Inspection on 19/05/08 for Ashwood Care Centre

This inspection was carried out on 19th May 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashwood Care Centre 03/11/08

Ashwood Care Centre 09/10/08

Ashwood Care Centre 06/11/07

Ashwood Care Centre 29/11/06

Ashwood Care Centre 12/07/05

Ashwood Care Centre 25/01/05

Ashwood Care Centre 19/01/05

Ashwood Care Centre 05/07/04

Ashwood Care Centre 30/09/03

Ashwood Care Centre 20/05/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Ashwood Care Centre 1a Derwent Drive Hayes Middlesex UB4 8DR Lead Inspector Mrs Clare Henderson Roe Key Unannounced Inspection 10:30 19 , 20 & 22nd May 2008 th th 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 Care Centre DS0000010923.V364364.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 Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood Care Centre Address 1a Derwent Drive Hayes Middlesex UB4 8DR 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) 020 8573 1313 020 8573 1124 ashwood@lifestylecare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd 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 DS0000010923.V364364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 32 Elderly Frail, of which 24 beds are for nursing and 8 are personal care or nursing 15 Elderly Personal Care 23 Older people with dementia - personal care. Minimum Staffing notice. Date of last inspection 6th November 2007 Brief Description of the Service: The home is situated between Uxbridge and Hayes. It is a purpose built home and there are 3 floors accommodating residents, with 2 units on the ground floor and 1 unit on each of the 1st and 2nd floors. The home can accommodate a total of 70 residents. 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. The home has one GP practice and there are weekly visits to the home, and other healthcare services can be accessed by the home for the residents. A Devotional Meeting is held regularly and religious and clergy visits are arranged as required. The home has a Manager, plus a Deputy Manager who also works as a registered nurse within the home. There is also a Head of Care in charge of the personal care units. The fees range from £394.01 to £787.97 per week. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced inspection carried out as part of the regulatory process. A total of 31 hours was spent on the inspection process. Two CSCI Regulation Inspectors and a Pharmacist Inspector carried out the inspection. A tour of the home was carried out, and service user plans, medication records, management records, training matrix, staff employment records, administration records, maintenance and servicing records were viewed. 18 residents, 20 staff and 3 visitors were spoken with as part of the inspection process. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home has also been used to inform this report. CSCI surveys for residents, staff, visitors, healthcare professionals and care managers were sent to the home and several have been received back. Comments have been reflected in general terms. What the service does well: What has improved since the last inspection? The Statement of Purpose and Service User Guide for the home have been updated. The gathering and recording of information regarding end of life care wishes has improved on most units, with some further work to be done to ensure this sensitive topic has been approached with all residents and their representatives, so that their wishes can be recorded and respected. Complaints to include all concerns received are now being recorded, investigated and responded to in a timely fashion. The duty roster is being updated to reflect any changes. Although it had not been submitted to us, the AQAA was available in the home and had been completed more comprehensively than the one presented for the last inspection. Staff meetings have been introduced and the majority of staff said that the Manager is open Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 6 and approachable. CSCI Surveys sent to the home prior to inspection had been promptly circulated to residents, representatives, healthcare professionals, care managers and staff, and several have been received back. Clear financial systems are now in place for any monies managed on behalf of residents, with the facility to ensure invoices for goods or services can be paid promptly. The Manager has introduced a system of formal supervision, however this still needs to progress further to ensure all care staff receive formal supervision a minimum of 6 times a year to discuss practice and identify training and development needs. Regulation 37 notifications are now being submitted to us promptly for notifiable incidents/accidents. What they could do better: There is still limited evidence of the involvement of residents and their representatives in the formulation and review of the service user plans. On the first floor nursing unit shortfalls in the completion, review and updating of service user plan documentation, to include identification of nursing needs, wound care and assessment documentation gave us cause for serious concern. Shortfalls in the management of medications, to some degree on the ground floor personal care unit and especially on the first floor nursing unit again gave us cause for serious concern. Safe guarding referrals have been made to the placing Authority. It is acknowledged that overall the service user plans and medication management on the other units are satisfactory. Issues regarding the provision of activities