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Inspection on 01/12/05 for Ashton View Nursing Home

Also see our care home review for Ashton View Nursing Home for more information

This inspection was carried out on 1st December 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The care plans looked at were very detailed and gave people reading them a clear picture of what each person needs help with, as well as the things that are important to them. Before people come to live at the home the manager will visit residents, either at home or in hospital, to make sure the care needed can be provided. Residents spoken to like the staff that work in the home and were happy with the care provided. Residents described staff, as being "grand", "lovely" and " kind". People visiting the home are made welcome and can visit at any time. The staff ask residents and their relatives what they think about the food, activities, environment and staff and what things they could to do to improve residents lives.

What has improved since the last inspection?

Good progress has been made by the manager to make sure things which needed improving from the last inspection had been done. She is willing to do something about things that need to be improved, but needs the support of the company to make the environment better for people living in the home. Meals are varied and well balanced offering residents a lot of choice and variety. All residents spoken to expressed satisfaction with the food provided. Care staff have had training in understanding how to recognise abuse and what they need to do in such cases. Staff have repainted the lounge and corridors in one of the units making it much brighter. More aids to helping people with dementia finding their way around the home have been provided.

What the care home could do better:

To ensure residents live in a more welcoming, pleasant and homely environment, parts of the home need to be refurbished, the lighting needs to be improved and carpets and furniture need to be replaced. Some toilets need sinks fitted so that residents can wash their hands after using the toilet. Although medication records are detailed they need to be improved upon, to make sure that medicines in stock are still to be used. Medication records need to be clear as to when medicines have been given to residents and that medicines are kept in the original containers. Not all staff have received the training they need to do their jobs properly, for example more training is needed in understanding the special needs of people with dementia. The staff need to make sure they have details of when the electrical wiring was last checked, so they know when the next safety check is due.

CARE HOMES FOR OLDER PEOPLE Ashton View Nursing Home Wigan Road Ashton-in-makerfield Wigan Lancashire WN4 9BJ Lead Inspector Kath Smethurst Unannounced Inspection 1st December 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 View Nursing Home DS0000005669.V269583.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 View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashton View Nursing Home Address Wigan Road Ashton-in-makerfield Wigan Lancashire WN4 9BJ 01942 722988 01942 274896 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) Southern Cross Care Centres Limited Care Home 55 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (19) of places Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 55 service users to include:up to 55 services users in the category of OP (Older People) up to 36 service users in the category of DE (Dementia). Within the 55 places there can be up to 14 older people with dementia requiring residential care, up to 19 older people requiring nursing care, and up to 22 older people with dementia requiring nursing care. The climate to be monitored and alterations made to roof if it becomes apparent heating & ventilation in larger lounge can`t be adequately maintained. The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 12th May 2005 3. 4. Date of last inspection Brief Description of the Service: Ashton View provides nursing and personal care for 55 older people some of whom have been diagnosed with dementia and associated conditions. It is located in the centre of Ashton-In-Makerfield convenient for public transport,shops and community facilities. There are three floors and there is a passenger lift to all levels. The home has three units. Ground floor (Evans) general nursing, first floor (Gerrard) EMI nursing, and second floor (Pilling) residential dementia care. All 55 bedrooms are single, 1 has an ensuite toilet. Communal bathrooms and toilets are provided on each floor. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 10.30 am. It took place over six hours during the morning and afternoon. The pharmacist inspector was also present. The inspector looked around some but not all of the home, checked care plans and some records as well as looking at how the medication was given out. To get more information about the home the inspectors spoke to eight residents, the manager and six staff. What the service does well: What has improved since the last inspection? Good progress has been made by the manager to make sure things which needed improving from the last inspection had been done. She is willing to do something about things that need to be improved, but needs the support of the company to make the environment better for people living in the home. Meals are varied and well balanced offering residents a lot of choice and variety. All residents spoken to expressed satisfaction with the food provided. Care staff have had training in understanding how to recognise abuse and what they need to do in such cases. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 6 Staff have repainted the lounge and corridors in one of the units making it much brighter. More aids to helping people with dementia finding their way around the home have been provided. 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 View Nursing Home DS0000005669.V269583.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 View Nursing Home DS0000005669.V269583.