Inspection on 09/11/06 for Ash Court Care Centre

This inspection was carried out on 9th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Ash Court Care Centre 20/07/07

Ash Court Care Centre 22/02/06

Ash Court Care Centre 11/01/05

Ash Court Care Centre 02/08/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ash Court Nursing Home Ash Court Ascham Street London NW5 2PD Lead Inspector Ms Pippa Canter Unannounced Inspection 9th November 2006 10:00 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 Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ash Court Nursing Home Address Ash Court Ascham Street London NW5 2PD 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) 020 7419 7474 020 7419 7676 florence.clarke@foresthc.com Ash Court Community Limited Care Home 62 Category(ies) of Old age, not falling within any other category registration, with number (61), Physical disability (1) of places Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. for the provision of general nursing care for up to 62 users aged 60 years and over. a) out of which 16 beds can also be used for people requiring personal care only. b) up to 3 of the 62 service users can also be aged 55 years and over. c) up to one named service user (as per Ash Court application of 21st February 2005) aged 53 years and over, can be accommodated for the provision of nursing care. Room 44 to be used only for Patients, who do not need to use a wheelchair or who do not need assistance to be nursed in bed. The Staffing Notice For the provision of general nursing care for one young Physically disabled, named person, aged 55 provided that there are sufficient resources and skilled qualified nursing staff to meet all Ms Q’S assessed health care needs at Ash Court Nursing Home. 22/02/06 2. 3. 4. Date of last inspection Brief Description of the Service: Ash Court is a purpose built care home with nursing. It is privately owned and managed. It can accommodate 62 people from the age of 60 years in 58 single and 2 double rooms. Sixteen of those places can be used for service users requiring personal care only. The level of fees has not been recorded as a preinspection questionnaire was not received prior to the site visit. The provider will be asked to supply this information and it will be included in the final report. The home is sited in a courtyard in a residential area. Access to the home is through a gated driveway. There is sufficient care parking space for 10 cars at the front of the property. The nearest underground station is Kentish Town and the home is on the C11, 134 and 204 bus routes. Entry into the complex is through a security gate. The front entrance is covered by a large conservatory, which is used by service users. Although a garden is not available service users have access to limited but well-presented outside space. The home is spread over three levels. Each floor is self-contained, with bedrooms, assisted bathrooms and seating-cum-dining areas. Each floor is staffed independently. There is a main kitchen and laundry room, which serves the whole home. All the bedrooms have an ensuite toilet and hand basin. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 5 Each room has a variable height profile bed. There are cantilever tables and footstools available. Room sizes, corridor widths and doorframes are large enough to allow access to wheelchair users or zimmer frames. A nurse call system is installed throughout the building. There is a shaft lift that gives access to the upper floors. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of one day by one inspector. The visit lasted a total of six and a half hours, from mid morning to late afternoon. The Manager was available and assisted the inspection along with additional input from the staff on duty, service users and visitors. Records such as care plans, daily logs as well as accident and incident logs were examined. A tour of the building was made with attention to the rooms of the service users being case tracked. Some service users were asked for their views of the running of the home and talked about their experiences of living there. Visitors also contributed their comments. Staff were observed carrying out their duties and were involved in general discussion with the inspectors. Prior to the inspection, we looked at all the information we had about the home, including notifications of accidents or serious incidents, past monthly reports about the conduct of the home sent in by the provider and previous inspection reports. A pre-inspection questionnaire was not received prior to the visit. Two have been sent electronically however a completed copy was not available when the draft inspection report was compiled. The inspector left an inspection comment card and various comment cards for service users, relatives, health and social care professionals as well as for General Practitioners. To date, none have been returned in time for the draft inspection report. Any comments received will be included in the final report. What the service does well: Ash Court is a purpose built home, which provides full disabled access. It is a safe, comfortable and warm environment for service users to live in. Over all the home is well maintained and it is decorated and furnished in a pleasant fashion. The bedrooms provide ample space, which allows for the inclusion of private possessions to make the rooms appear more homely. All rooms are equipped with appropriate beds for the comfort and safety of the service users. Aids and adaptations are available including hoists and a shaft lift. Each room has an ensuite facility of toilet and hand basin. There are assisted baths on all floors as well as communal lounges and dining areas. Service users have the choice to mix in the communal areas or remain in their rooms. The premises are very clean. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 7 The home has an experienced manager who works closely with the owner to provide a high standard of care for the service users. A comment made was, “I wish this home had been available to my own mother. I am impressed by the commitment of the staff and the high standard of nursing care available to the residents”. There is a thorough and robust recruitment and selection process for staff. The provider is keen to invest in staff training and development to ensure a high standard of personal care. An activities programme is available. The cultural needs of service users are acknowledged and met in practice. 