CARE HOMES FOR OLDER PEOPLE
Ashwood Care Centre 1a Derwent Drive Hayes Middlesex UB4 8DU Lead Inspector
Clare Henderson Roe Unannounced 12 July 2005 10.00am
th 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. Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ashwood Care Centre Address 1a Derwent Drive Hayes, Middlesex, UB4 8DU 020 8573 1313 020 8573 1124 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) Life Style Care Plc Mrs Karen White-Cancherini Care Home 70 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 32 Elderly Frail, of which 24 beds are for nursing and 8 are for personal or nursing. 2. 15 Elderly Personal Care. 3. 23 Older people with dementia - personal care. 4. Minimum Staffing Notice. Date of last inspection 25th January 2005 Brief Description of the Service: The home is situated between Uxbridge and Hayes. It is made up of 4 units and can accommodate a total of 70 service users. There are 68 single rooms and one double room, all with en suite facilities. There are local shops, bank and post office facilities nearby. The Beck Theatre is near the home, as are local pubs and restaurants. The home can be accessed by bus and main line train services. There is a full time Activity coordinator and a planned and advertised programme of activities. Outings are also arranged. The hairdresser visits 6 times a month. The home has one GP practice and there are weekly visits to the home, and other healthcare services are accessed by the home for service users. A Devotional Meeting is held every two weeks and religious and clergy visits are arranged as required. The home has a Registered Manager and a Deputy Manager who is in charge of the training programmes for staff and also works as a registered nurse within the home. The Support Manager provides supervision of staff on the personal care units. Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 17 hours were spent on the inspection process. The Inspectors carried out a tour of the home, and inspected service user plans. 10 service users, 3 visitors and 6 staff were spoken with as part of the inspection process. What the service does well: 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 Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 6 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 Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 7 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) 3. The home does not provide intermediate care. Service users are assessed prior to admission to ensure the home can meet their needs. EVIDENCE: A pre-admission assessment is carried out for all prospective service users. Samples of these were viewed and had been clearly completed. In addition, copies of Social Services assessments are also obtained. Therefore the home can ascertain if it is able to meet the needs of prospective service users. If a service users condition changes and intervention is required, the home accesses assistance from heath care professionals as appropriate. Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 8 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, 8, 9 & 10 The health and personal care needs of service users had been identified and were being met. Shortfalls in the management of medications potentially place service users at risk. Staff are courteous to service users and generally personal support is provided in such a way as to promote and protect the service users privacy, dignity and independence. EVIDENCE: Samples of service users plans were viewed. Overall these were comprehensive and identified service users needs and the action to be taken to meet these needs. Monthly updates had been carried out and there was evidence of new care plans being formulated for new problems identified. Risk assessments for falls were in place and had been updated following any falls with one exception, which was discussed. An update had then been carried out as part of the monthly review. Documentation for wound assessment and wound care was comprehensive and up to date. Nutritional assessments and care plans are in place, and monthly weights are carried out. Continence assessments had been carried out in most service user plans viewed, with one needing completing and one to be formulated. Care plans for continence care needs were in place. Moving & handling assessments were in place. Risk assessments had been completed for
Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 9 areas of identified risk. On the first floor unit a bedrail risk assessment had not been completed prior to the use of bedrails, and for another service user on the unit who, at their own request, no longer had bedrails or an airflow mattress in place, the relevant care plans and assessments had not been updated to reflect this. Some of the documentation had been superseded with new documents and archiving was to be carried out to ensure that clear, up to date documentation is held in the service user plan file. The home now has one GP practice providing cover and weekly and as required visits are carried out. Service users still have the choice to maintain their own GP if the GP is in agreement. There was evidence of input from other healthcare professionals recorded. Samples of the medication records on each unit were viewed. On the ground floor nursing unit these were generally being well managed. Two gaps in signing on the medication administration record (MAR) chart were noted for one service user, and no explanation or coding had been recorded. For one service user receipt of medications had not been recorded. All other charts viewed had receipts and administration of medications clearly recorded. On the first floor nursing unit there was an issue with overstocking of one medication. Records of receipts of medications received mid-cycle were not seen, and the Registered Manager said that the unit has a separate file for this recording which was not shown at the inspection. Some liquid medications had not been dated when opened. This is a repeat finding. For one service user topical creams were being stored in the bedroom, as an infection control measure. The service user is fully aware of this and the situation should be risk assessed and action taken to address any risk identified. On the ground floor personal care unit all medications and receipts were signed for on the charts viewed. Dates of opening were recorded on liquid medications. The senior carer was very clear on the management and administration of medications and the medications were being well managed. On the second floor personal care unit one MAR chart had not been amended accurately to reflect a change in the dosage of one medication. This was addressed at the time of inspection, plus the Unit Manager carried out a medications audit. On one MAR chart where the dosage of a medication had been reduced, this needed to be re-written for clarity. For one service user there was some overstocking of medications and this was addressed at the time of inspection. For one service user where the dosage of a medication had been increased this had been clearly recorded. On two units where a particular medication, which is available in three strengths, was being administered, the method of writing up the medication on the MAR chart to clearly identify the strength and number of each tablet to be administered was discussed. Action has been taken to address this finding.
Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 10 Staff communicated with service users in a courteous and respectful manner. Service users spoken with said that the staff are caring. Service users preferred term of address is recorded and respected. Service users receive their post unopened, or where service users cannot manage their own post, this will be kept for the next of kin. Service users can have a private landline or mobile telephone if they so wish, and there is also a telephone for use. Service users receive treatment and care in their own rooms. Staff spoken with said that there is good teamwork in the home, both among the care staff and also between the different departments. Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 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 standard(s) 13 & 15 Visiting is encouraged for service users to maintain contact with family and friends. Food choices are provided and service users preferences are met. EVIDENCE: Relatives and friends were seen visiting service users. Service users can choose whom they wish to see and their wishes are respected. Representatives who were asked said that they are kept informed of any concerns regarding their relative. There is information in the Service Users Guide regarding maintaining contact between visitors and the service users. The lunchtime meal alternative option and the teatime home made snack were sampled and were well presented and tasty. Service users spoken with said that the food was satisfactory. One minor issue had been discussed with the Registered Manager and was being addressed. Hot and cold drinks were available to service users. The lunchtime meal was well presented and service users choices were being respected. Staff were available to assist service users and the meal was conducted in a sociable manner. The kitchen facilities were not viewed on this occasion. Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 12 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 The home has clear complaints procedures and service users said that any concerns are promptly addressed. EVIDENCE: The home has a clear complaints procedure, which is on display in the home and available to service users and visitors. Service users and visitors spoken with said that any concerns raised are promptly addressed. Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 13 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) 26 The home is generally clean and tidy and the environment is safe for service users. The delay in addressing flooring issues on one unit causes malodour and is unpleasant for those people accommodated in and visiting the unit. EVIDENCE: The home was generally clean and tidy. There was a stale odour on the second floor and the corridor carpets are worn and in places stained. They are frequently cleaned, but the carpet needs to be replaced with suitable flooring to the needs of the service users accommodated on that floor. The Registered Manager has obtained quotes to replace the carpet with appropriate flooring but has not been authorised to carry out the work. This is a repeat finding and has now been discussed with the Responsible Person for the home. Flooring had been replaced in some other areas of the home, for example, one dining room and the new flooring is easy to clean and hygienic. The laundry was not viewed on this occasion. A recent inspection visit had been carried out in relation to blood glucose monitoring and associated infection risks and a separate report of the findings has been completed. The one recommendation from that visit has been included in this report.
Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 14 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 The home was appropriately staffed to meet the needs of the service users. EVIDENCE: Each of the units were staffed to meet the needs of the service users. The home accepts student nurses for work placements, and they are supernumerary to the staffing numbers. Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 15 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) None at this inspection. EVIDENCE: The administrator was on leave at the time of inspection. There is also to be a change of management at the home. These standards will be viewed at the next inspection. Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION x x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 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 x x x x x x x x Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 17 NO 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. Standard 8 8 Regulation 17(1)(a) 13(4)(c) Requirement All assessments to include continence assessments must be complete and up to date. Prior to the use of bedrails, a risk assessment must be carried out. The risk assessment for bedrails must clearly identify why the use of bedrails is indicated and the fact that where bedrails are to be used, this has been comprehensively assessed as the most appropriate safety intervention for the service user. These must be kept up to date and reflect any changes in circumstance. The service user plans must be kept up to date and accurately reflect the current condition of the service user and their needs. Records must be kept for all medicines received into the home, administered and disposed of. (previous timescale 25/01/05 not met) Dates of opening must be written on all liquid and eye drops. (previous timescale 25/01/05 not met) If a dosage change occurs, the MAR chart must be rewritten, Timescale for action 12/08/05 12/08/05 3. 8 15, 17 12/08/05 4. 9 13(2) 01/08/05 5. 9 13(2) 01/08/05 6. 9 13(2) 01/08/05
Page 18 Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 signed and dated. 7. 8. 9 9 13(2) 13(2) Any dosage changes must be accurately recorded on the MAR chart and signed and dated. Where a combination of strength of tablets is required to make up a prescribed dose, each strength must be individually written up on the MAR chart, and the actual dosage to be given of each strength clearly identified. The home must be kept free from malodours. Where necessary, alternative suitable flooring must be considered. (previous timescale 01/06/05 not met). Evidence that this has been addressed must be forwarded to the CSCI. 12/07/05 12/07/05 9. 26 16(2)(k) 01/09/05 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 9 Good Practice Recommendations It is strongly recommended that where it is deemed suitable to store prescription creams in a service users room, a risk assessment be carried out and action taken to eliminate any risks identified. It is recommended that prior to ordering any medication a stock check be carried out to avoid overstocking. That a system for assistance with the provision of immunisations against Hepatitis B for staff across Life Style Care PLC be introduced. 2. 3. 9 26 Ashwood Care Centre G61-G10 s10923 Ashwood Care Centre v232297 12.07.05 stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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