CARE HOMES FOR OLDER PEOPLE
Ashwood New Road Ware Hertfordshire SG12 7BY Lead Inspector
Patricia Rogan Unannounced Inspection 5th December 2005 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 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. Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ashwood Address New Road Ware Hertfordshire SG12 7BY 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) 01920 468966 01920 485188 Runwood Homes Plc Christine Chambers Care Home 64 Category(ies) of Dementia - over 65 years of age (64), Old age, registration, with number not falling within any other category (64), of places Physical disability over 65 years of age (64) Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Registered Manager must successfully complete the Registered Managers Award, followed by NVQ Level 4 in Care by 31.01.07. 12th May 2005 Date of last inspection Brief Description of the Service: Ashwood is a purpose built home arranged in six internally connected bungalows for 64 elderly people. Each bungalow is self-contained and offers a lounge, kitchen/diner and with adequate bathroom and toilet facilities. All bedrooms are well furnished. The main entrance to the home opens onto a sitting area and conservatory. There are pleasant gardens at the rear and inner courtyards, with mature trees. There is a laundry facility and staff members are employed to provide this service. There is a payphone for the use of the service users. A variety of social and recreational activities are offered to residents to choose from and participate. Ashwood is close to the town centre of Ware, which offers all high street facilities. There is a main transport system, bus and train, within walking distance of the home. Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors were present for this unannounced inspection, which took place during the day. It was the second inspection of the year. Several residents, and visitors and members of staff were spoken to individually. Brief questionnaires were handed to residents and visitors during the inspection. Their responses about the standard of care and staff support was very favourable. Some of the comments have been incorporated in this report. During the inspection, a tour was made of the building including communal areas and some resident’s bedrooms. The standard of documentation during the admission procedure was examined. Record keeping for the administration of resident’s personal allowances was also inspected. Where key standards were assessed at the previous inspection of 12th May 2005, these have not all been assessed again. Reference should be made to the report of that inspection for details. What the service does well: What has improved since the last inspection?
The requirement to redecorate one unit has been carried out. Such is the commitment of the manager and staff that they had painted the kitchen themselves but small areas of paint are peeling, risking contamination in food. An activities co-ordinator is now in post and residents said they are pleased to have the chance to join with others and try new crafts. A volunteer runs bingo sessions and several residents said they looked forward to this because it offered another chance to socialise. At the last inspection it had been recommended that all staff members should have had training in Adult
Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 Page 6 Protection and arrangements are now in place for the those staff who have not yet had this training. There is now an effective structure in place for formal staff supervision. Informal supervision is ongoing and the Manager has designated three hours every other Friday when staff can have a private discussion with her. 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. Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 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 Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 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 (Standard 6 does not apply to Ashwood) Residents had had a comprehensive assessment of their care needs and were given an opportunity to visit Ashwood prior to moving into the home. Short stay residents do not always visit the home before they arrive for their stay. However, many of the short stay residents have had breaks in Ashwood in the past and choose the home again because they know the staff. EVIDENCE: The records of the four most recent residents were inspected. These showed that a senior member of staff had carried out an assessment prior to inviting the prospective resident to visit Ashwood. The assessments were signed by the resident or their representative. Those residents and relatives who were spoken to during the inspection said they had been kept informed and involved throughout. One relative said staff had been very reassuring and had understood their concerns about residential care. He said it was because of this, his aunt was able to settle in surprisingly quickly. Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 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): 9 and 11 There is a policy and procedure in place should any resident be willing and able to take responsibility for their own medication. Residents and relatives have the assurance that as far as possible, they would be cared for in Ashwood to the end of their lives. EVIDENCE: Residents are aware that they can take responsibility for their own medication, however at the time of the inspection, no-one was self-medicating. One resident and her daughter who was present during the inspection said when a resident died after a short illness, the Manager came and spoke to everyone to let them know what had happened. They said the staff were understanding at their loss and gave them time to talk about their feelings. Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 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): 13 and 14 The staff in Ashwood are welcoming towards residents, their relatives and visitors to the home and it is this atmosphere which encourages good support from residents and the local community. On a daily basis, the staff ask residents about many aspects of their lives such as what they would like to wear, eat and what they would like to do for the day. Residents are also encouraged to attend residents’ meetings where they can share their opinions with others. EVIDENCE: All those spoken with confirmed that staff encourage them to go out if possible. Residents said the activities co-ordinator has given them more opportunities to follow their own hobbies and interests. Residents said they enjoyed holding bazaars and other fund raising events and liked having the chance to meet the local community. Relatives are actively involved in many of the events which take place in Ashwood. Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 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): 17 and 18 There are policies and procedures in place to ensure the residents’ legal rights are protected. The majority of staff have had training in Adult Protection. Residents are aware that they can have the support of an independent advocate. EVIDENCE: Residents and visitors said they had been treated respectfully and were aware that they had rights to make independent choices. Some residents said they had been told they could speak to an advocate if they wanted to have the support of someone not connected to the home. Residents said they felt confident that they could access legal advice if they so wished. Arrangements are now in place to ensure that those who have not yet done so, will have training in Adult Protection. Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 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, 21, 22, 23, 24 and 25 Ashwood has a relaxed atmosphere and there are sufficient indoor and outdoor communal areas to meet the needs of the residents. Residents are encouraged to bring small items of furniture, pictures and ornaments for their own rooms. Ashwood would benefit from refurbishment and repair in several areas. This view was shared by a number ofresidents, visitors and staff. Some equipment, particularly in the main kitchen, needs replacement. There is difficulty locating rooms and facilities because the doors are unmarked. This is particularly difficult for those residents who have a sensory impairment or cognitive impairment. EVIDENCE: The communal areas are homely, with ornaments and pictures. A resident said, “I felt at home as soon as I arrived.” Several resident’s rooms were seen with the agreement of the residents. All had been personalised. Residents and relatives, spoke of the difficulty finding their way around the home, particularly when they first moved into Ashwood. Clear signs would be helpful. The homely atmosphere would be greatly improved by redecoration and repair of those areas already identified by the Manager.
Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 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): 27 Residents and visitors spoke of the hard working staff. There is additional staff at peak times of activity but the extra worker(s) are shared between the units. Both residents and staff felt that this was not always sufficient. EVIDENCE: Several people commented on the length of time residents had to wait before they were able to have assistance to go to the bathroom. When residents were preparing for bed and two carers were needed to assist one resident, there were periods of time when the communal areas may be unattended. Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 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, 34, 36 and 37. The Manager encourages staff, residents and visitors to air their views and she is closely involved in all aspects of the running of Ashwood. The Service User Guide and the ‘Welcome’ pack all focus on the needs of the residents. Financial management procedures are in place. There is a rota for staff supervision. New staff members are supervised during their induction period. There are policies and procedures in place to ensure that residents’ rights are protected. EVIDENCE: Residents, visitors and staff said the Manager was approachable and helpful. It is impressive that the Manager has so much support that people were willing to help paint the kitchen. The management of residents’ finances was inspected and all was satisfactory. Other records were examined and were up to date. Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 Page 15 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 2 3 2 3 3 3 2 X STAFFING Standard No Score 27 2 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 3 3 X 3 x Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 Page 16 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 OP19 Regulation 23(2)(b) Requirement The Registered Person must ensure premises are maintained in a good state of decoration and repair in order to present a more pleasing environment for residents, staff and visitors. Several areas were seen to be in need of repair or refurbishment. The Registered Person should provide sufficient and suitable kitchen equipment, crockery, cutlery and utensils and adequate facilities for the preparation and storage of food. Fridge and freezer storage must be increased. A large balloon whisk needs replacing, additional serving bowls are required, drawer fronts need repair. Standard 16(2)(j) -The heated food trolleys should all be renewed or the insulation replaced, as advised by the environmental health authority when they inspected the kitchen early in 2005. Timescale for action 30/06/06 2. OP19 16(2)(g) 31/01/06 Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 Page 17 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 OP27 Good Practice Recommendations A review of staffing levels would be beneficial. The ratio of care staff to residents should be determined according to the assessed needs of the residents and according to the size and layout of the home. Ashwood DS0000019273.V272338.R01.S.doc Version 5.0 Page 18 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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