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All service users are assessed prior to admission to the home although not all their needs and aspirations are being recorded. EVIDENCE: The pre-admission assessments were checked for five service users. Most service users are admitted from hospital. The pre-admission information shows that service users have received a service user guide or the relatives have visited the home. When referrals are made to the home, an assessment is carried out by either the manager, or in her absence, the deputy or a registered nurse. The home has a comprehensive assessment form. On examination it was found that not all the assessments were recorded to the same standard. Although there were good examples of pre-admission Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 10 assessments on others there were gaps in the information recorded particularly around cultural needs. Although discussions with staff and observation showed that in practice staff were addressing these needs. One pre-admission assessment did not include the religious needs of a Muslim service user; nor did it take into account the fasting for religious festivals for a person with a poor appetite. On another file a nutritional assessment did not take into account the cultural needs of a Chinese service user. Other examples are that the summary of need was not completed, a problem index has not been filled in, and the wishes following death had not been discussed and recorded. Please see requirement 1. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a multi-disciplinary approach to meeting health and personal care needs. Staff follow correct procedures for the ordering, storage, administration and disposal of medication, which ensures the safety of service users. EVIDENCE: A comment from a visiting health care professional was “I wish this home had been available to my own mother. I am impressed by the commitment of the staff and the high standard of nursing care available to the residents”. Five care plans were examined. They were found to be in good order. The care plans are based on the activities of daily living. In relation to health care needs, the care plans were up-to-date and contained relevant and accurate information. Where possible, the content of the care plan had been discussed with the service user and/or the relative. Discussions with the staff showed that they knew and understood the health care needs of the service users. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 12 Manual handling, tissue viability as well as fluid and nutritional assessments are in place and being followed. Although in the case of the latter these do not always reflect the person’s cultural needs or identify the impact of fasting on a service user with a poor appetite Care records show referrals to and the involvement of other health care professionals. The records show that the registered nurses have identified changes in condition or behaviour and have referred to the General Practitioner (GP). All service users are registered with a local GP. Entries in care records show interventions from Occupational Therapist, Physiotherapist, Chiropodist, Dietician and a Tissue Viability Nurse. Dental and Optical needs are also addressed. Staff were seen offering the required level of support to meet the health and personal care needs. Observation of staff showed that the rights of privacy, dignity and choice underpin practice. Service users are supported to be independent. Staff continue to pay close attention to the needs of the service users and although not always recorded, were well acquainted with their likes and dislikes. The social histories of the service users were a disappointment to read in some instances. These were sketchy and did not reflect the roles, relationships, abilities and experiences of the individual service users. Discussions with the manager highlighted that this is an area of care planning that needs to be addressed. Please see requirement 2. A sample audit was taken of the storage and administration arrangements for medication on the first floor. The home has a policy for the administration of medication. It provides good practice guidance on all aspects of medication handling including the response to drug administration errors. Staff are following the correct policy and procedures. A sample of medication administration records (MARS) was checked and overall the recording of administration is good. There is a photograph of each service user attached to the MARS chart. There is a consistent approach in recording the use of food supplements and topical preparations. Only one matter was raised with the registered nurse on the floor. A prescription had been handwritten onto the MARS chart, which was not signed and dated. Please see requirement 3 Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs and aspirations are met regarding their daily lives and social activities. They are able to choose from a varied and balanced diet, that meets their medical as well as their cultural needs. EVIDENCE: The need to develop more social histories has been identified already in this report. This information can be fed into the activities programme as well as enable key workers to provide individual stimulation and occupation. Currently the activities programme is organised and implemented by external helpers. Service users confirmed that attendance is a matter of choice. On the day of the inspection, a reminiscence group was taking place in an upstairs lounge. The subject related to the role of women, food and the evacuation of children in the Second World War. The topic was relevant to all the service users even those from ethnic backgrounds who has experiences to contribute. There are also recent examples of service user’s artwork on display in the home. Only one of the service users attends a day centre and the manager has identified a need to establish more connections in the community Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 14 The home has an open door policy on visiting and there are no restrictions as to the length of time, friends and relatives spend with service users. Throughout the inspection visitors were seen being made welcome into the home. One comment was “This home gives excellent care”. Relatives are encouraged to participate in the care of service users particularly those from ethnic backgrounds. The main menu is varied with snacks available throughout the day. A daily menu is on display at the main reception desk. This menu only shows the set meals of the day and does not reflect the personal choices available to service users. Where communication is uncertain, objects of reference and pictures are used to determine the service users’ preference. The assessments and the care plans reflect the dietary needs of service users but it is not always apparent that their cultural needs have been recorded. In practice service users from ethnic minorities are receiving appropriate meals. Overall the service users found the quality of the food to be good. Nutritional assessments are in place. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected from harm by the homes’ policies and procedures relating to complaints and adult protection EVIDENCE: The home has a comprehensive complaint’s policy and procedure. The procedure is available in the service user guide, which is available in each bedroom as well as being on display in the home; at the front desk and on each floor. The service has received compliments such as “ Many thanks to all the caring team for the care provided to my mother” as well as complaints. Although no complaints have been referred to the CSCI, one has been sent to the Commissioning Department of Camden Social Services. A representative of the provider is now dealing this with. The home arranges resident and relative meetings where issued can be raised, discussed and resolutions found. Service users said that the staff were approachable if they felt unhappy with any aspect of their care. The service has a robust policy and procedure on adult protection, which is linked to local authority guidance. Staff have received training on adult protection and showed that they understood their role and responsibilities in this area for the safety ad protection of the service users. The provider ensures that there is a policy and procedure regarding service users’ money Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 16 and financial affairs. There is a system in place for the safe keeping of service users personal monies, which is managed by the administrator. It allows service users access to their personal funds and ensures that there is a clear audit trail. Previously relatives have commented that they are satisfied with the way the home manages her mother’s finances. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and clean environment, which meets their needs. EVIDENCE: The home is purpose built. All rooms are single occupancy with ensuite facilities. Bedrooms afford ample room and service users have the opportunity to personalise their rooms. The home provides a safe environment. A nurse call system is installed throughout the home and there is a fully integrated fire alarm system; this includes a sprinkler system and smoke detectors in each bedroom. Both systems are maintained by regular servicing. The radiators are low surface and can be controlled individually. Where oxygen is in use appropriate safety signage is displayed. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 18 Overall the home was found to be clean and tidy. The home has an infection control policy. Clinical waste is stored in suitable containers and collected on a regular basis through contractual arrangements by a reputable collection agency. Bottles of hand cleanser are available, together with protective clothing such as disposable gloves and aprons. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by a competent group of staff EVIDENCE: The provider is keen to invest in staff development and training. The home continues to offer placements for adaptation students and student nurses. Staff were spoken to and observed whilst carrying out their duties. They were seen to be sensitive to the needs of the service users, offering appropriate support and speaking in a respectful but friendly manner. Staff clearly know the care needs of the service users and care plans were being followed. An inspection of the rota showed that staff are deployed in sufficient numbers to see to the care needs of the service users. A comprehensive training plan was seen as part of the inspection. All staff receive training commensurate with their role in the home, which ensures that they are competent to do their jobs. Nursing staff are able to update their skills under the P.R.E.P arrangements. Ash Court Nursing Home DS0000010320.V287304.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the service users to ensure their safety and well being EVIDENCE: Since the last inspection there has been a change of manager. The current manager has returned the home. She is qualified, competent and experienced to run the home. She will need to apply for registration and this was discussed with her during the inspection. There are clear lines of accountability within in the and with external managers. The service has both a disciplinary and a grievance procedure. There are internal quality assurance systems in place. Views are actively sought from service users and their relatives about the service provided. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 21 As a pre-inspection questionnaires was not received, a sample of health and safety documents was taken. These confirmed that the home is being managed responsibly with essential checks being made. The provider monitors health and safety in the home. There are robust procedures in place to monitor compliance. Throughout the visit, no hazards were seen. Equipment is serviced regularly and where required repaired or replaced. The home has a policy relating to handling service users monies. Financial records are kept electronically on computer. These can be printed off for service users and relatives. Receipts are obtained as well as signatures for all transactions. There is a clear audit trail. Ash Court Nursing Home DS0000010320.V287304.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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 4 X X X X X X 4 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 4 X X 4 Ash Court Nursing Home DS0000010320.V287304.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 OP3 Regulation 14 Requirement All pre-admission assessments completed by the home must be completed to the same standard and include the cultural needs of the service user. Care plans must include a comprehensive social history with the permission of the service user. When a prescription is hand written on a MARS chart, there must be a corresponding signature and date. Timescale for action 31/12/06 2 OP7 15 30/03/07 3 OP9 13(2) 31/12/06 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 OP9 Good Practice Recommendations It is recommended that the home expand the drug profiles to enable care staff to familiarise themselves with the use of the drugs and their side effects. Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 24 Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ash Court Nursing Home DS0000010320.V287304.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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