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Inspection on 01/05/08 for Ashwood Nursing Home

Also see our care home review for Ashwood Nursing Home for more information

This inspection was carried out on 1st 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Ashwood Nursing Home provides a clean, comfortable and pleasing environment that is reasonably well maintained. The food provided is of a good quality and enjoyed by the residents. The atmosphere at the home is relaxed, with communication between staff and residents open and friendly. The staff and management of the home are welcoming to all visitors and on the whole staff were found to be very helpful. Many residents like the fact the home is near to where they used to live, as well as the unrestricted access their visitors have. The home manager has a good understanding of residents` holistic needs and tries to assist them in achieving the best possible outcomes.A health care professional contacted following the inspection said that `The home is a family home and the feel is that residents are part of an extended family`. The emphasis of the home is to look after people as a family member.

What has improved since the last inspection?

The new care documentation implement over the past year has improved the plans of care greatly with the use of individual risk assessments that are used to inform the care. In addition the documentation now reflects a more person centred approach to care. However there are still some shortfalls that include the provision of plans of care to reflect all the care needs and ensuring where ever possible the resident or their representative is involved in this process. Records relating to Controlled Drugs are now well maintained and accurate. The home have purchased more lancing devices to ensure residents do not share this equipment. The systems for labelling eye drops and creams have been improved. Although improvement in the medicine handling in the home has been noted further improvements are required. Practice observed during the inspection visit confirmed that staff were moving residents in a safe manner apart from when they moved them in wheel chairs without footplates being in place.

What the care home could do better:

The homes statement of purpose and service users guide need to be updated to reflect accurately all the required information to provide clear information to people who are living in and thinking of moving into the home. The management of the home needs to ensure that all prospective residents are suitably assessed and that the home confirms in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed and evidenced. Although the care documentation has been improved it still needs to reflect all the care needs of residents and take in to account residents and their representatives views. The systems for handling medicines need to be further improved to ensure accurate record keeping and robust systems for ordering and responding to any gaps in the administration charts. Suitable staffing arrangements must be maintained at all times to ensure appropriate staffing to meet the health and welfare needs of residents.All staff in the home need to be trained on Safeguarding Vulnerable Adults to ensure all residents are not put at risk of harm or abuse. The recruitment practice needs to be improved to ensure all the necessary checks are completed by the home before staff start to work in the home. This will ensure robust recruitment practice is followed and safeguard residents. All staff must be suitably trained so that they have the appropriate skills and competencies to meet the care needs of residents including their specialist care needs. The home needs to be under the direct leadership of the registered manager or an appointed person with the relevant qualifications and skills to replace her. A suitable quality monitoring process needs to be established to monitor and improve the service in response to residents and their representatives views this will include any response to complaints raised. Staff need to receive regular supervision to monitor their performance and develop their skills. Robust Health and Safety systems need to be adopted along with all the necessary safety checks being completed. The fire risk assessment needs to be updated and identify what safety provision is in place with respect to residents bedroom doors.

