Inspection on 21/06/05 for Ashtonleigh

This inspection was carried out on 21st June 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.

Other inspections for this house

Ashtonleigh 22/05/06

Ashtonleigh 25/10/05

Ashtonleigh 11/11/04

Ashtonleigh 17/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Ashtonleigh 4 Wimblehurst Road Horsham West Sussex RH12 2ED Lead Inspector Helen Tomlinson Announced Tuesday, 21 June 2005, 08.30am, V221766 st 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. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Ashtonleigh Address 4 Wimblehurst Road, Horsham, West Sussex, RH12 2ED 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) 01403 259217 Ashtonleigh Residential Care Home Limited Miss Nicola Purtill Care Home 30 Category(ies) of Old age, nota falling within any other category registration, with number (OP) 30 of places Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11th November 2004 Brief Description of the Service: Ashtonleigh is a care home registered to provide personal care for up to thirty older people. The home is converted large detached house on the outskirts of the town of Horsham. It has large gardens to the rear and a parking area to the front and side. It is in a residential area of the town. The accommodation is provided in twenty single rooms and four double rooms. Eighteen of the bedrooms have en-suite facilities. These are on two floors of the property with the upper floor being serviced by a passenger lift. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection began at 9am and the inspector left the home at 4.30pm. The registered manager, Mrs Purtill, was present throughout the inspection. There were twenty four residents accommodated in the home at the time. Ten residents and two visitors were spoken with. The care plans of three residents were examined in detail. The staff were observed and spoken with. Records and documents were examined as was necessary. A tour of the building took place. Prior to the inspection nine comment cards were received from relatives/visitors and seven from residents. What the service does well: Residents and visitors commented that the staff were friendly, helpful and kind. They described them as always willing to help and not seeming to be rushed. Staff were seen to be polite but relaxed with the residents and chatted easily about day to day events. The home was clean and tidy with homely fixtures and fittings. It was well maintained with clean and bright decoration appropriate to the residents. They commented favourably on their bedrooms and communal areas and were happy with the homely atmosphere of the home. Residents praised the quality, quantity and variation of food served. They said they enjoyed their meals and mealtimes were a social occasion within the day. Staff had received training which was relevant to the work they were doing and praised the amount of training offered in the home. They said they had a good relationship with the registered manager, who was very supportive and approachable. Staff were encouraged and supported to progress within care work if they so wished. Several residents commented to the inspector that though this was an announced inspection nothing had been specially prepared for the benefit of the day. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 6 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 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 Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 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 Residents have their needs assessed before they become accommodated in the home. EVIDENCE: The three residents, whose files were examined, had had their needs assessed, by a member of staff from the home, before they became accommodated. This assessments covered all the areas of their daily life and had a scale to assess the level of their dependency on staff to meet their needs. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 9 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 All residents had a care plan. In some instances the information was thorough, however they were not always up to date. Health assessments were present on the files seen. These had not always been updated to reflect a change in the resident’s condition. Changes to a resident’s condition had often been noted and not followed up. Some practices around the storage and recording of medication could potentially put the resident at risk. The staff treated the residents with dignity and respect and protected their privacy. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 10 EVIDENCE: Three of the resident’s care plans were examined in detail. These had some thorough information about the resident’s needs and how these should be met. In some instances when a change of care had occurred the care plans had not been updated e.g. the removal of a catheter for 1 resident. Health assessments for the risk of pressure sores, mobility and nutrition were present. These were not reviewed regularly and so did not always reflect the current situation. For two residents the nutritional risk assessment had not been reviewed since July 2004 and August 2004 despite weight loss. For another the mobility assessment had last been reviewed in October 2004. The pressure sore risk assessment did not include the pressure relieving equipment to be used although various types of mattress and cushion were seen in use. This should be documented. The mobility risk assessments did include the number of staff and equipment required for each resident. The registered manager stated that moving and handling equipment was provided on a one to one basis, this included belts, slings and slide sheets. The progress notes for the residents were not written on a daily basis. The registered manager stated this used to be done, but this practice had changed. For several residents there were changes in their condition noted with no follow up. For one resident there was an entry of “sores to both heel bones” on the 1/9/04 and the next entry was made on the 7/9/04 with no mention of the previous entry. For another it was written “not feeling well” on 17/5/05 and the next entry was 23/5/05. It was discussed that this could lead to health issues not being appropriately dealt with and a possible delay in seeking medical assistance. The use of these notes must be reviewed. Staff spoken with had a clear understanding of the healthcare needs of the residents. They said this came from the verbal communication between staff in the home. They were able to discuss the individual risks associated with the care of particular residents in the home. The registered manager said there was a good relationship with the visiting G.P.s and district nurses. The district nurses were attending to the needs of one resident. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 11 A senior care assistant had the responsibility for the management of the medicines in the home. This person had received training for this purpose. Medication was safely stored in the home. The position of the storage area resulted in the cupboard being hot on the inspection day. The temperature of this room was not monitored and it was advised this be done. Medication was given out from a trolley. This was safely stored. Examination of the medication administration sheets showed that in most instances these were correctly completed. For one resident a change in medication dosage, made by the doctor, was written in a very confusing manner on the administration sheet. This could have easily led to the incorrect dosage being given. For residents who held their own medications which included creams and inhalers, there was no risk assessment. This must be done. There was excessive stock of a controlled drug on the premises. The storage and records for this met with current guidance, but the registered manager was advised to arrange with the pharmacist to have the excess stock removed from the home. The residents spoken with said the staff treated them kindly, with respect and protected their dignity and privacy. Male residents spoke of being assisted by a male member of staff if they asked. Other residents said the staff asked them and assisted them in the way they wanted. Staff were seen to knock on bedroom doors, address residents in a friendly but respectful manner and assist and support in a polite and dignified manner. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 12 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 The residents were satisfied with the daily life of the home and the activities which took place. The food was nutritious and appealingly served with a variety and choice which suited the residents. It was served in a pleasant environment. EVIDENCE: On the day of the inspection residents were seen to be joining in with group activities or taking part in their own private interests. Residents had televisions, radios, telephones, books and magazines in their rooms. Daily newspapers were delivered if they wished. Some residents were playing board games, with staff, in the lounge. Residents sat outside to enjoy the sunshine and the gardens if they wished. Residents spoken with said the level of organised activity was sufficient and they chose to join in or not as they wished. Some residents said they would like to go out of the home more to go shopping, eat out and attend community events. They said they were reliant on family members for this. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 13 The staff were aware of the social background, interests and cultural needs of the residents. They said this was through informal discussion with the residents and their relatives. It was discussed that, if the residents agreed, to have a written social history may help new staff to understand the personality of the residents more easily. The food served was nutritious, well cooked and nicely presented. The residents spoke highly of the food saying they had a good choice at all meal times, with plenty of food served and a good variety. None of the residents asked before lunch knew what the meal was that day, but they did not mind this as the cook knew their individual likes and dislikes and did not offer them a meal they would not enjoy. Hot and cold drinks and snacks were served during the day. These were offered and presented in a dignified manner with saucers used and individuals offered a choice of biscuits. Where residents needed assistance with food and drink this was given discreetly and calmly. The dining room was nicely set, with plenty of space and gave a pleasant environment for the mealtime, which was also a social event. The meals were served in two sittings in an unhurried manner. Residents could eat in their bedrooms if they preferred. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 14 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 and 18 Complaints were acted upon appropriately. Appropriate measures had been taken to safeguard residents from abuse. EVIDENCE: Two complaints had been received at the home since the last inspection. These had been recorded and the outcomes were appropriate. The written complaints procedure was on display in the entrance hall of the home and present in the service user guide which was in each bedroom. Residents spoken with said they would approach the manager or any member of staff should they be dissatisfied with any aspect of care in the home. Since the last inspection two allegations of abuse had been made against staff at the home. These had been fully investigated and resolved at the time of this inspection. The registered manager had amended the procedures within the home, as a result of learning from these incidents. All staff had received training regarding the protection of vulnerable adults and had discussed the procedures at a recent staff meeting. Further training was planned in the near future. Staff were aware of the procedures to follow and their responsibilities to safeguard the residents. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 15 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 and 26 Residents live in a pleasant and well maintained environment. Some areas and practices in the home could present a risk to residents and staff. The home was clean, tidy and pleasant. EVIDENCE: The general environment was homely with domestic fixtures, fittings and furnishings. Foot stools, cushions, side tables and general household paraphernalia gave a comfortable environment to the home. Residents had personal items in their rooms and pictures and photographs were present. Residents commented favourably on the decoration of the home saying it was light and pleasant. Generally the home was well maintained. The carpet on the stairs was beginning to show signs of wear this must be monitored and not allowed to become a hazard to staff or residents. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 16 Staff had received training in fire prevention. They could talk through the procedure correctly. Fire fighting equipment was present and fire exits were clear. Wedges were in place to keep bedroom doors open. It was discussed that these must not be used and alternative means of holding these doors open, which meets with the guidance of the fire service, must be used. The laundry for the home is sited in the cellar. The door to this opens directly onto a flight of steep stone steps. This door was closed but not locked. A bolt was present at the top of the door, which was not in use, and a digital keypad was also present, though this was not in working order. It was discussed with the manager that this door must be made secure against residents being able to open it. The steps to the cellar had a linoleum covering which was torn and loose in some places. This presented a trip hazard to staff and must be replaced or repaired. The home was clean and tidy during the inspection. The general areas and all but one bedroom were free from offensive odour. The registered manager was aware of this problem and the carpet was cleaned that day, with alternative cleaning solutions being explored. Domestic staff were employed in sufficient number to keep the home clean. Staff were aware of infection control measures and wore gloves and plastic aprons as necessary. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 17 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 and 29 The staff numbers and skills were sufficient to meet the needs of the residents. The recruitment procedures were not adequate to ensure protection for the vulnerable adults in the home. EVIDENCE: The duty rota for week commencing 20th June 2005 was examined. This showed three care staff were on duty from 8am to 8pm. The manager had sufficient hours to carry out her management duties and provided an on-call service for the care staff, when she was not present in the home. There were suffiecient seniour care staff. Recruitment and promotion to become a senior carer was based on the abilities of the staff member and an assessment of their suitability for the post took place. There were sufficient domestic and cleaning staff, during the day, to meet the needs of the residents. Care staff with appropriate qualifications were responsible for the serving of the evening meal. This had been prepared by the cook earlier in the day. It was discussed with the manager and staff that this must be kept under review in line with the dependency needs of the residents. Staff said that currently this worked well with no resulting shortage of staff to assist the residents. A kitchen assistant was present at this time. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 18 Two staff files were examined. These did not have the necessary checks in place to ensure the person was fit to work with vulnerable adults. Discussions with the manager revealed that six staff were working in the home without these checks having been carried out. The manager was required to ensure these staff worked under the constant supervision of an appropriate staff member until satisfactory checks had been obtained. These checks must be applied for immediately. The registered person was contacted, in writing, separately about this matter. For one of these staff members the references from overseas had not been checked and verified. For both the application forms did not contain a full employment history and for one there was no verification of a work permit. It was discussed with the manager that the recruitment of staff, from overseas, through an agency made it more difficult for her to be fully involved in the recruitment process. She was reminded of her responsibilities and accountability regarding the recruitment of staff and advised to review the current procedures in place. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 19 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) 38 The majority of safety checks and procedures were in place to protect the welfare of residents and staff. EVIDENCE: All staff had received moving and handling training. Equipment necessary for the residents accommodated was present in the home in full working order. Bath hoists, hoists, turntables and slide sheets were present. The recommendation from the last Environmental Health Officer’s report had been met. Staff who work in the kitchen had completed food hygiene training. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 20 A part was on order for the central heating system. The manager stated a service of this was overdue and would take place when the part was obtained. The system was in full working order. The testing of portable electric appliances was booked for July 2005. The sluice had been serviced. Training for staff in health and safety had been booked. An accident book was kept. This did not meet the current guidance and the manager was advised to obtain a book which did. Regular health and safety checks of the premises would have picked up the issues noted under standard 19 regarding the cellar door, steps the worn carpet and the use of wedges under fire doors. Regular checks of the premises should take place, in line with the health and safety risk assessment of the home. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 2 Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 22 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. 2. Standard 7 and 8 8 Regulation 15(2)(b) 14(2) Requirement Residents care plans must be kept under review. Changes to residents needs must be fully assessed and met. Changes to their condition must be monitored. Changes to medication must be clearly documented. Excessive stock of medication must not be kept. Risk assessments must be completed for those residents who wish to administer their own medication. Wedges must not be used to prop fire doors open. Residents must not have access to the cellar. The floor covering on the cellar steps must be made safe. All staff must be recruited so as to ensure they are fit to work with vulnerable adults. Timescale for action 31/7/05 31/7/05 3. 9 13(2) 30/6/05 4. 9 13(4)(c ) 31/7/05 5. 6. 19 19 23(4)(c )(i) 13(4)(a) 30/6/05 11/7/05 7. 29 19 and schedule 2 30/6/05 Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 23 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. Refer to Standard 19 29 38 38 Good Practice Recommendations The carpet on the stairs should be monitored for wear and must not become a hazard to staff or residents. The registered manager should be fully involved in the recruitment of staff for the home. A health and safety check of the premises should take place on a regular basis. The accident book should meet the data protection guidance. Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY 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 Ashtonleigh H60 H11 S14377 Ashtonleigh V221766 030605 Stage 4.doc Version 1.20 Page 25 - 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. 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