Care Home: Ashberry Court

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What the care home does well Ashberry Court provides residents with a comfortable and homely environment, with gardens that are accessible for people with good mobility. Residents who were part of the inspection said the staff are good and the food is very nice, and they are able to choose how and where to spend their time. What has improved since the last inspection? There has been some upgrading of the fire system at the home, improvements have been made to the environment including carpets and redecoration, and the electrical certificate has been updated. What the care home could do better: The inspection identified that some improvements are required, to ensure that the home identifies the residents needs, and provides appropriate care to meet them. Additional training is required to ensure staff follow safe medication and moving and handling practices. An effective qualiy assurance and monitoring system should be developed to ensure the home meets the residents needs. Key inspection report Care homes for older people Name: Address: Ashberry Court 39 Lewes Road Eastbourne East Sussex BN21 2BU     The quality rating for this care home is:   one star adequate 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: Kathy Flynn     Date: 2 8 0 9 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 25 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 25 Information about the care home Name of care home: Address: Ashberry Court 39 Lewes Road Eastbourne East Sussex BN21 2BU 01323722335 01323722335 ashberry@broadgate-healthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Ramachandran Jalatheepan, Mr Varunatheepan Ramachandran care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category/ies of service only: Care home only - PC 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 - OP Date of last inspection Brief description of the care home Ashberry Court is a large converted house in an area of similar properties. The house provides accommodation and support for 22 older people. Access to some rooms is by passenger lift; other areas of the home are accessed by stairs or stair lifts. Fourteen rooms have an en-suite toilet and washbasin; the remaining rooms have a washbasin. Residents have use of two lounges and two dining rooms. There is access to a rear garden for people who are mobile. The home is sited on a main route into Eastbourne and although there are no shops Care Homes for Older People Page 4 of 25 Over 65 22 0 Brief description of the care home close by, the town centre is approximately 1 mile away and can easily be accessed by bus. There is on street parking available locally, in side streets. Details of the range of weekly fees can be obtained from the home. Residents pay for their own hairdressing, chiropody, personal telephone and TV, personal clothing and toiletries. Care Homes for Older People Page 5 of 25 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: one star adequate 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 1 star. This means the people who use this serviceexperience adequate quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in carehome settings. For the purpose of this report those living at Ashberry Court will be referred to as residents. This was a key inspection that included an unannounced visit to the home. A range of documentation was reviewed including care plans, medication charts, recruitment files, and the menus. The manager and care staff were happy to discuss the support they provide. They were very positive and felt they could meet the residents needs. Care Homes for Older People Page 6 of 25 The Annual Quality Assurance Assessment (AQAA) was completed by the acting manager within the required timescale, and identified areas where improvements have been made, and where others are planned for the benefit of residents. Care Homes for Older People Page 7 of 25 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 25 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 25 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. Prospective residents are assessed before they are offered a place at Ashberry Court, to ensure that the home can meet their needs. Evidence: The manager confirmed that people who wish to move into the home are provided with information about the support they offer and are assessed, with their involvement, to ensure the home can meet their individual needs. The layout of the home means that prospective residents must be reasonably mobile, using aids if required, and the manager is aware of these restrictions when she discusses places with prospective residents and their relatives. Four assessments were examined and this information is used as the basis of the care plan following admission. They were found to include information about the residents individual medical and social needs, but there was no a clear link between this Care Homes for Older People Page 10 of 25 Evidence: information and the actual support provided for people living in the home. Refer to Standard 7. One of the assessments did not provide a clear picture of a residents needs and discussion with the manager identified that it can be difficult to obtain information when completing the assessments. Additional information from GPs, District Nurses or relatives and friends may be required to enable the person doing the assessment to be sure that Ashberry Court can offer the support the prospective resident needs and wants. Prospective residents and their relatives can visit the home at any time to meet residents and staff, and they can move in on a trail basis to make sure their needs can be met, before they decide if the want to take a place on a permanent basis. Care Homes for Older People Page 11 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system provides staff with information about the needs of residents, although the care plans are not up to date, and the daily records may not reflect the needs of residents and how these are met. Medication training is provided for staff and policies and procedures are in