CARE HOMES FOR OLDER PEOPLE Ashwood Nursing Home Burwash Common Etchingham East Sussex TN19 7LT Lead Inspector Melanie Freeman Unannounced Inspection 1st May 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashwood Nursing Home DS0000013957.V363807.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 Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood Nursing Home Address Burwash Common Etchingham East Sussex TN19 7LT 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) 01435-883434 01435 883091 ashwoodnh4@hotmail.co.uk Ashwood Nursing Home Ltd Miss Ann Elizabeth Morrissey Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (19) of places Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is nineteen (19). Service users must be older people aged sixty-five (65) or over on admission, and those with a physical disability. Two named service users under sixty-five (65) years on admission with a learning disability only to be accommodated. 14th September 2007 Date of last inspection Brief Description of the Service: Ashwood is a nursing home that provides care up to nineteen older people or those with physical disabilities over the age of 65 years and three residents less than sixty-five years with a learning disability. Ashwood is in the hamlet of Burwash Common and set in grounds with flat access for residents. A well-stocked and managed garden is available to be used by the residents. There is ample off road parking for visitors. The nearest town is Heathfield; the village of Burwash is two miles away. The home is situated on the bus route and there is a railway station in Stonegate a nearby village. The home provides eleven single rooms, and four shared rooms over two floors, situated on the ground and first floors. Eight rooms provide en-suite facilities. Day space consists of a combined lounge/dining room. A passenger lift allows level access throughout the home. Current weekly fees range from £554.00 to £950.00 excluding hairdressing, chiropody, physiotherapy, newspapers and aromatherapy. In-house activities are limited, but external entertainers provide a range of activities at seasonal times and for a couple of hours one afternoon per fortnight. Ashwood Nursing Home DS0000013957.V363807.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. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Ashwood Nursing Home will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home by two inspectors who spent approximately six hours in the home. The registered manager who is also the homeowner was present throughout the inspection, facilitated the process and received the feedback from the inspectors at the visits conclusion. A tour of the premises was undertaken and a range of documentation was reviewed including the homes statement of purpose and service users guide, pre-admission assessment procedures, the systems in place for handling complaints and protecting residents from harm, staff recruitment files, quality assurance systems and some health and safety records. The care documentation pertaining to four residents were reviewed in depth. At the time of the inspection 10 residents were living at Ashwood Nursing Home. What the service does well: Ashwood Nursing Home provides a clean, comfortable and pleasing environment that is reasonably well maintained. The food provided is of a good quality and enjoyed by the residents. The atmosphere at the home is relaxed, with communication between staff and residents open and friendly. The staff and management of the home are welcoming to all visitors and on the whole staff were found to be very helpful. Many residents like the fact the home is near to where they used to live, as well as the unrestricted access their visitors have. The home manager has a good understanding of residents’ holistic needs and tries to assist them in achieving the best possible outcomes. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 6 A health care professional contacted following the inspection said that ‘The home is a family home and the feel is that residents are part of an extended family’. The emphasis of the home is to look after people as a family member. What has improved since the last inspection? What they could do better: The homes statement of purpose and service users guide need to be updated to reflect accurately all the required information to provide clear information to people who are living in and thinking of moving into the home. The management of the home needs to ensure that all prospective residents are suitably assessed and that the home confirms in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed and evidenced. Although the care documentation has been improved it still needs to reflect all the care needs of residents and take in to account residents and their representatives views. The systems for handling medicines need to be further improved to ensure accurate record keeping and robust systems for ordering and responding to any gaps in the administration charts. Suitable staffing arrangements must be maintained at all times to ensure appropriate staffing to meet the health and welfare needs of residents. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 7 All staff in the home need to be trained on Safeguarding Vulnerable Adults to ensure all residents are not put at risk of harm or abuse. The recruitment practice needs to be improved to ensure all the necessary checks are completed by the home before staff start to work in the home. This will ensure robust recruitment practice is followed and safeguard residents. All staff must be suitably trained so that they have the appropriate skills and competencies to meet the care needs of residents including their specialist care needs. The home needs to be under the direct leadership of the registered manager or an appointed person with the relevant qualifications and skills to replace her. A suitable quality monitoring process needs to be established to monitor and improve the service in response to residents and their representatives views this will include any response to complaints raised. Staff need to receive regular supervision to monitor their performance and develop their skills. Robust Health and Safety systems need to be adopted along with all the necessary safety checks being completed. The fire risk assessment needs to be updated and identify what safety provision is in place with respect to residents bedroom doors. 