Inspection on 20/08/05 for Askham House

This inspection was carried out on 20th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Askham House 14/08/09

Askham House 08/08/07

Askham House 26/07/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Askham House Benwick Road Doddington Cambridgeshire PE15 0TG Lead Inspector Shirley Christopher Unannounced 20 August 2005 @ 10:00 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 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. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Askham House Address Benwich Road Doddington Cambridgeshire PE15 OTG 01354 740269 01354 741996 n/a Askham Care Homes Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Marie Rankin Care home with nursing 27 Category(ies) of Mental disorder excluding learning disabilty or registration, with number dementia (1), Old age not falling into any other of places category (27), terminally ill over 65 years of age (27) Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27 April 2005 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. Accomodation is offered on two floors in mostly single bedrooms. There are four double bedrooms. The home can accomodate 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 longe, 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 seperately. This provides accomdation to adults with physical disabilties 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. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on Saturday the 20 August 2005 at 10.00 am. At the time of the inspection there was a nurse in charge and four care assistants on duty. There was also domestic support. The majority of service users had already had breakfast, either in the main dining room or in their bedroom and were getting up at their leisure. The nurse in charge was spoken to, as was one visitor and twelve service users. Three care plans were inspected and the fire records were seen. A tour of the environment was conducted. The nurse in charge stated that there were only a few visitors in the home today, because many were expected tomorrow for the planned gala being held in the garden. The home were also planning a raffle, monies raised go towards further social events. Most of the standards were not inspected on this occasion and the reader is advised to read this report in conjunction with previous reports to get a fuller picture Contact was made with the manager following the unannounced inspection and she confirmed that access to confidential records is restricted to herself and the administrator. Should an out of hour’s inspection take place, she would be happy to come on duty to provide access. She also stated that service users are asked if they wish to have a lock to their bedroom door and this is recorded on their file. Last wishes are also usually recorded. What the service does well: The home is well staffed and there is a low staff turnover. This enables care staff to get to know and establish positive relationships with the service users. Every service user spoken to was complimentary about the staff team and there was no one they felt they did not have a good rapport with. The home is managed in the interest of the service user. This was evidenced on the day of inspection. Service users are offered meals in their bedroom or in the main dining room. Service users actively choose when they get up, or go to bed. Social activities are provided in the home by the coordinator who works Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 6 three days a week. Some service users said there was not much to do, but stated that they chose to do very little and preferred to sit quietly, socialising and reading the daily newspapers. The home does organise a number of main events throughout the year, celebrating special occasions/events, and birthdays. What has improved since the last inspection? What they could do better: 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 Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 7 contacting your local CSCI office. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5 Service users are encouraged to make an informed choice, by visiting the home prior to admission and having a trial stay. EVIDENCE: Three service users files were inspected and provided evidence of a pre admission assessment. This gives basic information about the service user’s needs, before a care plan is implemented. This covers all the main areas of a person’s life, including a brief social history. The nurse in charge fully recognised the importance of an introductory visit to the home before admission. She stated that in reality it is usually the relative that chooses the home, but many of the service users are offered a period of respite care first. This enables them to get use to the home, before deciding if it is right for them. The home also provides a lunch club for local residents. A number of service users were introduced to the home this way. The home does not provide intermediate care. The homes statement of purpose and service user guide are made available to service users and had been updated at the last inspection. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 10 The last inspection report made a requirement in respect of the homes categories of registration, which does not currently include dementia. The home has a number of existing service users, to whom this category applies and the home were asked to apply for a variation in respect of these named individuals. The matron has formally responded to the CSCI regarding this matter and discussions continue. The CSCI are satisfied that the home are able to meet their needs and are not suggesting that they cannot be accommodated in the home. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10,11 Service users’ health care and social needs are appropriately documented and kept under review. EVIDENCE: The three care plans inspected provided clear, straightforward information about the needs to be met and addressed short term and long term needs. Information was provided about the service users’ life history and social needs. The nurse in charge, and a relative or service user signed the initial care plans. No evidence was provided that service users are involved in the monthly review of the care plans. Some documentation such as the manual handling assessments and risk assessments were reviewed infrequently, once a year or less. Where the need or risk is identified as high, more frequent reviewing would be appropriate. Evidence was provided of a collaborative approach to health care with active involvement of other agencies including the GP and District nurses primarily, but also the falls prevention coordinator, the chiropodist, the Parkinson’s nurse, speech and language services and the dietician. A number of service users in the home are at different stages of Parkinson’s disease. The matron has identified a support group for them to attend in March and transport by the Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 12 home will be provided. Service users spoken to were keen for this to happen but just needed a date for it to start. Service user weights were inconsistently recorded. There was no evidence on the files inspected that weight is recorded on admission. The nurse in charge stated that the scales had been broken, but were now fixed. No evidence was seen of nutritional screening, or action to be taken for unexplained weight loss. The GP visits at the request of the home and does not have a weekly surgery there. The head of care confirmed that the GP regularly reviews medication. A medication audit has not been carried out over the last two inspections. The CSCI employs an independent pharmacist. He carried out a full audit of the homes medication and records in February 2005, for which a report is available and was satisfactory. Service users spoken to felt that their rights and privacy were respected. One service user stated that staff just treated them as normal human beings. Care staff were described as attentive, without being too fussy. Service users who require staff assistance with personal care are supported appropriately. Service users were well-dressed and meticulous detail paid to their personal appearance, including nails being manicured and frequent visits from the hairdressers. The last wishes of a service user and their family are generally recorded, but there are occasions where people choose not to discuss this matter. The nurse in charge was asked to make a note on the file, where this is the case. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 13 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 standard(s) 12,13,14,15 Service users experience of the home was positive and the home is run in an ordered, relaxed fashion. EVIDENCE: Most of the service users spoken to were relaxing in the lounge. Lunch was served from 12.00 pm and the majority of service users ate their meals in the communal lounge. It was difficult to establish the level of social activity provided in the home on a daily basis. The home has an activities coordinator who works at the home three times a week. Social activities are planned in advance and include trips out. Recent examples include Wickstead Park and Hunstanton. Other events are advertised on the notice board and family and friends are encouraged to join in. There is a relatives committee, who fund raise for the home, to pay for social activities. On a more frequent basis the activities coordinator organises the hairdresser, does service users’ nails, holds quizzes and plays musical hats. Some service users stated that there was not much to do but attributed this to them being ‘lazy’. A number of service users were asked about joining in the Gala being arranged for the following day. Amongst the main concern was the weather. Some service users would like to go out in the garden but were afraid of falling. There are no restrictions on visiting hours and many visitors play an active role in the life of Askham House. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 14 All the service users spoken to stated that they are offered choices and are generally satisfied with life at the home. They all felt able to approach the matron, should they not be happy with any aspect of their care. One service user stated that residents meetings are held. The menu for the day was not seen and some service users did not know what they were having to eat although they said they were provided with a choice. One gentleman stated that meals are provided three times a day and supper is also offered. He did not have a jug of drink in his bedroom, but stated that care staff, frequently bring round tea and coffee with biscuits and should he need any thing he would pull his alarm cord. He stated that staff are very attentive. The meal was observed as it was being served. Care staff gave appropriate supervision to service users requiring it and the meal was served in a relaxed fashion. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 15 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 standard(s) x Standards not inspected. EVIDENCE: Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,25 The home is well-maintained and provided generous communal and private space for service users and their visitors. EVIDENCE: The ground floor of the home was inspected. Many of the Service users on the first floor were still getting up so were not disturbed. The home was maintained to a high standard of cleanliness throughout, with each bedroom being appropriately cleaned. No obvious maintenance issues were identified other than minor ones. The nurse in charge confirmed that most service users have lockable storage space in their bedrooms, although none of the bedrooms have locks. This is a minimum standard and evidence should at least be provided that service users are offered the choice of locks. Some service users have their own telephones in their bedroom. Hand-basins are provided in each bedroom and toilets and bathrooms are easily accessible. Storage space should be made available for the storage of aids and equipment including wheelchairs, a number were stored by the stairs and were awaiting collection. Screening was provided in double bedrooms. Bedrooms did not have a second chair for Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 17 visitors, but the nurse in charge stated that visitors are always asked. In a number of areas including the main lounge and service users bedrooms, the electrical sockets were overloaded using a single adapter. There were sufficient sockets available. The nurse in charge was asked to discuss this with the full time maintenance person employed at the home. Evidence was provided that electrical equipment has recently been tested. The nurse in charge also confirmed that the water temperatures had been adjusted, so not to exceed 43 degrees. The home has generous communal space and well-maintained gardens. There is also a separate, enclosed area available should people wish to smoke. The home is tastefully decorated, well lit and maintained to a high standard. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) x No standards were inspected on this occasion. EVIDENCE: The home was adequately staffed on the day of the unannounced inspection. No staffing records were available in the absence of the registered manager and the administrator. A requirement has been made in this respect. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 The environment provides a safe and pleasant place to live, without any immediate hazards to safety identified. EVIDENCE: In the absence of the registered manager the majority of these standards were not inspected. Evidence has been provided at previous inspections that the manager is suitably experienced and qualified. She is a registered first level nurse and is involved at a more operational level. Qualified nurses are in charge of each shift and are supported by a team of carers, the majority of whom are trained or are currently doing an NVQ qualification. At the last inspection 40 percent of care staff held a relevant qualification in care. Staff/ resident and relative meetings are held. Minutes were not requested at this inspection. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 20 The only records that were inspected on this occasion were the fire records. Evidence was provided that emergency lighting and weekly fire alarm testing is done. Staff have recently had a fire drill and servicing records were up to date. Labels on electrical appliances indicated that they had been tested recently and the water temperatures in a number of service users bedrooms and a bathroom were below the maximum temperature. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 4 4 3 x 3 2 3 x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x 3 3 Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 22 Yes 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. Standard 1 Regulation CSA 2000 Requirement The home must apply for a variation to their registration certificate for two exsisting, named individuals who have a formal diagnosis of dementia. (The home have written seperately to the Regulation manager in respect of this matter.) Any change in the homes registration must be reflected in the statement of purpose. Arrangements must be put in place to ensure staffing records are available at any time for inspection. Timescale for action To be agreed. 2. 29 17(3)(b) 30 September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations Evidence of service user involvement in the review of their care plans should be provided. Other documentation such as risk assessments and manual handling assessments should be reviewed according to the severity and degree of risk or where a change of need has occurred. I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 23 Askham House 2. 3. 4. 8 11 12 5. 6. 24 24 A record of service users weights should be kept and be sufficently recorded to help identify any unexplained weight loss or unhealthy weight gain. Last wishes as far as possible should be recorded Service users should be offered activities which suit their needs, with particular reference to particular physical conditions/ support groups should be acessed where approriate to need. Storage space should be available for aids and adaptations including wheelchairs The bedrooms should have locks on and the service user offered a key unless a risk assessment suggests overwise. All bedrooms should have lockable storage space and comfortable seating for two. Care should be taken that electrical sockets are not overloaded, using a single adapter. 7. Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE 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 Askham House I53 I03 s24321 ASKHAM HOUSE v234289 200805 stage 4.doc Version 1.30 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!