place, however these should be reviewed and updated to ensure staff follow best practice. Evidence: The care planning system is based on activities of daily living, which identifies problems and records what action should be taken to address them. These are kept on the homes computer, unfortunately the computer broke down on 16th July and the manager has been unable to find an engineer to repair it. The information already recorded on the computer is accessible and some has been printed and kept in the residents individual folders for staff to refer to. They are unable to add information to the care plans or complete the daily record of care offered, therefore staff now record the daily record in a separate book. Six care plans were viewed, with the pre-admission assessment details, and although Care Homes for Older People Page 12 of 25 Evidence: they contained information about the residents they were not specific enough, they did not identify all the residents needs, and this may have an impact on the support the home offers. A falls risk assessment had not been completed for a resident whose needs had changed and had fallen several times in recent weeks; staff were not following safe practices when assisting a resident who had fallen; some residents psychological and social needs were not included in the care plan and therefore could not be met; some specific problems were identified that were not appropriate for the resident concerned; residents are weighed when they are first admitted but nutritional assessments are not completed as part of the admission process; there was little evidence that the care plans are reviewed on a regular basis, with the involvement of the residents or their representatives. The daily records consisted of short comments in the main, with very little information about how the staff meet the residents individual needs. When well written they can help ensure a consistent approach and good quality of care for residents. It is in the homes interest to be able to show what they have done, along with providing the evidence on which to base the monthly review, and to record that they are following the assessment of needs. Residents are registered with GPs and support from District Nurses is provided as required. Appointments with allied health professionals can be arranged and there are regular visits to the home by the chiropodist. Medication training is provided for staff and those spoken with have attended this. The home has a safe storage system for the medicines and they are recorded appropriately. However the homes process of ordering and administering medication should be reviewed and appropriate changes made to ensure that medication is available for residents when required and staff follow a system that is based on best practice. Staff were noted to treat residents with respect, and communication between them was relaxed and friendly. Care Homes for Older People Page 13 of 25 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. Activities are available for residents to participate in if they wish, the meals are good and choices are available. Evidence: There are a range of activities at the home, exercise, karaoke, nail care and musical sessions are organised each week, and outings to Hampden Park and Beach Head were arranged during the summer. Residents involved in the inspection said that they can join in activities if they want, although some prefer to remain in their own rooms, and although staff are very good they do not spend time with them unless they are meeting their care needs. A senior carer is currently reviewing the activities with the residents and is developing a four week programme based on their preferences. The manager and senior carer said that staff should be able to spend time with the residents in their rooms on a one to one basis, and they will be looking at offering this support to residents as part of the programme. Friends and relatives are welcome at any time, and residents said that they can visit when the want to and the staff are very friendly towards them. Care Homes for Older People Page 14 of 25 Evidence: The home aims to support residents to make choices about their day to day lives, and they are able to choose how and where they spend their time. The meals at the home are good, residents involved in the inspection said that the food is very nice, the only problem was that sometimes we are given too much. Choices are offered and residents can change their mind and can have their meals at times that suit them. A resident who had a hospital appointment said the lunch had been very good and staff had saved it for him. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has policies and procedures in place to enable residents or their representatives to make complaints. Training in supporting vulnerable people is provided for staff to protect residents. Evidence: The manager advised that policies and procedures are in place to enable residents and visitors to raise concerns about the home and the services it offers. These include details of the time frame for dealing with complaints, and who can be contacted if the complainant is not satisfied with the homes response. People involved in the inspection said that they do not really have anything to complain about. Some said they would prefer not to have to live in a care home, but also said the staff and food is good and they have to accept we need help. Staff said that they attend training in protecting vulnerable adults, and they were able to demonstrate an understanding of abuse and what action they would take if they have any concerns. Care Homes for Older People Page 16 of 25 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. Ashberry Court provides residents with a comfortable and homely place to live. Training in the prevention of infection is provided for staff to protect residents. Evidence: The home is a converted building that retains some of its original features, a shaft lift and chair lift enable residents to access most of the home, and those residents who are mobile can access the lower ground floor by a short flight