CARE HOMES FOR OLDER PEOPLE
Ashview Nursing Home Ware Road Widford Nr Ware Hertfordshire SG12 8RQ Lead Inspector
Marian Byrne Unannounced Inspection 9th January 2006 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 Ashview Nursing Home DS0000019272.V275129.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. Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ashview Nursing Home Address Ware Road Widford Nr Ware Hertfordshire SG12 8RQ 01279 842 458 0208 209 0286 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) Mr P Patel Mrs Anjani P. Patel Caroline Elizabeth Jones Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. This home may accommodate 32 older people, who are frail, in need of nursing care. This home may accommodate 32 older people for respite nursing care. Date of last inspection 14th September 2005 Brief Description of the Service: The current proprietors were first registered in respect of Ashview Nursing Home in 1997 under the Registered Homes Act 1984, subsequently under the Care Standards Act 2000 in 2002. The home is registered to care for up to 32 physically frail service users in need of nursing care over the age of 65 years. Twenty four hour staff cover is provided by qualified nurses.The home is an old, large country house situated in a rural area on the outskirts of the village of Widford, between Much Hadham and Ware in East Hertfordshire. The building has been extensively refurbished to provide accommodation on two floors served by a lift. Assisted bathing facilities are provided. Because the home was not purpose-built there are varying floor levels, which have been rendered safe for wheelchair users by means of ramps in corridors. There is a large garden to the rear and limited car parking for staff and visitors to the front of the building. Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday and was carried out by two inspectors. Discussions were held with service users, visiting relatives, members of care staff, the manager, deputy manager and one of the proprietors. Staff were observed going about their duties and interacting with service users. All observations made indicated that staff were kind, caring and knowledgeable. Documentation examined included a sample of service users’ care plans. A brief tour was made of the building. All areas inspected were found to be satisfactory. There were 30 residents in the home on the day of the inspection. Staff levels were considered adequate to meet the needs of the service users. The Registered Manager was due to work providing hands on care on the morning of the inspection. The inspection indicated that the home continues to run smoothly, with contented service users and a well motivated and trained staff team. What the service does well: What has improved since the last inspection? What they could do better:
While this was in the main, a positive inspection care must be taken when serving lunch and other hot meals to ensure they are served at an acceptable temperature particularly to those service users who are served last. Formal supervision must be introduced and to enable the successful completion of this the Registered Manager must undertake training in supervision. The manager of the home must not have any nursing duties she must be free to manage the
Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 6 home at all times. The home lack adequate storage for equipment needed to assist service users in their day to day lives. The staff area of the home is very limited. 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. Ashview Nursing Home DS0000019272.V275129.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 Ashview Nursing Home DS0000019272.V275129.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): 3-5 All service users have a thorough assessment prior to admission to the home. Prospective service users are welcome to visit the home and on admission all have the placement reviewed to ensure the placement is suitable. EVIDENCE: Care plans inspected had a thorough assessment to ensure the home could meet the service user’s needs. Prospective service users are welcome to visit the home prior to admission and a review takes place after 6 weeks to ensure the service user’s needs are being met. Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 11 All service users have care plans. Service users assured the inspector’s that their needs were being met. The home endeavours to offer a home for life. EVIDENCE: Care plans inspected contained all the necessary information. The care plans are very clear and easy to follow. They are very personalised and give a good impression of the service user’s needs and their personality. The home has started to collate information of the life styles of the service users prior to admission to the home. Service user’s spoken with informed the inspectors that their needs were being met. The home has an appropriate policy to offer support to those service users who are in the final stages of their lives. Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 10 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): 14 - 15 Service users are helped to exercise control over their lives. Food served was of a high quality but not at an acceptable temperature. EVIDENCE: Service users spoken with assured the inspectors that they are helped to exercise control over their lives. The food served was of good quality when the inspector tasted the food it was tasty but was cold. The home must find a way to ensure that all food served it of an appropriately temperature. Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 11 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): 18. Service users are protected from abuse. EVIDENCE: Staff have received training to ensure they recognise signs of abuse and the appropriate procedure should this be necessary. Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 12 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 & 25 - 26. The environment was clean, fresh and odour free. The home was safe and comfortable. EVIDENCE: On the day of the inspection the home was clean, fresh and odour free. Service user’s rooms were personalised to reflect the personality of the resident. The home has ample communal areas for the service users, however the home lacks storage for the equipment service users need to support their every day lives. The space for staff is very limited. The home is decorated in a very domestic way making it homely and comfortable. Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 13 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): These standards were not inspected. EVIDENCE: Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 14 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): 32 - 33, 36 & 38. The home is well managed and run in the best interests of the service users. Good record keeping was found. The health and safety of the service users was protected. Service users are not being consulted formally on their living experience within the home. Formal supervision has not yet been established. EVIDENCE: The Registered Manager has a great deal of experience in managing nursing homes and she runs the home in the best interests of the service users. She keeps up to date with good practice and keeps her own training up to date. On the day of the inspection staff sought her out to speak with her. The Registered Manager must not be part of the staff working rota she must be in a position to manage the home and respond to incidents and emergencies. Records were available for inspection. Where inspected they were in order. Formal supervision has not yet been implemented the Registered Manager must undergo training in the delivering supervision to enable her to carry out this requirement. The home now has a quality assurance procedure this has
Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 15 not as yet been implemented. This requirement still remains from the previous inspection. The home is expected to respond to this and the implementation of supervision as a matter of urgency. Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 3 X X X X 3 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X X 2 X 3 Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 17 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. Standard OP33 Regulation 24 Requirement Timescale for action 31/03/06 2 OP22 23 3 OP15 16 4 OP31 8 A formal quality monitoring system must be implemented that includes an annual audit and a review of the quality of nursing care and canvasses the views of service users. A report of the findings must be produced and made available to service users. A copy must also be sent to the CSCI. Some progress has been made on this. This requirement has been brought forward from the last three inspection reports and must now be complied with as a matter of urgency. Failure to comply could lead to consideration of legal enforcement action. The Registered Proprietor must 31/03/06 ensure that there is adequate provision for the storage of equipment within the home. The Registered Manager must 31/01/06 ensure that the hot food served to service users is of an acceptable temperature. The Registered Provider must 15/01/06 ensure that the Registered
DS0000019272.V275129.R01.S.doc Version 5.1 Ashview Nursing Home Page 18 5 OP36 18 Manager is free to manage the home while on duty. The Registered Manager must 31/03/06 complete training on carrying out formal supervision and further ensure that all staff receive formal supervision. 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 Refer to Standard OP19 OP7 * Good Practice Recommendations Bedrooms with worn paintwork should be redecorated. It would be good practice to offer residents a choice of wall colour for their bedrooms. More detail should be sought and recorded in the care plans regarding service users backgrounds and social histories. That staff facilities within the home are improved in accordance with Regulation 23 (3) Ashview Nursing Home DS0000019272.V275129.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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