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): The admission procedure is satisfactory and systems are in place to ensure proper assessments are completed prior to people moving in. EVIDENCE: The admission procedure is satisfactory and individual assessments are kept for all residents. If possible the manager or deputy manager visit prospective residents prior to admission at home or hospital whether they are paying for themselves or the local authority funds their care. Inspection of the records of two of the most recent admissions showed a full assessment of care needs had been completed and where applicable social work assessments had been taken note off. The assessment document was detailed and included information relating to physical needs and personal preferences. All assessment documents had been signed and agreed by the residents or their carers. One resident gave an example of how staff had asked her about her needs and preferences prior to admission. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 9 Staff were aware of the need to undertake pre-admission assessments in order important information is recorded and to ensure individuals are not admitted unless the home was able to meet needs. The manager gave an example of this when recently she had assessed a potential resident, but had concluded the home would not be able to provide the level of care required. Ashton View Nursing Home DS0000005669.V269583.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&9 Care plans were detailed, up to date and provide staff with the information they need when delivering care. Medication administration systems need to be reviewed to ensure resident’s medication needs are met. Some medication records were not well maintained and did not accurately record handling of medication in the home. EVIDENCE: Care plans are of a good quality and continue to be very well maintained. Six care plans were inspected, two from each floor. All contained comprehensive information relating to residents personal, social and health care needs. Daily entries in care notes were completed in all the plans examined. The plans were easy to read and had been regularly reviewed. For example in one plan staff had identified that the resident’s nutrition was an area of concern. A nutritional assessment had been completed, staff were instructed to “ observe portion size”, and “ monitor weight monthly”. Examination of records of weight showed staff had monitored weight as required and after a period of weight loss, this resident was now seen to be gaining weight. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 11 The care plans examined contained some very good information in respect to residents past lives, needs, likes/dislikes and chosen lifestyle. For example one read, “X likes to look nice” a second “ Likes to be called Y”. There was evidence that the plans had been signed and agreed by either the residents or their relatives. The residents spoken to all said they were satisfied with the care provided. Comprehensive risk assessments were in place in all files examined. They covered areas such as nutrition, pressure areas, moving and handling, bedrails and falls. All had been reviewed and updated on a regular basis. Management of medication in the home was generally satisfactory but some improvements are needed. As at the previous inspection the new medication policies and procedures were not yet available in the home and had not been implemented. The new policies must be reviewed by the manager and implemented at the earliest opportunity. None of the current residents self-administered; all medicines were administered by registered nurses or on Pilling, by trained carers. Parts of the morning medication round were observed on all three floors, medication was administered one-by-one to each resident with records completed at the time of administration, water or squash was offered. On Pilling, the dosage of two tablets had been reduced from two to one. The tablets were packed into a monitored dosage system (MDS) with two tablets in each blister. The second tablet could not be accounted for. The manager should discuss the options for managing dosage changes with the supplying pharmacist to reduce the risk of accidental administration of both tablets. The Medication Administration Records (MAR) examined were generally up-todate; dividers and photographs were included within the MAR files to clearly segregate individual records and to assist in positive identification. Records of unwanted medication sent for disposal were maintained; the manager advised that disposal had been arranged through an authorised waste company. The handling of controlled drugs was entered into a separate register. Pre-printed MARs were used throughout the home where possible. Records of medicines received into the home were entered onto the pre-printed MARs, but where handwritten entries were made the receipt entries were sometimes omitted (Pilling). Some concerns regarding clarity and accuracy of the MAR were discussed: On Piling, inhalers were not well managed. The MAR for one resident indicated regular administration, but examination of the inhalers in stock and the receipt records suggested infrequent use. The dose of a second resident’s inhaler had been increased on discharge from hospital but the MAR had not been updated. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 12 Handwritten entries were not signed, dated independently checked and countersigned, and one handwritten entry was incomplete listing only the name of the medication with no dosage instructions. Where variable doses e.g. one or two tables were prescribed the actual dose given was not recorded. Unusually, Quetiapine was prescribed ‘one or two.’ the manger should seek confirmation of the dosage from the prescriber. On Gerrard and Evans the application of prescribed creams was sometimes indicated with a ‘tick’ rather than a signature. If a nurse delegates the application of creams to carers they remain accountable and must ensure the carer applying the creams is competent to do so. As discussed, further information regarding accountability and responsibility when delegating tasks is available through the NMC. On Gerrard, labels had been removed from a hospital medication discharge note and used to create a MAR. This practice should be avoided. Additionally, some medicines, that