Inspection on 04/03/09 for Ashton Manor

This inspection was carried out on 4th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashton Manor 11/05/10

Ashton Manor 08/03/10

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashton Manor 104 Aldwick Road Bognor Regis West Sussex PO21 2PD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sheila Gawley     Date: 0 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Ashton Manor 104 Aldwick Road Bognor Regis West Sussex PO21 2PD 01243842196 01243842196 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Stargate Partnership Ltd Name of registered manager (if applicable) Mrs Jennifer May Witcher Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 24. The registered person may provide the following categories of service only: Care home only - (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home Ashtom manor is a care home offering personal care only to people with dementia. It is situated in Bognor Regis and can accomodate 24 people. It is owned by Stargate Partnership Ltd who registered with The Commission in September 2008. The responsible individual is Mr Ayaru Shandakumar and the registered manager is Mrs Jennifer Witcher. Accomodation is laid out on three floors with passenger lift access to the second floor only. People are not currently accomodated on the third floor. There are 22 bedrooms all with ensuite facilities. Fees charged are £410-£450 per week. 24 Over 65 0 care home 24 Care Homes for Older People Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit as part of the inspection process was carried out on 04/03/09. It was undertaken by a lead inspector from the Commission for Social Care inspection. This was the first visit to a new registration of an existing service. Prior to the visit all files held by the commission, complaints and safeguarding issues were reviewed. The home had sent us their Annual Quality Assurance Assessment for the inspection, which gave us the information we needed on the home and any documents required on the day were made available. We were in receipt of any one surveys from a person who uses the service, one completed by a relative and one from a staff member. Care Homes for Older People Page 5 of 26 People who use the service, relatives and staff were spoken to on the day and surveys undertaken by the home were available. People who use the service spoken to stated that they are happy in the home and that they enjoy the food. All appeared happy were well dressed and the atmosphere in the home was relaxed. Three relatives were spoken to and they expressed satisfaction with the care on offer in the home. Staff spoken to on the day stated that they were happy working in the home and that the registered manager was supportive. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area because needs are assessed and information needed to make an informed choice is available. Evidence: People who use the service are fully assessed prior to admission to the home. All medical and personal care need is assessed and recorded. This includes mental health, continence, mobility, and communication. Two people who use the service the service were case tracked and their pre admission assessment was present in the care plans. The AQAA stated that they continue to meet this standard on pre admission assessment. Relatives spoken to confirmed that they were happy with the admission process and that they were given enough information on the home. Care Homes for Older People Page 9 of 26 Evidence: An up to date statement of purpose and service user guide is available. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience adequate outcomes in this area because needs are assessed and met but care planning and risk assessments could be more personcentered. People who use the service are treated with respect. Medicines are managed well but policies need to be specific to the home. Evidence: All residents have a plan of care which is drawn up following full assessment. Three people who use the service were case tracked, their care plans were inspected and these contained information on health, personal, and social need. This includes a dependency assessment. There was evidence review and social services review, and daily records. Risk assessments are in place in relation to falls mobility, medication moving and handling. The risk assessments current format is mainly tick box and could be more comprehensive and person centered. There is a nutrition screening tool in place but there are not weighing scales in place to meet the needs of people who use the service. This was discussed with the registered manager who stated that these have been requested from the responsible individual. This will be a requirement of this Care Homes for Older People Page 11 of 26 Evidence: inspection. Peoples end of life needs and wishes are not recorded and the registered manager stated that some families do not wish to discuss this. A chiropodist visits six weekly. The dentist and optician also visit the home. Changes in continence needs are reported to the continence service. Care is not person centered and the home operates a weekly bath list, daily hand care list, daily shave list, weekly nail care and twice monthly wardrobe check. Aids and equipment is available as assessed such as pressure relieving equipment and hoists. Medicines are received, administered, and returned correctly. Medicine administration charts (MAR) inspected were up to date except one and a staff member stated that she had administered the medicine but had forgotten to sign and she then did so. The MAR charts list many medicines that are not any