are still present. The Manager has now applied for an increase in the budget for activities, and some fundraising, led by staff and relatives is also taking place. The home has 4 units and the needs of the residents in respect of activities differ on each one, so the activities programme and provision needs to reflect this. Comments regarding the limited activities provision were received on some of the CSCI surveys received. There had been several comments made regarding the quality of the food, and was reviewed by us at the inspection, to include sampling of lunchtime meals. The menus are in the process of being reviewed under the Southern Cross Healthcare nutritional programme, and this should introduce more fresh produce and a wider choice to the menu. The importance of ensuring residents cultural needs, to include dietary preferences, can be met at all times was discussed. Although some unexplained bruising had been clearly documented, further action to report and investigate this had not been taken, and this needs to occur as part of the safeguarding adults procedures. It is acknowledged that staff are clear to report safeguarding adults concerns that are more clearly defined, for example, should they witness any physical or verbal abuse. Following the last inspection where shortfalls in the décor and furnishings were identified, a full environmental audit was carried out and a redecoration and refurbishment plan drawn up. However, this plan had not been adhered to and apart from a few areas that had been redecorated by the maintenance person, no other progress had been made. The home is shabby and in places malodorous, with some items of equipment in need of repair, and action must be taken to bring the home back up to a good environmental standard. Staff shortages in domestic hours, to include the laundry, have led to the home being dusty and dirty in areas and backlogs forming in the laundry. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 7 Again, this had been highlighted on several of the CSCI surveys received. In the area of care staffing had also not been reviewed in light of the increased dependencies of residents on the first and second floors. Although it is acknowledged that over 50 of care staff are trained to NVQ level 2 in care, continuing shortfalls were identified in up to date training in topics relevant to the diagnoses of the residents, plus some health & safety topics. The Manager has made efforts to increase the training available over the past 5 months, however there are significant and concerning backlogs in staff training in several areas, and a robust programme must be put in place to address these shortfalls. Systems in place for quality assurance have not been effective, as is evident from the major shortfalls found with the first floor service user plans and medication management. We have had repeated concerns regarding shortfalls in care planning, management of medications and associated staff training plus staff shortages. As a result of these concerns we have served Statutory Enforcement Notices separate to this report to ensure the health and welfare of residents. 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. The summary of this inspection report can be made available in other formats on request. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 8 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 Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Up to date information about the home is available to prospective residents and their representatives, providing them with a good picture of the home and the services available. Prospective residents are assessed prior to admission, thus the home ensures they are able to meet each person’s needs. EVIDENCE: Since the last inspection the Service User Guide and Statement of Purpose have been updated to reflect the current management arrangements for the home, and any other relevant changes. Pre-admission assessments were viewed on each unit. The majority had been well completed, with a few gaps in completion on 2 viewed. However copies of the Social Services assessments of the residents had been obtained. The information provided gave appropriate detail to ascertain that the home was suitable to meet the needs of each resident. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the service user plans on the ground and second floors were well completed, thus providing a clear picture of each resident and their needs, those on the first floor were poorly completed and placed residents at risk of their needs being neither identified or met. Medication management in some areas was good, however overall the findings gave cause for serious concern that residents’ medications were being poorly managed, placing them at risk. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. Some repeated shortfalls in identifying end of life care needs place residents at risk of not having their needs fully met. EVIDENCE: Service user plans were viewed on each unit. On the ground floor units and the second floor units these had been well completed and there was evidence of monthly review, plus updates following any changes in condition. Risk assessments for falls were in place. There was some evidence of involvement of residents and their representatives in the review of the service user plans, Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 11 however there must be evidence of input in the formulation and review of all service user plans. 