Care Home: Ash Court Care Centre

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What the care home does well The home was effectively managed and there was an open and inclusive atmosphere. The service ensures full and comprehensive assessments of needs were in place for individual people using the service. Staff were said by people using the service and relatives that the home was welcoming. There were various positive comments received from people using the service and from relatives. For example a relative said, "my mother receives excellent care at Ash Court, the staff are friendly and helpful, and interact with the residents. The staff are like a family, they work and get on well together, so the good atmosphere reverberates around the home". "There is a very good activities/entertainment programme at Ash Court to keep the residents occupied and stimulated". Another said, "the care service treats my father with dignity and care. All needs, physical, mental, emotional and spiritual are addressed in a professional, caring and sensitive manner". The home engages people in the community in activities such as garden parties and there was evidence of participation with people using the service, relatives, and local authority and health professionals as necessary. Staff were praised by people using the service and the surveys returned from staff made remarkable comments about the training and support they received as outlined in the report. What has improved since the last inspection? The home has been redecorated; the person centered approach to care planning has improved in that individuals` social care histories are now applied. Strategies in relation to the Deprivation of Liberty is in use as necessary to assist with providing appropriate care and support to individual people with disabilities. The home continues to record the preferred priorities regarding End of Life care and National Initiatives and to this end, is working towards the Gold Standard Framework. What the care home could do better: Two recommendations were made in respect to the ventilation which two people using the service said could be improved. One other relates to the drainage system which was said to carry a malodour from time to time into the room of an individual. The manager said that they plan to replace the showers and she agreed to look into the matters raised. Key inspection report Care homes for older people Name: Address: Ash Court Care Centre Ascham Street London NW5 2PD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pearlet Storrod     Date: 2 0 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 24 Information about the care home Name of care home: Address: Ash Court Care Centre Ascham Street London NW5 2PD 08444725181 08444120621 nancy.rasool@foresthc.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ash Court Community Limited care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 62 The registered person may provide the following category of service only: Care Home with ursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical Disability - Code PD Date of last inspection Brief description of the care home 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 star from £692.38 to £1,110. 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 only through the security gate. The front entrance is covered by a large conservatory, which is used by service users. Although a garden is Care Homes for Older People Page 4 of 24 0 62 Over 65 62 0 Brief description of the care home 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. 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. Care Homes for Older People Page 5 of 24 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 star. This means that the people who use this service experience excellent quality outcomes. This unannounced inspection took six hours to complete and I spoke with three people who use the service. The manager was available and assisted the inspector. Records like care plans, assessments, menus, complaints register, health and safety matters such as accident and incident records were cross- referenced where necessary. A tour of the building occurred and three people gave their views about the quality of the service from their experiences. One person commented positively on the 10th anniversary celebrated at the weekend. Staff were observed interacting with people using the service; The lunch time experience was observed in particular and those requiring support were afforded such in a respectful and caring approach. Care Homes for Older People Page 6 of 24 I looked at the complaint that had emerged and I had the benefit of attending the strategy meeting arranged by the local authority, the outcome of which there was no evidence to substantiate the complaint made. Though the process demonstrated the need for the manager to reinforcement the application for her staff to revisit the safeguarding policies and process in place. The Annual Quality Assurance Assessment returned to us duly completed was used in the inspection process and the information included, reaffirms the findings of the inspection. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: 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 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 8 of 24 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 9 of 24 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 using the service continues to be assured that their needs will be fully assessed; the home will recognize and meet their needs and aspirations. Evidence: Prospective people who use services are given the necessary information to enable them to decide whether to live at the home. Assessments of needs are available from social services and more detailed assessments were noted before and after moving in. The care needs identified were used to formulate the care plans, which were person centered. Where appropriate, additional resources were sought to enable the meeting of individual needs to be met. Care Homes for Older People Page 10 of 24 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. Care planning and reviews ensures that the personal and healthcare needs of people living at the home are met. Evidence: A sample of the care plans were taken from each floor. As stated earlier the care plans were person centered and based on comprehensive pre-admission assessment, which took into account issues relating to medical, health, personal and social care of individual people using the service. People