Inspection on 26/03/08 for Ashurst

This inspection was carried out on 26th March 2008.

CSCI found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashurst 25/09/08

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

CARE HOMES FOR OLDER PEOPLE Ashurst 36 - 38 Westbourne Park Scarborough North Yorkshire YO12 4AT Lead Inspector Pauline O`Rourke Key Unannounced Inspection 26th March 2008 10:00 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 Ashurst DS0000070214.V361958.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. Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashurst Address 36 - 38 Westbourne Park Scarborough North Yorkshire YO12 4AT 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) 01723 360392 Monami Care (Scarborough) Limited Post Vacant Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 19 N/a 2. Date of last inspection Brief Description of the Service: Ashurst is registered to provide accommodation and personal care for nineteen older people. Ashurst is a detached property and is located in a central area of Scarborough. The home is conveniently located for all main community facilities including the public transport network. Restricted on-street parking is available. The property consists of four floors with the accommodation for people who live in the home being located on the ground, first and second floors. The home has a small passenger lift. There are three double bedrooms although currently one double is being used as single accommodation. None of the bedrooms have en suite facilities. The care home has a small front seating area and rear garden. On 26th March 2008 the assistant manager confirmed that the fees range from £329.50 to £359.50 a week. In addition to this people pay for their own toiletries and the hairdresser. Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes The key inspection was the first inspection for this newly registered service. Prior to the inspection the company Monami Care (Scarborough) Limited was asked to supply the Commission with information about the service in a Annual Quality Assurance Assessment form. This information was requested for the first time in November 2007 and a second time in December 2007. No information was forthcoming. This report is based solely on information gathered during the visit to the home. The visit by one inspector lasted five and a half hours. During the visit to the home eight people who live there, and three staff were spoken with. Records relating to four people, four staff members and the management activities of the home were inspected. Time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Ashurst for the people living there. The assistant manager was also present at the start of the day but was required to leave due to poor health. What the service does well: What has improved since the last inspection? What they could do better: Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 6 The lack of support in management time dedicated to the home has led to this service being rated as poor. Staff should have access to regular training in health and safety matters as well as topics relating to support they provide to people in the home. Staff should have training in topics related to older age. This will enable them to have a better understanding of the aging process and offer more comprehensive support. The staffing levels should remain under review to ensure that staff have sufficient time to allow people time to spend on social activities. The quality assurance system should include information gathered from house and staff meetings, review of care plans, supervision with staff and surveys sent to other professionals as well as to the relatives and people in the home. This will enable an annual plan for improvement to be developed. The registered person must ensure that evidence that the electrical and gas systems in the home are safe is available for inspection at any time. 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 be made available in other formats on request. Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 3 People who use the service experience adequate quality outcomes in this area. People did not have comprehensive and up to date information about the home prior to moving in. People could choose to move into the home knowing their needs had been assessed and the home could meet them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide provided to people thinking about moving in to the home have not been updated to show that new owners are in place. Information in the Statement of Purpose needs to be updated to include an updated complaints procedure and clear information about the people they can provide a service to. Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 9 Four case files were seen and each of them contained an assessment of need. This information had been provided either by a care manager or by the assistant manager. It was detailed enough to develop a care plan. The majority of this information was historical as there had been only one new person admitted to the home since the new owners had taken it over. That person was not well enough to speak with during the visit. There was no evidence that people had been issued with a statement of terms and conditions or a contract before admission to the home. Where contracts were seen they did not show a full breakdown of who is responsible for paying each element of the fee. Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 People who use the service experience good quality outcomes in this area. People receive the care and support they need. The staff provide support in a sensitive way that promotes the independence and dignity of the people who live at Ashurst. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The case files each contained a care plan based on the assessment information of the individual concerned. Evidence was available to show that the plans are reviewed each month. The case files also contained evidence that people access health service as they need to such as the GP, district nurse, chiropody, sight tests and consultant visits where necessary. There is a medication policy in place and staff that administer the medication have all had in-house training supplied by the dispensing chemist. There is no evidence to suggest this training is accredited. The home uses a NOMAD Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 11 medication system and staff were observed dispensing the medication appropriately. The medication records were up to date and clearly signed. There is no one in the home who looks after his or her own medication. Throughout the visit staff were observed treating people with respect and enabling them to retain their dignity. The two carers on duty were both male and people living in the home had no objections to being helped by them. People said ‘the staff are alright you can have a laugh with them’ and ‘I don’t mind two men on duty they get on with everything’ Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. People are not supported in their leisure activities as staff do not have the time but they are encouraged to maintain positive relationships with their friends and visitors. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is a weekly plan of activities available but staff do not have the time to spend with people in the home. People spoken with said that there were some activities and they were sometimes taken for a walk. However staff said they don’t always get time to spend with people as they have domestic tasks to carry out as well as providing personal care. Visitors are welcome at any time and those spoken with said ‘I am always welcome, they keep me informed of any changes to mum’s situation’ and ‘I Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 13 can visit anytime’. People living in the home said that they could have visitors at anytime and staff will contact them if they ask them to. A rolling three-week menu is used for in the home. The cook and the assistant manager devise it with input from people in the home, although there was no evidence to support his claim. Special diets are catered for and currently they are providing a vegetarian and diabetic diet. The meal observed was hot, well presented and where necessary assistance was offered sensitively and appropriately. People said ‘the food is lovely’ and ‘if you don’t like the food they will offer you something different’ Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience poor quality outcomes in this area. People are not protected from the risk of harm or abuse. Policies are not in place to inform staff of the actions they should take where they suspect abuse has occurred. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is a complaints procedure in place. However this document requires updating to include the information as required by Regulation 22 of The Care Homes Regulations 2001 and standard 16 of the National Minimum Standards. The address of the local Commission of Social Care Inspection office also needs updating. No complaints have been received by the Commission or by the home. People spoken with said that if they had any concerns or complaints they would discuss the with the deputy manager. Relatives said they would happily speak to the deputy manager if they had any concerns and felt she would deal with them in a positive way. There was a very simple policy on adult protection. There was no evidence of the protocol with the local authority based on the document ‘No Secrets’. It is recommended this document is obtained and that the policy in the home reflects this document. Staff were aware of their responsibilities in reporting any suspicions of abuse within the home. Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate quality outcomes in this area. People live in a home that is reasonably comfortable. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Ashurst is currently undergoing a programme of improvement. This includes the kitchen area that was identified in an environmental health report from August 2007 as needing refurbishment. A copy of the refurbishment programme should be sent to the Commission. Whilst this report was produced prior to the new owners taking over the home it remains a requirement. There was no evidence to show that the gas and electrical systems had been assessed as being safe. There was no evidence that the home is insured. Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 16 People’s bedrooms had been personalised by the occupant and they were able to lock their own door if they wanted to. The communal rooms were warm and people said that they were comfortable and clean. The laundry meets the needs of the home. Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience poor quality outcomes in this area. People are supported by staff who know them but who have had no training or supervision in their roles. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There are always two members of care staff on duty over a twenty-four hour period. A cook is also employed each day. On 26th March 2008 there were two care staff, a cook and the assistant manager on duty. There was no evidence to show that there is a minimum ratio of 50 trained members of staff with National Vocational Qualification level two in Care. There was no evidence that training has been provided in the home since September 2007. There is a procedure for the recruitment and selection of staff and staff files seen showed this was followed. The files seen contained an application form, two references and a Criminal Records Bureau disclosure and/or a POVAFIRST check. All staff had a contract of employment Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 18 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 36 and 38 People who use the service experience poor, quality outcomes in this area. People are supported by inadequate management systems that do not ensure their health and safety needs are met We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: No information about this service was received prior to the inspection. The original request for the AQAA went to Manomi Care (Scarborough) Limited in November 2007 and a further reminder was set in December 2007. There is no manager in place at Ashurst. The assistant manager runs the home on a day today basis and she confirmed that someone form the company visited the home at least once a month as required by regulation 26 of The Care Homes Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 19 Regulations 2001. However a copy of the report made following these visits was not available for inspection as there is not a copy retained in the home. There is a limited quality assurance system in place and this consists of surveys going out once a year to people in the home and their relatives. There are no meetings held to facilitate group discussions about life within the home for either people who live at Ashurst or the staff who work there. Staff do not manage the monies of people living in the home. Staff are not receiving regular supervision and appraisal sessions. There is a health and safety procedure in place for staff to read. There was no evidence that staff have had training in first aid, fire training, although some fire training is planned for April 2008, manual handling, food hygiene and infection control. The storage and use of COSHH materials was found to be satisfactory although care staff have received no training in the proper use of chemicals. The gas or electrical safety certificates were not available for inspection. However these documents were provided to the Commission following the inspection. The gas certificate was dated 25.02.2008 and the electrical safety certificate was dated 17.06.2005. These documents must be available for inspection at any time. All accidents and incidents are reported as necessary. Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 20 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 1 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 X 1 Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? N/A 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 OP1 Regulation 4(1), 5 Schedule 1 and 5 Requirement The registered person shall provide a Statement of Purpose, which consists of the aims and objectives, facilities available, and an outline of the service provided. They shall also provide a Service User Guide which will provide people visiting the home the information they need to help them make a decision about moving in. People in the home should have a statement of terms and conditions outlining the fee and who is responsible for each portion of the fee. The registered person should consult people about their social activities and enable them to maintain their interests and hobbies. The registered person must establish a complaints procedure that provides timescales for actions taken. It should also be provided in different formats to allow for people with differing disabilities. Timescale for action 10/05/08 2 OP2 5 10/05/08 3 OP12 16(m)(n) 10/05/08 4 OP16 22 10/05/08 Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 22 5 OP18 13(6) 6 OP30 13(5)(6) 18(1)c 18(2) 7 OP36 8 OP31 8, 12(1) 9 OP33 24 10 OP38 26(5) The registered person must provide an adult protection policy in line with the local protocols with Social services. Staff must have training in the policy. The registered person must ensure that staff have access to training that will enable them to carry out their role safely. The registered person must ensure staff are provided with regular supervision and appraisals sessions. This will allow staff to identify their own training needs and help the registered person to identify what training each person needs to provide the most appropriate support to people in the home The registered person must appoint someone to manage the home. This will allow for the development of the service provided to people who live in the home. The registered provider must establish a system for reviewing the quality of the care provided at the home. The registered person shall supply the Commission a copy of the monthly report following the unannounced monthly visits. 10/05/08 31/05/08 31/05/08 31/05/08 30/06/08 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 23 1 2 OP33 OP19 People who live in the home should be formally consulted on a regular basis so that they can be involved in the development of a annual plan that will enhance their lives. A copy of the refurbishment programme should be supplied to the Commission. A copy of the current insurance certificate should also be supplied to the Commission. Ashurst DS0000070214.V361958.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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