Inspection on 07/05/08 for Ashwood Park Residential Care Home

This inspection was carried out on 7th May 2008.

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

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 Park Residential Care... 15/12/09

Ashwood Park Residential Care... 07/05/09

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

CARE HOMES FOR OLDER PEOPLE Ashwood Park Residential Care Home Seaside Lane Easington Colliery Peterlee County Durham SR8 3XZ Lead Inspector Miss Andrea Goodall Key Unannounced Inspection 10:00 7 , 8th & 9th May 2008 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 Park Residential Care Home DS0000071000.V364239.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 Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood Park Residential Care Home Address Seaside Lane Easington Colliery Peterlee County Durham SR8 3XZ 0191 527 3300 0191 527 3360 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) www.europeancare.co.uk European Care (England) Ltd Manager post vacant Care Home 65 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (35) of places Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 35 Dementia over 65 years of age, Code DE(E), maximum number of places 35 The maximum number of service users who can be accommodated is: 35 Not applicable. This is the first inspection since the home was registered to a new Provider in November 2007. 2. Date of last inspection Brief Description of the Service: Ashwood Park is a purpose-built home that provides residential care for 65 people over the age of 65 years. The accommodation is within two main units. The home is registered for 35 residential care places for older people, and 35 residential care places for older people with dementia care needs. The home has been operating for about 8 years. It was purchased in November 2007 by European Care Limited, which is a large national company that operates many care services throughout the country. Ashwood Park shares the site with Birchwood Court, which is another residential care home now owned by European Care Limited. The home’s driveway is well kept with several parking spaces and access to colourful gardens with seating areas. Internally, the home is furnished to a very good standard. All bedrooms are single occupancy with en-suite facilities. There is a good range of lounges and dining areas throughout the home, including a small library room. There is level access into the home, and the wide corridors and a passenger lift ensure that people who use a wheelchair can access all areas of the building. The dementia care unit is built in a square design with a central garden/patio area that offers a safe, private environment for residents to sit in. The home is Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 5 situated off the main street that runs through the centre of the village. All local facilities are within easy reach. The weekly fees for this home range from £434.50 to £455.50 (depending on dependency and funding arrangements.) Items not covered by the fees include chiropody, hairdressing, toiletries and clothing. Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Before the visit: We looked at: • information we have received since the home was registered to the new provider in November 2007 • how the service has dealt with any complaints & concerns • any changes to how the home is run • the provider’s view of how well they care for people in the annual assessment that we ask for (this is called an AQAA) The Visit: An unannounced visit was made on 7th May 2008, and another inspection visit was made on 8th May 2008. We told the manager what we found at a feedback visit on 9th May 2008. During the visit we: • talked with several people who use the service, about six relatives, several staff, the manager & two visiting professionals • joined residents for two meals and looked at how staff support the people who live here • looked at information about the people who use the service & how well their needs are met • looked at other records which must be kept • checked that staff had the knowledge, skills & training to meet the needs of the people they care for • looked around the parts of the building to make sure it was clean, safe & comfortable What the service does well: The home is a valued resource in this tightly-knit community. Most residents and staff members are from the village and there is a sociable, warm, easygoing atmosphere here. Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 7 Staff are very familiar with different people’s individual needs. Residents, relatives and visiting health professionals described the home as “very friendly”. Residents said that they can follow their own lifestyles, such as having a lie-in and a late breakfast, when they want. Residents can spend time socialising in the many lounges or in the privacy of their own room. Many residents and their visitors said the quality of meals is “very good”. The home has a very good quality of decoration and furnishings. It is a bright, warm, comfortable place for people to live. Staff are well trained in care and in dementia care needs so they know how to support people in the right way. There are very few changes to staff so people get to know each other well. There are good arrangements for supporting residents to keep their personal monies in a safe place if they want. The manager makes sure that relatives can make suggestions and comments about the home and listens to what they say. The home is run in the best interests of the people who live here. One resident said, ““I still do what I want when I want, but I’ve got help if I need it.” What has improved since the last inspection? What they could do better: It would be better if the information pack for residents (called a Service Users Guide) is updated so that people have information about the new Provider and management staff. Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 8 It would be better if new care plans were in place that show exactly what each person needs help with, and how staff are planning their care to make sure they get the right support. It would be better if there were guidelines for staff to help people who have behavioural needs. These would guide all staff to provide the same support in the same way when people are upset or angry. There should be a plan for people who are losing weight that all staff know about, including catering staff, so that they can make sure people get the right amount of food at times to suit them to help them stay healthy. People said it would be better if there was a minibus so that they could have the chance to go out to local places more often. It would be better if people had more chance to help themselves to parts of their meal to suit their own tastes. Locks to some toilet doors and to the kitchen need to be fixed. A small number of bedrooms that overlook the garden would benefit from blinds to make sure they are private. Records of hot water should show the actual temperature and it would be better if this was done weekly for baths. There should be records to show that staff have had fire training at the right times. 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 Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 9 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 Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 10 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 (NMS 6 does not apply to this service). People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People get information about the home but it does not include up-to-date information about the new Provider so this does not help them make an informed decision about whether to move here. EVIDENCE: Ashwood Park has been open for over 8 years. It was purchased by the new provider, European Care Limited in November 2007. However at the time of this visit the information pack (called a Service Users Guide) for residents and visitors is out of date. For example, the information still refers to the previous owner and manager. This means that new or prospective residents would not Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 11 have correct written information about the service before deciding whether to move here. The home’s previous manager indicated that the information is also available in audio-format, which would have been helpful for the two people living here with a significant visual impairment. However this information could not be found at the time of this visit. Ashwood Park is a well-known resource in this close-knit community. Most of the people who live here are from the local area and chose the home because they were familiar with it. Some people already knew a few of the residents here, and they felt that this made it easier for them to settle in. Some people had already stayed at the home for short-breaks. One resident said, “I didn’t want to come into a care home, but I like living here. The lasses (staff) are canny and they’re from Easington like me.” The needs of prospective residents are assessed before they move in so that the home knows whether those needs can be met here. Care Managers of the Social Services Department carry out most assessments and these are provided to the home. The home also carries out its own assessment of new residents, although these tend to be based on number scores and do not always assist staff in planning someone’s care. As someone moves into the home, life history records are completed (usually by relatives) which are a very good record of the person’s life, social hobbies, lifestyle preferences, and religious or other interests. Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 12 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Good staff practices and planned improvements to care records means that overall residents have good support with personal and health care needs. EVIDENCE: Care plans are records that are used by all care services to show what sort of help each person needs and how staff will provide that care. However at the time of the first visit, the care plans at Ashwood Park did not reflect the good staff knowledge, nor demonstrate the care required or provided by people. There are currently two different types of care plan being used at this home. The care plans for people who have dementia care needs are supposed to be based on their strengths and weaknesses, so that they can continue to do as much for themselves as possible and only be supported where necessary. However staff did not receive sufficient training in these care plans when they Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 13 were introduced last year. As a result staff have recorded lots of background details but the style of the record did not allow them to record a plan of how to support someone. For example, one person has significant behavioural needs that can make them aggressive towards staff (and occasionally other residents). However there are no specific guidelines or plans of how staff should help this person to manage their behaviour. In this way staff may not be providing a consistent response to that person’s needs, which could confuse the person and escalate their behaviour. This style of care plan also requires the staff to record various daily records. However, due to lack of training, these have become a repetitive and uninformative. For example, several entries simply stated “remains the same”, even on days when a significant event had occurred. The care plans for people living in the main residential unit were better because they did identify individual significant needs, such as bathing, continence, and skin care. However even these plans were not fully clear. For example a plan about bathing did not include details of, or the person’s views about, how often they would like to bath, in which bathroom, and by which staff. In spite of the unsatisfactory detail in care plans, it is very clear from discussions and observations of staff practices that all staff are very aware of the individual care needs of each resident. Residents receive very good individual support with their needs from all staff. Staff are able to describe those needs in a person-centred way, showing that they respect the individuality and preferences of each person. In discussions the new manager, and senior representatives of the provider, were already aware of the shortfalls in the care plans and have begun to address this. The inspector was shown a new care plan format, which is to be introduced at the home after staff have had training in this area. It is anticipated that this will lead to better care planning in the future. Health care records show that residents have good access to community health care professionals. Discussions with a visiting district nurse indicated that there are good relations and contact between the home and health services. Discussions with relatives showed that the staff keep them informed of any change in health needs. Throughout these visits it was clear that staff are able to recognise residents’ diverse needs and how these can be best supported. For example, staff were able to recognise from a resident’s change in posture that they may be experiencing pain even though the resident was unable to communicate this. Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 14 Staff were quick to contact health care services about this change in the resident’s well being. Nutritional assessments are carried out on admission, and every month the residents weight and nutritional assessment is recorded. However even significant changes in weight have not prompted a specific plan of care. For example one person has consistently lost weight over the past 10 months. However the nutritional assessment does not direct staff to take any action, simply providing a numeric score with no guidance. In discussions catering staff (who are responsible for residents’ nutritional care) had not been aware of this weight loss. They were able to describe what they can do to fortify the person’s diet and provide them with additional snacks. But there is no recorded plan of this, and no documented referral to a dietician. It is good practice that the home supports people to manage their own medication, if they are able and want to. A small number of people do this and there is a self-administration assessment to record their capability to do this. For all other people, senior staff are responsible for the administration of medication, and they are provided with suitable training in the safe handling of medicines. There is secure, suitable storage for medication in both areas of the home. The administration of medication was carried out correctly. (Staff were reminded that they do not sign the medication records if residents manage their own medication.) During discussions, staff talked about residents in a respectful way. Throughout the inspection visits there were many instances of good practice where staff supported residents in a sensitive and encouraging way. For example, sitting with individual residents to provide sensitive and engaging support at mealtimes, and supporting people with their mobility at the resident’s own pace. There was clearly a very good relationship between residents and staff. One resident said of staff, “They are all lovely. They are as important to me as family.” Residents are supported with their personal grooming and appearance. A weekly hairdressing service is available at the home, which several residents use. Residents can use their own bedrooms for privacy whenever they wish. There are easy-to-use locks on the inside of bedroom doors if residents do not wish to be disturbed. Visiting relatives said, “Staff are so friendly and helpful. Even though there are 60 people living here, staff know all their names.” Ashwood Park Residential Care Home DS0000071000.V364239.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. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents have very good opportunities to make choices about their own daily routines so that they lead a lifestyle that matches their individual preferences. EVIDENCE: People are encouraged and supported to choose their own daily routines. Some people like to get up early, other like a lie-in and daytime naps. One resident said, “I still do what I want when I want but I’ve got help if I need it.” Residents have lots of social, stimulating contact and there was a lot of laughter and chatter throughout all areas of the home. Throughout the visits there was a steady stream of visitors to the home. Those visitors who took part in discussions all had very positive comments to make. One relative said, “This must be the friendliest home in the area.” A visiting health care professional said, “There is always a good atmosphere.” Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 16 The home has two part-time activities staff who organise a range of activities both in the home. These include bingo, armchair exercises, garden ball games, manicure and foot spas, singers, and special suppers. A relative commented, “There is something on everyday if people want to join in.” Out of the home there are occasional walks with staff in the local village, two people go to a nearby luncheon club, and some residents visit Birchdale (a care home on the same site). The provider has proposals for a café between the two homes that would be for everyone in the village, as well as residents and their visitors. This would also support residents’ continued contact with their local community. Several residents (and relatives) commented that there is no longer a minibus for local trips out, as this is now used exclusively by another home with a day care unit. Although the manager is planning some coach trips out over the summer, the people living here said that they would welcome regular local trips out again. One resident said, “It would be good to get out a bit more, even just down to the coast.” Residents and their relatives had many good comments about the quality of meals. One resident said, “The grub is always very good.” Another resident felt that there had been improvements to catering since the new provider took over and commented, “We seem to get more treats now, like cream cakes.” Residents enjoy local traditional dishes that suit their cultural background, as well as modern dishes that broaden their menu choices. They can choose to dine in the pleasant dining rooms or anywhere else in the home. For example some people prefer to eat all their meals in their bedroom and this is respected and supported. Relatives commented that they are always invited to stay for a meal if visiting at that time. One relative said, “We’ve stopped and had a meal, and the quality was very good. She wouldn’t eat at home but she really enjoys her meals