Inspection on 19/09/05 for Ashwood Nursing Home

This inspection was carried out on 19th September 2005.

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

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

Other inspections for this house

Ashwood Nursing Home 27/04/09

Ashwood Nursing Home 28/10/08

Ashwood Nursing Home 01/05/08

Ashwood Nursing Home 14/09/07

Ashwood Nursing Home 06/03/07

Ashwood Nursing Home 13/06/06

Ashwood Nursing Home 28/02/06

Ashwood Nursing Home 07/03/05

Ashwood Nursing Home 14/01/05

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Ashwood Burwash Common Etchingham East Sussex TN19 7LT Lead Inspector Lindy Latreille Unannounced Inspection 19th September 2005 11.30 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 DS0000013957.V251024.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashwood 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 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 DS0000013957.V251024.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That Ashwood remains registered to accommodate nineteen (19) older people not falling into any other category, and those with a physical disability. That a Variation to accommodate a named service user under the age of sixty five (65) on admission, is granted solely in respect of this identified service user. 7th March 2005 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. At the time of inspection, nineteen residents were accommodated. The home is owned and managed by Miss Ann Morrissey. Ashwood is set in it’s own grounds in the hamlet of Burwash Common. The nearest town is Heathfield; the village of Burwash is two miles away. Accommodation is provided over two floors. There is a large accessible rear garden. The home provides eleven single rooms, and four shared rooms. Eight rooms provide en-suite facilities. There is a well-decorated combined dining and seating area. A passenger lift allows level access throughout the home. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 1130 and 1830. A tour of the home took place and residents were spoken to in the privacy of their rooms. Two Registered General Nurses (RGN’s) were on duty during the inspection and contributed. The chef explained the management of the kitchen and storage areas were seen. Residents care plans and relating documents were inspected and visitors were spoken to, albeit briefly. Staff were observed quietly carrying out their duties in a relaxed and encouraging way. What the service does well: What has improved since the last inspection? What they could do better: A pre-admission assessment should be carried out and recorded to meet the National Minimum Standards 3.3. That all services provided by the home should be contained in the statement of purpose. Visitors to the home should be recorded to meet fire evacuation criteria. An accessible complaints procedure should be in place and those received should be recorded. A 50 minimum of staff should be trained to National Vocational Qualification level 2. Care staff should have formal and documented supervision six times a year. Policies and procedures should guide staff and be currently reviewed. The management of medication administration should be reviewed and communicated to the Pharmacy Inspector. Please contact the provider for advice of actions taken in response to this Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 5. The statement of purpose showed no evidence of review and was dated 24/10/03. An admission of a resident with dementia is outside the category of the home. There was no prescribed pre-assessment document for each resident or for any resident that had been denied admission. All prospective residents are able to visit the home with family or friends. EVIDENCE: The Registered Manager confirmed that the statement of purpose has been discussed but there have been no changes and so the document remains dated at 24/10/03. A resident with dementia has been admitted to the home and her relatives are pleased at the progress that she has made. As this is outside the category of registration a variation should be completed. There is no mention in the statement of purpose of the respite service, meals supplied to a relative for a resident during the day when they are on a home visit. A visitor confirmed that her relative was attending the home to have a bath and this facility was not mentioned in the statement of purpose. There was no evidence that the information present in the care plan was draw from a pre-admission assessment as required in Standard 3.3 The Registered Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 9 Manager did confirm that when the General Practitioners make a referral she accepts their assessment and does not carry out her own. The home is in a small village and the residents were often known to the service before admission and their families and friends are welcomed and able to visit as they wish. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11. The assessed needs of the residents are in a care plan. Most health needs are met. Management of medicines is poor. All residents are treated with respect and their privacy is respected. No wishes are recorded on admission with regard to arrangements in the event of death. EVIDENCE: The resident’s needs are clearly recorded in the care plan but there is little guidance to staff as to how all these needs should be met. The Registered General Nurses (RGN) record the tasks done, but with little reflection from an holistic overview. Following falls there is no recording of risk assessments being updated or trends being reviewed for quality audit. The daily notes that all staff contribute to are not always reflected in holistic reports. Because of the lack of detail in the daily reports it is difficult to assess that all health needs are met. Where extra fluids are a need it was not possible to see that this was clearly met. Where the medication is dispensed there are no hand washing facilities and alcohol gel is not used. Medicines were put by hand into named pots. The charts were signed in advance of the medication being given to carers to give. The accuracy of the recording relied upon the carer informing the RGN that the resident had taken the medication. There were entries in the controlled drug Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 11 book that had been changed with tippex, which should never be used only crossed through and initialled. A referral has been made to the Pharmacy Inspector in the Commission for Social Care Inspection to make contact with the home and review procedures and policies. The residents were observed to be treated with respect at all times in manner and verbal tone. On occasions residents are put in reclining chairs for their comfort and the Registered Manager confirmed that staff were informed to be aware that such a procedure can be regarded as a restraint. The management of the resident in a reclining chair was not detailed in the care plan as guidance to staff. It is the policy of the home not to discuss the wishes of the resident or their family in the event of death on admission. The Registered Manager confirmed that it would be done when appropriate. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. There is no activity co-ordinator and a range of options is offered to the residents. Contact with families and friends are valued and facilitated. Staff took all opportunities to offer choices to the residents. The meals provided met the residents’ expectations. EVIDENCE: There many things that the residents can be involved in such as church attendance, hydrotherapy, speech and language, hairdressing, massage, travelling theatre groups, physical movement and aromatherapy. As there is no co-ordinator it is not possible to easily to see that all residents have the opportunity to be involved in a range of activities, an aspect that should also feed into quality control. Some staff take residents out in their own time and the Registered Manager confirmed that the staff are given their time back. Families and friends are made very welcomed in the home and though all were too busy to speak to the Inspector they all briefly were very positive about the care of their relatives. All staff were observed to offer choices for most situations, and they attended to the residents’ decisions. The residents make choices in their daily lives such as; time to rise, go to bed, choice of clothes and where meals are taken. The chef spoke positively about the quality of the food available and that the meals were mostly finished by the residents. They in turn spoke most highly of Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 13 the meals provided. No menu is displayed or discussed with the residents but if they are offered a meal that they do not like an alternative is made available. Meals take place in the dining room, if resident wish or in their bedrooms, and these are pleasant occasions. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Residents or visitors are made aware of the complaints policy as it on the wall in the corridor. The Registered Manager and her deputy have completed a course of training to support Adaptation Nurses and through their currency cascade training to the staff team. EVIDENCE: Anyone wishing to make a complaint has to speak to the Registered Manager. There is no complaints book available and information is not given to residents and their families on admission. The Registered Manager feels as they are such a small service and known to the community from which many of their residents are drawn the present procedure works well. There has been a recent complaint from a member of staff who resigned and this involved the Commission for Social Care Inspection. The complaint was not founded on three of the four aspects. Both the Registered Manager and her deputy have followed training updates and feel competent to train the staff team in all aspects of their work. Protection of vulnerable adults is covered in the new staff’s induction. The Registered Manager is aware that nurses from overseas may at times respond differently and confirmed that she is regularly observing and reminding all staff of good practice. Where residents are put in reclining chairs there is no monitoring but the Registered Manager believes that all staff observe and are aware that it is poor practice to use seating as a restraint. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Daily care is taken of the environment but there are signs of wear in carpeting around the front entrance. The front door is kept unlocked and visitors are able to let themselves in throughout the day. The laundry does not have an impermeable floor covering. EVIDENCE: The fabric of the home has not been refurbished, as a planning application will result in many changes if successful. The Environmental Health Officer (EHO) confirmed that she did not make requirements in her last report as the outcome of planning was still awaited and she will be following this up in her next inspection. The Fire Service confirmed that they had seen a robust risk assessment from the home. All rooms are decorated when residents’ leave and two rooms have been refurbished to a high standard. The safety of the home cannot be assumed as visitors let themselves in and do not sign in or out as is required by the National Minimum Standards. On the first floor there was a fire door that was open at the request of the occupant. This resident raised a concern that one resident, who is known to wander, and she has had to deflect her away from the door and the external staircase. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 16 The floor covering has been in place in the laundry for a number of years and now cannot be considered as impermeable and consequently must be replaced. The same floor covering is in the kitchen and the report of the EHO will address this. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28. The staff rota showed an increase in the number of staff to meet the needs of peak times. The Registered Manager visits the service even on days off. There is no RGN on three of the nights of the week. 50 of the staff are not qualified at National Vocational Qualification level 2. EVIDENCE: The rota shows staff on duty each day but not the capacity that they are working in. All the carers have duties for cleaning and laundry and the split of their time should show on the staff rota. Only one member of staff is following National Vocational Qualification training and other staff do not want to train. No agency staff are used in the home and there are no trainees. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 36. The Registered Manager is an experienced and qualified in practice to run the home but does not have a management qualification. There is no programme of quality assurance within the home. The carers do not have formal supervision to meet the National Minimum Standards. EVIDENCE: The Registered Manager is an experienced RGN and has followed further training to be a trainer of Adaptation Nurses from overseas along with her deputy. The Registered Manager, who is also the Provider, has run the home For eighteen years and therefore is an experienced manager but does not have a qualification in Management. There is no programme of quality assurance in the home and therefore it is not clear to see the checks that are in place for an annual internal audit as required by the National Minimum Standards. Questionnaires have been given to residents and relatives but it is not clear that the outcomes have been Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 19 identified to inform the quality of the care at the home. The Registered Manager confirmed that much of this work is done at a verbal level. No staff in the home receives formal supervision as required by the National Minimum Standards. The Registered Manager confirmed that there is constant verbal interaction between all the staff before every shift. Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 20 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 1 X 2 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X x Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 Standard OP1 OP1 OP3 OP9 OP16 OP19 OP19 OP26 OP28 OP27 OP33 OP31 OP36 Regulation 6(a) Requirement Timescale for action 19/01/06 19/11/05 19/11/05 19/01/06 19/01/06 19/11/05 19/01/06 19/03/06 19/12/05 19/11/05 19/01/06 19/12/05 19/12/05 That the statement of purpose is updated to show the full provision of the service. 4(1)(b) That a variation must be effected to include a service user with dementia. 14(1)(a) That all prospective resident are assessed before admission. 13(2) That the administration of medication reflects best practice. 22(i) That the complaints procedure is fully accessible. 13(4)(c) That risk assessment is in place to manage the open front door. 23(2)(b) That routine maintenance is programmed. 13(4)(a) That the laundry has an impermeable floor. 19(5)(b) That 50 of carers are trained at National Vocational Qualification level 2. 18(3)(b) That a qualified nurse is on duty for all shifts. 24(1)(a,b) That a programme for quality assurance is in place. 9(2)(i) That the Registered Manager has a management qualification. 18(2) That all carers have formal supervision six times a year. DS0000013957.V251024.R01.S.doc Ashwood Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashwood DS0000013957.V251024.R01.S.doc Version 5.0 Page 24 - 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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