it was advised were ‘discontinued’, remained listed on the MAR. The entries were not clearly marked to indicate discontinuation. All medication records including those for receipt and administration must be complete, clear, accurate and up-to-date. Medication was securely stored within the medication rooms. However, the medicine trolley on Pilling contained an unlabelled bottle of liquid medicine (Mirtazapine) and on Evans, there was a box of unlabelled tablets in use. On Pilling, medicines and eye-drops, which have a reduced life on opening, were not dated to help ensure they are not used for extended periods. Pilling does not have a medicines refrigerator and one bottle of eye drops requiring refrigerated storage was kept at room temperature. Medicines must be correctly stored and administered from the original pharmacy labelled container. It was advised that the possibility of covert administration of medication was under discussion with one resident’s family and GP. As discussed, nurses must consider the NMC guidance on covert administration and must ensure any decision is fully documented, risk assessed and regularly reviewed. The manger advised that from December the homes medication would be delivered from a new supplying pharmacy. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 13 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): 13 & 14 Visiting arrangements are good ensuring links between residents and their relatives and friends are maintained. In the main personal support is offered in such a way as to enable residents to exercise choice and control over their lives. EVIDENCE: The home has an open visiting policy. There are no restrictions on the time people visit and this was highlighted in the visitor’s book, where entries showed residents friends and relatives visiting at different times during the day and evening. The only time restrictions would be imposed is when requested by residents. Anecdotal evidence from both residents indicated the manager and staff encouraged links to be maintained. A resident spoken to confirmed her relatives were always made to feel welcome by staff. Further evidence of this was also observed, staff greeted visitors politely and took time to talk to them. In general residents expressed satisfaction with care provided and organisation of life at the home. It should be noted that a high proportion of residents have cognitive difficulties so were therefore unable to confirm they were able to exercise choice. Nevertheless, observation of care practice and information in care plans indicated residents are encouraged to make choices. For example in Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 14 respect to food. The lunchtime meal was observed to find residents could choose from four different options. One care plan instructed staff to “ encourage to converse one to one” a second described a resident as being “independent in her needs”. This demonstrated that those residents are enabled to exercise choice over their lives. Ashton Views policy on admission is that residents are encouraged to bring in personal items that will help them to settle in to life at Ashton View, the extent of which is agreed prior to admission. Evidence of personalisation was seen in resident’s bedrooms where personal mementoes and photographs were on display. The manager advised that residents were able rise and retire when they wished. Residents who were able to comment also confirmed this. Most residents hand over hand the responsibility for their financial affairs to their representatives. However if possible residents are encouraged and enabled to manage their own finances This was illustrated in the comments of one resident who said staff assisted her when she wished to withdraw money from her bank account. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 15 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): 18 The policies and procedures of the home ensure residents are safeguarded from abuse or harm. EVIDENCE: The Home holds a copy of the Local Authority “Protecting Vulnerable Adults” policy. The home ensures all staff completes a POVA and CRB (Protection of Vulnerable Adults Register/Criminal Records Bureau) before commencing work. Staff spoken to understood the potential indicators of abuse and were aware of the steps they needed to take if there was a suspicion or allegation of abuse. This was demonstrated by the action taken by the manager following concerns raised about a former member of staff. The manager informed all relevant authorities and disciplinary action was taken against the person in question. The manager has organised training sessions for staff in the recognition and prevention of abuse. To date most care staff have completed the training. A further session has been arranged for ancillary staff. This is a positive initiative given that all grades of staff have the potential to come across and report cases of suspected/alleged abuse. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 16 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 & 26. The standard of the décor and furnishings in parts of the home is poor with little evidence of improvement through future planning. Therefore parts of the home do not present as a homely and comfortable environment for residents. EVIDENCE: In previous inspections it has been identified that many areas of the homes environment need to be improved upon principally but not specifically Gerrard Unit. During the past twelve months the Commission for Social Care Inspection (CSCI) have been given assurances that a major refurbishment of the home was to take place. A meeting was held on the 27 July 2005 between representatives of Southern Cross and the CSCI where further assurances were given and that work would be started in the near future. To date no plans have been forwarded to the CSCI and no indication has been given about when refurbishment work will commence. This situation is unsatisfactory and some indication needs to be given when the promised refurbishment is to take place or not. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 17 Outdoor space is somewhat limited but this is counterbalanced in that the home is situated in the town centre close to all local amenities. A second floor rooftop garden terrace provides residents on Pilling Unit with a pleasant, safe, outdoor area. In general the Evans and Pilling Units communal areas are well maintained and furnished. Communal space on Pilling Unit did not appear to be sufficient for the number of residents accommodated. For example there was not enough space for all the residents to sit in the dining room. While this isn’t an issue currently as one resident likes to have his meals in his room, it could be in the future and needs to be considered. Major improvements are needed to the environment on Gerrard Unit. This unit provides nursing care for residents with dementia but the environment does not meet good practice guidelines. Since the last inspection staff have made great efforts to improve the environment on this Unit. For example the lounge and corridors have been painted. Steps have been taken to improve adds to orientation. Toilet and bedroom doors have been painted in blue and green. Bedroom doors have had doorknockers and letterboxes fitted. Notwithstanding staffs efforts major work needs to be undertaken by the company to ensure the environment is suitable for people with living with dementia. It is essential they have a supportive environment in order to compensate for cognitive difficulties and currently the unit does not provide this. Despite the efforts of staff more orientation aids and visual cues are needed. Lighting throughout the home is very poor and needs to be improved upon. The carpet and the vinyl flooring (Gerrard Unit) are stained. Furniture (Gerrard) is shabby and worn and needs to be replaced. All this creates a poor impression. It was also noted that one of the residents on Gerrard Unit was slipping down in her chair and looked very uncomfortable. This was discussed with the manager who advised a number of different chairs had been tried but none apart from one had any effect. Apparently the chair that was successful was a “Quinton” chair. The chair was used on a trial basis but because of the cost had to be returned. Southern Cross is a large company and may wish to consider purchasing one for the company, which could be used on an on need basis throughout the group. Toilet and bathing facilities are provided on each floor. Improvements have been made with the installation of new flooring to toilets and bathrooms. However no progress has been made in respect to the installation of hand washing facilities in the communal toilets where none are provided. This needs to be addressed to ensure residents are able to wash their hands after using the toilet. Policies and procedures were in place with regard to infection control. Staff were provided with protective aprons and disposable gloves. Liquid soap and paper towels were provided near to hand washing facilities. Staff were Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 18 observed to be maintaining good hygienic practices. The lack of hand washing facilities in some toilets could lead to the risk of cross infection. On the day of this unannounced inspection the home was clean throughout. Odour control on Evans and Pilling Units remains good. During the last inspection it was noted that odour control on Gerrard Unit was poor. This has improved but there was an underlying odour present throughout the course of the day. It would appear that the odour has impregnated carpets and furniture and the only way to resolve this is to replace them and deep clean the area. All laundry is undertaken on site and residents spoken to had no complaints about the standard of laundry service provided. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 19 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, 28 & 30 Progress has been made in addressing staffing levels ensuring consistency of care for residents. Progress has been made in providing staff with training but more specialist training is needed to ensure residents living with dementia receive good quality care appropriate to their needs. EVIDENCE: On the day of inspection sufficient staff were on duty to meet residents care needs. Examination of staff rotas showed that when staff were on leave or off sick absences were covered. Domestic and catering staff supports nursing and care staff seven days a week. An administrator and maintenance man are also employed. Discussion with staff working on Pilling Unit indicated that at some times of the day additional staff would prove beneficial. On Pilling Unit two staff are rotered to work one a senior care assistant who is counted in staffing but who also carries out administrative and supervisory tasks. Staff said that while this was sufficient during quieter periods an additional member of staff was needed, particularly in the morning when the senior care assistant had other duties that took her away from the direct care of residents. This is an area for the manager to consider. During the last inspection it was noted that at night there was only one nurse rotered to work covering Evans and Gerrard Units. Concerns were raised about whether this was sufficient given the complex needs of the residents living on Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 20 these units. It was therefore pleasing to note that an additional nurse now works at night. This is a positive initiative and should improve the quality of care provided for residents during the night. During the visit staff on all units were observed to respond speedily to requests for assistance made by residents and they also spent time socialising with them. During the last inspection it was identified that a very low percentage of staff were in receipt of the NVQ (National Vocational Qualification) award. Some progress has been made in this area but the percentage of staff is still well below the required 50 level. Currently five staff have attained NVQ and a further three are completing NVQ training. This situation needs to be monitored to ensure progress in meeting the required target is maintained and met. Staff spoken to confirmed they had undertaken moving and handling and health and safety training. During the last inspection it was noted that none of the staff providing care for residents living with dementia had undertaken relevant training. This situation remains unchanged. It is important that staff have the specialist knowledge and necessary skills, which will enable them to provide a good standard of care. The manager advised that she has already taken steps to address this and has arranged for ten staff to complete dementia care training. Staff will complete a four day course entitled ‘Yesterday, Today and Tomorrow’ in the near year. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 21 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): 33 & 38 The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents, staff and relatives. In the main Health and safety practices are satisfactory, but not all equipment service records were accessible which meant that important information was unavailable. EVIDENCE: Effective internal and external quality assurance systems are in place such as staff and residents meetings and visitor/residents surveys. The last residents meeting was held on the 18/10/05 minutes of which showed residents were satisfied with the care provided and organisation of life in the home. Each month the manager sends surveys to six residents representatives asking their views on the home and how they can improve. Reviews in care plans demonstrate residents and their representatives have been consulted and asked about the standard of care provided. For example one review read “ Family happy with care Y is receiving” a second “Son happy with care”. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 22 Southern Cross representatives visit the home on a monthly basis to audit records and speak to residents and staff. A written report is then produced of the findings, which is then forwarded to the CSCI. The home has a system for recording the complaints of those who don’t wish to complain formally. Residents are informed of CSCI inspections and inspection reports are available for visitors and residents to read. The Contracts Section of Wigan Social Services Department, in conjunction with a company called RDB Limited, has undertaken a voluntary star rating of homes in Wigan. As part of the rating process an annual audit of quality is undertaken. Ashton View is due to be assessed in the near future. In the main health and safety issues were satisfactory. Policies and procedures are in place and cover a range of topics linked to health and safety. Documentary evidence was available of staff having completed health and safety training including safe moving and handling techniques and first aid. All accidents and incidents had been recorded and reported correctly. There was documentary evidence to demonstrate the requirements made by the Greater Manchester Fire Service had now been addressed. Records examined provided evidence of regular inspections and maintenance checks of equipment and the building undertaken by external contractors. However it was noted that the electrical safety installation certificate was unavailable for inspection. This was discussed with the manager who thought the certificate was probably kept at head office. To demonstrate the electrical installation is safe a copy of the certificate needs to be forwarded to the CSCI. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 23 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 1 1 1 X X X X 3 STAFFING Standard No Score 27 3 28 1 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 2 Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13 Requirement The provider must ensure the MAR for inhalers are audited and that if still prescribed, Mirtazapine is re-ordered. The provider must ensure that medication policies and procedures are implemented. The provider must ensure that all medication records including those for receipt and administration are complete, clear, accurate and up-to-date. (Extended from 20/06/05) The provider must ensure that all medication is administered from the original pharmacy labelled container. Details of when the refurbishment programme is to commence must be forwarded to the CSCI. (Timescale of 01/07/05 not met) Handwashing facilities must be provided in all toilets. Details of how this is to be addressed must be forwarded to the CSCI. (Timescale of 01/07/05 not met) The carpet in the large lounge in Gerrard Unit must be replaced. DS0000005669.V269583.R01.S.doc Timescale for action 01/12/05 2 3 OP9 OP9 18 13 03/01/06 03/01/06 4 OP9 13 03/01/06 5 OP19 23 31/01/06 6 OP21 23 31/01/06 7 OP19 23 31/03/06 Ashton View Nursing Home Version 5.0 Page 25 8 OP20 16 & 23 9 10 OP20 OP25 16 & 23 13 11 12 13 14 OP28 OP30 OP31 OP38 18 12 & 18 9 16 (Timescale 01/11/05 not met) The armchairs on Gerrard Unit must either be recovered or replaced. (Timescale 01/11/05 not met) The dining tables and chairs on Gerrard Unit must be replaced. (Timescale 01/11/05 not met) Lighting in the home must be improved. Details of how this is to be addressed to be forwarded to the CSCI. (Timescale of 01/07/05 not met) Action must be taken to ensure that 50 of staff attain NVQ level 2. Staff must ensure staff undertake dementia care training. The registered manager must complete the NVQ level 4 registered managers award. To demonstrate the electrical installation is safe a copy of up date safety certificate must be forwarded to the CSCI. 31/03/06 31/03/06 31/01/06 01/06/06 31/03/06 01/05/06 31/01/06 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 OP9 OP9 Good Practice Recommendations Handwritten MAR entries should be signed, checked and countersigned. Verbal changes should be fully referenced. The supplying pharmacist should be asked to label both the outer box and inner bottle where applicable. Options for managing dose changes of medicines packed into an MDS should be discussed. Consideration should be given to implementing procedures for the use of homely remedies in agreement with residents GP’s. NMC guidance on the delegation of tasks to carers should DS0000005669.V269583.R01.S.doc Version 5.0 Page 26 3 4 OP9 OP9 Ashton View Nursing Home 5 OP9 be considered. Eye drops with a reduced in-use shelf life should be dated on first opening. Ashton View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 View Nursing Home DS0000005669.V269583.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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