Inspection on 09/03/07 for Ashton View Nursing Home

This inspection was carried out on 9th March 2007.

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

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

Other inspections for this house

Ashton View Nursing Home 30/10/09

Ashton View Nursing Home 15/05/08

Ashton View Nursing Home 07/12/07

Ashton View Nursing Home 30/08/06

Ashton View Nursing Home 01/12/05

Ashton View Nursing Home 12/05/05

Ashton View Nursing Home 06/01/05

Ashton View Nursing Home 12/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashton View Nursing Home Wigan Road Ashton-in-makerfield Wigan Lancashire WN4 9BJ Lead Inspector Grace Tarney Unannounced Inspection 9th March 2007 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.V314845.R01.S.doc Version 5.2 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.V314845.R01.S.doc Version 5.2 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 ashtonview@schealthcare.co.uk 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.V314845.R01.S.doc Version 5.2 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. 30th August 2006 3. 4. Date of last inspection Brief Description of the Service: Ashton View is located in the centre of Ashton-In-Makerfield and is convenient for public transport, shops and community facilities. There is level access to the front of the home with adequate parking to the front. There are no gardens, only 2 small sitting areas on either side of the car park. A second floor rooftop garden terrace provides residents on Pilling Unit with a safe outdoor area. There are three floors and there is a passenger lift to all levels. The home has three units. On the ground floor there is the general nursing unit (Evans), on the first floor there is a unit for residents with dementia who need specialist nursing input (Gerard), and on the second floor a unit for residents with dementia (Pilling). All 55 bedrooms throughout the home are single and 1 has an en-suite toilet. Bathrooms and toilets are provided on each floor. The provider informed the inspector that the fees within the home ranged from £320.00 to £485.00 per week. Additional charges are made for private chiropody, hairdressing and newspapers. This information was received on the 14/12/06. A copy of the most recent Commission for Social Care (CSCI) inspection report is displayed in the reception area. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was not told that this inspection was to take place although the home was aware that an inspection was due. This was because several weeks before the inspection questionnaires were sent out to the residents, their relatives and to the home itself. The questionnaires that were sent out to the residents were called Have Your Say and they asked what people thought about their care and of the quality of the service provided. 9 resident questionnaires and 11 relative comment cards were received. 2 Inspectors visited the home and spent 8 hours there. During this time the Inspectors looked at care and medicine records to ensure that the health and care needs of the residents were being met. The Inspectors then looked around the building at the bedrooms, bathrooms toilets and sitting areas on each unit to check if they were clean and well decorated. They then visited residents in their own bedrooms and lounge areas. This was to check out the care that was being provided for them. The Inspectors also looked at what the residents had for their lunch and evening meal. They also looked at how many staff were provided on each shift to make sure the residents needs were being met, and also looked at how management recruit and train their staff. How the home manages the residents’ spending money was also looked into. To make sure that the home and the equipment in it were safe the maintenance and service records were looked at. In order to get further information about the home the Inspectors also spent time speaking to 5 residents, 3 relatives, 2 qualified nurses, 3 care assistants the manager and the administrator. What the service does well: The manager and other senior staff make sure the home only cares for those people whose needs the staff can meet. The staff teams work well together and good systems are in place for sharing information about residents. Residents feel that they are well looked after by the staff and the following comments were made: “They are smashing”. “I am well looked after” Relatives spoke very positively of the kindness and consideration of the staff. The following comments were made: They are 100 dedicated and are most helpful at all times. The service given is beyond reproach and is sincerely appreciated. God bless you Ashton view. People visiting the home are made welcome and can visit at any time. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 6 The home makes sure that they check people out properly and safely before offering them a job. The manager and other senior staff are good at checking out the quality of care given. To do this they do regular checks on safety and care records within the home and also seek the views and opinions of the residents and their relatives about the care and services provided. What has improved since the last inspection? 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. The summary of this inspection report can Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 8 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.V314845.