Inspection on 14/12/07 for Ashurst Place

This inspection was carried out on 14th December 2007.

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

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

Other inspections for this house

Ashurst Place 09/10/06

Ashurst Place 23/11/05

Ashurst Place 17/05/05

Ashurst Place 18/08/04

Ashurst Place 20/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Ashurst Place Ashurst Place Lampington Row Langton Green Tunbridge Wells Kent TN3 0JG Lead Inspector Nicki Dawson Key Unannounced Inspection 9:25 14th December 2007 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 Place DS0000023924.V348584.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 Place DS0000023924.V348584.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashurst Place Address Ashurst Place Lampington Row Langton Green Tunbridge Wells Kent TN3 0JG 01892 863661 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) Miss Julia Lynn Watts Mrs Louie Watts Mr Paul Iles Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th October 2006 Brief Description of the Service: Ashurst Place provides care and accommodation for up to 37 older people. The home is a detached property, set in 23 acres. Accommodation for residents is provided on the ground and first floor. There is a shaft lift to the first floor. Five rooms have en-suite facilities. There are call points and TV points in every bedroom. The home is located in a rural area near to Langton Green where there are shops, a Post Office a church and a bus service. The town of Tunbridge Wells is situated approximately 3 miles away. Here, there are all the facilities of a large town including a main line station. Fees Range from £338.29 to £700.00 per week. Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced, which means that the residents, staff and home manager did not know that the inspector was calling at the home. The inspection started at 9.25 and took 6 hours. Discussion took place with residents, staff, the homeowner and home manager, to gain their views and knowledge of the level of care, provided by the service. The shared areas of the home and a number of resident’s bedrooms were entered. A number of records to do with resident’s care and safety were looked at. Survey questionnaires (“Have Your Say About...”) were sent by the CSCI to the home before the inspection visit. Comments made by relatives, residents, staff and health and visiting professionals were all positive about the level of care provided at Ashurst Place. For example, “The overall level of care is very high”. “The residents are truly being treated as family members”. The people who live at Ashurst Place are referred to as ‘residents’ throughout this report since this is what they are called by the care staff team. What the service does well: What has improved since the last inspection? What they could do better: The home should be more proactive in formally gaining the views of residents and relatives about the quality of care provided by the home. This is so that the home can act on any shortfalls that are identified to improve the service. Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 Page 6 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 Place DS0000023924.V348584.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 Place DS0000023924.V348584.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, 3 and 5 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A range of information about the home is made available to prospective residents and each resident has a contract explaining their rights and responsibilities. There is a robust pre-admission assessment process, so that no resident moves into the home without having their needs assessed and being assured that these will be met. EVIDENCE: The aims and objectives of the home are clearly set out in the home’s ‘Statement of Purpose’. The services and facilities that are available to residents living in the home are detailed in the home’s ‘Service User Guide’. Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 Page 9 A short leaflet detailing ‘need to know’ information regarding daily life in the home is left in the bedrooms of all new residents. Each resident or their representative is given a copy of a contract detailing the terms and conditions of their stay at the home. Contracts are easy to read and include information about fees, rooms and additional charges. Before new residents are admitted to the home a full needs assessment is carried out to decide whether or not the home is a suitable place for the person to live. The manager visits the prospective resident in their current accommodation. This is to discuss their needs and to get to know the person, before inviting them to visit the home. The home makes sure that any additional information, including social services assessments and community care plans are obtained. A resident who moved to the home recently, said that they found it easy to settle into the home. Ashurst Place DS0000023924.V348584.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 outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive health and personal care based upon their individual needs. Residents are treated with dignity and respect and their privacy is maintained. EVIDENCE: Each resident has a care plan that clearly sets out their health, social and personal care needs together with the staff support that is required to meet these assessed needs. Care plans are detailed and give a clear picture of each resident as an individual, with their own distinct needs. Staff said that these plans are easy to understand and use on a daily basis. A summary of each care plan is available to visiting professionals, so they can quickly find the information that they need. Each plan is regularly reviewed so that it is kept up to date with any changes in a resident’s care needs. Clearly written plans are also in place to minimise the effect of potential risks to residents. Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 Page 11 Residents are supported to access health care services to maintain their health and these visits are clearly recorded. The home have found it difficult to access a dentist for all residents, but are working hard to make sure that residents benefit from regular dental checkups. Where there are any concerns about a residents physical or mental health, professional advice is obtained. Health professionals commented that the home are, “good at liaising” with them, but that, “occasionally prompts are required” to make sure that residents’ health care needs are fully met. The registered owner said that all staff who administer medication have received training in how to do this safely. A staff member was observed administering medication as stated in the home’s procedures. Records kept of the medicines that staff give to residents are well maintained. This means that the arrangements for medicines in the home should help to make sure that each resident is given their medication in the way that it is intended by their GP. Residents spoke very highly of the staff team. They said that the staff were, ‘lovely’, ‘helpful’ and that, “at night time when you press the bell, the staff come promptly”. Staff talked with residents in a respectful and individual way. Each resident has a ‘do not disturb’ notice available on their bedroom door and these are respected by staff. Ashurst Place DS0000023924.V348584.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 good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported to live the life that they choose and to keep in contact with family and friends. EVIDENCE: People, who live at Ashurst Place, benefit from the flexible routine. On the day of the inspection, the pace of daily life in the home was relaxed and unhurried. A minister visits the home regularly and residents are free to attend local churches if they choose. Cultural needs are met once the pre admission assessment indicates this is possible at Ashurst Place. At the last inspection, residents spoken with missed the activities co-ordinator who had left and some residents complained of boredom. A senior carer is now responsible for organising activities. This includes, watching films, quizzes and an outing once a month. Regular events are arranged throughout the year. Festive activities are in full swing, with carol singers and a Christmas party for relatives and residents. Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 Page 13 Some residents still said that they were bored and that there was nothing to do except watch television. Residents said that their relatives are welcome to visit the home at any reasonable time. The home encourages residents to keep in touch with their relatives. Relatives commented that the home helped them to keep in touch with their relatives and that they were always told if there were any changes to their relative’s care needs. Residents are able to make choices in their daily lives. residents were asked their food preferences for lunch. During the inspection, Residents gave a mixed response to the quality of the food provided in the home. A number of residents spoken with on the day of the inspection said that the food was usually of a high standard, but that it was not to their liking now that the cook had left. Residents who were surveyed said that they aways liked the food on offer. The home manager said that a new cook was due to start work at the home in a few weeks time. Most residents eat their lunchtime meal in the dining room but trays are taken to residents wishing to eat in their rooms. Part of the lunchtime meal was observed and it was relaxed and unhurried. Ashurst Place DS0000023924.V348584.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 good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Concerns and complaints are taken seriously and acted upon. Staff feel confident to speak out if they have a concerns about the care of a resident, which protects residents’ well being. EVIDENCE: One complaint has been received by the home, since the last inspection. This complaint has been recorded in detail, together with the action that has been taken to rectify the compliant. The Commission has not received any complaints about the home. Surveys returned from relatives confirmed that everyone knows how to make a compliant and that any concerns they raise are responded to appropriately. The homeowner said that a staff training programme is in place to make sure that all staff receive training in safeguarding vulnerable adults. Staff demonstrated that they are clear about what to do if they suspect abuse and that they feel would feel confident to do so, if the situation arose. Residents said that they felt safe and secure living at Ashurst Place. Ashurst Place DS0000023924.V348584.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, 20, 23, 24, 25 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a homely, comfortable, safe and well maintained home. EVIDENCE: Ashurst Place is a large country house that has been converted to meet the needs of caring for older people. On the day of the inspection, the home was wonderfully decorated with Christmas trees in every room. One resident said, “It is beautiful here”. A great deal of time and energy has been used to make the home as appealing as possible for the residents that live here. Both communal rooms and residents’ bedrooms are of good size, bright and homely. The conservatory is designated as a smoking room and is situated at the far end of the lounge, which is non-smoking. Since one room leads into the other, consideration needs to be given to make sure that non-smoking Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 Page 16 residents are not adversely affected by smoke from the other end of the room. Residents’ rooms are individual to them and meet their needs and tastes. They contain their own personal items including photographs, pictures and furniture. Residents benefit from the beautiful setting of their home. It is located in a quiet country area where residents can walk around the grounds safely without any worry about cars and the potential hazards of crossing roads. The home was comfortably warm on the day of the inspection. The home is kept in a good state of repair and decoration due to the quick response by the maintenance team and a rolling programme of refurbishment. The home was clean on the day of the inspection and there were no unpleasant odours. One relative commented, ”this is one home that never smells”. The home have used department of health guidance to make sure that the home is always clean and hygienic. Ashurst Place DS0000023924.V348584.