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 Nursing Home DS0000013957.V363807.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 Nursing Home DS0000013957.V363807.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, 4 and 6 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home does not provide prospective residents, with a good level of information about the home, its facilities, services and the costs involved. The admission procedures do not ensure that all prospective residents are fully assessed by a competent person before admission and are not assured that their needs can be met by the home. EVIDENCE: The statement of purpose and service users guide was available on request along with the last inspection report. Both these documents were limited in their content and did not provide the required information. For example the statement of purpose did not record accurately the organisational structure of Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 10 the home, the number and relevant qualifications and experience of staff working in the home or the complaints procedure. It also did not clearly identify the aims and objectives of the home particularly in reference to the needs of those residents admitted with a learning disability. The service users guide did not include the terms and conditions of residency. An assessment of the admission process included a review of the documentation used in respect of the last two admissions to the home. In both cases there was no written evidence to confirm that a thorough assessment had been completed prior to their admission to the home. The registered manager explained that one of these admissions was completed in response to a very difficult situation and the prospective resident was well known to her. The other admission had visited the home before admission but an assessment was not fully recorded. Discussion took place around the need to ensure suitable admissions to the home with a full assessment process. Although the home writes to new residents or their representatives confirming the terms and conditions of residency the home does not confirm in writing that the home is able to meet the assessed needs of any prospective resident. It was again noted that staff are not trained to meet the specialist care needs of residents living in the home including those with epilepsy, dementia or a learning disabilities. Intermediate or rehabilitative care is not provided at Ashwood Nursing Home. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 11 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 and 10 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although in most cases individual plans of care set out resident’s personal, health and social care needs with risk assessments being used these are not written in consultation with the resident or their representative. Resident’s health care needs are met with the advice and support of community health care professionals. On the whole the homes practice ensure resident’s medicines are stored and administered safely. Care is delivered in such a way that promotes and protects the residents’ privacy, dignity and individuality. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care documentation pertaining to four residents were reviewed as part of the inspection process and each of these residents were met with during the inspection visit to the home. Since the last inspection the home has concentrated on implementing a new system that fully records all the required care documentation. This has been well established in some areas and demonstrated an individual approach to care. It was however noted that one resident that had been in the home for over a week had no plan of care or fully completed assessment of need. It was therefore unclear how here needs were being attended to. One resident has complex care needs that include seizures, difficulty eating with a history of choking and repeated infections. These needs were not clearly recorded in the plan of care with associated guidelines for care and nursing staff to follow. The documentation recorded community health care professionals input into care when contacted and daily records are maintained and provide a record of resident’s activity, wellbeing and medical condition. Assessments completed included a nutritional screening and risk assessments associated with pressure sore development, falls and the assessment of safe moving and handling. Records indicated that the plans of care have been reviewed on a more regular basis recently but there was no evidence to confirm that they are completed in consultation with the resident or their representative. Residents and relatives spoken to during the inspection visit were all positive about the care received. One relative said ‘my mother has improved greatly since being in the home mentally and physically’. Residents expressed a liking of the home and care provided saying ‘I am well looked after’ ‘I am very happy with the home’. The medicine room was found to be satisfactory although the light was not working this was being attended to. The Controlled Drug cupboard and register were checked and found to be well maintained and records were accurate. The medicine charts were on the whole complete although some gaps were noted. It was also highlighted that liquid paper was used to correct the records and the key to record why a medicine was not given was not clear. Creams and eye drops in use had been dated on opening and were all appropriate for use. The information in the documentation regarding a resident who spends much of their time away from the home is now sufficient to Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 13 determine whether or not the home actually supplies the medicines to be administered during the absence. The registered manager confirmed that each