CARE HOMES FOR OLDER PEOPLE
Ashview Nursing Home Ware Road Widford Nr Ware Hertfordshire SG12 8RQ Lead Inspector
Yoke-Lan Jackson Key Unannounced Inspection 10:00 4th May 2006 (26th May 2006) 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.V293636.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.V293636.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.V293636.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 13th January 2006 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. Qualified nurses and carers provide Twenty-four hour staff cover. The home is a large, old 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.V293636.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 04/05/06. The registered manager was present. There were 29 service users and 2 prospective service users waiting to be admitted. A team of 3 inspectors were involved in an inspection focused on staffing issues. Other areas were inspected in the course of the day. All the staff, visitors and some service users were interviewed. Staff files and other documents were examined. Copies of the duty rota for April and May 2006 were obtained. Further information was obtained by correspondence and by telephone interview. (See below for details of the inspection findings). What the service does well: What has improved since the last inspection?
The home has implemented a Quality Monitoring System. Major renovation work is being carried out in the basement to increase space for an administrative office and a staff room. The lounge and dining room have been redecorated. Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 6 The home has purchased a hot food trolley to ensure that food is served at an acceptable temperature. The registered manager has organised the staff supervision programme. 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. Ashview Nursing Home DS0000019272.V293636.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.V293636.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, 4, (6 is not applicable). The admission process involves a thorough pre-admission assessment of the prospective service user. The home will only admit a prospective service user whose needs can be met. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The registered manager ensures that the home only admits service users within the registered category. An examination of the care plan files indicated that the pre-admission assessment is carried out before a prospective service user is admitted. The written care plan was signed and dated by all parties concerned. On the day of the inspection, there were 2 new admissions. Ashview Nursing Home DS0000019272.V293636.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, 9,10 Service users are treated with respect and dignity. Their health, personal and social care needs are set out in the written care plan. Medication is administered in accordance with legislation and guidelines specified by the Nursing and Midwifery Council. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Several service users were interviewed on the day of the inspection. They all expressed how pleased they were with the staff. Many commented how well they know the staff. There is good rapport between the service users and the staff. One service user who has been in the home for a number of years commented, “The staff are very nice and kind to me. If I ask for anything they would do it for me. I would not like to change anything”. When asked about the care given, another service user remarked, “Everybody is very kind and caring. I have no complaints”.
Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 10 Each service user has a written care plan that was recently formatted and updated. Currently there are five service users requiring PEG feeds. They have access to the Speech Therapist and the Dietician to ensure that their health care needs are met and maintained. A monthly weighing chart is kept for each service user. The local Pharmacist provides regular training on the administration and storage of medication. The registered manager confirmed that the medicines are administered appropriately and that proper recording is done. There is a revised Medication Administration Record (MAR) Chart. Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 11 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, 15. Service users have the opportunity to exercise choice and control over their lives, including religious and social needs. They receive a wholesome and balanced diet with choices given. Service users maintain contact with their relatives and friends. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The service users interviewed confirmed that they are given choices over their social and recreational activities. Service users have a choice of menu. One service user commented “the food is very good” and that she is “consulted about it”. The lunch served on the day of the inspection included freshly grown rhubarb that was cultivated in the back garden of the home. The home has weekly delivery of fresh food. A picture book on food is used to aid communication for those service users with limited verbal communication so that they can indicate their selection. Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 12 The home is hoping to recruit more staff to assist with activities. Currently there are 2 part time activity co-ordinators. The activity programme has been reviewed in preparation for the summer months. Among the activities planned is a monthly choir singing and prayer session. Some service users visit the local parish church and write in the parish magazine about their experiences at Ashview. Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 13 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): 16,17,18. The home has a robust Complaint’s Policy and Procedure. Service users’ legal rights are protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Staff have training on issues concerned with the protection of vulnerable adults (POVA). A POVA training session took place on 27/04/06. The home follows the POVA procedure set by Hertfordshire Social Services. Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 14 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, 22, 24, 25, 26. Building work is in progress and therefore there is a temporary loss of amenity for the service users. However, the service users have access to safe, clean and comfortable communal facilities. Service users have the specialist equipment they require to maximise their independence. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The basement below the main lounge is being renovated and it is anticipated that the building work will last until the end of July 2006. As a result, the main lounge is temporarily not in use because of the drilling noise. All service users are currently using the dining room/lounge area. There is restricted space but the service users appeared relaxed and well cared for.
Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 15 Service users are generally satisfied with the accommodation provided. The bedrooms are arranged to suit the individual lifestyle. One service user commented, “I stay in my room, listen to music and watch TV. I would not like to change anything.” On the day of the inspection there were 21 wheelchair users. The registered manager assured the inspector that the appropriate servicing of wheelchairs, hoist and other equipment is carried out regularly. Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 16 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, 30. This is a nursing home with an experienced and committed staff team. However, in view of the high nursing needs, one nurse placement on each shift is an unsafe practice. The home has a recruitment policy and procedure. However, there is poor practice in maintaining staff records. Because of this, the overall quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to the service. There is a staff training and development programme. EVIDENCE: Copies of the staff duty rota between 22/04/06 to 19/05/06 were obtained on the day of the inspection. The staffing level consists of 1 trained nurse and 5 carers on each shift on most days. The registered manager has to cover some of the shifts as a second nurse as well as managing the home. On the day of the inspection, the home had 29 service users and 2 possible admissions. There were 21 service users with restricted mobility. These were all wheelchair users who require hoisting which needs at least 2 staff. Five service users require percutaneous endoscopic gastronomy (PEG) feeds. Apart from the registered manager, there was only 1 trained nurse (bank staff) on duty. Her roles and responsibilities included the administration of
Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 17 medication and the setting up of PEG feeds. She was required to oversee the nursing care needs of 29 service users. This practice is unsafe. To ensure that all the service users receive safe and competent care, the home must increase the number of trained nurses so that there are 2 trained nurses on each shift, apart from the registered manager. The registered manager is aware that the number of nurses employed in the home is insufficient. Many of them worked overtime as bank staff to augment the staffing level. The duty rota showed that there was a total of 7 trained nurses working in the home and 2 of these work the night shifts. On the day of the inspection, it was noted that the deputy manager had her duty changed to cover night shifts as one night staff nurse was on sick leave. The home does not employ agency nurses. The staff files examined had evidence of CRB clearance and 2 references. In some cases, however, the contractual terms and conditions were missing, and some documents had not been kept up to date. It is required that the staff records should be complete and kept up to date. (See Management Section and Statutory Requirements.) Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36, 37, 38. The home has implemented a quality monitoring system. In general, the health, safety and welfare of the service users and staff are protected. However, the registered manager must ensure that their welfare and safety are not compromised as a result of staff working too many hours, which may in turn affect staff performance. The records required by legislation have not been maintained, kept up to date and accurate. However, a staff supervision system is in place. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 19 EVIDENCE: The system for monitoring the quality of the service is now implemented. Service users, relatives and others have been given the QA questionnaires and their responses have been received and collated and the outcome published. The registered manager is currently recruiting permanent and bank staff to ensure that all staff work reasonable hours. However, the staff files examined were not kept up to date and some documents were missing. It is required that the staff records should be complete and kept up to date. (Please see Statutory Requirements). Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X 3 X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 3 2 2 Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP27 Regulation 18 (1)(a) Requirement The registered manager must ensure that the skill mix of qualified and unqualified staff are appropriate to the assessed needs of the service users at all times. The number of trained nurses must be increase by 1 on each shift. The registered manager must maintain in the care home the records specified in Schedule 4. It is required that the staff records be complete and kept up to date. The registered manager must maintain in the care home the records specified in Schedule 4. It is required that the staff records be complete and kept up to date. Timescale for action 30/06/06 2. 3. OP38 OP29 18 (1)(a) 17(2)(3) (a) 4(6) 30/06/06 30/06/06 4. OP37 17(2)(3) (a) 4(6) 30/06/06 Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashview Nursing Home DS0000019272.V293636.R01.S.doc Version 5.1 Page 23 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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