here.” The home has tried to improve the information for residents with dementia care needs by developing a photographic menu book with some menu choices in it. However residents are asked for their menu choices the day before and many are unlikely to remember their choice the following day. At this time, meals are served to residents already plated-up. This means that residents could not select which parts of the dish they would like, even for buffet-style meals. Some people said that they would prefer to be able to choose how much gravy, sauces and custard they had on their meals. In the dementia unit people were encouraged to go the dining room as early as 11.35am, even though the meal was not served until after 12noon. Several Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 17 people got fed-up of waiting and kept leaving the dining room. The manager and senior staff acknowledged that this is unnecessarily early and can easily be changed so that people enjoy a timely dining experience. It is good that some residents have their own drinks, snacks and fridges in their bedrooms. The home now employs a trolley hostess whose primary role is to ensure that residents always have access to hot and cold drinks. There is a small, but well-equipped kitchenette for visitors to make their own drinks if they wish. Ashwood Park Residential Care Home DS0000071000.V364239.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Suitable complaints and protection systems are in place and dealt with effectively, so that residents’ rights and welfare are safeguarded. EVIDENCE: All residents (or their relatives) are given a copy of the complaint procedure, which is in the Service Users Guide (an information pack). At this time some of the information in the Service Users Guide is out of date but the general principle of the complaints procedure is clear, and in discussions people were able to describe what they would do if they were dissatisfied with the service. There are records of the minor concerns, such as occasional lost laundry, that have been dealt with by the home over the past year. Some residents were able to give examples of “grumbles” that they told the manager about, which have been satisfactorily addressed. One resident said, “I would go to the manager if I needed to. She is very good at putting things right. She encourages us to say anything at our monthly meetings.” Relatives said, “The manager has an open door for anyone. Even the staff office is open for residents and visitors to pop in. There are always staff around if we need to mention anything to.” Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 19 In discussions the new manager was able to demonstrate her good understanding of safeguarding adults procedures, and described how the outcomes of complaints and safeguarding issues are used to direct how the service might improve (and how potential risks to residents can be reduced). For example, the home had recently made a safeguarding referral to Social Services Department about the inappropriate behaviour of one resident towards others. All agencies were involved in reassessing the resident for a suitable alternative placement, and staff provided increased monitoring and supervision during his stay to ensure that the risk to other residents was minimised. All new staff receive training in Safeguarding Adults as part of their Induction training within the first 6 months of their employment. All existing staff have had specific in-house training and some have had training from the local authority on safeguarding adults protocols, with the remainder nominated for future courses. In discussions with 6 staff all were very aware of their responsibility and duty to report any bad practices and have the details of contacts (including CSCI) to contact if necessary. It is good practice that this information is on the staff room notice board so that staff have daily access to it. Ashwood Park Residential Care Home DS0000071000.V364239.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, 20, 21, 23 & 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is well decorated, well-maintained, comfortable and safe so residents live in good quality accommodation that meets their needs. EVIDENCE: This modern, purpose built home is designed into two main units. One is the dementia care unit with 25 places. The rest of the home is called the ‘general’ unit with 40 places (of which 10 places can also be for people with dementia care needs). The standard of décor and furnishings throughout the home is very good. The home has an on-site maintenance staff to attend to repairs, safety and maintenance checks, and this means that the building is well-maintained for the people who live here. Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 21 The home has an excellent range of lounges, dining rooms, library and other seated areas for resident to enjoy. There is a well-kept central garden area in the dementia unit, which is accessible by all residents if they wish. Children from a local school have provided a sensory area in this garden for residents to enjoy. It is also well used for games in better weather. There is also garden furniture at the front of the home where many residents and relatives were enjoying the nice weather during these visits. Bedrooms are a good size, well-decorated, and have been highly personalised by residents with their own pictures and other personal items. All bedroom doors have locks, so that people can choose to lock their room or not. Most bedroom doors are fitted with a ‘dorguard’, which allows the door to stay open but closes it in the event of a fire. (The manager indicated that the few remaining doors are also to be fitted with this equipment.) A small number of bedrooms overlook the central garden area in the dementia unit. At this time the windows to these rooms do not have blinds. This means that people using the garden can see directly into the bedrooms, and this may compromise the privacy of the people who use those bedrooms. There are plenty of bathrooms and toilets around the home for people to use, but these are not as warmly decorated as other areas of the home. Also the locks to two toilets and a bathroom in the dementia unit were broken at the time of this