Inspection on 14/12/05 for Ayletts House

This inspection was carried out on 14th December 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 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

Ayletts House 13/02/09

Ayletts House 06/02/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ayletts House Main Road Broomfield Chelmsford Essex CM1 7LE Lead Inspector A Thompson Unannounced Inspection 14th December 2005 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ayletts House Address Main Road Broomfield Chelmsford Essex CM1 7LE 01245 441854 01245 443504 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) The Croll Group Manager post vacant Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 27 persons) 23rd June 2005 Date of last inspection Brief Description of the Service: 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, visitors 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 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. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 1015 hours on Thursday 14th December 2005. This was the second inspection of this home in the inspection year 2005/6. An additional pre-arranged visit took place on 29th December 2005 to complete this inspection. This was only necessary as on the 14th December a residents outing took place, which involved several residents, the assistant manager and several key staff. The content of this report reflects the inspector’s findings on the day/s of the inspection, and from taking account of relevant findings from previous inspections of the home. Practice and procedures occurring after this inspection will be reported on in future inspection reports. Some residents and staff were spoken with. Random samples of records, policies and procedures were inspected and a tour of parts of the premises and grounds took place. All residents spoken to expressed satisfaction with the care they received and with the quality of the food and accommodation offered. There were no relatives available to speak with, but questionnaires were left at the home so that they had the opportunity to make their views on the service known to the Commission. Staff confirmed they received good support from management. They also confirmed that they had been offered training appropriate to their role, including NVQ awards. What the service does well: The management team believe in close teamwork, to support and guide staff in carrying out their individual duties and tasks. Good training opportunities are offered to staff. The management team believes in maintaining good communication links with relatives of residents. The premises facilities throughout the home are of a high standard. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: The home now needs to have a manager who is registered with the CSCI (as required by regulation). ------------------------ 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. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home’s assessment format and process was adequate for ensuring that initial perceived needs were identified upon admission of new residents. EVIDENCE: The home’s written pre-admission assessment is completed by staff, who visit the prospective new resident in their own home. Relatives are requested to be in attendance at the time of the assessment to assist in the information gathering process. The assessment format used was seen and included headings under personal details, next of kin information, life style and social needs, cultural, previous occupation, physical needs, hygiene needs, personal care needs, psychological considerations, manual handling considerations, vision, hearing, orientation, likes, preferences and dislikes, dietary considerations, a pressure sore assessment scale and personal safety and risk assessments. Files also evidenced that individual daily plan of care summaries are compiled using information from the pre admission assessment and after admission. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8&9 The health care needs of residents were generally assured. The home’s medication procedures, practices and staff training appeared to provide adequate guidance for dealing with medicines. EVIDENCE: Treatment of pressure sores (if they occur) is provided by District Nurses who visit the home daily to administer insulin and attend to changes of dressings. Pressure relieving equipment is also provided by district nursing services, body charts are completed by staff and senior staff have received training on dressings and pressure area care. The homes GP practice nurse will visit the home on a monthly basis to individually review and assess residents general health needs as identified by staff. The GP practice regularly (advised 3 monthly) reviews medication regimes. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 10 There were risk assessments on the risk of falling and on general daily activities for residents. Dental needs are attended to by either visiting a community based dentist or receiving visits, for minor treatments, by a dentist to the home. An optician and chiropodist also visit to provide services to residents in the home. Advice and staff training on management of continence issues is provided by the community continence advisor based at a local hospital. The manager advised that currently no residents maintained responsibility for their own medication needs. For future needs in this area a risk assessment format is in place and all rooms have lockable bedside cabinets. The home has a written policy/procedure on medication practices. This remains unchanged and includes guidance for staff on ordering, storage, administration and on returning unused stocks. Medication stocks and medication administration records inspected were all considered appropriately maintained. Medication is delivered to the home by the pharmacist. The home now uses the ‘monitored dosage system’ of storing and administering medication. Staff had received training on this method by the supplying pharmacist. Since the last inspection a second mobile medication cabinet/trolley had been purchased. Senior staff in the home are responsible for the administration of all medication and have received certificated training on this subject by an external training provider entitled ‘control of medicines’. Areas of competence included; storage, drug formulation, labelling, administration, homely remedies and recording. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 & 15 Regular opportunities are provided to residents to meet their recreational, social and religious interests and needs. Residents were supported in exercising choice regarding day to day routines in the home. Meals provided would appear to ensure a wholesome, varied and nutritious diet for residents. EVIDENCE: The home benefits from the use of the minibus shared with two other homes owned by the proprietors. For in-house activities, in addition to the lounge areas, there is designated activities room located on the lower ground floor. Residents interests were seen to be recorded in their individual profile files under headings of previous hobbies, religious and cultural needs, places of interest, likes and dislikes, preferred mealtimes, preferred meals, rising and retiring times and routines of daily living preferences. The assessment document includes a life history and a questionnaire section asking for pastimes that residents have enjoyed to be completed either by themselves or relatives. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 12 Activities are offered by a visiting co-ordinator and by staff. Individual activity record sheets are maintained and were inspected. Daily activities offered around the home included: music, barbeques (in summer), nail care, ball games, videos, singalongs, crafts, quizzes, bingo and exercise & movement Outside entertainers also visit the home and outings take place. On the first day of this inspection a group went to Tiptree to visit the jam factory museum and have lunch. Residents spoken with who wished to express an opinion said that they are satisfied with the activities, choices, and routines offered them in the home. Records confirmed that residents are permitted to bring agreed personal possessions with them when they move into the home. Insurance is available for valuable items. The manager advised that currently no residents handle their own financial affairs without support from relatives and the management of the home. Personal allowance monies are provided by relatives to the home and records of incoming and outgoing expenditure are maintained and receipted. Information regarding independent advocacy services was detailed in the information folder in the main entrance hallway. The activities organiser has taken on the responsibility of holding residents meetings at approximately two monthly intervals. There are also six monthly meetings for relatives. A new cook-in-charge had been employed since the last inspection and nutrition records evidenced menu choices were being provided. Food stocks were good. The main meal of the day is lunch and there is a choice of two meals offered. The residents preferred choice is requested by staff the evening before. Drinks are available throughout the day, supper snacks are offered. Residents were asked their views on the quality, quantity and choice of meals provided. All who expressed an opinion confirmed that they were satisfied with the food. During the inspection the inspector observed that mealtimes appeared unhurried and relaxed allowing residents appropriate time to enjoy their meals. Several went out for lunch (with staff support). Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home’s complaints procedure allowed for residents and relatives to formally raise any concerns or areas of dissatisfaction with the service. EVIDENCE: The homes complaints policy remains unchanged. Written details confirmed whom the complainant should complain to. Also clearly shown were time scales for the homes response which confirmed that a written response will be provided to the complainant within 28 days from the date of the complaint. A written record is maintained of all complaints. There were none since the last inspection. Written details were also included on how to contact the local office of the registration authority. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26 Furnishings in the home looked comfortable and the premises were very well maintained. The premises appeared generally safe, accessible and had sufficient (according to these standards) numbers of toilets and bathrooms. The home was considered clean and hygienic. EVIDENCE: General maintenance in and around the home is provided by a visiting maintenance person each week. Renewal of the fabric and redecoration of the premises takes place on an ongoing rolling programme. Since the last inspection new carpets had been laid in the office and ground floor corridors and the front porch had been refurbished. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 15 The groundfloor bathroom had also been completely refurbished in the past 12 months, this included the installation of new high quality assisted bathing facilities. In the inspectors view the premises were very well maintained, furnished and equipped to a high standard. All residents’ bedrooms in Ayletts benefit from fitted ensuite facilities, seven of these have baths and four have showers. Communal bathing facilities are provided for with fully assisted baths on the ground and first floors and a shower room on the second floor. Communal toilet facilities were seen to be located close to the lounge areas. The homes sluice facility was located in the laundry room on the lower ground floor. The laundry facilities were suitable for the size of the home and were appropriately equipped according to these standards. A call bell system was seen fitted in every communal room, bathroom and all bedrooms inspected. Bedrooms inspected were varied in shape and size. All were well decorated, equipped and furnished to a comfortable and homely standard. Residents spoken with confirmed that they were satisfied with the accommodation provided them. They also said that they had been permitted to bring into the home with them items of personal possessions. Doors to private rooms were fitted with locks. All rooms were centrally heated with thermostats fitted to bedroom radiators, as were radiator guards. The manager confirmed that hot water was regulated for delivery at or close to 43 degrees Celsius (not tested but records were seen to evidence that staff manually check temperature every three months). The inspector asked residents if the lighting in their rooms was adequate for them, those who expressed an opinion said it was. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 Staffing levels and skills appeared to meet the needs of residents. Staff were provided very good training and development opportunities to equip them with the skills for their role. EVIDENCE: The home’s staff rota was seen. Minimum daytime staffing remains at four carers on duty throughout the day with three waking carers on duty at night. In addition, cooking, domestic and maintenance duties are undertaking by additional rostered staff. A new cook-in-charge had been appointed since the last inspection. At the time of this inspection five members of staff were undertaking National Vocational Qualification level 2 with two already holding this award. Two staff were on the NVQ level 3 and one had this award. One member of staff is a qualified nurse. This equates to at least 50 of the staff team qualified to NVQ level 2 or above. One member of staff is also an NVQ Assessor. The assistant manager has just completed (earlier in December) the registered managers award (NVQ level 4). Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 17 The staff induction and foundation training package has been implemented since 2004. These were modular based with induction covering four modules over six weeks, headings included: principles of care, procedures, records, fire, manual handling, health & safety, risk assessment, infection control, food hygiene, practical skills, equipment, needs of service users, effects of setting, specific disabilities, care of dying, activities. Foundation training takes place within six months over five modules, headings included: care base, communication, development, abuse & neglect, particular needs. All staff had an individual training record book as evidence of completion, verified by a senior/supervisor. In-house and external staff training had taken place. Records were inspected and evidence training in: skin & pressure area care, catheter care, urinary tract infection, diabetes, fire awareness, POVA (abuse), wound management, activities, manual handling, medication, food hygiene, infection control, NVQ 2, 3, 4 and assessor award, continence, dementia awareness, first aid, use of hoist, personal development, and managing aggression. Two staff are manual handling trainers. Other training scheduled to take place in 2006 includes: first aid, dementia awareness, care planning, health & safety, infection control, abuse and protection, food hygiene and fire safety. Staff recruitment records included copies of proof of ID and a photograph, this fully met the recommendation in the last report. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 The home is run and managed efficiently and effectively. Procedures for gaining the views of residents and relatives were in place. Records required by regulation were up to date. Residents financial interests were supported and appear to have been safeguarded. EVIDENCE: The home’s management team comprises of the manager (not currently registered with CSCI), an assistance manager, a deputy manager and three seniors (daytime), with one night time senior. The assistant manager has (in December 2004) completed the registered managers qualification (NVQ level 4). Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 19 The registered provider should make application to begin the process of formal registration with CSCI, of the home’s manager, this is required by regulation. It should be noted that Ayletts is considered to be run and managed professionally and competently, and that the current manager of the home was registered at another service with the previous registration authority. Unfortunately this registration was not transferable to Ayletts. The home’s quality assurance questionnaire sheet was unchanged. Headings include questions to residents asking their views and opinions on the personal care provided, the catering & meals, staff support, daily living, premises, management of the home and any other comments. The annual review of service had just taken place with responses being collated to identify any necessary actions. Where appropriate residents are supported in the completion of this document by relatives. Residents personal allowance monies were held for safe keeping in the home. Transactions were recorded and receipts had been kept as evidence of these transactions. A random sample of records were inspected and were considered to be appropriately maintained at the time of this inspection. Random samples of records required to be kept inspected included: staff rota, records of monies held for safe keeping, regulation 37 notices, details of next of kin and background information, assessments, medication records, accident records, fire drills, procedures and equipment checks, nutrition records, regulation 26 reports, care plans and visitors. All were considered appropriately maintained. Evidence had been provided to CSCI to confirm that portable electrical appliances had been tested, this fully met the requirement in the last report. Appropriate insurance was in place and fire equipment had been serviced/tested in the last 12 months. Hot water supply is regulated for delivery at or near to 43 degrees celcuis. Supply is manually tested by staff every three months. Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 4 3 4 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 X Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 21 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. Standard Regulation Requirement Timescale for action 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 Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Ayletts House DS0000017758.V272971.R01.S.doc Version 5.0 Page 23 - 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!