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 good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported by an effective and friendly staff team that have the skills to meet their assessed needs. EVIDENCE: There are six care staff on duty during the morning, three in the afternoon and two during the night. Catering and domestic staff are also employed. Staff said that there is ‘always’ enough staff on duty to attend to all residents needs. Relatives who were surveyed were very positive about the support provided by the staff team. One relative commented, ”I am very grateful to everyone at Ashurst for being so good…and giving him (their relative) a good life”. Staff were observed taking time to sit and chat with residents on an individual basis, which residents clearly benefited from. Just fewer than 50 of staff are trained to National Vocational Qualification (NVQ) level 2 or above. This award is useful because it helps staff develop good care practices and their skills in working with people who live in a residential care home. Seven additional staff are training towards NVQ 2 so that the home will exceed the National Minimum Standard, which is to train 50 of the care staff team. This is good practice. Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 Page 18 Before new members of staff are employed at the home, the home carries out a number of checks to make sure that all members of staff working at the home are suitable to care for vulnerable residents. The homeowner is responsible for making sure that care staff have the skills they need to support the residents who live in the home. She confirmed that all new care staff receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision. Staff surveyed said that their induction covered the areas that they needed to know, “very well”. In addition to the introductory training, care workers undertake a number of training courses that develop their skills in caring for the people that live in the home. The homeowner is developing a new training programme, which she believes will help make sure that her staff are trained and kept up to date in the skills necessary to perform their jobs. Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from the management approach of the home because their health, safety and welfare are promoted at all times. EVIDENCE: Residents benefit from daily contact with both the homeowner and manager. They have over 20 years experience in the running a service for older people. The homeowner has both of the formal qualifications specified by the National Minimum Standards. The manager is currently working towards these qualifications. These awards are recognised by the Commission to be useful because they help to make sure that people who manage residential care services have the competencies that are necessary to do so. Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 Page 20 Residents and staff spoke very highly of both the homeowner and manager. They said that both were approachable and helped to create the lovely friendly atmosphere in the home. The manager said that residents’ views would always be taken into account when making any decisions about the running of the service. It is useful to do this formally by sending out questionnaires to residents and relatives to gain their views about the quality of the service. This is overdue and the homeowner said that she would attend to this immediately. Where the home is responsible for keeping small amounts of money on behalf of a resident, clear and accurate records are kept. Each resident’s money is kept separately and securely. The homeowner values staff supervision as an effective way of communicating with the staff team. She has changed the way that she carries out staff appraisals to make them more effective and admits that as a result she has not supervised staff as regularly as she would like. This was reflected in the mixed staff responses about the level of support currently provided by the management team. Some said that it was ‘usually’ provided, and others that it was ‘always’ provided. The homeowner said that all items of equipment in use in the home remain in good working order and she has provided the dates on which they have been serviced. There is a rolling staff training programme in place to make sure that all staff receive training in the essential areas of manual handling, health and safety, fire and first aid. The homeowner acknowledges that there are some gaps in training for new staff, but intends to fill these in the near future. Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 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 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 3 Ashurst Place DS0000023924.V348584.R01.S.doc Version 5.2 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP19 Good Practice Recommendations The home’s smoking policy should be reviewed to make sure that other residents’ smoke does not adversely affect non-smoking residents. 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