time with any concern. This is positive working practice. Ashton Lodge Version 1.10 Page 20 Residents Meetings are held regularly and minutes of the recent meeting were viewed. Residents can choose to attend. Information and events are shared with the residents and the residents have the opportunity to make suggestions, matters of interest or concerns. Records of residents’ valuables and cash are accurately detailed and up to date. Residents said they get their money weekly and have to sign for it. This was checked to be the case. There is a maintenance programme for the home and the equipment. A random sample of records checked was up to date including fire drills. During the tour of the home, fire exits were clearly marked and were not obstructed. Ashton Lodge Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 2 3 3 3 4 x 5 3 6 N/A HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 2 3 3 3 2 3 2 Score Standard No 7 8 9 10 11 Score 3 3 1 3 x Standard No 27 28 29 30 3 2 3 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 3 34 x 35 3 36 x 37 x 38 3 Ashton Lodge Version 1.10 Page 22 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 It is required that the medication must be given out and then MAR sheets to be signed. This must be on individual basis. This is in line with the home’s own policies and procedures. This concern has been raised at the last inspection. It is required that accurate key symbols, provided at the foot on the MAR sheets, must be used when signing the MAR sheets. It is required that continence pads are stored more discreetly. It is required that the base of the bed in bedroom 7 is replaced. It is required that the carpet in the hallway is replaced. It is required that the offensive odour is eradicated Timescale for action Immediate 2. 9 13 Immediate 3. 4. 5. 6. 24 24 24 26 12 23 23 16 Immediate 09/05/05 01/07/05 02/05/05 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. Ashton Lodge Refer to Standard None Good Practice Recommendations Version 1.10 Page 23 Ashton Lodge Version 1.10 Page 24 Commission for Social Care Inspection The Pavilions 5 Smith Way Grove Park, Enderby Leciester, LE19 1SX 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 Version 1.10 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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