longer being administered to the person. That this could present a risk of accidental administration was discussed with the registered manager. There are not any people self medicating at present. There are policies and procedures in place for the management of medicines but these are organisational and are not specific to the home, for instance they say that all medicines should be administered nurse but this is not relevant in this home as it does not provide nursing and does not have any registered nurses employed. The home has a controlled drug cupboard but does not have a drugs fridge. That drugs should not be stored in the kitchen fridge was discussed with the registered manager. Carers were observed offering care and assistance in a respectful and dignified manner. Relatives spoken to stated that they were happy with the care on offer in the home. One stated his mother was much improved since moving into this home. Care Homes for Older People Page 12 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area because the lifestyle in the home suits the people who live there. Evidence: The AQAA states that people living in the home have choices in daily living and activities and that visitors are encouraged. Three visitors were spoken to on the day and they confirmed this. There is an activities coordinator employed three days a week who involves the people who use the service in exercises, quizzes, dominos, painting and drawing. There is karaoke on Fridays. One of the relatives spoken to confirmed music and activities. The AQAA states there are plans to increase activities. The meal seen served today was appetising, plentyful and nutritious. People who use the service who required help with their meal were assisted in an unobtrusive manner. People who use the service and relatives spoken to stated that the food is always enjoyable. The cook was spoken to and she is about to commence a National Vocational Qualification in catering. There is not a four week rolling menu in place but the cook does record the meals cooked in a diary and this evidenced that there is variety in meals offered. For those people assessed as needing pureed food the various Care Homes for Older People Page 13 of 26 Evidence: components of the meal were all pureed together. Discussion was had with the cook on this practice and she agreed that to give the people on pureed food the opportunity to visualize and taste the different foods in the meal by liquidizing them separately would benefit the people. This would also address equality issues. Frequent drinks were offered throughout the day. The fact that there is not a menu in place and on display was discussed with the registered manager and she agreed to put this in place. The possibility of creating the menu in different formats to help people who use the service understand it and have some knowledge and anticipation of what is to be served was also discussed. People can bring their own belongings into the home and can personalize their rooms. Care Homes for Older People Page 14 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area because complaints are listened to and people are protected from abuse. Evidence: There is a clear complaints procedure which is on display and which is included in the Statement of Purpose and Service User Guide. The procedure clearly identifies whom a complaint should be addressed to and the timescales in which a complaint will be dealt. It displays the Commissions contact details. There have not been any complaints since the service registered. People who use the service were clear as to whom they can raise concerns with. Relatives spoken to all stated that they would know how to complain but that they have not had the need to. They say any issue raised with the manager is dealt with promptly. There are safeguarding policies and procedures in place. The registered manager is attending a West Sussex workshop on safeguarding in March. There is safeguarding training booked for staff in April and the registered manager stated that she will also cascade the information she receives on her workshop to ensure staff are up to date with policies and procedures. Staff spoken to demonstrated an awareness of procedures to follow. Care Homes for Older People Page 15 of 26 Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience adequate outcomes in this area because the home does not have the equipment needed to maintain hygiene. Evidence: The communal areas on this occasion were neat, clean, and free from offensive odours. The sitting and dining room are comfortable and are domestic in style with comfortable furnishings. There is new dining room furniture; carpeting and flooring have been replaced. Bedrooms are neat, comfortable and personalized. All bedrooms have en suite facilities and are personalized where possible. In some rooms the armchairs are old and worn or unsuitable. Some bedrooms were malodorous due to continence problems. The registered manager stated that there has not any carpet cleaner in the home for the past six months. She stated that she had requested this item from the responsible individual but it had not as yet been provided. The downstairs bathroom had chipped enamel and the floor attachment of the bath hoist was dirty and chipped. This is the only bathroom with a hoist. One further toilet Care Homes for Older People Page 17 of 26 Evidence: did not have any toilet roll holder, soap or hand towels. The registered manage stated that she would put these items in place in this toilet. There are pressure relieving equipment, hoists, wheelchairs and grab rails in place. There are suitable laundry facilities sited away from food preparation and storage. Machines have the necessary temperature programmes to deal with all laundry. There was a lapse in the contract for the collection of clinical waste resulting in the overflowing of yellow bags of clinical waste. This posed a risk of infection to the people who use the service, staff and the community. The registered manager had evidence that she requested this be rectified in January and February. The bins were finally emptied on Monday of this week 02/03/09. The registered manager stated there is a contract in place now. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes area because needs are met by suitably qualified staff. Evidence: Staff rota showed staffing levels were sufficient to meet the needs of residents. There is housekeeping and kitchen support. There are robust recruitment procedures in place and staff files inspected contained all the documentation required to ensure the protection of people who use the service. There was evidence of application forms with employment history. Criminal Records Bureau Clearance and Protection of Vulnerable Adults (POVA) check, two references, identity documentation, and photograph were all in place. Staff spoken to stated that the home is a pleasant and place to work and that the registered manager is supportive. There have been difficulties, however, in the late payment of their salaries which have been ongoing since the new provider took over and this is causing a certain amount of stress to staff and financial hardship. People who use the service find the find the staff helpful. Relatives confirmed that staff are attentive and kind. Staff were observed offering care and attention in a timely and Care Homes for Older People Page 19 of 26 Evidence: respectful manner. There is a staff training programme in place which covers all mandatory training. Five of the eleven carers have yet to complete the National Vocational Qualification Level 2 or above. Staff were aware of Whistle blowing procedures. Staff confirmed supervision is in place. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience adequate outcomes in this area because there are shortfalls in the provision of equipment, quality monitoring of the home and supervision is not in place for the registered manager. Evidence: The home was bought by the current provider Stargate Partnership Ltd in September 2008. The responsible individual is Mr Ayaru Shandakuma. The registered manager has many years experience in care. She managed this home from 2001 to 2005 and then moved to another home in the organisation that then owned it. She moved back in July 2007 and became registered with the Commission in February 2008. She has completed the NVQ level 4 in care and the Registered Managers Award. Quality assurance systems are in place but there are shortfalls. People who use the Care Homes for Older People Page 21 of 26 Evidence: service, their families and health professionals are surveyed annually. The AQAA was completed and returned when we asked for it. Relatives spoken to stated that the registered manager is very approachable and responds promptly to any requests. Staff meetings are held six monthly or more frequently if needed. Supervision is in place for staff and supervision records were seen. The registered manager does not receive any supervision. The responsible individual does not do regulation 26 visits and the home is not regularly visited by a representative of the organisation. Regulation 26 reports are not compiled by the responsible individual and given to the registered manager. The home does not hold any money for people who use the service. There are shortfalls in the management of staff salaries in that they are frequently paid late causing financial hardship. The registered manager ensures the health, safety and welfare of people who use the service and staff by the provision of mandatory training. However there are some shortfalls in the provision of equipment. There is not a drugs fridge to ensure the safe storage on medicines requiring refrigeration. There is not a weighing scales suitable for the needs of the people who use the service to ensure that weigh is monitored. There is not a carpet cleaning machine to ensure carpets are cleaned and rooms smell fresh. The registered manager stated that she has requested the purchase of weighing scales and carpet cleaner from the responsible individual but the equipment has not been forthcoming. The lapse in the collection of clinical waste was a risk to the health and safety to people who use the service, staff and the local community. The Commission was not informed of this issue via a regulation 37 notification. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 23 The registered person must ensure weighing scales suitable for the needs of the people who use the service are in place. To monitor weigh gain or loss and to take appropriate action 30/04/2009 2 26 13 The registered person to 30/04/2009 ensure hygienic practices in the home by the purchase of a carpet cleaner To prevent stained carpets and malodour in the home 3 33 26 The responsible individual must ensure that regulation 26 visits are carried out and that a written report is prepared and a copy supplied to the registered manager. Th ensure quality is monitored in the home and that the views of people who 04/09/2009 Care Homes for Older People Page 24 of 26 use the service, families and friends is sought. 4 36 18 The registered person must ensure that all staff working in the home receive supervision. To ensure staff are supported in their role. 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!