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Inspection on 12/05/05 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 12th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Residents and a visitor spoken to like the staff that work in the home and were happy with the care provided. Residents described staff, as being "kind" and "lovely" while a visitor said the care at the home was "very good". 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. 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.

What has improved since the last inspection?

After being without a manager for some time the home now has a new one. The manager has a lot of experience and has ideas about what things are needed to improve the home. Whilst the manager is very experienced she is in the process of obtaining a formal management qualification.

What the care home could do better:

To ensure residents live in welcoming, pleasant and homely environment parts of the home need to be redecorated and have carpets and furniture replaced. Although medication records are detailed they need to be improved upon, so the date when medicines have first been given is clear to those reading them.The times when medicines are given need to be looked at to make sure there is enough space left for the medication to work, as it should. The home does not always have enough staff on duty to make sure that residents get the care they need and a review of the number of staff working at busy times needs to be looked at. 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.

CARE HOMES FOR OLDER PEOPLE ASHTON VIEW NURSING HOME WIGAN ROAD, ASHTON-IN-MAKERFIELD, WIGAN, WN4 9BJ. Lead Inspector Kath Smethurst Unannounced 12 May 2005 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. 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 F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashton View Nursing Home Address Wigan Road, Ashton-in-Makerfield, Wigan, WN4 9BJ. 01942 722988 01942 274896 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) Highfield Care Homes Limited CRH Care home with nursing 55 Category(ies) of DE Dementia 36 registration, with number OP Old Age 19 of places ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 55 service users to include:up to 55 service users in the category of OP (Older People) up to 36 service users in the category of DE (Dementia) 2. 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. 3. The climate to be monitored and alterations made to roof if it becomes apparent heating and ventilation in larger lounge cant be adequately maintained. 4. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 6 January 2005 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 F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 9.15 am. It took place over eight 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 ten residents, one visitor, the manager and seven staff. What the service does well: What has improved since the last inspection? What they could do better: To ensure residents live in welcoming, pleasant and homely environment parts of the home need to be redecorated and have carpets and furniture replaced. Although medication records are detailed they need to be improved upon, so the date when medicines have first been given is clear to those reading them. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 6 The times when medicines are given need to be looked at to make sure there is enough space left for the medication to work, as it should. The home does not always have enough staff on duty to make sure that residents get the care they need and a review of the number of staff working at busy times needs to be looked at. 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. 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 F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 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 standard(s) 3 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 six 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. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 9 One visitor spoken to described how her relative had been visited prior to admission and had been asked about her needs and preferences. In the main staff were aware of the need to undertake pre-admission assessments in order important and significant information is recorded. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 Health care needs were on the whole well met with evidence of multi disciplinary working taking place, but staff were not always completing relevant records, which meant important information had not been recorded. 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, in order to fully protect residents. EVIDENCE: 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. There was evidence that the plans had been signed and agreed by either the residents or their relatives. The residents and visitor spoken to all said they were satisfied with the care provided. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 11 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. The health care needs of residents were on the whole being met. Individual care records inspected showed evidence of visits from General Practitioners, chiropodist, optician, tissue viability nurse, physiotherapists, dieticians, hospital consultants and community psychiatric nurses. While nutritional assessments are undertaken, it was found in one resident’s care plan (Gerrard Unit) that fluid and food intake charts had not been routinely completed, even though concerns about nutrition had been identified. Care notes and discussion with staff indicated this resident was refusing meals and drinks and had also lost weight. Reference to food/fluid intake was made in care notes but was not specific in terms of quantity and intake charts had not been completed since the 28th April 2005. It is acknowledged staff had sought advice and a specialist appointment had been made nevertheless, it is important that fluid and food intake is accurately recorded whenever nutritional needs are compromised. Management of medication in the home was generally satisfactory but some improvements are needed. The new manager has already identified where improvements could be made to the administration system and has decided to change the supplying pharmacy. Training in the new system has been arranged to coincide with the implementation at the end of May. Examination of residents care notes showed their medication was regularly reviewed. The manager advised that new medication policies and procedures were to be introduced. However a copy of the existing medication policy could not be located during the inspection. In order staff are fully aware of their responsibilities the new policy should be implemented at the earliest opportunity. 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 to residents with their medicines. Qualified nurses (Evans & Gerrard Unit) or trained carers (Pilling Unit) administer medication. A name and initial list is maintained for qualified nurses, but not for trained carers administering medication, this is recommended to assist in the identification of initials used on the administration records. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 12 Concerns were raised in respect to the timing of the medication rounds and this was discussed with staff. On Gerrard Unit (first floor) the medication round was still in progress at 11:15, staff advised that other rounds began at 14:00, 18:00 and 20:00. This must be reviewed to ensure that an appropriate dosage interval is maintained. The medication records inspected were in the main up to date. However there was an occasional lack of clarity in records. For example on Pilling Unit a dosage had been increased mid-month but the date of the change had not been entered on the MAR sheet hence, it was not possible to determine the dose given on any actual day. On Gerrard Unit There were some ‘blanks’ where administration or the reason for non-administration was not recorded. One tablet was prescribed for twice daily dosing, records showed only one dose. One residents MAR sheet indicated that a dose of medication should be increased for one week, the start date was not indicated and the nurse-incharge thought that the increased dose had been given for an extended period. This needs to be improved upon to confirm the correct dosages are administered. Records of unwanted medication sent for disposal were maintained but comprehensive up-to-date records of medication received had not been completed. This needs to be addressed to ensure guidelines are adhered to. It was noted that handwritten medication sheets were not signed, independently checked or countersigned, it is recommended that this be adopted throughout the home to reduce the risk of error. The medicine trolley on Pilling Unit contained some unlabelled medication and on Gerrard Unit some discontinued or otherwise unwanted medicines. All unwanted medication must be segregated for disposal. Anecdotal evidence from residents indicated that staff respected their privacy and dignity. During the inspection staff were in the main seen to treat service users with respect and consideration, were attentive to individual needs and were discreet. Written evidence in care plans showed that resident’s needs in respect to dignity were considered important. For example personal appearance. In one plan staff were instructed to ensure that “make-up is applied” while in another “ensure clothes are colour co-ordinated”. During the inspection it was observed that residents on Gerrard Unit had nothing on which to wipe their hands and face after breakfast, as napkins were not provided. This prevents residents maintaining dignity. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 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 standard(s) 12 and 15 Daily activities within the home are well managed but opportunities for pursuits outside the home are limited. Meals are good, offering variety and choice, but the mealtimes are inflexible and people are not able to choose the time they eat. EVIDENCE: Activities are displayed in the reception area. The home employs an activities organiser. However on the day of inspection she was providing cover in the kitchen. This resulted in the advertised activities not taking place. Despite this written records showed leisure activities do take place on a regular basis. For example the recorded activities for one resident during the previous week included crafts, baking and beauty care. One area the home should address is in respect to trips outside the home. The records examined showed little evidence of residents taking part in activities in the community. During the inspection staff on Evans and Pilling Unit were observed spending time with residents chatting or playing games and a good natural banter was observed. Those residents who commented said they enjoyed talking to the staff and confirmed they spent time socialising with them. The level of social interaction on Gerrard Unit was observed to be less frequent. While staff spoke to and were friendly towards residents the amount of time spent sitting and talking was less than the other units. This was discussed