4 service user plans were viewed on the 1st floor unit. In one instance, for a resident who had been admitted 4 weeks prior, with complex care needs, only one care plan had been formulated and little other information was available. For another resident who had returned from hospital the service user plan had not been updated to reflect this, despite significant changes in their care needs. Risk assessments for falls were in place but had not always been updated following a fall. Wound care documentation was viewed on the 1st floor unit. 5 residents were found to have wounds and the documentation was not always up to date. The care plans had dressing regimes for frequency of dressing changes, however there was no clear evidence to show that dressing regimes had been followed. In one instance where the dressing regime had markedly changed, no information regarding the new regime had been recorded. The pressure sore risk assessment document in use does not identify if there are any wounds present on an individual. Pressure relieving equipment was seen in use, however the documentation did not identify the equipment to be used for each individual. Comments were received that pressure-relieving equipment was not always available for every individual requiring it. There was no up to date photographic evidence seen to show the condition of each wound. Pain assessments had not been completed. There was no evidence of any recent referrals to the Tissue Viability Nurse Specialist or the Dietician, despite marked changes in the condition of some wounds. Overall the management of wound care on the 1st floor unit gave us cause for serious concern and a safe guarding referral has been made to the placing Authority. Other documentation viewed on the 1st floor unit did contain assessments for nutrition, continence and moving & handling, however these had not always been completed. Instructions for one resident stated that they were to be weighed weekly, and this had not always been done. For one resident who had been recorded as having marked weight loss, no action had been taken to follow up this finding. Some of the assessment documentation had not been updated following a significant change in a residents’ condition. On the other floors assessments for nutrition, continence, moving & handling and dependency had been completed and updated. Bedrail assessments were not seen for each person for whom they are being used. The Manager explained that the Deputy Manager is in the process of reviewing these assessments, however the importance of ensuring the completed documentation is available for each resident was discussed. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 12 Because of the concerns for the health and well being of the residents on the first floor a Statutory Enforcement Notice has been issued, separate from this report. There was evidence on all floors of input from healthcare professionals to include GP, optician, chiropodist and district nurse. We met with one of the GPs for the home who was very positive regarding the way the staff communicate with them in respect of the medical needs of the residents. Comments received from another healthcare professional were also positive. On the second floor personal care dementia unit, the condition of some of the residents had deteriorated. Although some re-assessments had been carried out, there had been some delays in identifying suitable alternative accommodation for these residents. This has been fed back to the placing Authority. We started inspecting the recording of receipts, administration and disposal of medication on 20/05/08.On the ground floor no omissions were noted in the recording of administration, but on auditing several tablets e.g. tamsulosin and omeprazole there were too many tablets left. This means that staff were signing for tablets when they had not given them. On the first floor we were very concerned at the number of residents not receiving their medication because no stock was available. For this reason a specialist pharmacist inspection was sought. This was carried out on 22/05/08. One resident on the first floor had not received pain relief for 7 days because it had not been ordered. This was despite the GP confirming that it must continue and a relative complaining that the resident was in pain. When the pain relief was reinstated it was not given at the prescribed frequency. No assessment of pain was being made by the home. This resident also, did not receive medicines for his heart for 7 days and diabetes for 3 days. The recording of receipts and administration on the MAR (Medication Administration Records) showed some gaps. Two residents were prescribed folic acid but there was no supply and none administered and no indication whether it should be administered or not. Tablets to reduce cholesterol at night, a tablet for a chronic illness and calcium were all recorded as (O) out of stock for these residents. The home did not have a nebulising machine to continue the treatment of a resident prescribed nebules by the hospital. A resident had not received an injection for anaemia for 2 weeks, a tablet for pain relief for 6 days and a strong ant- inflammatory for 7 days. When the latter was re-started, there was evidence that the wrong number of tablets were given. One resident was prescribed an antibiotic to be given through a special line. Training had been provided by the district nurse. There must be evidence of this training with the date, what was covered and who received this training. If possible, assessments of competency should be obtained. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 13 The clinical room on the first floor was dirty and untidy. Feeds were stored on the floor and injections were not locked in a designated medicine cupboard. The clinical room must be kept locked when not in use. It was noted that when the inspectors arrived that the keys were left in the Controlled Drug (CD)cabinet and the clinical room was open and unattended. Professional lancing devices were purchased for the home during the period of the inspection. All units should be recording the minimum and maximum temperature of the fridge and not just the actual temperature as noted. Balances in the Controlled Drug Register were correct. Some attention is needed though in ensuring that there is more accurate recording. A witness signature was not always obtained when CD were disposed of. Initials were used instead of signatures and spaces were left between entries. Some balances were not zeroed when destroyed or returned to a resident. On the residential unit there were good practice in accurately recording medication. No gaps were noted and audits could all be reconciled. Many residents were asleep when medication was administered in the morning and this was recorded on the MAR. A review by the GP may be appropriate if the resident is frequently asleep. Care workers should also be reminded to use their full initials to avoid confusion with codes for non-compliance. The home needs to ensure throughout the home and particularly on Floor 1 that there is robust, recording of all receipts, administration and disposal and also quantities brought forward from one cycle to the next. If the quantity of medicine gets low then it must be ordered in plenty of time to allow continuous supplies. If the code O is used then the reason must be given. Variable doses must be recorded accurately to allow audit and review of the medication. Every effort must also be made to establish residents on the same cycle so that ordering and checking can be done at the same time each month. Because of the concerns for the health and well being of the residents on the first floor a Statutory Enforcement Notice has been issued, separate from this report. Staff were seen caring for residents in a gentle manner, respecting their privacy. In the main residents were being addressed using their preferred term of address, however in one instance residents were heard being addressed as ‘darling’ and the inappropriateness of this was discussed with the person concerned. In the day rooms there was a good atmosphere and bright, cheerful interaction between residents and staff. Residents spoken with said that the staff are very caring and helpful, and that they are being well looked after. Comment was received that at times communication between staff and residents is not easy, due to a combination of English being a second language for the staff and residents with hearing difficulties. It is acknowledged that this is not an easy area to address, however information regarding English classes Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 14 for staff was available, and staff are encouraged to improve their skills in this area. Service user plans viewed did not always provide details of residents’ wishes in the event of deterioration and end of life. In some instances information was very clear, however other records viewed were very brief and had not been kept up to date. This is a repeat finding. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities provision at the home remains limited, thus residents are not being provided with a range of activities to meet their individual interests and needs. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information regarding advocacy services is available, thus ensuring the residents’ right to independent representation is respected. The food provision at the home is somewhat basic, thus residents are not being provided with a varied and well-balanced menu to meet their individual needs. EVIDENCE: The home has a full-time activities co-ordinator and there is an activities programme available on each floor. Several comments had been received regarding the shortage of funds for activities to include outings and entertainers, plus the fact that the care staff are expected to carry out the activities and do not always have the time to do so. We recommended that an activities programme be formulated each week, and that the person leading each activity session be identified on the programme. In some of the service user plans viewed a comprehensive ‘Life History’ had been completed and the information in the care plans for activities was in the main personalised to the Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 16 individual. The room that had previously been designated for activities is now used as the smoking room. This is a large room, and whilst it is important that facilities are available for those who wish to smoke, the home needs to look at alternatives so that all residents who wish to participate in group activities can use this large room. The issue with the limited budget being available for activities is a repeat finding, and the Manager has put in a request to Southern Cross Healthcare for an increase in the budget to provide realistic funds to provide a full programme of activities and outings to meet all the residents assessed needs. This is vital to ensure that each residents’ needs can be met in this area. Fund raising is one method being employed to try and raise some additional funds for activities, and relatives are participating in this process. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home and refreshments are offered. Residents can choose to receive visitors in their own bedrooms or in one of the communal rooms, as they so wish. Information regarding advocacy services was displayed in the main entrance of the home. The home has contact with Age Concern and various advocacy services to provide financial advice. We viewed the kitchen and all the records were up to date. Residents are offered a choice of meals and documentation to evidence this was available. There are two main meal choices for lunchtime, and if requested in advance alternatives can be provided. Comment was received that if a resident does not like the meals on offer at the time of the meal, it is not always possible to get an alternative supplied as the catering staff are on their lunch break. A list is compiled for breakfast, lunch and supper choices, and staff were heard offering residents choices. Comment was received regarding limited provision of brown bread sandwiches, and this was discussed with the cook who stated that they do follow what residents order, and on the dementia care unit a selection of brown and white sandwiches are provided. We did witness the sandwiches being prepared and both types of bread were being used. Several comments were received regarding the food being somewhat ‘bland’ and also the limited range of puddings provided. We sampled the meals on each day of inspection and it was found that although well presented, more work is needed to make the food more ‘tasty’ and ensure the meat is well cooked and soft. In addition, on studying the menus a variation of sponge pudding is provided for several lunch and supper meals throughout the week. It was also noted that several of the menu alternatives on offer come from frozen produce, for example, veggie burgers, vegetable cheese bakes, pasties. This is in addition to items such as fish & chips, also cooked from frozen. The importance of providing a varied menu and meeting the needs of each individual with a well produced balanced diet was discussed. It is recommended that the pudding menus be reviewed and the sponge cakes be provided for afternoon tea instead of as puddings. The home is in the process of introducing the new Southern Cross Healthcare Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 17 nutrition system ‘NUTMEG’, although progress on this has been somewhat slow. These menus are based on providing a well-balanced, nutritious menu with mainly fresh ingredients being used. It is acknowledged that some residents were satisfied with the meal provision, however negative comments were also received during the course of the inspection. The provision of meals to meet the cultural needs of residents was discussed, to include the importance of these being available 7 days a week. On the ground and second floors jugs of drink were seen and drinks were being provided for the residents, however this was not in evidence on the first floor, and comment was received regarding the lack of drinks provision. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has clear complaints procedures in place to address any concerns raised by service users and their visitors and these are followed, thus ensuring they are listened to and action is taken. Procedures for the protection of vulnerable adults are in place, and staff are aware to report concerns, thus protecting residents. Minor shortfalls identified should be easy to address. EVIDENCE: The home has a clear complaints policy and this is on display throughout the home. Since the last inspection 42 complaints and concerns have been recorded and documentation was available to show that these had been investigated and responded to. It is acknowledged that all concerns, however minor, are recorded and responded to, in a spirit of openness and transparency. Some of the concerns received on the CSCI surveys have been referred to the placing Authority. The home has Adult Protection procedures and also has a copy of the Hillingdon Safeguarding Adults documentation. The Manager had referred several issues to the Safeguarding Adults team, several of which had not warranted their input, however this showed that the Manager is proactive in making such referrals if she has concerns. Staff given scenarios in relation to safeguarding adults were clear to report any concerns and also understood Whistle Blowing procedures. Some unexplained bruising was found and although this had been documented in the individuals’ service user plans, no Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 19 report had been made to the Manager. The importance of reporting and investigating any unexplained injuries was discussed. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The redecoration and refurbishment plan has not been carried out, thus residents are not being provided with a homely, clean and safe environment to live in. Required equipment is not always available, thus placing residents at risk of their needs not being appropriately met. Some areas of the home were not clean, plus a backlog of laundry could lead to infection control issues, and thus a risk to the residents. EVIDENCE: Following the last inspection a full environmental audit of the home had been carried out and a redecoration and refurbishment plan, to be completed by the end of March 2008, drawn up. Although some redecoration of corridors and a few individual bedrooms has taken place, the full plan has not been followed and timescales had not been met. The décor was marked in places and some of the furniture is worn and damaged. Some carpets are in need of replacement and on the second floor suitable flooring to meet the needs of the Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 21 residents must be installed to aid with odour control. Comments received include ‘generally the home is shabby and the bedrooms are poor’. The home has a fire risk assessment that is due for annual review. The Manager said that she was aware of this and the review would be carried out. Bathroom areas on the first floor were being used as storage areas. These areas are also in need of redecoration as part of the overall plan. There are no hoists on the second floor, however there are residents who currently require a hoist for moving & handling purposes. The hot water urn on the first floor had been out of order for some weeks and this has necessitated carrying very hot water in jugs between floors, which is a safety hazard. Other items of equipment were also unavailable and this must be reviewed as part of the refurbishment process. The home has had recent issues with a shortage of domestic staff. A tour of the home was carried out and each floor was found to be in need of cleaning. Particular areas of concern were the lack of dusting being carried out, leading to thick layers of dust on light fittings, tops of doors and other surfaces. Beds and other furniture had not been pulled out for cleaning behind and under them. The kitchenettes on each floor had debris on the floors and the sinks were stained and marked. Cups to include drinking beakers in use were very stained and it transpired that despite a requirement in the last report to ensure that all crockery and cutlery is returned to the main kitchen for washing this is not happening. This was discussed with the cook and the need to ensure good communication between all staff to ensure clear processes are followed was identified. Staff on the first floor were seen wearing gloves in the corridor and this was discussed with the staff concerned. In one bathroom on the first floor a bag of clinical waste had been left on the floor, and this had not been cleared by the next day, causing a malodour. The second floor was also malodorous. Overall the environment is currently of a poor standard and this must be addressed as a matter of urgency. By the end of the inspection action was being taken to address the cleanliness issues, however issues of this nature should have been identified and swiftly addressed when the problem first arose, and not as a reaction to a CSCI inspection. The laundry room was being kept clean, however due to a shortage of laundry staff hours there was a significant backlog of laundry to be done. Comment was received regarding delays in both personal clothing and bedding items being returned after laundering. There is a pile of unidentified clothing in the laundry room and this needs to be made available to residents and their representatives for claiming. Due to the limited hours being worked there is no time to sew on name tapes for residents, and the expectation is that residents or their representatives carry this out. Some of the bedding was torn and old, and in need of replacement. The Manager said that she had purchased flannels for use, and these were colour coded for infection control purposes, however it was not clear that staff had fully understood this concept. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in staffing levels of care and domestic staff were identified, thus placing residents at risk. Whilst over 50 of the staff have NVQ in care qualifications, the lack of training and updates in topics relevant to the needs of the residents could lead to their needs not being effectively met. EVIDENCE: Following the last inspection some adjustments had been made to the staffing in order to provide more effective 24 hour cover. However, the dependencies of the residents on the second floor had increased markedly since this time, with several residents being referred and assessed for dementia nursing care. The needs of the residents on the first floor had also increased. Staff spoken with stated that all the residents on this floor require the assistance of 2 staff to provide personal care, which leads to delays in some residents having their care needs met. Comments regarding the home being short of staff in various areas were also received on the CSCI surveys. The need to ensure the home is staffed at all times to meet the needs of the residents and the home was discussed with the Manager and Operations Manager. Temporary cover is now being provided for administration duties. We observed several staff going out of the home in order to have a cigarette, and the frequency of this appeared to be more than the official staff break times. Time management for staff needs to be addressed in order to ensure staff are using their time effectively. There Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 23 is also a shortage of domestic and laundry staff, which has resulted in the shortfalls identified under Standard 26. Because of the concerns for the health and well being of the residents a Statutory Enforcement Notice has been issued, separate to this report. According to the homes AQAA over 50 of the staff are trained to NVQ level 2 in care. Speaking with the care staff several of them are very experienced and apply their learning from the NVQ training to their working practices. We viewed 3 sets of