using the service were registered with a local GP and there was evidence of input from various health professionals such as physiotherapist, chiropodist, dietician, occupational therapist and tissue viability nurse. Dental and optical needs were also taken into account. Medication management appeared sound as noted from a sample audit taken. An individual commented, since 6 months ago - we are happy with the GPs service. We received eleven surveys from people using the service, four from relatives and Care Homes for Older People Page 11 of 24 Evidence: twelve from staff. All the comments received were positive though two concerns were noted from two of the surveys received; the issues are outlined under the outcome for Environmental Standards. A relative commented, My father has complex needs and over the 22 months, my fathers care has been managed well. They said further, My father is deeply religious and at times staff have taken him to church. He receives communion every week and his rosary beads are placed on his table or in his hands. His Irish music is played for him, his mental and physical disabilities are managed in a professional and individual manner. Another person said, Care needs are under regular review and appropriate changes are implemented; my uncle is treated well and his dignity well preserved. The following comment was noteworthy, My father has a complex and terminal illness. We are so reassured to know that his last days will end with dignity and care at Ash Court. The staff at Ash Court care for my father as if he was their relative. Words cannot convey our heartfelt thanks. The home had policies and procedures in place in respect to End of Life Care and the manager asserts that they had registered their interest for the Gold Standard Framework. Care Homes for Older People Page 12 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from a choice of activities in the home and were encouraged to pursue their interests. Relatives asserts that the home was welcoming. People using the service made their own decisions wherever possible about what they do. Mealtimes were enjoyed by people using the service and choice of food were available and cultural and religious preferences were taken into account. Evidence: People using the service are afforded the opportunity to exercise choice and determination in all aspects of his or her life according to individual need and capabilities. Activities were provided and recreational activities included arts and crafts, exercises, reminiscence, sing along, bingo, quizzes and various others according to information outlined in a survey returned to us. There was evidence to demonstrate that peoples cultural and religious needs were taken into consideration at all times. For example, St. Patricks day was celebrated and the weekend before this inspection, the home celebrated its 10th anniversary. I understood from staff and heard from people using the service, that the event was astounding with staff dressed in various cultural costumes and different kinds of food provided for the extravaganza. An individual told me it was a beautiful, eventful and enjoyable day. Care Homes for Older People Page 13 of 24 Evidence: One survey had the following comment, we would like if other outings could be arranged more as the weather improves. Another said, the home should consider purchasing their own transport which could be shared amongst their other registered services. An individual using the service commented, if they were taken to the activities then they can take part - but sometimes language can be a problem. Relatives with whom I spoke commented positively about the visiting arrangements. There was evidence of family contact and the wife of an individual told me that she was pleased with the services provided to her husband. She further commented on the improvement noted, in the health of her relative who was recovering from ill health. Another relative said in a survey, There is a very good activities/entertainment programme at Ash Court to keep the residents occupied and stimulated. ....My mother only has soup and yogurt/puddings, still have problems with the consistency of soup and puddings, usually when temporary chef on duty. People using the service, relatives and staff participate in planning the menu. The dietary needs and food preferences were taken into account when planning meals. Religious needs were observed as necessary. Individual people had the choice of where to eat. A person using the service said in their survey, I just walked in saw how welcome you were made; how clean it was; because it was 9 am, people were being served breakfast in bed, it had a very warm welcome feeling and it is still the same. Another individual said, At the moment the halal meals are better but we have asked if we can be provided with the order list and can choose different variety of foods that must be on the list. Care Homes for Older People Page 14 of 24 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. People using the service and their relatives were able to sort out their concerns and complaints as they arise. People who use services were protected by the arrangements in place in respect to adult protection though there was a concern that a staff member had not followed the process appropriately. Evidence: All the surveys returned to us asserted their individual knowledge about the complaints protocol with exception to one relative who said, I have not received a copy of the homes complaints procedure. The procedure was available in the service users guide, which was available in the room of each individual, at the reception and on each floor. The surveys from staff reflected the process to be followed if a concern was brought to their individual attention by a person using the service, relative, friend or advocate. No formal complaints were received since the previous inspections and this was indicated in the AQAA and reaffirmed by the manager. One survey had the following comment, if anything is wrong you only have to ask. Another person said, if every home was the same as Ash Court - no one would have anything to complain about. One other said they would, just talk to the nurse on duty, thats who we approach if there is a need! The service had a robust policy and procedure on adult protection, which was linked to local authority guidance. The manager acknowledged at a safeguard strategy meeting that I attended, that a staff member had not followed the correct procedure in respect Care Homes for