Inspection on 10/08/07 for The Ashford Nursing Home - Brabourne Care Centre

This inspection was carried out on 10th August 2007.

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

The Ashford Nursing Home -... 24/05/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Ashford Nursing Home - Brabourne Care Centre Hythe Road Ashford Kent TN24 0QJ Lead Inspector Lisbeth Scoones Key Unannounced Inspection 10th August 2007 10:15 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 The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.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. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Ashford Nursing Home - Brabourne Care Centre Hythe Road Ashford Kent TN24 0QJ Address 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) 01233 643555 01233 645370 Opus Care Limited Claire Sherwood Care Home 82 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (53) of places The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2006 Brief Description of the Service: The Brabourne Care Centre is a purpose built, large, detached three storied building with plenty of car parking space. It is set in newly planted gardens and situated on the Hythe Road close to its sister home, the Ashford Nursing Home, the town centre and junction 10 of the M20 motorway. The home is served by public transport with local amenities nearby. The home is on three floors. The top and ground floors comprise 53 beds for older people with nursing needs, the middle floor has 29 beds for older people with dementia related needs. All the rooms are single en-suite. Every floor provides a number of communal areas, including a lounge, dining and quiet areas. There are two passenger lifts. At the time of the inspection, the acting manager advised that weekly fees are in the range of £448,37 to £481,92 and £833.10 to £900. Additional extra costs are clearly identified in the Welcome and Introduction Pack, which is given to all prospective residents. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 10 August 2007 between 10.00 and 17.00. It comprised in depth discussions with the acting manager, Mrs J Cain, and nursing staff on duty, a meeting with a number of residents and a visiting relative. A tour of the building was made and documentation examined in respect of care plans, risk assessments, medication records, complaints book, residents’ contracts, training records and a sample of staff files. The inspection processes was further informed by information collected before, during and after the visit. The manager had completed an Annual Quality and Audit (AQAA). Comment cards to be completed by residents and relatives were left at the home for distribution. Some of these were returned and information thus obtained is incorporated in the report The home currently has a full staff complement. A comprehensive feedback session was provided to the acting manager at the end of the inspection visit. What the service does well: What has improved since the last inspection? Pre-admission assessments have improved and now highlight the need for and availability of appropriate equipment. Information thus obtained is crossreferenced to the care plan. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 6 Care plans are comprehensive and regularly reviewed. Visits form GP’s and health care specialists are clearly recorded. A comprehensive complaints file is maintained. A programme of regular staff supervision has commenced. Quality assurance systems have been introduced in respect of audit, residents’ satisfaction and formal Regulation 26 visits to the home. The CSCI is informed of all reportable events as per Regulation 37. 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. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with good information about the services the home provides. Every resident is provided with a written contract. However additional information should be written into contracts for self-funded residents. Residents are only admitted to the care home following an assessment of need. EVIDENCE: The home produces a Statement of Purpose, Welcome pack and Service User Guide containing pertinent information about the services provided. These documents are regularly reviewed and updated. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 9 A sample of contracts for self-funding residents was examined. These lack clarity in respect of the way the “free” nursing care contribution would be deducted form the weekly fee. It was agreed that all contracts would be reviewed. The Office of Fair Trading report “Fair Terms for Care” (2205), available at www.oft.gov.uk applies. It is evident from documentation seen that comprehensive pre-admission assessments are undertaken. At the previous inspection a discussion took place about the type/level of pressure relieving equipment the home would provide. At this inspection the acting manager said that the policy is being reviewed. The acting manager said that the pre-admission forms might be further improved to incorporate issues pertaining to the Mental Capacity Act. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans contain current and reviewed information about residents’ needs. Visits from GP’s, specialists and care managers are clearly recorded. Medication records are well maintained. Residents are treated with kindness and respect for their privacy. EVIDENCE: Those care plans seen were comprehensively maintained. It was said that wherever possible residents and their next of kin would be involved in the writing and review of the care plan. It was recommended that such involvement be recorded. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 11 Care plans are informed by risk assessments pertaining to risk of developing pressure ulcers and risk of falling. Good wound care documentation was seen. Nutritional assessments are undertaken to determine any risk in that respect. See also standard 15. The home is reviewing its policy on the supply of pressure relieving equipment. Some residents are supplied with bedrails following risk assessments. The need for risk assessing other equipment, which could be construed as restraint, was discussed. It is evident that the home consults with consultants and specialist nurses. Such visits and consultations are now clearly documented. In respect of a regular physiotherapy visit, it was recommended that these and any treatment provided be also recorded. Medication records are well maintained. It is evident that the staff know the residents very well and it was observed that they interacted with the residents in a kind and respectful manner. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a varied and imaginative programme of activities according to their abilities and interests. Residents are provided with choices enabling control over their lives. Residents receive wholesome, varied and balanced meals. EVIDENCE: The home employs two activities coordinators who organise and provide a range of activities. On the day of the visit, a large number of residents were enjoying an organ and hymn singing session. Residents spoken to said they enjoyed the music and other entertainment. An activities programme is on display and a newsletter produced. The acting manager said that the home is planning to provide activities more suitable for residents who, due to their disability, cannot take part in “group events”. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 13 Since the previous inspection, the home has provided a 5-week placement for 2nd year occupational health students. This scheme may be extended to 3d year students on a 12-week placement. Since the previous inspection, the garden has been enhanced with parasols, extra garden furniture, plants and flowers for residents to enjoy. The home has a hair and beauty salon and residents are given the opportunity to have reflexology and hand massage. The chef said she regularly meets with the residents to ensure they enjoy the meals provided. Residents said and the menus indicate that the meals are varied, wholesome and balanced. Colourful daily menus have been produced. A finger buffet is provided on Wednesday. A varied cooked breakfast and cakes and cookies daily. These are particularly appreciated by residents in the dementia care unit. As already referred to, nutritional assessments are undertaken. Residents are weighed regularly. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaint procedure and residents know that their complaints will be listened to. Residents are protected from abuse and staff training is provided. EVIDENCE: Since the previous inspection, complaints are now maintained in a complaint file. The file includes evidence of the action that was taken to rectify the concerns raised. A relative said he would speak to the nurse in charge when there was a complaint issue. The home has a policy and procedures in place to guide staff in what to do when an adult protection alert needs to be raised. As evidenced on the training matrix, all staff receive regular awareness training in this subject. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 15 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): 19, 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, spacious, light and well-designed environment. The communal areas are homely, comfortable, tasteful and colourful. Residents are provided with specialist equipment to maximise their independence. The home is clean and hygienic. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 16 EVIDENCE: The home is bright and comfortable. Residents are provided with a single ensuite room, all with large windows and pleasant views. The corridors are wide thus providing optimum moving space. Two lifts are available. Additional storage space has been provided for large pieces of equipment as hoists and wheel chairs. The garden has recently been enhanced with a water feature, more plants and flowers and seating. The acting manager said that a sensory garden is being planned. The home employs a Home Coordinator Manager who manages all non-nursing services. A team of domestic staff ensures that the home is clean, fresh and pleasant. A laundry service is provided. Staff are trained in infection control issues. A resident appreciated the fact that her flowers are always looked after. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 17 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): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by the numbers and skill mix of staff. Staffing levels however need to be kept under review. Staff are provided with the induction and on-going training they need to care for the residents. The home has good recruitment procedures. However staff files need to be scrutinised to ensure that all required documentation has been received. EVIDENCE: Since the previous inspection, there has been considerable staff turnover. Staffing now appears to be stabilised following a recent recruitment drive. The acting manager advised that staffing levels are as follows: Top Floor: one nurse and 4 care staff, middle floor: 2 nurses and 4 care staff, ground floor: 2 nurses and 4 care staff. Two residents spoken with said that there were not always enough staff on duty. Since the previous inspection, the then deputy manager has been appointed the dedicated training officer for the home and Ashford Nursing Home. A The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 18 comprehensive training matrix is in place and individual staff training and development profiles have been introduced. Staff spoken to praised the quality of the training so far received. All staff are trained in dementia care. The home encourages and provides NVQ training. Currently 15 staff members are NVQ qualified. The home is working towards a ratio of 75 NVQ trained, some at level 3. All staff are provided with a contract of employment. As was recommended at the previous inspection, an effective audit system needs to be introduced ensuring that all references have been received and health questionnaires satisfactorily completed. In two out of the three staff files examined, references were missing. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well managed home. Good quality assurance systems have been introduced ensuring that the home is run in the best interest of the residents. Resident’s financial interests are safeguarded. Residents are cared for by staff who receive regular supervision. The health, safety and welfare of residents and staff are promoted. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 20 EVIDENCE: At the time of the visit, the CSCI had been advised that the registered manager was due to resign. She was not present at this visit. The home is currently managed by the deputy manager in an acting manager capacity. The acting manager is an experienced registered nurse with a background in management. She works in a supernumerary capacity and is supported by the Director of the company and senior trained staff. She operates an “open door” policy. Since the previous inspection, the dementia care unit has been opened. The unit incorporates five designated beds for residents diagnosed with Parkinson’s disease. The acting manager praised the unit staff on their sterling work. The future of the dementia care unit was discussed in respect of management and categories of registration. Since the previous inspection, quality assurance and audit systems have been introduced ensuring that residents’ views are requested and acted upon. Residents and staff meetings are held regularly. The Director of the company carries out formal visits in accordance with Regulation 26. An annual development plan for quality assurance is in the process of being completed. The home does not get involved with residents’ financial affairs. Residents are invoiced monthly for any costs incurred. Since the previous inspection, formal staff supervision has been introduced. Accident records are maintained and the CSCI is informed of any reportable events in accordance with Regulation 37. From information received prior to the visit, it is ascertained that the home provides a safe and regularly maintained environment for its residents. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 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 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 3 3 The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 22 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 OP2 Regulation 5 (1) (bb) (4) Requirement That contracts are provided in compliance with the Regulation Timescale for action 30/09/07 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 2 3 Refer to Standard OP7 OP29 OP33 Good Practice Recommendations That residents and their relatives are involved in their care plan That recruitment files are complete That an annual quality assurance plan be developed The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V345285.R01.S.doc Version 5.2 Page 24 - 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!