visit, which did not support people’s dignity and privacy. Bedrooms have numbers and photographs of residents to help people find their way around. In the dementia unit there are also some posters to show where toilets and bathrooms are. The manager and provider are aware that this unit could provide more environmental clues for people with dementia, and this work is planned as a special project in the near future. The square design of this unit is good for people as it allows them to walk all around the unit stopping off at lounges, garden or staff office on the way. The lighting around much of the building is bright as there is good natural light in most rooms and corridors. In the dementia unit one corridor and some bathrooms are quite dim. The manager commented that there are plans for the whole of this unit to receive upgraded lighting as part of a refurbishment plan. The standard of cleanliness and odour control around all areas of the home is excellent. The home has a well-equipped laundry and dedicated laundry staff. Ashwood Park Residential Care Home DS0000071000.V364239.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. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides competent, well-trained staff and in sufficient numbers to ensure that the needs of the people who live here are met. EVIDENCE: The staff team consists of a manager, two deputy managers (who take responsibility for supervising each unit), senior and care staff. The deputy managers and seniors have special responsibility for overseeing the staff teams in each of the two units, so staff know which unit they will work in each day. The staff rota provides 11 care staff during the day, 9 care staff in the afternoons, and 4 staff on duty at night. These are satisfactory staffing levels for the number and needs of the people who live here. This was evident by the good staff presence around lounges and corridors, so that residents could usually see a member of staff if they needed support. There are also satisfactory levels of catering and domestic staff. This is evident from the very good standard of catering and housekeeping services that residents receive. Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 23 A visiting health care professional said, “The staff provide the same, friendly care to everyone here, no matter what their needs. Residents seem to enjoy spending time in staffs’ company.” European Care is an equal opportunities employer and promotes clear equality and diversity procedures when recruiting new staff. At this time there is only one part-time vacant care post, and these hours are being covered by existing staff. Many of the senior staff have worked here for several years and this provides good continuity of care for the people who live here. Since the last inspection a small number of staff have left, including the previous manager. A sample of staff personnel records generally showed that the correct recruitment and selection checks had taken place and this ensures that only suitable staff are employed here. (Some personnel files need to be brought up to date and the new manager is working through these.) Of 37 care staff, 24 have completed a national care qualification called NVQ level 2, as have both Activities co-ordinators. Seven more care staff are about to complete this award. Six senior staff have completed NVQ level 3 and four more are about to complete this care qualification. Around 10 care staff who work in dementia care unit have had certificated training in dementia awareness through a local college, and 3 more staff are currently engaged in such training. Ten more staff are to commence this training next week. All staff will receive training next week called ‘Yesterday, Today, Tomorrow’, which is designed for staff who support older people with dementia care needs. In this way the home demonstrates that staff are well trained in the needs of the people who live here. Several staff commented on their enjoyment of the dementia courses and mental capacity act training. They felt that they are able to use this knowledge in the home to provide a better service for the residents. One relative said, “They have a fabulous way of helping people with dementia - they know just how to get them to do things for themselves.” Staff have coped well with the change in owner, and more recently the change of manager. Discussions with several staff, with different roles, confirmed their continued commitment and enthusiasm about the home. Staff said that they feel well supported in their work and described their training opportunities as “very good”. A visiting trainer said, “It’s a very enthusiastic staff team. Even the younger ones seem very committed to training. The new manager has provided them with lots of resources for their NVQ work. She positively promotes them towards their career development.” Ashwood Park Residential Care Home DS0000071000.V364239.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, 32, 33, 35 & 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is well-managed so it is run in a way that upholds the best interests of the people who live here EVIDENCE: The previous registered manager left in January 2008. A new manager was subsequently appointed and began working here at the end of February 2008. The new manager is about to apply to CSCI for registration approval. Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 25 The new manager has 25 years experience of working in social care for older people. Before coming to work at Ashwood Park she was the registered manager at a similar home for older people for 6 years. The new manager has attained NVQ level 4 in Care and the Registered Manager’s Award. These are both suitable qualifications for a manager of a care service. She is supported by two deputy managers who take special responsibility for supervising the two units within the home. The manager is supervised by a Performance Manager who also visits the home at least once a month to assess and report on its operations. Residents, relatives and staff described the new manager as “very approachable” and had many positive comments to make about the changes she has made. The manager consults regularly with residents and relatives for their views about the quality of the service. This is in the form of discussions with individuals, and monthly residents’ meetings. The Provider is a large national care organisation that has comprehensive quality assessment processes. It also uses annual questionnaires for residents to review its services. Residents and relatives feel the manager listens to them and acts on their views. It was clear from these visits that the manager and deputy managers take time to talk with visiting relatives and keep them updated about any changes. The home benefits from a full time administrator who supports the many administrative tasks that are required in running a care service. She also takes responsibility for securely storing residents’ personal monies, if they request this. Records of residents’ monies were examined, and were found to be well managed with clear details and references of any transactions made on behalf of residents, for example hairdressing bills. Staff receive training in statutory health & safety matters so that they know how to support residents in a safe way. All catering staff and (and some care staff) have training in food hygiene. There are sufficient staff trained in first aid to ensure that there is always an appointed first aider on duty. Around 15 staff had certificated Fire Safety training in November 2007. However at this time there were no records available in the home to show whether, since then, staff have received the required in-house fire instruction at the right intervals, that is 6 monthly for day staff and 3 monthly for night staff. Health & safety checks of the premises and equipment are carried out by a maintenance staff. At this time checks of hot water outlets are only recorded Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 26 as having been carried out, and do not include the actual temperature of the hot water (so water could be too cold). At this time the kitchen door does not fit fully into its rebate so the lock does not work. In this way residents could wander into this area by mistake, and this presents a potential hazard to their safety. Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 27 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 4 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 3 3 4 2 X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 X X 2 Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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 5 Requirement The Service Users Guide must be updated to reflect the new provider, manager and any other changed arrangements at the home since the new provider began operating this service. This is to ensure that all residents, and prospective service users, have relevant upto-date information about the service. The new care plans must set out the specific needs of each residents and detailed guidance for staff in how to support those needs. Monthly evaluations must report a meaningful assessment of the progress or change in need. This is to guide staff in how to support people with their significant needs in a consistent, planned way and that any changes in need are identified. Behavioural guidelines must be in place to support the staff to manage incidents of challenging DS0000071000.V364239.R01.S.doc Timescale for action 01/08/08 2. OP7 15 01/09/08 3. OP7 13(7) 01/08/08 Ashwood Park Residential Care Home Version 5.2 Page 29 behaviour. This is to ensure that staff provide support in a consistent and de-escalating manner. The nutritional needs of residents must be managed by a clear, co-ordinated approach involving care staff and catering staff, and this must be outlined in a specific plan of care. This is to ensure that people’s nutritional well-being is fully promoted by all staff. Records of in-house fire instruction must be in place to show that night staff receive this instruction at intervals of 3 months and all staff who work during the day receive this instruction 6 monthly. 4. OP8 12(1)a 13(1)b 16(2) 01/07/08 5. OP38 23(4)(d) 01/08/08 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. Refer to Standard OP3 OP9 OP12 OP14 Good Practice Recommendations It would be better if assessments tools included detailed outcomes so that the information could be better used to plan someone’s care. Staff should not sign the medication administration record where the medication has been self-administered by a resident. Serious consideration should be given to the provision of a minibus, which could be shared by the two homes on the site, for regular local trips out for residents. The home may wish to consider the possibility of asking residents for their meal choices at the table at the time that the meal is being served, so that people can make an immediate and visual choice of the dishes offered. Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 30 5. OP15 It would be better if residents had some opportunities to independently choose from the meal and drinks selections (e.g. from buffet meals, sauces, side dishes and soft drinks) and to serve themselves wherever capabilities allow. This would ensure they retain their rights to choice and independence. Also, it would be better for some people if they were supported to go to the dining room when their meal was actually about to be served, rather than too early. Locks to toilet doors and bathroom should be fixed as soon as possible to protect residents’ dignity and privacy. Also consideration could be given to the provision of decorative shower curtains in bathrooms to support residents’ privacy, and to brighten these rooms. Blinds should be provided to the small number bedrooms that overlook the central garden area in the dementia unit, in order to protect the privacy and dignity of the people who use these rooms. Hot water temperature records should record the actual temperature reading, and it would be better if checks of baths were carried out weekly to make sure that they maintain a safe temperature for body immersion of around 43°C. The kitchen door needs to be fixed to enable the lock to be operated so that residents are prevented from mistakenly going into this area. 6. OP21 7. OP23 8. OP38 9. OP38 Ashwood Park Residential Care Home DS0000071000.V364239.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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