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. Residents have an assessment undertaken before their admission to the home and this gives an assurance both to residents, relatives and staff, that a resident is only admitted if the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evans and Pilling Units During the last inspection the Inspector saw that the home staff were very good at making sure people had an assessment of their needs before they were admitted. Because of this the Inspector only looked at 1 assessment on the nursing unit (Evans) and 1 assessment on the residential unit (Pilling). Both these assessments were detailed and gave a good picture of what the needs of the residents were. Gerard Unit The Inspector was informed that before residents are admitted to the home the manager or one of her nursing staff (both are qualified psychiatric nurses) carry out an assessment of the prospective resident’s needs in consultation with the resident, their relatives and relevant health care and social care Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 10 professionals. The purpose of such an assessment is to assist the prospective resident (and their relatives) in their consideration of how appropriate a placement at the home would be and enable the nurse conducting the assessment to assess if the home will be able to meet the prospective resident’s needs properly. The care records for the last three residents admitted to the home contained a record of assessment for all 3. Standard 6 does not apply. The home does not provide Intermediate Care. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10. Quality in this outcome area is adequate. Although some of the care plans were not regularly looked at and updated, overall the care plans reflect the needs of the residents and their health and care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evans Unit The care plans of 2 of the residents were looked at. The care plans contained a lot of information about how to care for the residents. They were not however, always detailed enough. The admission details for 1 of these residents were not completed fully. There was nothing written down about whether their families were to be informed in the event of admission to hospital or change in their condition. The admission details were not signed by the nurse or dated. 1 of the care plans showed that the resident had 3 pressure sores. This resident was being cared for on a pressure-relieving mattress and this was written in the care plan. There was a good plan of care about how to further reduce pressure, such as positional changes and care whilst sat out of bed. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 12 The home had also sought the advice of a nurse who specialised in wound care. It was difficult to know how well the sores were healing however, because the information in the notes was not up to date. It was not easy to tell from the notes if 1 of the pressure sores had healed. There was nothing written down about 1 of the pressure sores since the 9th of January 2007 and the other since the 23rd of February 2007. The manager told the Inspector that she would make sure that the nurse on duty that day would get the care plan up to date. The care plan of the other resident showed that he had a lot of nursing care needs. There were good plans of care in place to deal with them. This resident also had diabetes and staff were taking blood samples every day to check his blood sugar levels. There wasnt an actual care plan that stated this had to be done although staff were recording the results every day. Staff agreed that they would write in the residents’ care plans how often a residents’ blood sample was to be taken. This resident also had a catheter in place for urine drainage. There was a good care plan in place for this but the staff were not recording how often the drainage bag that was attached to his leg had to be changed. Both the care plans gave detailed information about the residents’ religions and whether they practiced their faith. Pilling Unit The care plan of 1 of the residents was looked at. It was detailed and gave the staff enough information to know how to care for the resident. The staff on each unit looked at whether or not there was any risk in relation to the residents developing pressure sores and also if they were at risk due to problems with their diet and fluid intake. These are called risk assessments. They also assessed if it was safe to use bed rails and looked at any other general safety risks. Risk assessments were in place for whether a resident was at risk of falling. They also looked at and they wrote down, how any resident was to be assisted with being moved around and by how many members of staff and what equipment, if any, was to be used to assist in safe moving and handling. From the care plans inspected it was evident that the residents were weighed at least on a monthly basis and any weight loss identified and acted upon. Equipment necessary for the prevention and treatment of pressure sores was readily available within the home In answer to the questions on the Have Your Say Questionnaire Do you receive the care and support you need? 8 said always and 1 said usually. A relative made the following comment in the survey comment cards: Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 13 I have had complete peace of mind over the wonderful care my dear husband has been receiving at what must be the best home in this country. I cant thank everyone in the home enough for such tender care to give comfort to every patient. Every member of the staff is always cheerful Another relative made the following comment: Nothing is too much trouble. A relative told the Inspector: The staff are very good at contacting the Doctor when there are problems” The medicines on Evans Unit were not inspected on this visit. The medications on Pilling Unit were securely stored in a locked room and the medicine trolley was secured to the wall when not in use. Controlled drugs were securely stored, safely administered and accurately recorded. The areas in need of putting right were as follows: • 1 of the residents was prescribed her medicine 3 times a day but was not receiving the midday dose. • Another resident was prescribed a painkiller 1 or 2 tablets 4 times a day. This resident was not receiving them 4 times a day and staff told the Inspector that she did not need them 4 times a day. If