Inspection on 08/03/10 for Ashton Manor

This inspection was carried out on 8th March 2010.

CQC found this care home to be providing an Poor service.

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 Manor 11/05/10

Ashton Manor 04/03/09

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Random inspection report Care homes for older people Name: Address: Ashton Manor 104 Aldwick Road Bognor Regis West Sussex PO21 2PD zero star poor service 28/01/2010 The quality rating for this care home is: The rating was made on: 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 review of the service We call this review a ‘key’ inspection This is a report of a random inspection of this care home A random inspection is a short, focussed review of the service Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report Lead inspector: Suni Chotai Date: 0 8 0 3 2 0 1 0 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): Name of registered manager (if applicable) Stargate Partnership Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 24 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 24 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 Ashton 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 Care Homes for Older People Page 2 of 10 2 8 0 1 2 0 1 0 Brief description of the care home 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 Care Homes for Older People Page 3 of 10 What we found: A pharmacist from CQC, Suni Chotai visited the home on 8th March 2010 to check improvements relating to medicine management To assess medicine management we check all current and previous months medicine administration record [MAR] charts We also watched medicine being given to people and we talked to two members of staff who deal with medicines We looked at two peoples care notes and we checked medicine management facilities There were twelve residents in the home at the time At a previous inspection we had found three tablets in a bin (that had no lid) in the lounge area We were told these were spat out by residents The service has now got a new system in place to handle medicines which have been spat out This system is an improvement and eliminates the unsafe method of disposal used before All medicines received into the home are recorded on the medicine administration record [MAR] chart Medicine no longer needed are recorded in a book and stored safely until the pharmacy picks them up for safe disposal Having these records allows for any audit that might be necessary A new medicine fridge is now available and the temperature was recorded We were informed that a Controlled Drugs cupboard is on order There were no Controlled drugs in the service at the time of this inspection There is a medicine trolley and a metal cupboard for safe storage of other medicines We noted that the medicines key was not kept on the person in charge but in an unlocked drawer The Royal Pharmaceutical Society of Great Britain guidance document recommends that the person in charge must hold the keys on their person for safe keeping of medicines We watched a carer give medicines to three people at lunch time and for one person the accepted safe practice was not followed The carer worked from the instuctions on the Blister pack rather than the instructions on MAR chart This puts people at risk as there may have been a change in medicine instructions We saw for one residents medicine, the doctor had made dose changes which the care staff had indicated on the MAR chart However for another resident there was no evidence to prove that a change in dosage direction written by care staff was made by the doctor This could put residents at risk as the service had acted on a verbal instructions only For two medicines we found that there were more signatures on the MAR chart than doses available We asked the manager to explain this and she was not able to give an explanation This means the records relating to medicine administration are not a true and accurate record and residents are not receiving there medicine as prescribed Where medicine were prescribed to be taken only if needed, there were no care plans around the use of this medicine for consistency Any medicine prescribed that was not given was marked O which means other The reason a medicine was other was somethimes recorded as not needed There is no reason given as to why the medicine was not needed Care staff must keep clear, Care Homes for Older People Page 4 of 10 accurate and complete records of treatment given or omitted to protect residents from harm The home has a written policy and procedure on medicines management in place and staff have been trained in safe practice and we noted further training has been scheduled What the care home does well: 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 2 Care Homes for Older People Page 5 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards No Standard Regulation Requirement Timescale for action 1 7 15 In line with regulation 15(1) residents must have clear individual care plans describing the support that staff give to meet identified needs This must happen in order that residents needs can be met consistently and safely 28/02/2010 2 18 13 In line with regulation 13(6) the registered person must ensure all staff receive training in challenging behaviour This must happen to meet the needs of a resident and to reduce the risk of harm 28/02/2010 3 19 23 In line with regulation 23 the 28/02/2010 registered person must ensure the environment meets residents needs Particular attention must be paid to - Providing seating in the lounge that is clean and promotes good infection control Ensuring bathing facilities are safe and meets residents needs Provide suitable flooring in residents bedrooms that promotes good infection control And that staff receive training in Page 6 of 10 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards No Standard Regulation Requirement Timescale for action infection control This must happen in order that residents live in a safe and comfortable environment 4 27 18 In line with regulation 28/02/2010 18(1)(a) the registered person must ensure that suitably qualified staff are on duty at all times, with particular attention to night shifts This must happen to safeguard residents from harm 5 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 Care Homes for Older People Page 7 of 10 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, 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 9 13 The registered manager must ensure that a there is clear documented evidence for any treatment changes showing that there was professional input To ensure that healthcare needs of residents are met 30/04/2010 2 9 13 To have a controlled drugs cupboard which complies with the Misuse of drugs [safe custody] Regulations 1973 and its amendments To comply with the law 30/04/2010 3 9 13 To have a Care Plan on the use of medicines that are to be given only when needed So that there is consistency in the use of this medicine 30/04/2010 4 9 13 To ensure medicine are given 30/04/2010 using safe methods and records are true and accurate So that people get the the Care Homes for Older People Page 8 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 correct dose of medicine and there is written evidence of medicines given which is true and accurate including recording reason for when medicines are not given 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 1 9 The registered manager must review the security of the medicine keys Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000 Copies of the National Minimum Standards –Care Homes for Older People can be found at www dh gov uk or got 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 Helpline: Telephone: 03000 616161 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 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