of steps. There are gardens to the front and rear of the home, however these are also only accessible by people able to walk. Some of the people involved in the inspection choose to remain in their own rooms, they said their rooms are very nice and they were able to bring pictures, ornaments or furniture with them when they moved in. The home was clean, well decorated and there is an ongoing maintenance programme. Training is provided for staff with regard to preventing cross infection, and those spoken with have attended this. Care Homes for Older People Page 17 of 25 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. Robust recruitment procedures are used when employing staff to protect residents. Training is provided for staff to ensure they are aware of their roles and responsibilities. Evidence: The staff that took part in the inspection have been employed at the home for a number of years, they have considerable experience of supporting people in a residential setting, and they all said that they really enjoy working at the home. They feel that they can offer the support the residents need, while also encouraging them to be as independent as they can. There are clear procedures followed by the home when employing new staff. Four staff files were examined and they contained the relevant information including application forms, two references, interview notes and Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks. It was clear that one member of staff had commenced working at the home before the CRB check had been completed, and without a POVA check. The manager confirmed that she would be seeking advice to ensure the home follows appropriate procedures. All staff are required to complete induction training when they start working at Ashberry Court, and the records support this. The manager and staff confirmed that Care Homes for Older People Page 18 of 25 Evidence: there are opportunities for them to go on to the National Vocational Qualifications, and those spoken with have completed NVQ level 2 or 3 and the manager is currently working towards level 4 in management. There is an ongoing programme of mandatory training, all staff are required to attend and certificates are provided to evidence this. The manager confirmed that she will be arranging training for staff to ensure they can complete the care plans and are able to offer appropriate support for people with dementia type disabilities. A key worker system is in place and residents are informed of this when they are admitted. Residents involved in the inspection said they were not aware of this, however staff were quite clear about the residents that they have been allocated and the support they offer them and their relatives. Care Homes for Older People Page 19 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management approach aims to involve the residents, relatives and staff in decisions about the development of services at the home. Evidence: The home has been without a registered manager for 18 months. The acting manager has been working there for over 15 years, she has considerable experience of supporting people in care home environment, and when she has completed the NVQ management course she will be applying to the commission to register as the manager. There are clear lines of accountability, staff have particular areas they are responsible for and they feel they work well together as a team. The manager advised that questionnaires are used to obtain feedback about the services offered at the home from residents and visitors, and reports are produced by the provider monthly under Regulation 26. Care Homes for Older People Page 20 of 25 Evidence: These reports include statements about different aspects of the home including the care received by residents. However they do not provide a clear picture of how the home meets the needs of the residents, with positive comments and any concerns identified. If completed appropriately the information obtained could be used effectively as part of the quality assurance and monitoring system, which if in place may have identified the difficulties with care planning and medication. The home is responsible for some of the residents money, records are kept of deposits and payments, and if necessary the home makes purchases on behalf of the residents and then bills the placing authority. Health and safety systems are in place at the home, and the staff member responsible confirmed that regular checks are made throughout the home, and outside contractors are used to check and provide appropriate certificates, which include the lifts and the homes electrical system. Moving and handling training had been arranged for the week of the inspection, and the expectation is that the manager and staff will discuss with the trainer appropriate support for residents at risk of falls, or who have fallen, to protect residents and staff. Care Homes for Older People Page 21 of 25 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 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 That the care planning system is reviewed and updated and reflects the needs of the residents and how these are to be met. To ensure the residents receive the support and care they need and want. 29/10/2009 2 9 13 That the processes for medication be reviewed and appropriate practices developed to ensure staff order and administer medicines safely. To ensure the homes practices protect residents. 29/10/2009 3 33 24 That an appropriate quality assurance and monitoring system is developed and introduced. To ensure the services offered at the home meet the needs of residents. 18/12/2009 Care Homes for Older People Page 23 of 25 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 4 38 13 That moving and handling training is reviewed and updated to enable staff to follow safe practices. To ensure residents are protected when staff assist them with their mobility. 29/10/2009 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 Care Homes for Older People Page 24 of 25 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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