CARE HOMES FOR OLDER PEOPLE
Ashview Nursing Home Ware Road Widford, Nr Ware Herts SG12 8RQ Lead Inspector
Tom Cooper Unannounced 14 September 2005 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 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 I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ashview Nursing Home Address Ware Road, Widford, Nr Ware, Herts, SG12 8RQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01279 842 458 0208 209 0286 Mr P Patel Caroline Elizabeth Jones CRH Care Home 32 Category(ies) of OP-32 registration, with number of places Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home may accommodate 32 older people, who are frail, in need of nursing care. 2. This home may accommodate 32 older people for respite nursing care. Date of last inspection 24 September 2004 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 I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place place on a weekday afternoon. Discussions were held with service users, visiting relatives, members of care staff, the manager and deputy manager. 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, complaints records, staff recruitment records, accident records and medication records. Medication storage and administration practice were checked. A brief tour was made of the building. All areas inspected were found to be satisfactory. There were 28 residents in the home on the day of the inspection. Staff levels were considered adequate to meet the needs of the service users. 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:
The home provides a safe, comfortable environment in which service users feel secure and at home. Service users spoken with all said that staff were friendly and caring and expressed confidence in their skills and knowledge. Several visiting relatives also praised the high standards of care in the home and the kindness and dedication of staff, emphasising the friendly and welcoming approach adopted. Observations of staff at work dealing with service users indicated that staff treated service users with respect and courtesy. In addition, individual staff consulted said that teamwork in the home was good. There was a cheerful atmosphere with some lighthearted banter between staff and residents. There are effective systems in place for recruitment, induction, supervision and ongoing training of staff. Medication storage and administration were found to be satisfactory. All records checked, including staff recruitment, medication, four service users’ care plans, complaints and accident records had been completed satisfactorily and kept up to date.
Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 6 Most service users said the food provided was generally good although one questioned the quality of the produce purchased. Some vegetables grown in the home’s garden are consumed. Service users were well presented physically and appeared well cared for, with smart hair and fingernails. A hairdresser visits regularly. Staff were present in the lounge to support service users. Cold drinks as well as tea and coffee were available and being offered. The home employs an activities organiser with previous occupational health experience, who provides a range of stimulating activities including quizzes, reminiscence therapy and cookery. Recently eight service users had been on a very successful outing to Southend which evidently was much enjoyed by all. The social calendar for the month is on display in the home. Service users spoken with said they were satisfied with the opportunities for activities available in the home. During the inspection several service users and their visitors were outside on the patio in the attractive and easily accessible garden enjoying the afternoon sun. Complaints records indicated that staff were recording informal issues brought to their attention. One formal complaint received had been responded to appropriately. Service users consulted said that they would approach the manager should they wish to make a complaint and felt that any concerns would be taken seriously. The premises, although not ideally suited to the needs of elderly people with restricted mobility, are well maintained and apart from an unpleasant smell noted in one bedroom were adequately clean and tidy on the day of the inspection. Furnishings and fittings are adequate and suitable for the needs of service users. Special equipment is provided as necessary, although some of the bedrooms have restricted space that precludes the safe manoeuvring of hoists therefore admissions to these rooms must be carefully considered. What has improved since the last inspection?
All residents have now been provided with a copy of the home’s service user’s guide so that they now have easy access to information about the service provided. All medication records checked were found to be accurate, including running totals noted of tablet numbers held in the storeroom. Appropriate safety notices have been placed in rooms where oxygen is stored. Window restrictors have been placed in one bedroom and the staff room as required at the last inspection. Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 7 No service users spoken to raised any concerns about the performance or behaviour of staff. Following the last inspection the manager investigated reported concerns about some members of the night staff but was unable to identify particular individuals. She had addressed the matter by reemphasising to all staff the importance of treating service users with proper respect and consideration at all times. The fire risk assessment for the home was completed and forwarded to the CSCI as required. The manager stated that all the remedial action identified as necessary had been undertaken. The manager is now fully aware of the need to explore any gaps in employment history that may be present on job application forms. No such gaps were noted on the application forms examined of recently recruited staff. This means a more rigorous approach to establishing the fitness of staff prior to employment has been adopted. Written reports on the conduct of the home following regular visits made by the proprietor had been sent to the manager and were held on file. Such visits can be seen as part of the quality monitoring process as long as any shortcomings noted are subject to action plans for putting them right and the action prescribed is actually taken. The manager had ordered new chairs and tables for the home. Two new adjustable height beds had been delivered earlier in the week. The manager said that the home now had eight such beds and the plan was gradually to purchase more until each service user had one. This would be a positive step forward. A revised and updated induction programme for new staff has been introduced that will ensure that staff receive the relevant induction and foundation training required to meet the standard over a period not exceeding six months. The manager has devised a simpler staff supervision format that will make the process of holding supervision sessions every two months more feasible. Staff spoken with said that they felt well supported and found supervision valuable. What they could do better:
A proper quality monitoring system must be introduced that includes an annual audit of systems in the home and a review of the quality of the nursing care provided. At the moment some quality monitoring takes place but it does not involve service users adequately, although questionnaires have been circulated to service users’ relatives and visitors. A professionally recognised quality assurance system would be preferable although an inhouse-designed method would suffice providing it objectively assessed nursing and personal care, premises, equipment, health and safety, medication and so on. This has been
Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 8 required in at least the last three inspection reports therefore the proprietors must now address the matter with some urgency. More detail should be included in service users’ care plans of their individual personalities, social histories and backgrounds, to provide staff with a greater insight into how to meet their non-medical needs. Enforcement action will be taken if this is not now addressed by 1st January 2006. The paintwork in some bedrooms visited was rather worn. These should be redecorated. Some colour variation from room to room would improve the presentation of the premises, which in the opinion of the inspector was slightly institutional due to the uniform wall colour used throughout. Service users asked said they had not been offered any choice of room colour and this should be considered by the manager, in line with current good practice. 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 I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 9 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 Standards Statutory Requirements Identified During the Inspection Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 10 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 standard(s) 1 2. Prospective and current service users have sufficient information available to them to allow them to know what services the home offers and to decide whether it is suitable for their needs and expectations. Each service user has a contract of occupancy in the home that sets out the terms and conditions of residence. EVIDENCE: The home has a Statement of Purpose that contains the required information about the service to be provided. In addition, each service user has been issued with a copy of the Service User’s Guide. Copies of the Service User’s guide and the last inspection report are on display in the entrance hall. This means that prospective and current service users have access to relevant information about the service and can measure their experience of it against the stated aims of the home. Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 7, 9 10 Care plans are in place for service users that cover their health, personal and social care needs. The addition of extra information about social and emotional social and emotional needs would help to give staff greater insight into how to meet them. Staff support service users to self-manage medication in appropriate cases, subject to mutual agreement and risk assessment. An organised and strictly managed system is in place for the storage, handling and administration of medication. Service users feel that staff treat them with respect and promote their dignity and privacy. This makes them feel valued and secure. EVIDENCE: Four service users’ care plans were examined and they all contained clear details of medical needs and up to date risk assessments for areas such as falls, tissues viability, moving and handling and so on. Some details of social care needs were also included as well as some instructions to staff on how to proceed. However, it is recommended that where possible more details be included regarding the personalities of the individuals concerned as well as
Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 12 social, emotional and spiritual needs so that staff may have greater insight into how to proceed to meet them. Nevertheless all the care plans seen conveyed a good overview of the person’s requirements, especially from the physical/medical point of view. One service user was self-managing medication at the time of the inspection, following an assessment of the patient’s capabilities. Staff discreetly monitor the situation to ensure ongoing safety. The operation of the medication system based on the ground floor was examined and found to be well organised and properly recorded. All the requirements made at the last inspection had been met. No gaps were found on the medication administration record (MAR) sheets and in spot checks made in respect of five different medicine packs the tablet numbers matched the numbers recorded on the MAR sheets. Controlled drugs were separately recorded and stored. Appropriate safety notices were displayed in rooms where oxygen was stored. The medication fridge was clean and well ordered, with temperatures recorded daily. Dates of opening were routinely recorded on packs of medication. Opened bottles of eye drops being stored were all within their expiry dates. All service users consulted expressed positive views about the performance, skills and attitudes of staff, describing them as caring, polite, sympathetic and helpful. They said that staff respected their privacy and knocked and waited at their bedroom doors before entering. This was observed in practice during the inspection. Several visiting relative made similarly positive comments. Medical examinations and treatments always take place in private. One service user who preferred not to mix with the others said that staff understood her wishes and she was therefore able to her to spend her time as she chose. Other service users felt that they were generally able to make decisions for themselves. Service users were well dressed in their own well-laundered clothes and were clean and tidy with attention having been paid to hair and fingernails. Male residents had been shaved. Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 12, 13 15 Service users are able to lead the lifestyles they choose, participating in the varied range of activities as they wish and supported by staff as necessary. The home welcomes visitors and staff encourage and support service users to maintain social contacts outside the home. The home provides well balanced, nutritious food that most service users enjoy. Service users can take meals in their rooms if they choose. EVIDENCE: The home employs an activities coordinator, who has previous occupational health experience. She organises and provides a varied range of stimulating activities including quizzes, cooking sessions and reminiscence therapy. Recently staff had hired a coach and took a group of eight service users to Southend for the day, which evidently had been a great success. Service users and visiting relatives expressed satisfaction with the activities on offer, saying they felt that good opportunities for leisure and stimulation were available. Details of forthcoming events are displayed in calendar form. Occasionally service users are consulted over their views on the running of the home and details of suitable activities proposed for individuals were noted in the care plans seen. It has previously been reported that the coordinator maintains
Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 14 records of activities occurring, although these were not checked at this inspection. Service users and visitors consulted said that there were no restrictions on visiting and that staff were always welcoming and friendly. The open approach is referred to in the Service User’s Guide. During the inspection a number of visitors came and went within the home in a relaxed and natural way. The manager continues to encourage the development of contacts with the local village community. The proprietors hold an annual barbeque and Christmas party for relatives and near neighbours from the village. Service users asked for their rating of the food provided all said that it was adequate, with several describing it as excellent. Visiting relatives concurred with this assessment. However, one resident felt that the quality of produce purchased was not always high, although the homegrown vegetables produced in the garden were an exception. Service users can choose to take meals in their bedrooms if they wish and two commented that this was much appreciated as it suited them well. The kitchen was not inspected on this occasion. Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 15 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 standard(s) 16 Service users and relatives are aware of the home’s complaints procedure and are confident that any complaints made will be taken seriously and responded to appropriately. EVIDENCE: Service users consulted emphasised that they had no wish to make any complaint about the home. However they were aware of the procedure to follow should the need arise, all saying that they would first approach the manager or the proprietor. They were confident that any matters raised would be dealt with properly within a reasonable timescale. One complaint about Ashview had been copied to the CSCI since the last inspection. The manager had responded to this within a week and the situation had prompted an adjustment of the admissions policy. Another formal written complaint from a former resident’s relative had also been dealt with and documented appropriately. Other more minor grumbles had been recorded in the complaints book, reflecting the home’s current more proactive approach to this subject. Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 16 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 standard(s) 19, 20, 21, 22, 23, 24, 25 26 The environment is safe and well maintained. However, the relatively small size and restricted space of some bedrooms mean that care must be taken to ensure that service users’ moving and handling needs can be met prior to admission. All communal facilities are safe, accessible and comfortable. Sufficient numbers of suitably equipped bathrooms and toilets are provided to meet service users’ needs. Specialist equipment and adaptations are available on the premises suitable for the needs of elderly people with restricted mobility. Service users’ bedrooms are of a reasonable size and are arranged to suit their individual requirements. Heating, lighting, water supply and ventilation are effective, safe and provide a comfortable environment for service users. Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 17 The home is generally clean and tidy and free from unpleasant smells. Standards of cleaning have deteriorated slightly recently due to staff shortage but remain acceptable. EVIDENCE: The home is in a rural setting on the edge of a village. A gravel driveway to the front of the building provides limited car parking and there is a large garden to the rear that has been laid out with level pathways around the perimeter leading from the large patio. The garden has seating, raised flower beds and a vegetable and fruit garden. Residents like the rural setting and enjoy eating the vegetables produced in the garden during the summer. The building has many period features although extensive modifications have been made to eliminate steps between the various floor levels. As a result there are relatively narrow sloping corridors on the ground and first floors that, albeit safe, are not ideal for wheelchair users. The proprietor has a programme for maintenance and renewal in place. A fire risk assessment had been completed since the last inspection and the manager stated that all remedial work identified as necessary had been completed. The home has two lounges and a dining room that together provide sufficient communal space to meet the standard. There is also a hairdressing room. There are two assisted bathrooms and two walk-in shower rooms. Chair hoists are provided in the bathrooms. Thermostatic mixer valves regulate hot water temperatures and regular tests are recorded. Special adaptations to meet the needs of service users with restricted mobility include handrails fitted along corridor walls, ramped floors, level access to the garden for wheelchair users, eight adjustable beds (two new ones were delivered earlier in the week of the inspection), free standing and bath hoists and pressure relieving equipment. There are cordless call points in each bedroom, bathroom and toilet. There are thirty single bedrooms and one double. Although all the bedrooms meet the minimum space standard, the shape of some rooms restricts the bed position and hoist access therefore admission to these rooms must be restricted to service users without major lifting requirements. Service users may bring in small items of furniture subject to the manager’s agreement and the relevant fire regulations. Individual bedrooms had been personalised with pictures, ornaments, soft furnishings and photographs. All
Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 18 rooms are lockable and have a lockable drawer for the storage of valuables. The paintwork in some rooms was rather worn and these rooms should be redecorated. The home is centrally heated. Radiators have protective covers fitted to prevent burns. Bedroom windows are openable by residents, although all upper storey windows have restrictors fitted following assessment of the risk of falls. On touring the building all areas were found to be fresh and reasonably clean, apart from a moderate unpleasant smell associated with incontinence noted in one bedroom (this was dealt with by staff before the end of the inspection). The laundry is equipped with two commercial washing machines and a dryer. A good standard of laundry was reported by service users and observed during the inspection. Red alginate bags are used for laundering soiled linen. Consistent with good infection control practice appropriate arrangements are in place for the storage and collection of clinical waste, and liquid soap and paper towels are provided in areas where personal care tasks are performed. Disposable gloves and aprons are available for staff. Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 30 Adequate numbers of suitably qualified staff are provided at all times. The home has an effective recruitment policy and carries out thorough preemployment checks to establish the fitness of individuals to work at the home. The home’s induction and foundation training programme for new staff ensure that they are competent to do their jobs and aware of the relevant policies and procedures. EVIDENCE: The staff rota was available for inspection. Staff confirmed that there were a minimum of two registered nurses and four care assistants on duty during the day shifts, with one registered nurse and two care assistants at night. One registered nurse and five care assistants are provided at weekends with support from a senior nurse on call. An additional care assistant comes on duty at 6 am. No agency staff are used, any potential shortfalls in staffing being covered by staff seconded from one of the proprietors’ other homes. Housekeeping, domestic and maintenance staff are employed. An administrator is employed part time two or three days per week. The personnel files of the two most recent recruits were examined and each contained a fully completed application form, two positive references, a Criminal Records Bureau disclosure and the required identification evidence. This indicated that a rigorous recruitment process was being operated to meet the standard.
Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 20 The manager had drawn up a new induction and foundation training programme that involves a lengthy checklist of key competencies through which the candidate must work, with competence verified and signed off by the supervisor, to be fully completed within six months of the commencement of work. The new programme had just been introduced and should result in more comprehensive training for new staff. An example seen had been diligently filled out. Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36, 37 The registered manager is very experienced in the care of the elderly and is undertaking a care home management course to expand her management skills. Various reviews and checks are carried out to ensure that standards are maintained. Service users’ views are sought via questionnaires. However, a formal quality assurance and quality monitoring system must be introduced that includes a review of the quality of nursing care and a report of the findings must be produced and made available to service users (see requirement). Staff receive regular individual supervision covering work related issues and records are kept. Rigorous record keeping practices are followed that demonstrate a disciplined approach to health and safety, care management and the vetting of staff that protects the interests of service users. Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 22 . EVIDENCE: The manager is a registered nurse and has worked in the home since 1999, first as deputy manager before being promoted. She was registered as manager in January 2003. Both she and the deputy manager are currently enrolled on an NVQ course in care home management. There are various review processes in place e.g. for care plans, premises, policies etc. In addition, questionnaires have been issued to service users’ relatives and friends and one of the proprietors visits regularly and produces reports on the conduct of the home. All these processes contribute to maintaining standards. However, no formal quality assurance and monitoring process has been established as required by the Regulations therefore this remains an outstanding requirement despite having been required in previous inspection reports. A system must be introduced before the end of the year that involves a verifiable method of reviewing the quality of nursing care as well as canvassing service users’ opinions. A report detailing the findings and any actions planned for improving the quality of care in the home must be produced and made available to service users and a copy sent to the CSCI. The manager has devised a new supervision record format that simplifies the process and should facilitate individual sessions for all care staff every two months. Supervision covers care practice issues and professional development. The manager is considering spreading the load of supervision responsibilities through the senior team. Staff spoken with felt that they were well supported by senior colleagues and described teamwork and communications in the home as good. Handover meetings between shifts are used to pass relevant information to incoming staff so that they know the priorities for their shifts. All the records checked, including care plans, risk assessments, accident reports, staff recruitment documents, complaints and medication records had been diligently completed, indicating a disciplined approach. Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x 2 x x 3 3 x Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP33 Regulation 24 Timescale for action A formal quality monitoring by 1st system must be implemented January that includes an annual audit and 2006 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. This requirement has been brought forward from the last two inspection reports and must now be complied with as a matter of urgency. Requirement 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 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.
I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 25 OP7 Ashview Nursing Home Ashview Nursing Home I52 s19272 Ashview Nursing Home v247293 300905 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Hertfordshire Area Office Mercury House, 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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