resident who needs blood glucose monitoring has a separate lancing device. An anonymous report prior to this inspection visit identified that one resident did not receive her ongoing medication because it was out of stock. This is being investigated in accordance with the safeguarding of vulnerable adults procedures. Contact with the lead authority following the inspection confirmed that this investigation has been concluded and that the registered manager is reviewing procedures, training and practice in the home. This will include more robust ordering, a thorough investigation for any gaps in administration and for her to supervise and monitor the handling of medicines more closely. Some residents are prescribed medicines on an ‘as required basis’ and individual guidelines need to be provided so that residents receive medicines, as they need them an example of this is the use of Diazepam or pain killers. During this visit staff were seen and heard to be kind and attentive to the residents who they clearly know very well. Staff spent individual time with residents finding out what they wanted and ensuring when they were feeding them that they were not rushed. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 14 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 and 15 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Links with friends, relatives and the community are encouraged and choices made are respected. Residents receive a wholesome and appealing diet. EVIDENCE: Structured daily activities do not take place, leaving residents to spend their time as they wish to. Some residents choose to spend their time in the privacy of their bedrooms and others prefer to sit in the day room one resident chooses to visit and spend time at a her husbands. During this visit there was no evidence of specific activity or entertainment provision in the home however the staff spent time with residents and this was said to be what they enjoy most. Social care plans are being developed and are individual in there approach. Residents said that they are able to spend time where they want to with some Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 15 preferring to stay in their own rooms that are in most cases very personalised and seen as their own personal space. Resident’s religious needs are explored and responded to. Visiting is very much encouraged and it was clear from observation and contact with relatives that people are welcomed and feel comfortable when they visit. The meal provided was attractive and was well enjoyed by residents. The chef had a good understanding of resident’s needs and individual likes and dislikes. Staff were seen to be kind when assisting residents to eat, spending plenty of time ensuring residents were able to eat at a pace comfortable to them. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 16 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 and 18 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and residents and their advocates feel their comments are listened to and acted on. Whilst the home has relevant policies and procedures around Safeguarding Vulnerable Adults staff training does not ensure they have appropriate skills. EVIDENCE: Since the last inspection the homes complaint procedure has been updated and now includes timescales for responding to complaints made. This procedure now needs to be fully implemented replacing any other procedure in the home. Staff also need to be aware of the procedure and have access to the complaint forms to be used. Information on complaints must be stored appropriately ensuring confidentiality is maintained. All complaints received need to be recorded and audited so that the home can demonstrate that it is using complaints as a quality monitoring tool to review and improve the service that it provides. The registered manager confirmed that the home had not received any complaints since the last inspection apart from the one complaint, which was referred via the Commission. This complaint was investigated and responded to by the manager. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 17 Residents spoken to said that any concerns that they had would be dealt with if they raised them with the manager. The home has a Safeguarding Vulnerable Adults and whistle blowing procedure along with the local policies and procedures. As mentioned previously in this report a Safeguarding Vulnerable Adults alert has been raised in respect of medicine administration in the home. This has been investigated by the manager and responded to appropriately to the satisfaction of the lead authority. It was identified that staff have not received any training on safeguarding Vulnerable Adults and this shortfall was discussed with the registered manager who demonstrated that she had a good understanding of adult protection issues. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 18 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 and 26 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in an attractive home like environment that is reasonably well maintained and clean. EVIDENCE: Ashwood Nursing home is a converted premise that has retained a home like environment. The home was found to clean with many of the resident’s rooms being very personalised. One resident was clearly very pleased to have her own furniture around her saying her room ‘looked like home’. There is a large well-maintained garden at the rear of the home for residents to enjoy in good weather. Resident’s accommodation is found on the ground and first floor, which is accessed by a passenger lift. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 19 The communal space available is located on the ground floor and consists of one room that is used as a lounge and a dining room. This room is attractive but would be cramped when the home is fully occupied. There was written evidence to confirm that the home is completing individual risk assessments that take into account the environment. I was however noted that residents were being moved in wheel chairs without footplates being in place. It was also noted that many of the bedroom doors are left open and do not have self-closing devices. This was discussed with the registered manager who was advised to contact the fire brigade for advice. Infection control practice was found to be appropriate with protective clothing being available in the home. The laundry facilities were seen and were appropriate for the size of the home, with the manager confirming that the two washing machines have sluice cycles that can be used for soiled laundry. Some hand washing areas did not have liquid soap and paper towels and this could be improved with fixed appliances to ensure its availability. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 20 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 and 30 People who use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staffing arrangements and staff training do not always ensure the needs of residents can be met. Recruitment practice is variable and does not always promote resident safety. EVIDENCE: At the time of this assessment visit 10 residents were living at Ashwood Nursing Home, the residents have a mixed dependency but most have a high dependency needing regular nursing intervention or supervision. A review of the duty rotas and discussion with the registered manager confirmed that • On two occasions in March 2008 the home was staffed with one registered nurse working in the home. Albeit that another registered nurse was on call in her private accommodation attached to the home. • There were six occasions during the period between 17 March 2008 to 30 March 2008 when there was just two cares working in the home at night. Albeit that a registered nurse was on call in her private accommodation attached to the home. The manager also advised that the registered nurse would complete all medicines before retiring and a registered nurse would also be available to complete the morning medicines. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 21 The registered manager was advised that these staffing arrangements were not acceptable and did not ensure that the needs of residents could be met. She confirmed that this would not happen again and that there would always be a registered nurse on duty in the home with appropriate supporting staff and that staff leaving had caused staffing problems. The staffing arrangements at the time of the assessment visit were found to be suitable and included a registered nurse the registered manager her two daughters one working as a senior carer and the other working as a carer and an additional carer. An administrator, chef and cleaner were also working in the home. The duty rotas were not available in the home and ones relating to the previous month needed to be transcribed from the diary for the inspectors during their visit. The registered manager was reminded that the duty rota must be retained and record clearly every one who is working in the home, their roles and the hours that they work. The recruitment files pertaining to the three staff were reviewed as part of the inspection process. Records examined confirmed that although references are sourced these are not provided from the previous employer in all cases. Records did not contain a photograph of the staff. Although Criminal Records Bureau and POVA checks were in place for all staff it was noted that one staff member was recorded in the diary as working 17 days before her POVA was received and two months before her CRB was received. The registered manager was not clear on what had happened regarding this recruitment and her daughter advised that this carer had worked under her supervision during this time until her CRB was received there was however no evidence to support this. The registered manager has secured employment advice and support from a professional financial organisation to assist her with ensuring the home complies with current employment law and practice. All terms and conditions of employment are being replaced and a staff handbook is also now available. Although there was evidence that induction training is provided it was not clear what the training included or that it adequately follows the Skills for Care training specifications for the provision of social care. Most staff have or are progressing a National Vocational Qualification in care and it was confirmed that more carers are to be recruited. As a training matrix is not maintained staff files were examined as the inspectors were advised that all staff training is recorded in these. This confirmed that staff have received training on first aid and food hygiene as recorded in the last inspection report. It was also identified that staff training is not well developed in the home and there was no evidence to confirm that staff had received training as required in Health and Safety, infection control, Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 22 safe moving and handling or safeguarding vulnerable adults. As previously mentioned in this report staff have not received training in respect of the specialist care needs of residents. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 23 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 and 38 People who use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager has the relevant skills and experience, however the current management structure does not provide clear leadership to the staff. Quality assurance processes need further development to ensure that the Home is run in the best interests of residents. Resident’s financial interests are safeguarded. The health, safety and welfare of residents and staff are generally promoted although staff training and regular safety checks in the home need to be maintained. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager is a Registered Nurse and has attained the Registered Managers Award. The manager has run the home for over 20 years. She has an in depth knowledge of residents and their varied needs. It was unclear how available the registered manager is to the home she said that she worked in the home most days but there was evidence to suggest that she was not always available. There was also evidence within the care documentation that the homes staff contact the registered managers daughter for advice on care and management issues. An example of this was when the Registered Nurse contacted her to discuss a residents high temperature and what action should be taken. This was discussed with the registered manager who concurred that this was not a suitable management contact. Clearly the management arrangements in the home need to be clarified to ensure suitable management arrangements and leadership are provided at all times. There was no evidence that the home had sought residents and their representative’s views on the service and care provided by the home as part of their quality monitoring system. The registered manager confirmed that she does not have any involvement with resident’s monies and all residents have an identified person who deals with their finances. When asked about formal staff supervision the registered manager said that she was not providing this for staff at the moment. As identified earlier in this report staff are not provided with the necessary health and safety training to ensure their and residents safety. The electrical installation safety check has not been completed and a recent fire risk assessment was not available at the time of this inspection. Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 25 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 2 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X X X X 3 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 26 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. Standard OP1 Regulation 4, 5 and 6 Requirement The registered person shall produce a written statement of purpose and service users guide to provide all relevant and required information to ensure people can make an informed choice about where to live. That the registered person must ensure that the home carries out its own written assessment before admitting anyone when ever possible. Prospective residents must be provided with written confirmation that the care home is suitable for the purpose of meeting their health and welfare needs. (outstanding requirement from last inspection report with a completion date of 31/12/07) Care plans must be complete of all needs, preferences, wishes and support of each resident. (outstanding requirement from last 2 inspection report with a completion date of 30/11/07) Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 27 Timescale for action 01/07/08 2. OP3 14 (1) 01/06/08 3. OP3 14(1) 23/06/08 4. OP7 15 23/06/08 5. OP7 15 Care plans must be composed 23/06/08 and reviewed with input from the resident and or their advocate, unless the offer is declined. (outstanding requirement from last 2 inspection report with a completion date of 30/11/07) 6. OP9 13(2) 7. OP18 13(6) 8. OP27 18(1) 9. OP29 19(1) There must be arrangements for accurate recording of medicine administration and supply of medicines. (outstanding requirement from last inspection report with a completion date of 30/09/07) That the registered Person makes arrangements to ensure staff are suitably trained to prevent residents being harmed or put at risk of harm or abuse. The registered person must ensure that at all times suitably qualified, competent and experienced staff are deployed in the home in such numbers to meet the health and welfare needs of residents. That the registered person operates a thorough recruitment procedure that ensures the fitness of people who work in the home. This should include the completion of a CRB and POVA check and securing two authentic/appropriate references for each employee before they work in the home. That staff receive regular training to ensure that they are appropriately qualified and competent and have the skills to DS0000013957.V363807.R01.S.doc 23/06/08 01/07/08 23/06/08 01/06/08 10. OP30 19 (5) 01/09/08 Ashwood Nursing Home Version 5.2 Page 28 11. OP31 10(1) 12. OP33 24(1)(a)( b) (2)(3) meet all the needs of residents in the home. The management arrangements 01/06/08 must ensure that the registered manager provides clear leadership to the home and is available for all management matters. That a suitable quality 01/07/08 monitoring system is maintained to ensure residents and their representatives views are taken into account and demonstrates ongoing review and improvement to the quality of care and services in the home. This should take into account any complaints and concerns raised with the home. 13. OP36 18(2) 14. OP38 23(2) Care staff should receive regular 01/07/08 formal supervision. The sessions should cover all aspects of practice, the philosophy and care in the Home and the career development needs of the individual. An appropriate contractor must 16/07/08 survey the home’s electrical fixed wiring installation to ensure it does not present a risk. (outstanding requirement from last inspection report with a completion date of 30/11/07) That suitable arrangements are put in place to promote residents and staff health and safety. This should include appropriate staff training. That the Registered Person updates the fire risk assessment in consultation with the fire brigade. DS0000013957.V363807.R01.S.doc 15. OP38 12 (1) 13 (5) 01/07/08 16 OP38 23(4) 01/06/08 Ashwood Nursing Home Version 5.2 Page 29 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 OP9 Good Practice Recommendations Clear guidance should be available to staff, on all medicines prescribed on an as required basis, to take into consideration each resident’s needs and choices, in addition to the prescriber’s directions. Records should be maintained to evidence the necessary maintenance according to the manufactures directions of all medical equipment. That a pain management tool be included in care plans, when appropriate. It is recommended that all types of niggles and concerns be recorded so they can be used as part of the quality monitoring system. That accident records be reviewed for trends and patterns and show when risk assessment are updated. 2. OP8 3. 4. OP8 OP16 5. OP38 Ashwood Nursing Home DS0000013957.V363807.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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