staff employment records. With the exception of 2 photographs, for which there were clear pictures from passport and other identification documentation, all the information and checks required under Schedule 2 of the Care Homes Regulations 2001 were in place. The Manager said that she would ensure photographs were done for these staff at the beginning of their next shifts. The home has a training matrix on which all training is recorded. We looked at this document and it is clear that there has been a marked increase in training over the last 5 months. However there are still a number of shortfalls with training in topics relevant to the diagnoses and needs of the residents and it is clear that there is a significant backlog in training for staff, both in these topics and also statutory training (see Standard 38). Comment was received from staff to confirm this ongoing shortfall. The majority of staff working on the second floor had received training in dementia care, and the Head of Care for the residential units is a trainer for the ‘Yesterday, today and tomorrow’ dementia care training, which we were informed several staff had recently completed. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Manager has the qualifications and experience to manage the home and has an open approach. The home has a quality assurance system, however this is not working effectively, thus monitoring is not identifying shortfalls. Resident’s monies are being well managed, thus protecting them from risk. A system of supervision is being introduced for all staff to keep individual practice, training & development under review and bring staff up to date with current good practice. Record keeping on the first floor was poor, thus placing residents at risk of their needs not being met. Health & safety records are up to date, however repeated staff training shortfalls in this area could place residents at risk. EVIDENCE: Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 25 The Manager is a first level registered nurse and she has previous home management experience. She has been at the home for 5 months. Residents and relatives spoken with said that the Manager is approachable and listens to issues raised, as did the majority of staff spoken with. The home has a quality assurance system in place and monthly audits of the home; medications and catering are carried out. However, it is clear from the shortfalls identified in this report that the auditing system is not working effectively. Action must be taken to introduce a robust system of quality assurance so that shortfalls are promptly identified and action taken to address them, in all areas of the home. The Manager has introduced regular staff meetings, residents & relatives meetings and a committee meeting, which is a group of staff and relatives involved with fund raising for the home. Minutes of each meeting are recorded. The Manager did send out satisfaction surveys a few months ago, with very few being returned. Southern Cross Healthcare annual surveys are to be sent out annually and the results collated. We looked at the financial recording for monies held by the home on behalf of residents. Records of all income and expenditure are clearly recorded, and the system ensures that any interest earned is allocated and recorded. Receipts for all income and expenditure are available. A new system for the management of resident’s funds has recently been introduced at the home, and this appears to be clear and allows for any invoices to be promptly paid on behalf of residents. On the first floor monies and house keys were found in the drug storage cupboard. These had been removed by the 3rd day of inspection. The Manager has introduced formal supervision for staff, and this system is in progress, with a view to all staff receiving supervision a minimum of 6 times per year. It is acknowledged that it will take time to introduce the process fully. The poor standard of the care records and medication management viewed on the first floor gave serious cause for concern. There were significant shortfalls in the completion of documentation and also in the management of medications. In the case of registered nurses this breaches the Nursing & Midwifery Council guidance for records and record keeping and medication management. This must be addressed as a matter of priority. Servicing and maintenance records were sampled and those viewed were up to date. Risk assessments for equipment and safe working practices are in place. There is a significant backlog in staff training, to include health & safety training and updates. This must be addressed as a matter of priority to ensure that staff have the knowledge and skills to care for residents safely. Comment was received that even when staff have had moving & handling training some practices do not reflect current moving & handling techniques, and this was discussed with the management. It is noted that 2 care staff have completed training to be trainers in moving & handling for staff at the home. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 2 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 X 18 2 1 X 1 2 X X X 1 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 3 1 1 Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 OP7 OP8 Regulation 17 17(1)(a) Requirement Risk assessments for falls must be updated following any falls. All wound care documentation must be in place and up to date, so that the development and progress of any wounds can be clearly identified. Where necessary a referral to the Tissue Viability Nurse specialist must be made without delay. Pressure relieving equipment must be available for all residents who require it, to aid in the prevention of and healing of pressure sores. All assessments must be complete and up to date, to accurately reflect each residents current condition. Weights must be carried out in accordance with the plan of care, to ensure that the needs of the resident are being addressed. Where significant weight loss is identified a referral to the Dietician must be made without delay. Prior to bedrails being used, a full assessment of suitability DS0000010923.V364364.R01.S.doc Timescale for action 01/06/08 23/05/08 3. OP8 16 01/06/08 4. OP8 17 01/06/08 5. OP8 17 23/05/08 6. OP8 13(7) 01/06/08 Ashwood Care Centre Version 5.2 Page 28 7. OP10 12 8. OP11 12 9. OP12 16(m)(n) 10. OP12 16(m)(n) 11. OP15 16(2)(i) & 16(4) 12. OP18 13(6) 13. OP19 23(2) must be carried out and written consent for their use must be obtained. Residents must be addressed by their preferred term of address at all times, respecting their dignity. The wishes of residents and their representatives must be clearly recorded in respect of their care during their final days. This information must be updated should their wishes change, in order to ensure their wishes are respected and adhered to. Previous timescale of 01/02/08 not met The budget available for expenditure on all areas of activities, outings and entertainment must be appropriate to meet the needs of all the residents in this area. Previous timescale of 01/12/07 not met All residents must be consulted about their interests and hobbies and the activities programme must reflect these, to provide appropriate activities to meet the residents wishes and needs. The food provision at the home must be reviewed to ensure that there are choices available at each meal to meet the preferences of the residents. This must include any cultural preferences. Drinks must be freely available to all residents throughout the 24 hour period. Any unexplained bruising or injuries must be appropriately reported and investigated to ensure the safety of the resident. The redecoration and refurbishment plan must be reviewed to reflect timescales for completion so that the necessary DS0000010923.V364364.R01.S.doc 01/06/08 01/07/08 01/07/08 01/07/08 01/06/08 22/05/08 01/09/08 Ashwood Care Centre Version 5.2 Page 29 14. OP21 23(2)(l) 15. OP22 23(2)© 16. OP26 13(3) 17. OP26 13(3) 18. OP26 16(k) 19. OP30 12 20. OP33 24 21. OP36 18(2) work is carried out by 01/09/08, to provide a good environmental standard throughout. Bathrooms must not be used as storage areas. Suitable storage facilities must be available at the home. Equipment must be maintained in working order. Any repairs necessary must be arranged promptly to minimise any risk or inconvenience. Cutlery and crockery must be washed up under correct conditions using the dishwasher to minimise any infection risk. Previous timescale of 16/11/07 not met The home must be kept clean throughout and laundry must be completed in a timely fashion, to minimise the risk of infection. Action must be taken to address the areas of malodour to provide a pleasant environment for residents to live in. Staff must receive training in topics relevant to the diagnoses and care needs of the residents to provide them with up to date skills and knowledge to care for them effectively. An action plan to address this must be drawn up. Previous timescale of 01/12/07 not met The training must be completed by 01/08/08 There must be a robust system in place for quality assurance, to identify shortfalls swiftly so that action can be taken to address them and protect residents. All staff must receive formal supervision on a regular basis to discuss practice and identify training and development needs. An action plan to address this must be put in place. Previous DS0000010923.V364364.R01.S.doc 01/07/08 23/05/08 01/06/08 01/06/08 13/06/08 01/08/08 01/06/08 01/07/08 Ashwood Care Centre Version 5.2 Page 30 22. OP37 17 23. OP38 13 timescale of 01/02/08 partially met All resident records must contain 01/06/08 clear, up to date and accurate information and there must be in place effective systems for review and updating so that the information is always current. All staff must undertake training 01/07/08 and updates in health & safety topics to include moving & handling and infection control, so that practices are up to date in line with current legislation and guidance. Previous timescale of 01/02/08 not met RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP9 OP12 OP12 OP15 OP15 Good Practice Recommendations If residents do not take their medication because they are refusing it regularly or are asleep then this should be reviewed by the GP. The name of the person nominated to lead each activity should be identified on the activity programme, for clarity for staff and residents. Consideration should be given to identifying an alternative venue to allow those who wish to smoke to do so, while also ensuring there is an activities room for residents use. The items available as alternatives to the main menu should be reviewed to include more fresh produce. The frequency of serving sponge puddings should be reviewed and alternatives introduced to provide a wider range of puddings. Ashwood Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Care Centre DS0000010923.V364364.R01.S.doc Version 5.2 Page 32 - 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. 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