Inspection on 17/05/06 for Ashurst Park Care Home

This inspection was carried out on 17th May 2006.

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

Ashurst Park Care Home 23/07/07

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 Ashurst Park Care Home Fordcombe Road Fordcombe Tunbridge Wells Kent TN3 0RD Lead Inspector Elizabeth Baker Unannounced Inspection 17th May 2006 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 Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 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 Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashurst Park Care Home Address Fordcombe Road Fordcombe Tunbridge Wells Kent TN3 0RD 01892 709000 01892 709053 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) www.fshc.co.uk Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Vacant Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care to be provided to 3 named older people with a diagnosis of dementia (details of the named people held at the CSCI office in Maidstone) 8 November 2005 Date of last inspection Brief Description of the Service: Ashurst Park Care Centre provides care for up to 53 older people who need nursing care. The home is purpose built on two floors with a passenger lift between the floors and disabled access. There are two rooms, which can be used for shared occupancy. The home is situated in large park like gardens, which are accessible by residents. The home is situated in a rural area, approximately half a mile from the village of Fordcombe. Infrequent bus services pass at the end of the drive. Car parking is available to the front of the building. The home has a large lounge with separate dining room on the ground floor with a smaller lounge/kitchen area on the first floor. A small bar is provided on the ground floor. Bedrooms on the ground floor have ensuite facilities. All rooms used by residents are connected to the nurse call system. There is a separate physiotherapy room. Fees currently range from £750 to £850 per week, depending on need and type of bedroom. These fees are exclusive of hairdressing, chiropody, physiotherapy and newspapers/magazines. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first unannounced visit to the home for the inspection period 2006/07. The inspection took over seven hours and was carried out by lead inspector Elizabeth Baker and Registered Nurse inspector Justine Williams. The visit consisted of a partial tour of the premises, inspecting some records for case tracking purposes and talking with some residents and staff. A number of residents and staff were interviewed in private. The newly appointed Manager, assisted throughout the visit. The new provider’s progress on achieving compliance with previous requirements was assessed. Some judgements about the quality of care, life and choices were taken from direct conversation with residents and direct observation. In support of this visit the Commission received comment cards about the service from 15 residents and four relatives/advocates. Some of their comments and responses have been incorporated into the report. At the time of the visit 43 residents requiring nursing care were residing at the home. What the service does well: What has improved since the last inspection? A new permanent manager has been appointed. Some of the requirements made following the November 2005 inspection have now been met. Some residents commented that meals have started to improve. The newly appointed activities coordinator should ensure more activities and services are available to all residents. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 6 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. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 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 Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 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 the following standard(s): 1, 2, 3, 4, 5 and 6. Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Prospective residents do not receive a full and comprehensive assessment. Not all prospective and current residents can be assured the home can meet their needs. Prospective residents are provided with information about the home to help them make an informed choice. EVIDENCE: The new provider has produced terms and conditions of residence, which all prospective residents should receive. The documents are supported by additional letters, which further explains how the gross weekly fee is arrived at. A colour brochure is available and this informs prospective residents and their advocates about the home with regard to meals, complaints and general routines. The new manager said some of the inserts to the brochure are currently being updated to reflect recent changes to the home. The manager said a separate comprehensive document, which sets out the prospective residents’ holistic needs and ultimately determines the level of fees to be charged, is also provided to new residents, as a means of demonstrating the home can meet their needs. However despite all the information now Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 9 available, some residents could not recall having had a contract. Indeed six of the 15 returned comment cards from residents indicated they had not received a contract. One respondent added they would like one sent to their daughter. A number of residents said they had prior knowledge of this home, either through visits to former residents or short stays. One resident said this was far the best home she has visited and is very pleased with her choice. The records for six residents were seen. Pre-admission assessments were seen for residents who have moved into the home more recently. In addition all residents had been assessed on or shortly after admission, none of these assessments had been