Inspection on 14/08/09 for Askham House

This inspection was carried out on 14th August 2009.

CQC found this care home to be providing an Adequate 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

Askham House 08/08/07

Askham House 26/07/06

Askham House 20/08/05

Askham House 26/04/05

Askham House 05/11/04

Askham House 08/06/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Askham House Benwick Road Doddington Cambridgeshire PE15 0TG Lead Inspector Joanne Pawson Key Unannounced Inspection 14th July 2009 10:00 DS0000024321.V376761.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Askham House Address Benwick Road Doddington Cambridgeshire PE15 0TG 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) 01354 740269 01354 741996 www.askhamcarehomes.com Askham Care Homes Limited Mr Salim Giga Mrs Marie Eileen Rankin Care Home 27 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (27), Terminally ill over 65 years of age (27) Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to 8 Beds Personal Care 1 named adult under 65 years of age with a Mental Disorder Date of last inspection 8th August 2007 Brief Description of the Service: Askham House is situated just on the outskirts of the village of Doddington. From this rural location there are good road links to the Cities of Cambridge, Ely and the nearby town of March. Accommodation is offered on two floors in mostly single bedrooms. There are four double bedrooms. The home can accommodate up to twenty- seven service users, with a residential or nursing need. The home is comfortable, spacious and well maintained. It has a number of small sitting areas and a living room/dining room facing a small courtyard garden. The home has a third, more spacious lounge, with a bar and overlooking extensive gardens. This is also used for the provision of day care for local residents. There is also a further dining area. The home is approached through a long, private tree lined drive leading up to the main house. There are ample gardens and acres of land belonging to the owners of Askham House. On the same site is a second home belonging to the owners, but managed entirely separately. This provides accommodation to adults with physical disabilities and who may require nursing. The two homes share a main kitchen, and food is brought over to Askham House on heated trolleys. Askham House has a small kitchenette for the preparation of drinks and snacks. The weekly fees are between £343 and £650 at the time of the inspection. There is a notice in the main hall stating when the last inspection was and that there is a report available and a copy of the report was seen on a table in the inner hallway. Askham House DS0000024321.V376761.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 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection of this service and it took place over 7 hours and 30 minutes as an unannounced visit to the premises. It was spent talking to the manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. The requirement from the last inspection to ensure the entrance to home is safe has been met. Information obtained from the Annual Quality Assurance Assessment (pre inspection information completed by the manager) and from returned surveys was also used in this report. Ten surveys were returned from people who live at the home, and five were returned from visitors to the home and eight from the staff. What the service does well: All of the complaints and the outcome of the investigations are recorded in detail so that the manager and owner can ensure that all complaints are taken seriously and dealt with appropriately. The home holds regular residents’ meetings where they ask the views of the residents’ and if they would like anything done differently. Two recent changes as a result of the meetings are that cakes are bought twice a week rather than home made ones and cheese and biscuits are available. Although some residents’ have said they would like more in-house activities instead of trips out a programme of short trips have been organised for those who would still like to go out. One resident stated ‘it’s brilliant here, they couldn’t do more for you. There are lovely people.’ What has improved since the last inspection? What they could do better: Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 6 Staff must follow the procedure for the recording of administration of medication. This will ensure a true and accurate record is kept of what medication the residents have taken. This will help to ensure that the residents get the medication they have been prescribed. The fire alarms must be tested weekly to ensure that they work. This will help to keep the residents safe. All staff who may be in charge of the home when the manager is not present must be aware of the procedure to be followed if an allegation of abuse is made. This will help to ensure the safety of the residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 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 Askham House DS0000024321.V376761.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5,6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home completes pre admission assessments to ensure that it can meet the needs of the residents before they move in. EVIDENCE: The homes brochure and information pack is provided to anyone enquiring about living in the home. Prospective residents and their families are invited to visit the home before they move in. The residents we spoke to on the day of the inspection confirmed that they were invited to visit the home. An assessment is completed before people move into the home. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 9 When a new resident moves into the home the manager or a senior nurse explains the service users guide to them and answers any questions they may have. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience adequate quality outcomes in this area. The care staff do not always have the written information they require this could mean the residents’ needs may not always be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at three care plans. The first care plan contained a detailed life history of the resident. There was a care plan for the resident’s pressure sore but this did not state the maximum time that the dressing should be left before changing. The records for the changing of the dressing showed that the time varied from one day up to ten days. When we asked the nurse in charge of the shift what she had been advised about the changing of the dressings she stated that the tissue viability nurse had told her that the dressing must be left a maximum of five days before it should be changed. The social care plan for the same resident did not contain any information about the interests of the Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 11 resident. Although the mobility section stated that the resident was to be hoisted with a sling the care plan did not state what size the sling should be. The manager stated that this was not recorded as each resident has their own personal sling in their room. There was good information on a medical condition that the resident suffered which included information for staff about symptoms the resident may experience. The second care plan we looked at also contained a very good life history of the resident. A risk assessment for the resident’s pressure sores had been completed and a score of 22 had been given and a rating of high risk although according to the table on the care plan 22 is very high risk. The section of the risk assessment which should be completed to indicate what steps should be taken to prevent adverse effects of pressure was blank and no boxes had been ticked. On the reverse of the pressure sore risk assessment there is a section where the identified risk and action required should be completed and this was also blank. Records showed that again the time between the redressing of the wound varied between one and ten days. One entry on the dressing chart referred to a heel dressing although there was no mention of a heel pressure sore in the risk assessment or care plan. The daily notes of the third care plan we looked at showed that the resident had developed a pressure sore the previous day and a care plan had been completed to assess what action needed to be taken. The daily notes also stated that the dressing to the resident’s forehead had been renewed although there was nothing about this in the care plan. Further investigation showed that the resident had an accident on the 24th June and had needed the wound dressed. There was also a care plan for nutrition which showed that the resident was at risk from malnutrition, dehydration and weight loss and that the resident should be weighed monthly. However the weight records showed that the resident had not been weighed since March. The manager stated that this was because the scales had been broken for two months but that the resident had now been weighed but that it had not been recorded in the care plan. We observed the nurse in charge of the shift administer medication. The correct procedures were not followed and the medication administration sheets were signed when the medication was given out even though the nurse did not always see the resident take the medication. The manager stated that it was not normal practice for the record to be signed before the resident took the medication. We looked at the medication administration records for the last month and there were no omissions of signatures. All of the residents’ we spoke to confirmed that they are treated with dignity and respect. The staff were observed to treat the residents with respect for the majority of the time although one member of staff referred to the people who need help to eat as ‘these are the ones we have to feed’ and one carer was observed standing next to a resident when assisting her to eat rather than sitting down at the same level. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. Residents can choose to take part in group or individual activities’. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a plan for group activities which are normally held in the large lounge such as quizzes and bingo. The activities coordinator also spends time talking with residents’ in their own bedroom. The residents’ we spoke with told us that their relatives and friends can visit and that they can see them in the communal areas or in their bedroom. One of the surveys received from a resident’s relative stated ‘very caring and friendly supportive staff both to us as visitors and our relative’. All of the relatives’ surveys indicated that the home helps their relative to keep in touch with them. We observed lunch time in the small lounge and then in the small dining room. The residents were asked what they would like to eat and if they wanted salt Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 13 and pepper on their food. One carer was seen to sit down next to a resident and gently encouraged him to eat and gave him assistance when he needed it. Another carer was seen to stand next to a resident she was assisting to eat and commented to another carer ‘she keeps staring at me look’. Although the resident’s food had been pureed it was not explained to the resident what it was. One resident was assisting herself to eat when a nurse came in and started to assist her. The nurse then went off and the resident didn’t attempt to feed herself so one of the carers commented ‘are you going to finish your dinner’ but the resident replied ‘well she started to feed me’. The resident then fed herself the dessert. Residents’ should be encouraged to be independent where possible. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience adequate quality outcomes in this area. Residents are confident that they can make a complaint and that it will be dealt with appropriately. Not all staff are aware of the correct procedure to be followed if they suspect a resident has been abused. This could place the residents at risk from abuse or harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: 90 of the surveys returned from the residents told us that they were aware of who they should talk to if they wanted to make a complaint. When we spoke to residents on the day of the inspection they also told us that they knew who to complain to and felt they could do this if they needed to. We looked at the record of complaints and they were clearly recorded with any action taken as a result of the investigation also recorded. The pre inspection information supplied by the manager showed that all staff have attended or are booked to attend training on the safeguarding of vulnerable people. During the inspection we asked the a member of staff if the manager was not present what she would do if she suspected a resident may have been the victim of abuse. The member of staff was not able to tell us the correct Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 15 procedure even though she had attended safeguarding training. Staff competencies must be assessed when they have completed training to ensure they understood the training and are aware of the correct procedures. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the service experience good quality outcomes in this area. Askham House provides a clean and homely environment for the residents’. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The service provides a pleasant environment both inside the home and in well maintained and spacious gardens. Up to three domestic staff are available to keep the home clean together with a gardener. The home also has an enclosed courtyard area with seating, with tables and chairs, and shaded sitting areas in the garden. The residents were seen enjoying the courtyard on the day of the inspection. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 17 On the day of the inspection, the home was clean and tidy and free from unpleasant odours. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. Recruitment and training procedures ensure a well trained staff team are available to support the people living in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The service employs a good mix of staff with the necessary skills and experience to meet the needs of the people living in the home, and also supports student nurses, social workers and health and social care students on placement. A thorough recruitment process is followed, and was evidenced on the staff files examined, with the necessary application, references and checks all in place before anyone starts working in the home. All staff receive a variety of training, both mandatory and specific to the people they support in the home, and records of the training provided were seen on Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 19 the files examined. The service has also supported NVQ training for its care staff, with just under 90 of the carers having achieved NVQ level 2 or above. During the visit we spoke to three members of staff. One member of staff thought the best thing about the home was the homely atmosphere and the activities and they also told us that they read the care plans for new residents and if there are any changes with any of the residents she informs the manager so that the care plan can be updated. The second carer told us that ‘it is the sort of home that if my mother had to go in to a home I would be happy for her to come here’. All three members of staff we spoke to had attended training in safeguarding, moving and handling and the fire procedure. Two members of staff spoken to told us that they would like more time to spend with the residents. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 People using the service experience good quality outcomes in this area. The residents’ benefit from a strong management team We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager has many years of experience and is supported by the proprietor who visits the home on a regular basis. All of the residents and staff spoke to spoke highly of the manager. We looked at the records for checking the fire alarms. These had not always been completed weekly. We expect the home to manage this issue. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 21 The home has its own quality assurance system which includes giving out questionnaires to the residents’ staff and visitors. The results are then analysed and acted upon. Records and discussion with the carers show that they receive adequate supervision and can talk to the manager when needed. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 X X X 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 3 X 3 X 3 3 X 3 Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15 Requirement Timescale for action 01/11/09 2. OP8 17(1)(a)S chedule 3(3)(n) 3. OP9 13(2) 4. OP18 13(6) The care plans must be kept under review and updated with the necessary information so that staff have the information they require to meet the residents’ needs. All pressure sores, their 01/10/09 treatment and outcome must be recorded in the care plan in sufficient detail that staff know what action they need to take and when. There must be an accurate 01/10/09 record of the administration of medication. This will ensure that residents are receiving their medication as prescribed. All staff must be aware of the 01/10/09 safeguarding procedures and what they should do if they suspect abuse may have occurred. This will help to protect the residents. Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 24 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 Askham House DS0000024321.V376761.R01.S.doc Version 5.2 Page 25 Care Quality Commission Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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