CARE HOMES FOR OLDER PEOPLE
Ashtonleigh 4 Wimblehurst Road Horsham West Sussex RH12 2ED Lead Inspector
Miss Helen Tomlinson Unannounced Inspection 25th October 2005 2.30pm 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 Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ashtonleigh Address 4 Wimblehurst Road Horsham West Sussex RH12 2ED 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) 01403 259217 Ashtonleigh Residential Care Home Limited Miss Nicola Purtill Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st June 2005 Brief Description of the Service: Ashtonleigh is a care home registered to provide personal care for up to thirty older people. The home is a converted large detached house on the outskirts of the town of Horsham. It has large enclosed gardens to the rear and a parking area at 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 DS0000014377.V260694.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place at in the afternoon and evening. The registered manager was on holiday at the time of the inspection, but the owner of the home was present. The inspector spoke with ten residents, four members of staff and two visitors. The plans of care for four residents were read and other records examined as necessary, including medication charts and recruitment files. Staff were observed assisting and supporting the residents. A tour of the building took place. What the service does well: What has improved since the last inspection?
Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 6 Following the last inspection seven requirements and four recommendations were made. At this inspection 5 of the requirements had been met. It was not possible to assess all the recommendations without the registered manager being present. The plans of care seen had been regularly reviewed and were up to date. The health assessments had been reviewed and any change in care had been recorded on the care plan. There was one exception to this seen and the person in charge stated this was a recent change in the resident’s care and the difference it made to all paperwork kept had been overlooked. The progress notes for the residents were now being completed daily in order to make sure any issues or concerns were followed up. A new record had been created to be used at the handover between staff. This meant that any change to a resident’s condition or care was recorded on a separate sheet and used to help staff quickly make themselves up to date following time off and at any shift change. A check on the stocks of medication held at the home had been completed. Excess stock had been returned to the pharmacist. The drug cupboard and trolley were tidy with only medication in current use kept. A new system for the disposal of waste medication had been identified and appropriate records were kept. A risk assessment had been completed for all residents who administered their own medication. Staff had more clearly completed the medication charts and the appropriate codes were being used for medication not given as prescribed. The digital lock on the door at the top of the cellar steps had been mended and was in working order. Despite this the door was not properly closed and so the lock was not in use. The risk these steps present, unless the door is closed and locked to residents, was brought to the attention of the person in charge. The ripped linoleum on the cellar steps had been replaced and no longer constituted a trip hazard. A new accident book had been purchased, since the last inspection. This met with the data protection act. What they could do better:
The staff files examined showed that staff were starting work at the home without all the necessary checks, to make sure they were fit to work with vulnerable adults, being completed. This was discussed with the manager at the last inspection and a requirement made that this practice did not continue. This requirement remains unmet. Most of the fire doors were closed. Later in the afternoon, when some residents returned to their own bedrooms and wished to have their doors open, they were wedged in the open position. It was discussed with the owner of the home that an alternative method of holding bedroom doors open, which meets with the guidance of the fire service, must be used. The accident book showed a high number of falls for some residents. There was no specific risk assessment carried out to identify the possible causes and any action required to reduce the risk. These should be done.
Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 7 If a resident receives an injury as the result of a fall or other accident it was not clear that appropriate medical advice, either doctor or district nurse, had been sought. Whilst staff at the home would be expected to administer first aid, no other medical help should be given by them. If residents suffer a head injury appropriate medical advice must be sought. Clinical waste bins, with appropriate bags, should be available in all areas where this waste may be disposed of. 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. Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 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 Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed at this inspection. Standard 3 was met at the last inspection. Standard 6 does not apply to Ashtonleigh. EVIDENCE: Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9. Residents had a plan of care which was regularly reviewed and up to date. Health needs were assessed and these were up to date. Staff had improved the practices for the storage, administration and recording of medication since the last inspeciotn. This was safe for the residents in the home. EVIDENCE: Four resident’s files were examined. These contained plans of care which recorded appropriate information for staff to know how the person wished and needed to be cared for. The information in these plans and the assessments had been reviewed, at least monthly, and was up to date. This was an improvement on the records seen at the last inspection, some of which had not been fully kept up to date. For one resident a change in their needs for moving and handling had been recorded in the daily notes only with no change to the moving and handling assessment or care plan. In all other resident’s files the health assessments and care plans had corresponding information recorded. For one resident who had been admitted in the last four days there was an assessment of need which detailed their abilities and the support needed. A full plan of care had not yet been completed for this resident, however the information present was sufficient to offer appropriate assistance, until such
Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 11 time as the their needs were more fully understood and a detailed plan of care completed. There were no specific risk assessments on file. The accident book did show repeated falls for several residents, due to their condition. The person in charge discussed the actions taken to try and prevent these falls. He said the manager did look at the accident book to see if any resident was having many falls and if so to devise a plan to reduce these. A specific risk assessment for falls should be done to make sure all possible steps are taken to reduce the risks. An assessment of the risk of developing a pressure sore was carried out. The plan for the reduction of this risk included the equipment to be used. Pressure relieving mattresses and cushions were in use. At the last inspection some concerns regarding the storage of excessive medication were raised. At this inspection all medication was safely stored and no excess was in the home. The drug cupboard and the trolley were tidy with only medication currently prescribed being present. The temperature of the drug room was being monitored and recorded. At the last inspection this had been advised. The medication administration record charts had been accurately completed with the appropriate codes being used should any medication not be given as prescribed. A new method for disposing of waste medication had been put into place. This met with new guidance. Risk assessments for residents wishing to administer their own medication had been devised since the last inspection. These covered all necessary areas and had been reviewed monthly. It was discussed with the person in charge that all medication which was hand written onto the charts should be witnessed by a second member of staff and both staff should sign the sheet. A discussion took place regarding homely remedies and advice was given. The senior care staff in charge of medication in the home was due to undergo up dated training. The storage and recording of medication in the home was greatly improved since the last inspection. Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 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 the following standard(s): 13 and 14 Residents were encouraged and assisted to maintain contact with their relatives and friends. Residents said they could make choices about their lives in the home. EVIDENCE: Residents said their relatives and friends could visit at any reasonable time. They could see them in the lounge or the privacy of their own rooms, whichever they chose. At the time of the inspection there were several visitors in the home. They said they were always welcomed warmly, staff were “very friendly and kind” and they could be a part of the care of their relatives if they wished. They said they were assisted to take their relative home for visits, stay at the care home for meals or entertainment and felt as involved in the life of the home as they wished. Staff knew about the relatives and important people in the lives of the residents. They spoke with the residents about their past lives, likes and dislikes and other personal information which showed how well they knew the residents in their care. The residents had a church service at the home on a monthly basis, which they said they enjoyed. Residents spoken with said they were asked about their choices in how they wished to live their lives. They could chose what time to get up and go to bed, where to eat their meals and their likes and dislikes of food were understood and respected. They said they could chose how to be assisted and were encouraged to be independent when they were able. Staff said that although
Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 13 the routines of the residents were known and understood they were not rigid as “the routines of the residents may change, just like ours do.” Some of the resident’s choices were recorded on the plans of care. A notice regarding the local advocacy service was on the notice board in the home. Relatives were invited to advocate on behalf of the resident should this be needed and they agreed. Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 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 the following standard(s): NONE Standards 16 and 18 were met at the last inspection. EVIDENCE: Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 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 the following standard(s): 19,20,22 and 26 Residents benefit from a home which was well maintained. Some fire doors were wedged open. Residents can access comfortable and homely indoor and outdoor communal areas. Any specialist equipment required by the residents was available. The home was clean, pleasant and free from offensive odour. EVIDENCE: The home was well maintained, tidy and homely in appearance. Since the last inspection a requirement to remove unsafe floor covering from the cellar steps had been met. The digital lock to the cellar door had been mended, but the door was not securely closed when the inspector toured the building. A notice to staff of the importance of this for the safety of the residents was in place. Staff should be reminded of the risk to residents if this door is not securely shut. A requirement was made following the last inspection, that fire doors must not be wedged open. Most of the fire doors were closed, however those of residents who wished to spend time in their rooms were wedged open. Alternative devices to safely hold the doors open should be used. The
Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 16 proprietor was advised to seek the advice of the fire service and fit appropriate safe devices. The requirement to keep all fire doors closed remains unmet. There is a large lounge in the home where many residents choose to sit. Some stay in their own bedrooms at their request. A seating area was available in the entrance hall of the home. Some residents sat on the sofa in this area, where they could see staff, visitors and other residents coming and going. A dining room is available. This is pleasantly decorated and furnished, providing a congenial setting for meals to be served. There is a large garden to the rear of the property, with a patio. Seating for residents was available on the patio area. Some residents said they liked to sit outside in the good weather and make use of the well kept gardens. All communal areas were fully accessible to the residents, nicely decorated with homely fixtures and fittings. Individual assessments, for the residents, provided information as to any specialist equipment required to fully meet their needs. This equipment was available in the home. A hoist was available for one resident and other moving and handling equipment such as belts and a turntable. Staff had received training in the correct use of this equipment. Assisted bathing facilities were present. Grab rails and handrails were present in the toilets and on corridors. The home was clean and free from offensive odours. Residents and visitors said “the home is always clean and tidy.” Staff were aware of the procedures to follow in order to prevent the spread of infection in the care home. They wore correct protective clothing when carrying out care for the residents and when serving meals and drinks. Two clinical waste bins did not have the correct waste bags in them. This resulted in staff carrying waste to another part of the home. Correct waste bags must always be present in the bins provided. Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 The number and skill mix of staff was appropriate to meet the needs of the residents. The recruitment procedures were not adequate to ensure protection for the vulnerable adults in the home. Residents benefit from staff who have received appropriate training and can meet their needs. EVIDENCE: The registered manger was on holiday at the time of this inspection. The senior carer in charge had the experience and knowledge to run the home in her absence. The residents spoke highly of the staff, saying they were “kind and considerate” and “good at their jobs.” The number of staff on duty was adequate to meet the needs of the residents living at the home. Staff on duty at this inspection had a good knowledge of the residents, their individual needs and wants and the general running of the home. At the last inspection a requirement was made regarding the recruitment of new staff in the home. All information required to make sure new staff were fit to work with vulnerable adults had not been obtained for all staff working in the home. The files of two staff, employed since the last inspection, were examined. These did not contain all the necessary information and the preemployment checks, to safeguard the residents, had not been completed prior to them working at the care home. One staff member started work in August 2005 and the Criminal Record Bureau check was dated seventh October 2005. There was no evidence that a check against the POVA register had been completed prior to them starting work. For the other staff their start date was
Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 18 thirteenth of July 2005 and the POVA and CRB were dated 20th August 2005. For one employee there were unexplained gaps in the employment record and for both only one reference. It was discussed with the proprietor that the requirement made at the previous inspection had not been met since these employees had begun work without the necessary checks in place. The proprietor confirmed that at the time of the inspection all staff working in the home had satisfactory checks completed. Staff said there were good opportunities for training in the care home. They said they were offered training from a variety of sources, including the manager of the home and external training agencies. Staff on duty had completed fire safety training, moving and handling, first aid and health and safety. Specialist training regarding specific disease areas had been completed. This included disorders of the respiratory system, pressure sores and continence. Staff had received training in the protection of vulnerable adults and those with responsibility for administering medication had received training with an up date due shortly. Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,36 and 38 The home is run in the best interests of the residents. Resident’s financial interest are safeguarded. Staff receive appropriate supervision. The health and welfare of residents is promoted. One issue of fire safety was raised. (see standard 19) EVIDENCE: Residents said they could put their ideas and points of view, on the general running of the home, to the staff, manager or proprietor. They said they were listened to and any issues they raised were acted upon. There was no formal quality assurance system in the home. The proprietor stated informal discussions with staff and residents took place frequently and these informed any changes made to the running of the home. It was discussed that a more formal and documented system of the review of services offered should be present in the home.
Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 20 Some residents have their personal monies in the safekeeping of the home. Records for these with all transactions, were kept. These were up to date and all monies were securely stored. Staff said they had opportunities to communicate with the manager on a one to one level about their progress, training needs and any other issues they may have. This occurred on a monthly basis with staff meetings every three months. The staff spoken with said they felt well supported by each other and the manager and could discuss any issues or concerns openly. Staff were aware of their responsibilities to protect the residents health and safety. Most staff had received training in this aspect of their job. At the tiem of the last inspection the central heating was due a service and the electrical goods were due to be PAT tested. The proprietor confirmed these had both been carried out. At the last inspection the accident book did not meet data protection guidance. This had been changed and met with current guidance. Some entries in the book led to a discussion, following the inspection, with the registered manager. There were records showing that wounds occurring as the result of an accident required dressings to be applied. These had been done by the registered manager and no evidence was present that the district nurses had been informed or involved in this process. There were records of head injuries with no medical intervention or advice having been sought. Appropriate medical or nursing personnel should be informed and their advice sought following an accident and injury to any resident. Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 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. 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 3 x 3 x x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 3 3 x 2 Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 22 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 OP19 Regulation 23(4)(c) (i) Requirement Wedges must not be used to prop fire doors open. This requirement remains unmet since the inspection of 21/6/05. The timescale given of 30/06/05 has expired All staff must be recruited so as the ensure they are fit to work with vulnerable adults. This requirement remains unmet since the inspection of 21/6/05. The timescale given of 30/06/05 has expired Timescale for action 30/06/05 2 OP29 19 and Schedule 2 30/06/05 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 OP8 OP26 Good Practice Recommendations A specific falls risk assessment should be completed. Clinical waste bags should be in place where all clinical waste may be collected.
DS0000014377.V260694.R01.S.doc Version 5.0 Page 23 Ashtonleigh 3 4 OP33 OP38 A more formal system for the review of quality of care in the home should be in place. Medical or nursing advice should be sought following injury as the result of an accident. Ashtonleigh DS0000014377.V260694.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Worthing LO 2nd Floor, 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 DS0000014377.V260694.R01.S.doc Version 5.0 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. 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!
