Inspection on 05/06/06 for Ashwood

This inspection was carried out on 5th June 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashwood 03/04/07

Ashwood 09/01/07

Ashwood 05/12/05

Ashwood 12/05/05

Ashwood 19/08/04

Ashwood 06/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Ashwood New Road Ware Hertfordshire SG12 7BY Lead Inspector Bijayraj Ramkhelawon Key Unannounced Inspection 5th June 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 Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 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.V298305.R01.S.doc Version 5.2 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. 5th December 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. At the time that this inspection took place, fees ranged from £432-£580 Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Feedback received from service users and visitors was positive. Service users were complimentary of staff, food and the services they received. However, there were major shortfalls including fire doors were wedged open; the bath hot water temperature was 49.5°C and rising; there was a strong, lingering and offensive smell in bungalows 3 and 5 which must be identified and eliminated; the external surfaces of the hot trolley units which were peeling off must be repaired or replaced (A requirement was made by the Environmental Health Officer in February 2005 and not complied with); risk assessment for service users with electric reclining chairs was not carried out; food and hygiene and infection control training was not provided for all staff; temperature records of the fridge in the satellite kitchens was not taken and kept; smoke from the designated smoking area filtered to the main lounge. The management must be proactive in ensuring that safe practices are maintained. There have been a high number of falls recorded in the month of April 2006 of which 55 happened during the night. The home has adopted a policy that when a service user has 3 falls in a month then the risk assessment is checked and when someone falls 6 times in a month then a visit by a GP is requested. This policy must be reviewed to ensure that appropriate action is taken to prevent further falls when a service user has a fall on the first occasion. The advice of the falls prevention team has not been sought. Care plans were well documented and showed that service users’ needs were being met and staff said that they were happy to be working at the home and that they were well supported by management. What the service does well: Feedback from service users and their relatives was positive. Care plans examined showed that service users needs were being met and that their privacy and dignity was respected. The home had received a number of compliments in relation to the provision of care. Three complaints have been received since the last inspection and all have been dealt with in accordance with the complaints procedure. Service users were complimentary of the staff, food and their rooms. They were encouraged to participate and air their views at meetings. Records were generally kept in good order. The management operates an open door policy and is transparent. Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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.V298305.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. Each service user had a comprehensive assessment of their needs and was given an opportunity to visit the home prior to moving. Short stay service users did not always visit the home before they arrived for their stay. However, risk assessment in relation to moving and handling of service users must be carried out to ensure that any risk identified is minimised and managed. EVIDENCE: Care plans examined included an assessment of needs for each service user. Reports from other professionals formed part of the care plans. Each service user had their plan of care and daily living based on the assessment of needs. However, risk assessment in relation to moving and handling of service users was not carried out. Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 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): 7-10 Overall the quality outcome in this area is poor. This judgement has been made using all available evidence including a visit to this service and was strongly influenced by information in care plans and the policy on responding to falls. Good care practices and interactions between staff and service users were observed. Care plans had the required documentation but these must be reviewed on a regular basis to reflect the changing needs of service users. These must also include the religious and cultural needs of service users. The administration and management of medicines was satisfactory. However, a copy of the ‘Royal Pharmaceutical Society booklet on the administration and control of medicines in care homes’ should be provided as a guide for staff. The advice of the falls prevention team must be sought in view of minimising and management of service users who were prone to falls. EVIDENCE: Service users spoken to confirmed that they were well cared for and their individual needs were being met. Care plans had all the information including assessment of needs, health and personal care being provided. However, these were not reviewed on a regular basis to reflect the changing needs of service Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 10 users. Religious and cultural needs of service users were also not identified. There have been 40 falls recorded in the month of April 2006 of which 55 happened during the night. The home has adopted a policy that when a service user has 3 falls in a month then the risk assessment is checked and when someone falls 6 times in a month then a visit by a GP is requested. This policy must be reviewed to ensure that appropriate action is taken to prevent further falls when a service user has a fall on the first occasion. The advice of the falls prevention