with the manager and ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 14 she indicated she had already identified this as an area for improvement, which would be addressed in future training. Residents with religious beliefs are encouraged and enabled to maintain links. Care plans contain details of resident’s preferred religion. The menus have recently been reviewed and changed. Residents were consulted to ensure they were satisfied with the changes. The menus were inspected and were found to be well balanced and varied. A choice is offered at every meal. Residents who commented expressed their satisfaction with the quality, quantity and choice of food provided. One resident described the food as being “good”. On Evans and Pilling Units dining tables were tastefully set with linen tablecloths. However there were no tablecloths in use on Gerrard Unit. The lack of tablecloths resulted in a poor general appearance of the tables and lack of a congenial atmosphere. The manager advised that there was an ample supply, and that they would look into the issue. On arrival at 9.15am breakfast had not been served. Concerns were raised with the manager in regard to the time those residents who chose to get up early would have to wait for their meal or drink. Assurances were given that drinks were provided prior to breakfast being served. Nevertheless a more flexible breakfast time would be preferable and is strongly recommended. The manager said she was in the process of reviewing all mealtime arrangements. The breakfast meal was observed on Gerrard Unit. Staff were sensitive and discreet when providing assistance and no one was rushed. It was noted that in the dining room there was a lack of space. The tables were very close together which meant that if needed to assist the residents in this area there would not be room for them to sit down. While this was not an issue on the day it could be in the future and as such needs to be considered. During the inspection one resident was observed to be sat at the table for a considerable time both before and after the meal. It was evident this resident wished to leave the table but it was some time before staff provided the necessary assistance. This suggested that additional staff at mealtimes would be beneficial. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 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 standard(s) 16 Systems are in place with regard to the investigation and recording of complaints but details of the outcome are not being recorded, resulting in no written evidence being available that concerns raised were acted upon. EVIDENCE: A detailed complaints procedure is in place. Details of how to complain are contained in the “Service User Guide” which each resident has a copy of. A system is in place for recording complaints. The homes complaints book was examined and showed two complaints had been logged in 2005. However there was no information about the investigation, the outcome or if the complaints had been resolved. The manager was not in post when the complaints were made but offered assurances that in future this information would be documented. Since the last inspection in January 2005 the Commission for Social Care Inspection (CSCI) received one complaint about the home. The complaint related to lack of care and attention to pressure areas and dental care, loss of spectacles and poor communication with relatives. The concerns relating to pressure area and dental care were not upheld, while those relating to poor communication and loss of spectacles were unresolved. The home fully cooperated in the investigation process and acted upon the requirements and recommendations made by the CSCI. For example in respect to consultation with relatives. It was pleasing to note that in care plans discussions with relatives about resident’s care and well being are now well documented. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 16 None of the residents or visitor spoken to have made a complaint, but all indicated they knew whom to approach if the need arose. One resident said, “I’ve got no complaints”. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 17 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 standard(s) 19, 20, 21 and 26 The standard of the décor in parts of the home is poor with little evidence of improvement through future planning, therefore, the home does not present as a homely and comfortable environment for residents. EVIDENCE: In previous inspections it has been identified that many areas of the home’s 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. To date there is no definite timescale when work will commence. This situation is unsatisfactory and some indication needs to be given if the promised refurbishment is to take place or not. If not then remedial work needs to be undertaken as a priority in order to improve the environment for residents. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 18 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. There is an absence of orientation aids, visual clues and there is no direct access to outdoor space. It is essential that people with dementia have a supportive environment in order to compensate for cognitive difficulties and currently the unit does not provide this. The lighting is poor and although the inspection took place on a sunny day it was very dark. Redecoration and painting in the communal areas is also required. The wallpaper is torn in places and the woodwork is damaged. The carpet and the vinyl flooring are stained. The furniture is shabby and worn and needs to be replaced. All this creates a poor impression. Toilet and bathing facilities are provided on each floor. Improvements have continued since the last inspection 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 observed to be maintaining good hygienic practices. The lack of hand washing facilities in some toilets could lead to the risk of cross infection. Only one domestic was on duty during the morning of the inspection. This was due to a member of staff ringing in sick at short notice so preventing cover from being obtained. Despite this the home was for the most part clean. Odour control on Evans and Pilling Units was good. Odour control in the communal lounge on Garrard Unit was very poor with a strong smell of urine apparent. As the day progressed attempts had been made to disguise the malodour with air freshener but the smell of stale urine was still evident in the late afternoon. Odour control has been a long-standing issue on this unit despite the continued efforts of staff to improve it. It would appear that the odour has impregnated carpets and furniture and the only way to resolve this is to replace them and ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 19 deep clean the area. It is totally unacceptable for residents to have to live with such a situation and steps need to be taken to rectify this issue. All laundry is undertaken on site and residents spoken to had no complaints about the standard of laundry service provided. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 20 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 considers Standards 27, 29, and 30 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 On occasions the home operates under the means the needs of residents are not being selection procedures are robust but policies home had not always been followed. Staff training which compromises the quality of specialist needs living in the home. EVIDENCE: While there has been a turnover of staff several staff had worked in the home for a number of years, which provides residents with consistent care. On the day of inspection the home was understaffed. For example there was only one domestic on duty, the activity organiser was providing cover in the kitchen and on Gerrard Unit one care assistant reported sick at short notice preventing cover being obtained in the morning. This situation led to staff being very busy. An example of this was observed on Gerrard Unit. One resident was seen to be sat at the dining table for a considerable time both before and after breakfast. It was evident this resident wished to leave the table but it took staff a considerable length of time before this resident was provided the necessary assistance. Discussion with staff 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 ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 21 required staffing levels, which fully met. The recruitment and to protect people living in the have not received appropriate care provided to people with administrative and supervisory tasks. Staff spoken to indicated 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. Examination of the rotas showed that only one nurse is rotered to work at night. The nurse on duty covers both the general nursing (Evans) and EMI unit (Gerrard). Given the complex needs of the residents on both these units it is questionable whether this is sufficient. One of the nurses spoken to commented that when she worked on nights she was very busy and felt another nurse was needed. An example of this related to the administration of medicines. The member of staff described how it took her a lengthy period of time to complete the night medication round. All these areas need to be addressed. The manager advised she was reviewing rotas and was planning to make some changes. Currently the shift structure makes it difficult to cover vacant shifts. The manager has already spoken to staff about this and was formulating new rotas. In respect to additional staff the manager will need the support of her senior managers. It is important to regularly review staffing levels given that the needs of older people can increase suddenly as a result of an accident, illness or as part of the ageing process. Therefore a review of staffing levels must be undertaken by the company to ensure the needs of residents are being met. The company has recently audited all staff personal files. The audit document was examined and it was noted that a number of shortfalls had been found. For example not all files contained two references although this could be historical. What was of more concern was that it had been discovered that in some files there was no record of returned CRB checks having been seen although the staff in question say they have completed one. The manager said this was an area she had already identified as being a priority. It was evident form checking files and the comments from some staff that they have not been receiving the training they require. Only two staff have attained NVQ (National Vocational Qualification) level 2, which is a very low percentage. The manager is endeavouring to address this and has now registered twelve staff for NVQ training. This needs to be monitored to ensure progress in meeting the required 50 target is maintained. Staff spoken to confirmed they had undertaken moving and handling and health and safety training. However on Gerrard Unit none of the staff including the nurse in charge had undertaken training in dementia care. 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 future. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 22 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 35 After a period of management instability the home is now being well managed. Improvements to the accounting system have been made which protect resident’s financial interests. EVIDENCE: After a considerable period of time without a permanent manager a new manager has now been appointed. She has only been in post for six weeks but nevertheless has a good understanding of the areas, which need to be improved in the home. She has already improved medication systems and the menus and is planning to review rotas, staff training and the environment. While there are some issues the manager will be able to address herself, she will need the support of the company if she is to achieve her objectives in respect to others for example the environment. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 23 The Manager is a Registered Nurse (RGN & RMN) with extensive experience of running care homes for older people. She is currently undertaking the NVQ level 4 registered managers award and is aware she complete the course in order to continue managing Ashton View. An application for registration with the Commission for Social Care Inspection has not yet been made. This was discussed with the manager who advised she was in the process of completing her application and gave assurances it would be completed without delay. Staff spoken to all indicated that the manager provides clear leadership and direction. One member said, “she gives us direction, I know what she expects and I like that”. Residents who commented were all aware of whom to approach if they had a concern or problem. Following a recent review the company has introduced a new accounting system for resident’s monies. All monies held for safekeeping are kept in individual plastic wallets in the homes safe. A record is kept of monies credited and debited and receipts were obtained for financial transactions. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 1 1 1 x x x x 2 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 2 x x x 3 x x x ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 25 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 19 Regulation 14 Requirement Food and fluid intake charts must be completed when there are concerns about dietary intake. The provider must ensure that all medication records including those for receipt and administration are complete, clear, accurate and up-todate. The medication rounds must be audited to ensure that an appropriate dosage interval is maintained. The provider must ensure that all unwanted medication is promptly segregated for disposal. Details of the outcome of all complaint investigations must be documented. Details of when the refurbishment programme is to commence must be forwarded to the CSCI. (Timescale of 1 March 2005 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 1 March 2005 not F56 F06 S5669 Ashton View V225434 Stage 4.doc Timescale for action 7 June 2005 20 June 2005 2. 9 13 3. 9 13 20 June 2005 20 June 2005 20 June 2005 1 July 2005 4. 9 13 5. 6. 16 19 22 23 7. 21 23 1 July 2005 ASHTON VIEW NURSING HOME Version 1.30 Page 26 met) 8. 9. 10. 11. 12. 19 19 20 20 25 23 23 16 & 23 16 & 23 13 Communal areas in Gerrard Unit must be redecorated and repainted. The carpet in the large lounge in Gerrard Unit must be replaced. The armchairs on Gerrard Unit must either be recovered or replaced. The dining tables and chairs on Gerrard Unit must be replaced. Lighting in the home must be improved. Details of how this is to be addressed to be forwarded to the CSCI. (Timescale of 31 March 2005 not met) Steps must be taken to rectify the malodour on Gerrard Unit. Adequate staffing levels must be maintained in all three units in the home. To ensure staffing levels during the day and night are sufficient a review of current staff ratios must be undertaken. Details to be forwarded to the CSCI in the action plan. Confirmation that all staff have completed a Crimanal Record Bureau check must be forwarded to the CSCI. Action must be taken to ensure that 50 of staff attain NVQ level 2. Staff must ensure staff undertake dementia care training. The manager must apply for registration with the CSCI The registered manager must complete the NVQ level 4 registered managers award. 1 November 2005 1 November 2005 1 November 2005 1 November 2005 1 July 2005 13. 14. 15. 26 27 27 16 18 18 1 July 2005 1 July 2005 1 July 2005 16. 29 19 1 July 2005 17. 18. 19. 20. 28 30 31 31 18 12 & 18 8 9 1 December 2005. 1 June 2005. 1 July 2005 1 May 2005 ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 27 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. 3. 4. 5. 6. 7. Refer to Standard 9 9 9 10 12 15 15 Good Practice Recommendations The new medication policies and procedures should be implemented at the earliest opportunity. Handwritten MAR entries should be signed, checked and countersigned. Verbal changes should be fully referenced. A list of trained carers, their initials and training date should be maintained. To preserve residents dignity napkins should be provided. The activity programme should be reviewed to ensure more trips outside the home are provided. Tablecloths should be used at mealtimes (Gerrard Unit) in order to add to the domestic and congenial atmosphere of the dining room. In order to ensure residents are able to choose the time they eat more flexible mealtimes should be introduced. ASHTON VIEW NURSING HOME F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection 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 F56 F06 S5669 Ashton View V225434 Stage 4.doc Version 1.30 Page 29 - 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!