completed in full, and many were not signed and dated by the RGN completing the form. In particular there was no information in all but one file about the residents wishes on and after their death. None of the cognitive assessments had been completed, and social history was scant. The home is registered for three specific residents with a diagnosis of dementia. Sadly two of these three residents have subsequently died. In addition to the remaining resident, some other residents were displaying confused and disorientated behaviour, calling out and appearing quite distressed at times. Residents who exhibit these behaviours could indicate the onset of dementia, should be assessed by the relevant healthcare professionals to ensure they receive the appropriate support and services. Thereafter the home should consider its ability to meet these residents’ needs, and the impact on other residents. Depending upon the outcome a further variation to the home’s registration may be required to ensure the home does not compromise its registration criteria. The home has a contract with the local Primary Care Trust for eight step-down beds. These are used for residents who are waiting to return to their homes after hospitalisation but some adaptations to their own homes are required. The home is not registered for intermediate care. Standard 6 is not applicable. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 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, 9, 10 and 11 Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ needs are not set out comprehensively in the plans of care. Residents can be confident that their health needs are met. Residents are not protected by the home’s policies when they are self- medicating. Residents feel they are treated with respect. EVIDENCE: The care plans for six residents were seen, all failed to include psychological and social care aspects. The manager has recently introduced night care plans which contained a good level of detail including how residents liked to settle at night, preferred time of going to bed, what drink they liked. The care plan of one resident with a diagnosis of dementia and another exhibiting confused behaviour failed to include any information as to how to manage their behaviours. Whilst staff spoken with had good awareness of day-to-day risk management, risk assessments were brief and basic and should be expanded upon in scope and detail. These included the use of wheelchair lap straps, which although are used to maintain resident’s safety, could be construed as Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 11 restraint. Despite many of the residents being mentally agile they had little or no knowledge of their care plans and had not signed them in many cases. Clinical risk assessments with respect to skin integrity, continence, nutrition and moving and handling had been completed, and the equipment needed to meet needs had been accessed. Weight charts had not been completed for one resident who was identified as being nutritionally vulnerable. Access to GP’s and other healthcare professionals was well documented including appointments with dentists opticians and chiropodists. Of concern however was that one resident had been identified as vulnerable to skin breakdown and records indicated that the resident was being nursed on a Spenco mattress. These mattresses have been proven many years ago to be completely ineffective for protecting skin integrity. The home’s medication practices and policies were robust where nursing staff take responsibility for medication. Most of the requirements made at the last inspection with respect to medication have been met. However clear instruction regarding PRN medication should be written in the care plan, and self-medication risk assessments must be completed urgently. One resident had numerous medication left on her table, some prescribed some over the counter. Risk assessments must include safe storage of medicines and lockable storage must be provided. Residents spoke very highly of the staff, and interaction between staff and residents observed was friendly and with respect for individuals privacy and dignity. Comments included “you couldn’t do better” of the staff, and “they are wonderful, you ring the buzzer and they are there at your elbow”. Residents spoken with said staff assist them appropriately when helping them with their personal hygiene needs. A resident said the laundry service is very good with clothes being returned the same day. Comment cards returned from residents indicated staff are friendly and are very caring. However two respondents indicated this was not always their experience with particular regard to night staff that sometimes are not as caring as day staff. Another respondent indicated their wheelchair, which is their own property, has been used for other residents without permission. Care plans were deficient of residents’ wishes and preferences in respect of death and dying. Whilst recognising this is a sensitive subject, it is an important aspect of care and needs to be addressed. Contact information was suggested to the manager, where details on how to obtain this information may be obtained. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 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): 12, 13, 14 and 15 Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The new manager is making some progress in ensuring the quality of meals is improved. EVIDENCE: Visitors were seen coming and going throughout the visit. A number of residents were engrossed in listening to a visitor reading aloud from a novel. The home has a grand piano and residents said they enjoy listening to a particular resident playing this. A resident spoke of the delight she had on accompanying a member of staff on a trip to town to purchase items to be used for activity sessions. The trip included a lunch. A resident added an additional comment to their comment card “the sundries and toiletries trolley hasn’t been coming round for a long time now. This was useful.” Of the 15 comment cards returned from residents, two indicated they could take part in the activities arranged by the home; four indicated they usually can and seven indicated sometimes. It was good to hear therefore that a new full time activities person has been employed. Unfortunately due to an unforeseen incident the planned programme has been delayed. This includes Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 13 the reintroduction of the shopping trolley. However residents fully understand the situation and are eagerly awaiting the activities coordinator’s safe return. Although two care records inspected contained biographical information, the other records did not contain this information. This situation does not ensure that the diverse needs and interests of all residents are identified and met. Mealtimes are 8am, 12.30pm and 5.00pm. The manager said snacks such as sandwiches and biscuits are available to all residents between supper and breakfast, and are usually served with the hot drink round at 8pm. However this is not the experience of all residents, who indicated they are offered drinks but not snacks. Mixed views were obtained from residents and comment card respondents about the quality of meals. Comments included “meals were very poor quality, but have improved”; “lunches are usually good; suppers are extremely variable”; “cooking is good and ample choice. Makes my diet easy to follow”; “meat sometimes tough, needs cutting up, vegetables uncooked, portions too large”; “Fresh fruit always available”. Indeed only one of the 15 resident respondents indicated they like the meals at the home. Five indicated they usually like the meals and eight indicated they sometimes like the meals. The manager indicated she is well aware of the long-standing problems. Indeed since her appointment she has changed some practices and is now involved in menu planning. The manager endeavours to have a lunchtime meal with residents every day and “table hops” to gain residents views. To assist the home in improving the quality of meals, a copy of the Commission’s recent quality bulletin “Highlight of the day? Improving meals for older people in care homes” was given to the manager. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 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): 16 and 18 Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Not all complainants can be assured their complaints will be listened to, acted on and satisfactorily resolved swiftly. EVIDENCE: One resident mentioned they had cause to complain on a number of occasions about the noise from another resident, who was showing signs of confusion. A member of staff interviewed was aware of the matter and said it had been recorded in the resident’s care records. However this had not been recorded as a complaint and the manager was not aware of it. Eight of the 15 returned comment cards indicated residents know how to make a complaint. One respondent added an additional comment that they would like more information about the complaints procedure. All four relative/advocate respondents indicated they know how to make a complaint. One respondent added the additional comment “when complained it was dealt with very satisfactorily”. Sadly this is not the experience of all complainants, including one, which has been ongoing since 2004. Staff have received adult protection training. A member of staff described appropriately what they would do if they suspected abuse had taken place. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 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, 21, 22, 23, 24, 25 and 26 Quality of this outcome area is good. This judgement has been made using available evidence including a visit to the service. Proposed improvements to the environment will enhance residents’ quality of life. EVIDENCE: Following a fire safety audit of the home in October 2005 by an Inspecting Officer of Kent Fire and Rescue Service, a number of requirements were made. The new manager was unable to confirm whether all outstanding matters had been complied with. The manager was also unable to ascertain whether the home had submitted a fire audit assessment to Kent Fire and Rescue Service, for comment and approval. However she is now endeavouring to contact the former acting manager of the home to clarify matters. The local authority carried out an environmental health inspection of the kitchen 21 March 2006. This identified the standard had fallen below the Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 16 standard expected of a nursing home. A compliance re-visit was made on the 16 May 2006. The manager said all matters had been satisfactorily complied with. Apart from one area on the first floor, the home was clean and odour free. Eight of the 15 returned comment cards from residents indicated the home is always fresh and clean; five indicated it is usually fresh and clean and two indicated only sometimes. However one respondent indicated their room needs cleaning more frequently, they would like the room hoovered more and the floors could be cleaner. Bedrooms are usually redecorated when occupancy allows. Some doors and doorframes along corridors have been contact damaged. The home was opened in 1989 and was refurbished sometime later. The ground floor was in a better decorative state than the first floor. The manager reported that the new providers have visited the home and proposals are now in hand to refurbish the home. It is hoped this will commence in the autumn. Bedrooms vary in shape and size. Some rooms have patio access into the grounds. Some of the ensuite rooms have