Older People Page 15 of 24 Evidence: to reporting a concern, complaint or allegation. She reinforced the need for all staff to revisit the policies and procedures in this regard. To that end, the information outlined in the staff surveys reflected training and refresher training in relation to the protection of vulnerable adults. The AQAA indicated that the safeguard strategy meeting though inconclusive following investigation, that this was a learning process for the home. Care Homes for Older People Page 16 of 24 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. People using the service live in a safe, well-maintained environment. Staff tries to ensure that the home is clean, pleasant and hygienic. Evidence: The home was relatively safe with a well maintained environment. Examination of the health and safety records indicated that the health and safety systems such as fire alarm tests and testing of the emergency light, sprinklers, fire extinguishers and portable appliance tests, including inspection of the the the lift, electrical beds and hoists and such like, were all up to date. Refurbishment had been undertaken fairly recently though it was noted in two surveys returned to us that the home could be better ventilated, one person said, it could be more fresher. A relative mentioned, some problems with drainage pipes occasionally. Nasty smell seeps into dads room. The manager should look into the issues raised above. Care Homes for Older People Page 17 of 24 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. People using the service benefit from the support of a committed and experienced staff team. People using the service are protected by the operational practice used for the recruitment of staff. Evidence: The policies and procedures for the recruitment of staff seemed robust. The manager asserted that the home had not had to use agency staff within the last year and this was also outlined in the self-assessment document. This ensured continuity of care from a regular staff team. I observed within the file of an individual a Border and Immigration document from the Home Office and the manager and I discussed this; she explained that they had to now sponsor staff from overseas that they employ and that once documents were completed, they were then scrutinized by the Border and Immigration Office. An inspection in this respect the transaction was dated 13/7/09 and was noted to be satisfactory. Feedback from the relative of a person who use the service said, Staff are most helpful and act on what you ask right away if they are not busy. Another relative asserts sometimes there are no staff in the lounge when needed. They said also, my mother receives excellent care at Ash Court, the staff are friendly and helpful, and interact with the residents. The staff are like a family, they work and get on well together so the good atmosphere reverberates around the home. Care Homes for Older People Page 18 of 24 Evidence: A training programme was in place and conversion courses continued to occur. The manager was reminded to ensure that the process to be followed in respect to the reporting of safeguarding issues were reinforced to prevent a similar situation that occurred fairly recently. Staff were motivated and each of the twelve surveys returned spoke favourably about the quality and quantity of the training they have benefited since working at the home. It was worthy to note the following comments from some staff members: The knowledge I acquired as a professional nurse back home and the additional information and trainings given by the home were enough to equip me with knowledge to hand and give the quality of care needed by the service users. Another staff member said, I have had a lot of training and it all has really helped me understand what different residents need and the best way to give this. All comments received were positive. Care Homes for Older People Page 19 of 24 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. Ash Court was a well run home with an open and inclusive approach. It was managed in the best interests of the people living there. Evidence: The previous key inspection referred to another registered manager being in charge of the home. This was a temporary arrangement reverted back to status quo. The initial registered manger Nancy Rasool, has the necessary qualification, knowledge, understanding and managerial skill for effective and efficient running of the service. The home continued to portray a welcoming environment with an atmosphere that was homely as stated in a survey from a relative. Likewise an open and transparent management style continued to be apparent. Information from the AQAA were noted to be accurate. Continuous investment in staff development was noted. The manager stated that the service was in the process of going for the Gold Standard Framework relative to the End of Life Care. As noted, a good system/ methodology was in place regarding this. Care Homes for Older People Page 20 of 24 Evidence: People using the service, relatives and staff participated in planning the menu and there was evidence of collaborative work with the (DoLS Assessor ) a training session had occurred on the inspection day and I spoke with the assessor who provided me the opportunity to attend such training sessions. Monthly visiting reports were noted and these were informative; feedback from people using the service, relatives and staff confirmed their general satisfaction with the services offered. The finances held for people using the service were managed by the homes administrator on the computer; the system continued to be effective with safeguards in place and clear audit trails. Health and safety records were inspected and these were found to be up to date and accurate; essential checks were made and acted upon where necessary. The only comment to make was that the weekly fire alarm checks should occur at different alarm points on a rotational basis each week, as discussed with the manager. Care Homes for Older People Page 21 of 24 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 22 of 24 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 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 2 25 26 The registered person should investigate and rectify the issue relating to the issue relating to the drainage pipes. The registered person should look into the issue raised regarding improved ventilation. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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