the resident does not need the tablets as prescribed then staff must refer it back to the residents’ GP for a change in prescription. • 1 resident had been given his medicines on one specific evening but they had not been signed for. Evans and Pilling Units The residents on both units looked clean and well cared for. They were all suitably and appropriately dressed. Staff spoke to them in a very respectful way. It was a noted that on Pilling unit a bathroom and a toilet had no locks on the doors. The manager told the Inspector that was this would be seen to by the following Monday. Gerard unit Gerard unit provides care and accommodation to residents who require EMI nursing care. The care records of 3 residents were inspected on this occasion. On the whole these records were well organised and identified the care and support residents required to meet their needs including their mental health. Care plans that were in place addressed the health, personal and social care needs of residents and were generally evaluated at least monthly – although some were inspected that had not been formally evaluated since the 20th of January 2007. It is recommended that care plans be formally evaluated at least monthly. One residents care file contained a care plan for wound care that had not been formally evaluated for some time and their wound assessment chart needed to be brought up to date – it was evident that this person’s dressings had been changed the day before this inspection but this was not reflected in the care plan, wound risk assessment or daily statements. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 14 Whilst it is acknowledged this resident’s needs in this area appear to be being met this must be reflected in their care records. Risk assessments, that seek to protect resident’s health and safety were recorded in respect of residents skin integrity, mobility, and nutrition (including weight monitoring) and other relevant areas and were also in the main evaluated at least monthly. However a number of risk assessment evaluations had not been formally evaluated since the 20th of January 2007. Written daily statements were made in respect of each resident. However these were not always timed – it is recommended they be so. All residents are registered with a local GP and it was evident that all were enabled to access optical, chiropody, dental, and other specialist services as they required – such as those provided by psychiatrists and community psychiatric nurses. The inspector was informed that all medical consultations/examinations take place in the privacy of the resident’s own bedroom. A local pharmacy provides a full pharmaceutical service to the home that includes professional advice on medicines. The arrangements for the receipt, recording, storage, handling, administration and disposal of resident’s medicines were appropriate. The nurses manage all aspects of resident’s medication on Gerard unit. Medication administration records had been completed appropriately. The register for controlled drugs and the arrangements to store controlled drugs were not inspected as these are managed on another unit within the home. The 14 residents who were living on Gerard unit at the time of my visit appeared to be well cared for, were well groomed and appeared to be content in their environment during this unannounced visit to the unit. None of the residents were able to express a view about their care on Gerard unit (due to their medical conditions). and unfortunately the inspector did not see any visitors to Gerard unit during his time at the home. However it is acknowledged that comment cards have been received by the CSCI from relatives (and residents living on other units of the home) that speak positively about the care and support provided by the staff at the home. During the inspection of Gerard unit staff were observed supporting and caring for their resident’s appropriately and sensitively and sought to protect their privacy and dignity as much as possible. The inspector’s individual discussions with the staff on Gerard unit at the time of inspection revealed they were all aware of the importance of maintaining residents privacy and dignity (particularly so with the highly vulnerable residents who reside on Gerard unit). Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15. Quality in this outcome area is adequate. The home enables the residents to have as much choice and enjoyment as possible, both with the meals and the activities that are available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents’ routines of daily living and their social interests were recorded in their care plans. Throughout the day the Inspector saw that on both Pilling and Evans units the residents were able to spend their day wherever they wished to. An activities co-ordinator is employed by the home on a part-time basis. A programme of activities, events, and outings was prominently displayed in the reception area. It was unclear however, what structured relevant activities are provided for residents on Gerard unit. This needs to be addressed. In answer to the questions on the Have Your Say Questionnaire Are there activities arranged by the home that you can take part in? 3 residents said always 3 said usually and 3 stated that it was not applicable as they or their relative were unable to take part. 1 relative commented: I have seen my mother taking part in making Christmas cards or birthday cards. Also helping to make cakes and many other activities which she is capable of. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 16 Another relative commented: They had a good time with a Halloween party. Excellent food and good music provided, every member of staff was dressed up. It was fun. Theres always a million and one things to do or something going on. Residents are encouraged to bring personal possessions into the home. Many of their bedrooms were personalised with small pieces of their own furniture, pictures, photographs and ornaments etc. Residents told the Inspectors that they are able to have visitors at any reasonable time and they can see their visitors in private. The visiting policy is described in the useful and informative Service User Guide. One relative commented: When I walk in the home there is always a lovely atmosphere and I am always made welcome. The Inspectors did not eat with the residents but watched what the residents on Evans and Gerard units were having for lunch. The lunch was served from a heated trolley and the Inspectors were told that the residents were asked the day before what they would like to have. Their choice was written down on a list that the staff were following. The main meal is served at lunchtime and the lighter meal in the evening. Three meals a day are provided plus supper. On the day of inspection lunch was either quiche with vegetables or sandwiches. On Evans unit soup was not being served. When the manager questioned the cook as to why no soup was being served the reply was that nobody had requested it. Seven of the residents had a liquidised diet. The serving dishes in the hot trolley were labelled meat and vegetables. Staff were unsure as to what the meat actually was. For sweet it was sponge pudding and custard. The menu for the evening meal was fish and chips or pudding and chips. The menus that the inspectors looked at did not reflect what was actually being served. The menus also showed that the main meal was served at lunchtime. That was not the case. Staff were very patient and took their time when they were helping the residents who needed assistance to eat their meals. In answer to the questions on the Have Your Say Questionnaire in reference to the question of: Do you like the meals at the home? 4 answered Always, 4 Usually and 1 did not answer. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. The complaint system in place enables residents to feel that their views are listened to and acted upon. Staff have a good knowledge and understanding of what abuse is, thereby reducing the possible risk of harm or abuse to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A detailed complaints procedure was in place and was displayed in the reception area. The complaints procedure was also included in the Service User Guide A record is kept of any complaint made and includes details of the investigation and any action taken. In answer to the questions on the Have Your Say Questionnaire the following comments were made. 1.Do you know how to make a complaint? 5 said always, 2 said never but the Inspector is not sure if this means never had to make a complaint. One comment was that there was no need to complain. Another was: There is never any single thing to complain about. 2.Do you know who to speak to if you are not happy? 5 said always and 4 said usually. No complaints have been made to the home or to CSCI since the last inspection of January 2007. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 18 A policy and procedure was in place in relation to the detection of abuse and neglect (including whistle-blowing) and how to respond to suspected abuse. The home had a copy of the Local Authorities procedure for protection of vulnerable adults. A discussion with care staff showed that they were aware of the different forms of abuse and the procedure to follow in the event of any allegation of abuse. Training records were inspected and showed that not all staff had received training in abuse awareness. The Inspector was informed that this is an ongoing process and that training sessions have been planned for the future. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 24 25 & 26. Quality in this outcome area is adequate The residents live in clean and comfortable surroundings that are gradually being improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspectors visited each unit, walked around most of the building and looked at several bedrooms, the lounges, the dining rooms, bathrooms and toilets. The ground floor corridors had been repainted. They looked bright and clean. Evans Unit There is a large lounge/dining area that overlooks the main road. This room had been stripped of old wallpaper and paint and was about to be redecorated. The painters and decorators were painting whilst the Inspectors were in the home. New dining and lounge furniture had been provided. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 20 The toilet opposite the nurse station had been redecorated. There was a lock on the outer door and a privacy curtain in place. The water supply was now adequate. The bathroom with the unassisted bath had no call bell lead to the toilet. The paintwork in this bathroom remained badly marked. It was also not identified as a toilet. There were also several toilets that were not identified as such. Wash hand basins had been installed in at least 3 of the toilets that are situated in the alcoves off the corridors. Staff and resident hand washing facilities, such as liquid soap and paper towels had not been put in place i some of them.. Most of the toilets and bathrooms did not have any clinical waste bins in place. Most of the bedrooms were decorated to a good standard. They remained without an overriding door lock. The carpet in bedroom to 219 was uneven and was therefore a trip hazard. Pilling Unit The Inspector that was told that major building work is to begin on this unit is within the next few weeks. This will improve the amount of living space for the residents. The unit has a combined lounge and dining room and a smaller lounge area. These were clean, warm and comfortably furnished. The assisted bathroom had no call bell lead to the toilet and there was no lock on the door. Another toilet also had no lock on the door. Most of the bedrooms were decorated to a good standard. In answer to the questions on the Have Your Say Questionnaire the following comments were made Is the home fresh and clean? 