baths. Two residents spoken with said they enjoy their baths and can take them as regularly as they like. Bedrooms visited had been individualised with personal effects. One resident said they did not find their bed that comfortable because of the special airflow mattress, which had been supplied. However the resident was fully aware of the implications to their health of not using this. Sadly as mentioned previously, care records for another resident indicated the resident having an assessed need for this type of mattress also. This had not been provided. The type in use for that resident would offer limited comfort but no protection from acquiring pressure sores. Residents enjoy the gardens and bird watching from their bedrooms. It was sad to see that patio and walkways around the home again require attention because of moss and or weeds growing between the block paving. This not only reduces the outlook for some residents, but may also make it hazardous for residents to walk along. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 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, 28, 29 and 30 Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staff morale is good resulting in an enthusiastic workforce. Residents could be at risk because robust vetting for recruiting new staff is not always carried out. EVIDENCE: At the time of the visit staff were seen going about their duties in an unhurried manner. In addition to care staff, staff are employed for administration, reception, activities, cooking, cleaning, maintenance and laundry. Contract gardeners are used as and when required. Staffing levels more or less comply with the requirements of a former health regulatory authority. A number of comment cards returned from residents contained additional comments including “Time delays in answering buzzer causes distress”; “staff are nearly always available except in the evenings between 6 and 7 there seems to be a lack of visible staff as they are helping residents to bed, but if one of those who likes to sit up longer needs assistance to go to the toilet for example, you have to search for someone or wait”. All four comment cards returned from relatives/advocates indicated in their opinion there are not always sufficient staff on duty. The manager said staffing levels had already been discussed and agreed with the Regional Manager. It is now intended that additional staff be employed for busy periods covering 6pm to 9pm and 6am to 8am. Apart from a student nurse, there are no care staff trained to NVQ level II care. The new manager is aware of the need to ensure 50 of unregistered Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 18 care staff must have this qualification. Proposed plans have been delayed because the area’s NVQ assessor is on maternity leave. However the manager who has a teaching qualification, has already organised in-house training sessions for staff in preparation of commencing the NVQ course in the late summer. The first session is to commence on 2 June 2006. Arrangements are now in hand for the reintroduction of regular supervision of all care staff. This will be done in conjunction with the manager of a nearby associated home as well as the home’s Regional Manager. Staff responsible for supervision are being trained to carry out the role. To ensure staff do not compromise their employment conditions, the manager intends to write to all care staff seeking details of any additional employment they may have. Two staff files were inspected. The maintenance of the files made for easy auditing. However it was difficult to establish whether one particular employee had been CRB checked. Two “to whom it may concern references” had been accepted. The references were dated February 2005 and January 2005. The employee commenced at the home on 7 March 2006. There was no recorded evidence recent references had been sought. Induction records for new care staff were not available for inspection as it the home’s practice for these to be retained by employees during their induction process. For overseas nurses this can take between six to nine months. The new manager produced a training matrix. This has not been kept up to date. Indeed the pre inspection questionnaire indicates there has been no dementia training at the home during the last twelve months. However during an interview with a member of staff it was established that some care staff had received such training. The manager said sorting out training is one of her top priorities. Subjects for future training includes catheter care, protection of vulnerable adults, malnutrition scoring tool, dementia care, compiling post registration educational portfolios and care plans. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 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): 31, 32, 33, 34, 35, 36, 37 and 38 Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The new manager demonstrated a clear understanding of what needs to be done to improve residents’ quality of care at the home and is developing a plan on how this will be achieved. EVIDENCE: The manager of the home took up her appointment in April 2006. A member of staff commented they are pleased a new permanent manager is now in post; that the manager seems very business like; is very good; has organised meetings and is easy to approach. A resident said the new manager is splendid and efficient. The manager is a Registered Nurse, has a Diploma in Social Sciences and a BA Hons (Professional Education). The manager is about to commence on a Registered Manager Award course. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 20 As mentioned previously the manager is actively trying to resolve the numerous problems in respect of residents’ meals, as part of the home’s quality assurance programme. The manager has also facilitated meetings with residents, relatives and staff since her appointment. The regional manager supports the home and manager as is required by regulation. The pre-inspection questionnaire indicates new policies and procedures were implemented in March 2006. The questionnaire also indicates inspection and servicing of the home’s equipment is regularly undertaken. Following a recommendation made at the last inspection the maintenance manager now keeps a record of regular checks on nursing aids and equipment, including wheelchairs, commodes, bedrails and Zimmer frames. This will ensure equipment is fit for use. The maintenance manager had just attended a fire warden course. Because of this the home will be increasing the frequency of fire drills and fire training for night staff. The manager is aware of the need to ensure sufficient staff are trained in First Aid and is making enquiries as to where this training can be accessed. The lounge/dining area on the first floor contains a small kitchenette. During the visit a container of pink alcohol based cleaning fluid was seen stored in the under sink cupboard. The cupboard door was missing. The kitchen area is open plan design. This situation could be potentially hazardous to residents and visitors, including small children, who may mistake the contents for a fruit drink. Small amounts of personal monies are held for safe keeping by the home for a number of residents. Records are maintained of transactions and amounts are reconciled monthly, as well as by the Regional Administrator on a quarterly basis. However the safe keeping arrangements prevent residents accessing their monies, if required, out of normal working hours and weekends/bank holidays. Restrictive access to this money is not mentioned in the service user guide. The manager said a system for recording furniture brought into the home has not yet been implemented. Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 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 3 2 2 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 2 2 2 2 Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 22 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 2 Standard OP2 OP3 Regulation 5 14(1) Requirement All residents must be provided with a contract. All prospective residents must be pre assessed and full details of their needs must be properly documented. Needs assessments of all residents must be continually reviewed to ensure their needs can continue to meet within the home’s current registration criteria. Care plans must be complete of all assessed needs; Care plans must be composed and reviewed with input from residents, if they so wish to be involved, and their signatures obtained. Clear instructions of the administration of PRN medications must be included in the respective care plans. (Timescale of 30/11/05 not met); Risk assessments must be undertaken on all residents who self-medicate and the findings recorded. DS0000066424.V291967.R01.S.doc Timescale for action 31/08/06 30/06/06 3 OP4 14(2) 30/06/06 4 OP7 15 31/07/06 5 OP9 13(2) 30/06/06 Ashurst Park Care Home Version 5.1 Page 23 6 OP11 12 7 8 9 10 11 12 OP15 OP16 OP19 OP26 OP29 OP36 16(2)(i) 22 23 16(2)(k) 18 18(2) 13 OP37 17(2) Schedule 4 14 OP38 13(4) 15 OP38 13(4) Care plans must be complete of wishes and preferences in respect of death and dying. (Timescale 31/12/05 not met) All residents must be offered snacks between tea and breakfast times. All complaints must be logged in a manner, which allows effective monitoring. Contact damage to doors and doorframes in resident areas must be made good. All areas of the home must be kept odour free. All staff references must relate to the current employer Appropriately trained supervisors must supervise all staff, and the findings recorded. (Timescales 11/08/04 and 31/01/06 not completely met) A record of furniture brought by a resident into the room occupied by the resident must be held. (Timescales 11 August 2004, 10 May and 30 November 2005 not met). All potential risks to residents and visitors must be identified and removed, including unsecured cleaning agents. Sufficient numbers of staff must be appropriately trained in First Aid. (Timescale 31/03/06 not met) 31/08/06 30/06/06 30/06/06 30/11/06 31/07/06 30/06/06 31/08/06 31/08/06 31/05/06 31/08/06 Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 Refer to Standard OP8 OP8 OP8 OP8 OP9 OP10 OP12 OP19 Good Practice Recommendations Risk assessments must be undertaken when wheelchair safety straps are used, and the findings recorded. All residents must be weighed regularly. Pressure risk assessments must be accurate. Pressure sore prevention aids must be appropriate to the assessed need. Pain assessments must be provided for residents assessed as needing them. Residents own property, including wheelchairs, must not be used by other residents. Full details of residents’ social interests are sought and recorded. Compliance with the Fire Officer’s requirements must be sent to the Commission. Confirmation that the home’s fire risk assessment complies with the requirements of the Fire Officer must be sent to the Commission. Paths and patio areas must be kept clear of moss and weeds. 50 of unregistered care staff must be trained to NVQ level II care. The manager must attain an appropriate management qualification to NVQ level 4 or equivalent. Restrictive access by residents to their personal monies must be recorded. Prospective residents should be informed of such restrictions. All records must be kept up to date, including the staff training matrix. 9 10 11 12 13 OP19 OP28 OP31 OP35 OP37 Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Ashurst Park Care Home DS0000066424.V291967.R01.S.doc Version 5.1 Page 26 - 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. 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