Inspection on 13/02/09 for Ayletts House

This inspection was carried out on 13th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ayletts House 06/02/07

Ayletts House 14/12/05

Ayletts House 23/06/05

Ayletts House 08/08/04

Ayletts House 14/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ayletts House Main Road Broomfield Chelmsford Essex CM1 7LE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: June Humphreys     Date: 1 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ayletts House Main Road Broomfield Chelmsford Essex CM1 7LE 01245441854 01245443504 enquiries@crollgroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Croll Group Name of registered manager (if applicable) Carole Armitage Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 27 persons) Date of last inspection Brief description of the care home Ayletts Residential Home was originally constructed as a large domestic dwelling and under went extensive building work and complete refurbishment for use as a care home for older people. There are two lounge/dining rooms on the ground floor and a sitting room, visitor?s room and activities room on the lower ground floor. Twenty-four bedrooms continue to be offered as single room accommodation. The remaining bedroom (registered as a double room) was being occupied by two residents who wished to share. All private rooms benefit from fitted ensuite facilities, seven also have baths and four have showers. A shaft passenger lift provides access to all rooms on each of the four levels of the home. A small well maintained garden area with patio Care Homes for Older People Page 4 of 27 care home 27 Over 65 27 0 Brief description of the care home and lawn is available for residents to use. Ayletts is positioned just off the approach road to Broomfield Hospital and is close to Broomfield Village. There is a regular bus service to both Chelmsford and Braintree from close by. Visitor car parking is provided at the front, side and rear of the property. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 stars. This means that people who use this service experience excellent quality outcomes. This was a routine unannounced inspection, which included a visit to Ayletts on the 13th February 2009. One inspector undertook the site visit, and all of the key national minimum standards were addressed. Opportunity was taken to speak with residents, relatives, staff, and the registered Manager. The Manager completed and returned the Annual Quality Assurance Assessment to the Commission, which is a self-assessment of how the service is doing. Information from the document has been included in the report. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The home is run and managed by a committed manager who is supported by a team who work well together; and they are fully able to meet the needs of the current residents. The format used for the assessment of new prospective residents is satisfactory, but further detail on the form would demonstrate that all necessary information required has been collected. This is important as the current staff ratios would not allow for the service to admit people who have high complex needs without a review of current staffing levels. The manager should ensure that the recording of fire drills reflects the number that was identified as having taken place, and the staff that have attended. Care Homes for Older People Page 8 of 27 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 set out 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. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into the home have their needs assessed so that they, and the home can be sure the placement is appropriate. Evidence: Two sample initial assessments were looked as part of this inspection. All of which were completed prior to the residents admission. New admissions to the home are only made following an assessment of the persons needs. The format used for the assessment is satisfactory but further detail on the form would confirm that all the necessary information had been collected. The manager showed a good awareness of the needs, and types of conditions that the home is able to meet, and clearly took this into account when considering prospective admissions. The manager stated in the AQAA Each resident is allocated a member of the care staff to act as a keyworker who is responsible for monitoring, reviewing and co-ordinating the care plans for each resident. The keyworker is present on the day of admission, in order to introduce Care Homes for Older People Page 11 of 27 Evidence: themselves, and help the new resident settle in. A new resident was spoken to on the day of inspection and said that her move into the home had been smooth, and staff had welcomed her and supported her . Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living in the home can be assurred that the individual plan of care, will reflect the high level of care and support that is being provided. Evidence: Three care plans were looked at as part of this inspection. Those seen were written in a set format and provided comprehensive details of individual needs, and the actions needed to meet them. Good personal details were included which provided a picture of the person being cared for, such as personal preferences etc. Individual progress was tracked on the daily record sheet, including information relating to district nurse or G.P visits. Staff were able to demonstrate good understanding of individual needs and good care practices, they knew each resident well, and interactions between staff and residents was observed as being warm and friendly. Personal care was delivered discreetly and those residents spoken with said that they were well-treated by the staff and felt that their privacy was respected - this was seen to be the case in several instances and Care Homes for Older People Page 13 of 27 Evidence: confirmed by the postive comments made by residents when speaking to them. One resident said I always receive the care I need. Another person said The staff work very hard to make it nice for us. I am never afraid to ask for help. Risk assessments on manual handing, monitoring of weights, nutrition, falls and pressure sores had been completed, and reviewed to try to keep residents safe. Two residents medication was case tracked as part of the inspection and found to be accurate. An auditing process is in place that is regularly completed by the manager. Staff who administer medication had received training. This covered safe handling practices, and the importance of recording. There were records of training, and dates when refresher training should be undertaken. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents who live at Ayletts are supported to live their lives according to their personal and individual preferences. Evidence: Observation during the inspection showed that the routines in the home are flexible and varied according to individual needs and wishes. There are daily activities offered in the home which include music, games, crosswords, puzzles and craft activties. An activity co-ordinator is employed for 16 hours per Week, and part of their role is to monitor and record residents preferences i.e. who takes part or not, and their comments. A number of residents have personal televisions in their bedrooms and prefer not to join in. Staff also provide extra support when residents go out, and a minibus is available to enable this to happen frequently. A key worker system is in operation in the home, and this tries to ensure residents receive a person centred service. Residents are given opportunity to, and assisted to be involved in the running of the home though talking to their key worker, and regular residents meetings. Care Homes for Older People Page 15 of 27 Evidence: Meals observed on the day of the inspection smelt and looked appetizing. A choice was offered of salmon and roasted peppered sauce or cod with prawns. There was an option of several other choices which are regularly available to residents should they not wish the main choices. An example was of one resident who had a cheese salad with a jacket potato. The resident said I dont enjoy fish but the staff are always happy to help, and something else offered. The home currently has a four week menu which is regularly reviewed as part of residents meetings. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 service has a complaints procedure that is up to date and on display to residents;and the quality of recording of complaints and safeguarding ensures that peoples concerns can be addressed promptly. Evidence: Staff spoken to were aware of the complaints policy, and able to advise where a copy was on display. Staff generally were very proactive about ensuring residents concerns were reported and one person said residents are treated very well here, but I would complain if need be. The CSCI has not received any complaints in the last year about the home, and records viewed on the inspection showed that the home had also not received any formal complaints. A resident who was interviewed confirmed that they could speak to the manager if they had any concerns, and felt able to do so. Several other residents who completed feedback questionnaires were all aware of how to make a complaint if they needed to. Policies and procedures relating to the protection of vulnerable adults were in place with appropriate guidelines for staff to follow should a complaint of abuse be made, or they observe an incident of abuse taking place. Two staff induction checklists were looked at as part of the inspection, and both had covered basic safeguarding issues Care Homes for Older People Page 17 of 27 Evidence: and how to respond. All senior staff had attended a two day course in safeguarding which was organised by Essex county council, and when spoken to were clear about reporting and recording. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 registered manager ensures maintenance and repairs are acted on promptly to ensure that residents are provided with high quality accommodation, which is safe, well-maintained, clean and hygienic. Evidence: On the day of the inspection the home was comfortable, clean and completely odour free. The enviroment was observed to be cosy, and domestic in style. Staff identify any repairs required, and record when these have been actioned. The home has a maintenance person who undertakes repairs in the home, and demonstrated a good understanding of issues relating to a safe enviroment. The manager stated in the AQAA We ensure that the home is maintained to a good standard. We have improved in the last 12 months by the purchase of 0- zone machine to combat odour and infection. Staff training in Infection Control had been arranged at regular intervals. Personal protective equipment (disposable gloves and aprons) was available to staff to promote good infection control practices. All residents spoken to as part of this inspection confirmed that the home is always kept clean and tidy. All residents bedrooms benefited from fitted en-suite facilities, seven of these have Care Homes for Older People Page 19 of 27 Evidence: baths and four have showers. Communal bathing facilities are provided, with fully assisted baths on the ground and first floors, and a shower room on the second floor. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 provides staff in sufficient numbers, and with suitable skills and experience, to ensure that residents needs can be met. Evidence: The current staffing levels are four staff during the day and evening, and three staff at night. The manager descibed herself as a working Manager, and this was certainly observed to be the case on the day of the inspection. The manager is included in the staff ratios. Staff spoke of a good team spirit, and everyone working together. Eight residents were spoken to as part of the inspection and all were very complimentary about the staff. One resident said You rarely wait long, there is usually someone around to help. Another resident said I am pleased to say the staff are very good, kind and helpful. The home has up to date polices and procedures in place with regard to the recruitment of staff. Two random staff files were selected. Records show that the home adheres to its policies and procedures and undertakes all the required checks on potential staff. Records included copies of proof of ID and a photograph, references and uptodate C.R.B checks. Staff said that they felt well supported and received a good range of training whilst Care Homes for Older People Page 21 of 27 Evidence: working at the home. They felt that they had the skills to do their job, and were not asked to carry out tasks that were outside of their abilities. Staff consulted felt that there was a high level of skills within the team, and were able to offer good support to residents. The manager confirmed mandatory training, and updates were completed by all staff. This included fire safety, manual handling, health & safety, risk assessments, medication, skin & pressure area care, infection control and food hygiene. A training profile was seen that identified what courses staff had attended, and when. The manager stated that the service aimed to carry out supervision on a 6-8 weekly basis. This target had not always been met but overall records demonstrated that staff meetings and supervision were being offered regularly, and staff did feel day-to-day informal supervision with the manager was available. The number of staff with an N.V.Q qualification has increased since the last inspection, and the service now has a high number of qualified staff. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has a clear understanding of the needs of older people, and the focus of the service provided; they have established well-organised systems and processes to enable people to receive a consistent level of care. Evidence: The home is run and managed by a committed manager who is supported by a team who work well together; and are fully able to meet the needs of the current residents. Whilst the current ratio of staff is sufficent it was observed that it is at times reliant on the commitment and level of care provided by the individual members of the team. It would be difficult to maintain the same standard of care should current resident deteriorate and require a higher level of support, or the admission of new people who have significantly higher needs. A range of people were spoken to as part of the inspection and included people who live in the home, relatives, staff and proffessionals. All spoke positively of the service, and the support people receive. One relative said the service is of a high standard, and we are very happy that mum is Care Homes for Older People Page 23 of 27 Evidence: here. A healthcare professional said the staff know the service users well, and respond quickly to summon outside support for people when they need it. The home has a full range of policies and procedures that safeguard residents interests. The standard of care offered within the home is good; both in the delivery of care, and the recording of information. Residents meetings take place regularly, and the minutes seen demonstrated that residents are encouraged to bring up suggestions and any concerns that they might have. Residents stated that they felt the staff are keen to listen to their views, and do act on any concerns they may have. Staff stated that communication and support is good, and this included hand overs at every shift change and regular staff meetings. A sample of records relating to health and safety were seen at this inspection, and were well maintained i.e. fire testing, and boiler servicing. Fire drills however were not appropriatly recorded, although the manager stated that they had been held. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Residents assessments must 01/05/2009 include all information relating to peoples health, personal and social care needs to ensure the home are able to provide the necessary level of support. To ensure peoples needs can be met by the home Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 38 It is recommended that the registered manager improves the recording of fire drills, and includes a list of the staff that have attended. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!