7 replied always.1 usually 1 no answer. Comments made were: Everywhere is spotlessly clean. Also lovely decorations, flower pots on each table. Every comfort. Another comment was: Like all homes, it stinks. It is clean and tidy but the smell of urine is dreadful. Gerard unit is situated on the middle floor of the home and was clean, warm and appropriately ventilated at the time of inspection. Malodours were being well managed at the time of inspection. The main lounge/dining area has been re-painted since the last inspection. New armchairs and dining furniture had been provided. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 21 The manager informed the inspector that a programme to refurbish the communal areas (including the corridors) of the unit was due to start shortly after this inspection. Such a refurbishment can only significantly improve the environment and comfort of the residents who live on Gerard unit. Bathrooms and toilet areas were clean, appropriately equipped (including liquid soap and disposable hand towels to prevent the spread of infection). However not all the privacy locks fitted to the doors to these areas were working properly. This requires to be addressed. The manager informed the inspector that it is proposed to change an existing (unassisted) bathroom on the unit into a shower room. 10 residents bedrooms were inspected. These were clean, centrally heated (the manager informed the inspector that all radiators on Gerard unit had now been guarded to minimise the risk of burning) and appropriately furnished. It was evident that an ongoing programme of redecoration was being operated in respect of resident’s bedrooms. A number of bedrooms inspected were very personalised. The home was adequately heated. All the rooms were centrally heated with radiators in place that were suitably protected to prevent any accidental burning. The previous problem with hot water pressures was being addressed. Up to now, 10 thermostatic control valves had been installed to the taps in several areas. Hand washing facilities were not in place in all bathrooms and toilets. To prevent infection they must be in place. Disposable gloves and disposable coloured aprons were provided for staff use. The laundry area was clean, well equipped and looked well organised. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 29 & 30. Quality in this outcome area is adequate. The residents’ needs are being met although the staffing levels provided are the minimum. The staff are safely recruited, suitably experienced and trained, and in the main, have the knowledge and skills to meet the residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evans Unit Examination of the duty rotas, observation by the Inspector and a discussion with staff and residents showed that the unit, at times was working with the minimum amount of staff The Inspector did not look at the documented needs of all of the residents who were sat in the lounge but it was clear that they were highly dependent. There were 18 residents on this unit, the majority requiring 2-1 care. Once again staff told the Inspector that it was during the morning and meal times that they felt the most pressure. This nursing unit was working with 1 qualified nurse and 3 care assistants between the hours of 8 a.m. to 8pm. Management are reminded of their responsibility to ensure that staffing is provided in accordance with residents’ needs and not the number of residents. Pilling Unit There were 11 residents on this unit. The unit was working with 2 care assistants throughout the day and night. Staff said that they felt there was enough staff on duty for this number but as the number of residents increases they may struggle to meet their needs. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 23 The staff on both units were seen to have a natural and comfortable understanding with the residents and they found time to sit and talk with them. Gerard Unit Inspection of staffing rotas and discussion with the manager and staff revealed that at the time of inspection 14 residents occupied Gerard unit. The provision of staff was – 1 qualified nurse and 3 carers from 8am until 2pm, 1 qualified nurse and 2 carers from 2pm until 8pm and 1 qualified nurse and 1 carer from 8pm until 8am. The inspector is of the view that the home needs to review the provision of staff in relation to the dependency levels of residents on Gerard unit – particularly during the night to ensure residents are being observed appropriately. In answer to the questions on the Have Your Say Questionnaire and the relative comment card the following comments were made: Are the staff available when you need them? 6 replied always and 1replied sometimes. The personnel files of 3 staff members were inspected. All were in order and these staff had been properly and safely employed. They had a completed application form, 2 professional references, an enhanced criminal records disclosure (CRB) or POVA 1st check and a health status declaration. A wide range of appropriate and ongoing training in moving and handling, protection of vulnerable adults, basic food hygiene, fire safety and other relevant topics is provided to staff at the home. Although it is noted that some training needs to be extended to cover all staff, a programme of training has been developed to achieve this. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38. Quality in this outcome area is adequate. Some current practices do not promote and safeguard the health, safety and welfare of the people using the service This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes’ manager is a Registered General Nurse and a Registered Mental Nurse. She is in the process of being registered with the Commission for Social Care Inspection. She is a very experienced nurse who has spent 14 years in the private sector, 2 of these at Ashton View. She keeps herself clinically updated on a regular basis. She has also achieved the Registered Managers Award. The manager is skilled at caring for the residents, and both residents and staff spoke positively about her attitude and kindness. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 25 The Manager has to do a monthly check of lots of things in the home. She has to check to make sure that there are no hazards around the building and also check the records about care, medicines and any accidents that have happened. Every 6 months management send out comment cards to residents and relatives asking what they think of the quality of the care and the facilities. The comments are received by the company’s’ head office and then shared with the home. In this way the home can take steps to put into practice what has been said about what could be improved. The system for the safekeeping of residents’ finances was good. The management of residents’ finances are generally undertaken by their families or designated representative. Generally only personal allowances are held by the home in a residents’ account. Individual computer records are made of all transactions and balances. Receipts are held for any purchases made and receipts are given to relatives when they deposit any “spending money” for their relative. The home had a detailed Health & Safety Policy. Regular weekly checking and testing of fire detection system, fire exits and emergency lights was undertaken and documented. Any accidents that happen are properly recorded and monitored. There remain some issues in relation to infection control. Staff/resident hand washing facilities need to be in place in all resident areas and clinical waste bins must be provided in toilets and bathrooms. Information obtained from the pre-inspection questionnaire and from random checking of servicing records showed that the homes fixtures, fitting and equipment are properly maintained and regularly serviced. The Inspector also checked the 5year electrical inspection certificate as this had been a previous requirement. This had been done but the comments were that “the installation is generally in a poor standard due to lack of maintenance. The lighting fittings in a number of areas are a fire risk and require urgent attention. A number of lighting circuits require rewiring due to excessive cable lengths and loadings”. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 26 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 2 x x 2 3 2 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(1) Requirement Staff must make sure that care plans are in place for any identified need, give clear guidance on every aspect of care and are up to date. (This was a previous requirement following the inspection of the 4/01/07) Staff must continually look at the changing needs of the residents and review the care plan at least on a monthly basis. Residents must be given their medicine as it has been prescribed. If staff have any concerns or have evidence to show that a certain medicine is not required they must contact the GP. Staff must not change a prescription.. To protect the privacy and dignity of the residents, safety locks must be fitted to the toilet doors identified as being without or not working, on Pilling and Gerard Units Residents must be provided with a varied and nutritious diet. Management must check the DS0000005669.V314845.R01.S.doc Timescale for action 30/04/07 2. OP7 15(1) 30/04/07 3. OP9 13(2) 09/03/07 4 OP10 12(a) & 23(1)(a) 16/03/07 5. OP15 16(2)(i) 30/04/07 Ashton View Nursing Home Version 5.2 Page 28 6. OP21 7 OP24 8 OP24 9. OP21 10 OP21 11 OP27 content and choice of the food provided, particularly any special diets. 13(4)(a) Management must make sure that residents are protected from avoidable risks to their health and safety. Call bells must be fitted in the 2 toilets identified in this report as being without one. A refurbishment plan must be forwarded to the CSCI by the documented date. 12(a) & Over riding locks must be fitted 23(1)(a) to bedroom doors and the residents provided with a key unless their risk assessment indicates otherwise. A refurbishment plan must be forwarded to the CSCI by the documented date. (This was a previous requirement following the inspection of the 30/08/06 & 06/09/06 13(4)(a) To ensure the safety of residents & 16(2)(c) and staff the carpet in bedroom 219 must be replaced. An improvement plan must be forwarded to the CSCI by the documented date 13(3) To prevent and control cross infection, the provision of washbasins in every toilet must continue. Clinical waste bins must also be provided. An improvement plan must be forwarded to the CSCI by the documented date 13(3) To prevent and control cross infection, staff and resident hand washing facilities must be provided in all toilets and bath/shower rooms. 18(1)(a) The adequacy of the daytime staffing must be continually kept under review to ensure that sufficient staff are provided to meet all of the care needs of the DS0000005669.V314845.R01.S.doc 10/05/07 10/05/07 10/05/07 10/05/07 10/05/07 09/03/07 Ashton View Nursing Home Version 5.2 Page 29 12 OP38 13(4)(a) residents. To ensure the safety of residents, staff and visitors the requirements identified in the electrical periodic inspection report of November 2006 must be complied with. Details of how this will be achieved must be included in the improvement plan. 10/05/07 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 OP7 OP12 Good Practice Recommendations Staff should make sure that daily statements about the care and condition of the residents is always dated, timed and signed Management need to look at reviewing the activities that are provided for the residents on Gerard Unit to check that they are available and suitable for their needs. Ashton View Nursing Home DS0000005669.V314845.R01.S.doc Version 5.2 Page 30 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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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