team has not been sought. The administration and management of medicines was satisfactory but staff were not aware of the ‘Royal Pharmaceutical Society booklet on the administration and control of medicines in care homes’. Service users who required nursing care had regular input from the District Nurses. All service users were registered with a GP and a log of visits from them, District Nurses, Community Psychiatric Nurses and all other health care agents was maintained. All service users were appropriately dressed, well groomed and they confirmed that staff addressed them by their preferred names. Staff members on duty were observed to deliver care and to attend to service users’ needs in a manner that was conducive to respect for their privacy, dignity, choice and wishes whilst actively promoting independence where possible. All personal and intimate care practices were carried out behind closed doors. Doctors and District Nurses also see service users in the privacy of their own rooms. Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 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): 12-15 The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. Autonomy and choices for service users were exercised. Day care activities must be provided to ensure that service users have the opportunities to pursue their leisure, social, recreational and cultural interests. A programme of weekly activities must be planned and displayed for service users to inform them of the activities taking place. A choice to the current menu must be provided to enable service users to choose from the main course. EVIDENCE: The activity co-ordinator was on holidays. There were no day care activities being provided to ensure that service users have the opportunities to pursue their leisure, social, recreational and cultural interests. There was no programme of activities planned. Staff said that the Salvation Army, pupils from the local schools and people from the church visit the home. However, autonomy and choices to clothes and preferences were exercised. Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 12 The lunch was unhurried with assistance and encouragement given by staff. Tables were laid nicely and a choice of drinks was available and there was individual cutlery. Service users spoken to were complementary of the food provided. The current menu did not have a choice of hot meal. Personal belongings were evident in service users bedrooms. Service users have their relatives or social workers or solicitors as advocates. There was a monthly service users meeting held with minutes kept. Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 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): 16,18 The quality outcome in this area is good. This judgement has been made using all available evidence including a visit to this service. The home has a complaints procedure which service users and visitors spoken to were aware of. Staff have attended training in the protection of vulnerable adults. Service users were aware that they could have the support of an independent advocate. EVIDENCE: A copy of the complaints procedure was available to prospective and current service users. Those spoken to said that they were aware of the complaints procedure but would prefer to speak to a member of staff or the manager if they had any concerns. Staff confirmed that they have received training on Protection of Vulnerable Adults. Three complaints have been received since the last inspection and all have been dealt with in accordance with the complaints procedure. Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 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): 19,26 The quality outcome in this area is poor. This judgement has been made using all available evidence including a visit to this service. The home was reasonably kept clean but bungalows 3 and 5 had a strong, lingering and offensive odour which must be rectified to prevent the risk to service users and staff health. EVIDENCE: The communal areas were homely with ornaments and pictures. Bedrooms had personal belongings of service users. Accommodation is provided for single occupation on ground floor, which were accessible and safe. The gardens were well maintained. Each bungalow has a lounge and a kitchenette/diner. There was an identified area for service users to smoke but the smoke drifted into the main sitting room where a number of service users stayed during the day. Non-smokers have complaint about this smoking room being an open space area (See Standard 38). Bungalows 3 and 5 have a strong, lingering and offensive odour. Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 15 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): 27-30 The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. The skills and experience of staff were varied. There was an enthusiastic, dedicated and caring staff team who took great pride in the service provision. Training in the effective implementation of care plan must be provided for all staff. EVIDENCE: There was adequate number of staff rostered on duty per shift during the day. There were also adequate number of domestic and catering staff allocated per day and the home has the services of a maintenance person. Service users were complimentary about their rooms, staff and food. They said that ‘ staff are good, they look after us’. Food is nice too and plenty. Staff files inspected had all the relevant documents required by this Standard. Staff spoken to confirmed that they have received appropriate training, this included statutory training. They also said that they receive regular supervision and an annual appraisal and they have been given a copy of the General Social Care Council Code of Conduct. However, they had not received training in devising implementing and maintaining and effective care plan. Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 16 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): 31,33,35, 36 and 38 The quality outcome in this area is poor. This judgement has been made using all available evidence including a visit to this service. Service users, their relatives, visitors and staff were encouraged to air their views with regular meetings held and minutes kept. Financial management procedures were in place. Staff received regular planned supervision. There were policies and procedures in place to ensure that service users’ rights were protected. There was an enthusiastic, dedicated and caring staff team who took great pride in the service provision. However, there were major shortfalls and management must take proactive measures in adhering and ensuring that safe practices in relation to health, safety and welfare of service users and staff were maintained. This included adherence to fire safety regulations in ensuring that fire doors were not wedged open; bath hot water temperature must be monitored to provide water close to the safe required level; the strong, lingering and offensive smell must be identified and eliminated; the external surfaces of the hot trolley units which were peeling off must be repaired or replaced; risk assessment for Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 17 service users with electric reclining chairs must be carried out; food and hygiene and infection control training must be provided for all staff; temperature records of the fridge in the satellite kitchens must be kept; designated smoking area must ensure that the smoke does not filter to the main lounge next door. All the above pose a risk to service users and must be rectified. EVIDENCE: The management has an open-door policy where staff could see them at any time with any issues or concerns they may have. However, fire doors were wedged open; the bath hot water temperature was 49.5°C and rising; there was a strong, lingering and offensive smell in bungalows 3 and 5 which must be identified and eliminated; the external surfaces of the hot trolley units which were peeling off must be repaired or replaced (A requirement was made by the Environmental Health Officer in February 2005 and not complied with); risk assessment for service users with electric reclining chairs was not carried out; food and hygiene and infection control training was not provided for all staff; temperature records of the fridge in the satellite kitchens was not taken and kept; smoke from the designated smoking area filtered to the main lounge. All statutory records were available for inspection and maintained in accordance with legislation. Staff spoken to were aware that service users can access their records and information held about them in accordance with the Data Protection Act 1998. There were policies and procedures in place to ensure that the health, safety and welfare of service users but these were not promoted and protected. These records were accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. The CSCI has been kept informed of all accidents and admissions to hospital. A valid insurance certificate was displayed in the reception area and this offered cover of no less than £5 million. Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 18 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 x x x x x x 1 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 1 Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 19 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. 2. 3. Standard OP3 OP7 OP7 Regulation 13 (5) 15 (2) (b) 15 (1) Requirement Risk assessment in relation to moving and handling service users must be carried out. Care plans must be reviewed at least once a month. Care plans must include the religious and cultural needs of service users from ethnic minority communities. Risk assessment, minimisation and management of service users who have falls must be carried out. A programme of weekly activities must be planned for service users. A choice to the current menu must be provided Offensive odours in bungalow 3/5 must be identified and rectified. Training in the effective implementation of care plan must be provided for all staff. Bath hot water temperature was 49.5°C and rising. This must be reduced to the safe required level of 43°C. Timescale for action 29/07/06 29/07/06 29/07/06 29/07/06 4. OP7 13 (4) (c) 29/07/06 29/07/06 05/06/06 18/08/06 05/06/06 5. 6. 7 8. 9. OP12 OP15 OP26 OP30 OP38 16 (2) (m) & (n) 16 (2) (i) 16 (2) (k) 18 (1) (c) (i) 13 (4) (c) Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 20 10. OP38 13 (4) (a) & 23 (4) (a) 23 (2) (c) Doors must not be wedged open. 05/06/06 These must only be kept open by means approved by the Fire Safety Officer. The external surfaces of the hot trolley units were peeling off and in disrepair and unable to be cleaned effectively. These must be repaired or replaced (EHO report – 16/02/05). Temperature records of the fridge in the satellite kitchens must be kept Food and Hygiene training must be provided for all staff handling. Risk assessment for service users with electric reclining chairs must be carried out. Designated smoking area must ensure that the smoke does not filter to the lounge next door to protect other service users inhaling the smoke. Training in infection control must be provided for all staff. 05/06/06 11. OP38 29/07/06 12. OP38 16 (2) (g) 13. 14. 15. OP38 OP38 OP38 18 (1) (c) (i) 13 (4) (c) 13 (4) (c) 18/08/06 29/07/06 08/09/06 18/08/06 16. OP38 18 (1) (c) (i) 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. Refer to Standard OP9 OP27 Good Practice Recommendations The Royal Pharmaceutical Society booklet on the administration and control of medicines in care homes should be provided. 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. DS0000019273.V298305.R01.S.doc Version 5.2 Page 21 Ashwood 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 © 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 Ashwood DS0000019273.V298305.R01.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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