Care Home: Ashbourne

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What the care home does well Ashbourne is an established small care home providing personal care and accommodation to older people. The property blends in with the other private residential properties in the area. All the bedrooms are individual and have ensuite facilities, on the ground and first floor. There is a garden, which is used by the people using the service in summer and on warmer days. There is good information about the services and facilities at Ashbourne made available to people considering using the service. People are encouraged to visit and are involved in the assessment of needs process to ensure their needs Ashbourne DS0000070317.V378193.R01.S.doc Version 5.2 can be met. People are involved in the development of the care plan, which ensures individual needs, requirements and preferences are met. People’s who use the service are supported to maintain their daily routines, choice of lifestyle and interests. People have a choice of communal areas that they can use in addition to the privacy of their bedrooms. All the meals are prepared at the home. There is a good choice of meals offered to suit individual dietary needs and preferences. The complaints procedure is clear and concerns are addressed promptly. The staff recruitment and training is good. There is a stable staff team who receive regular training for their job role and awareness training to support the people who use the service. There are good internal monitoring systems and checks in place to ensure the health and safety of the people who use the service, staff and visitors. Some of the comments we received in the surveys and from speaking with the people using the service, relatives and staff, included: “Its not a big place but it is homely” “They do respect me, my privacy is important to me” “I know dad likes the staff and the carers like dad too” “They fully respect my dad’s views and wishes” “We have no concerns about the care mother receives – it’s good and she’s happy” “I like to sit in my room and occupy myself with music and TV” “Girls are very good and ….. is here too” “Cannot fault the care and help they give me” “Promotes staff training in all aspects” “Good team work” What has improved since the last inspection? Ashbourne has addressed the requirements and the majority of recommendations made at the last key inspection of the service.AshbourneDS0000070317.V378193.R01.S.docVersion 5.2Care plans have been updated and are being developed into ‘person centred care plans’ taking into account individual routines and preferences. The management and storage of medication and controlled (very strong) medication is good using the approved controlled drugs storage. A Chef has been recruited to work full-time at the home. Some staff have attended the 3 day ‘dementia awareness’ training. There have been some environmental improvements made, which include the level access to the home, refurbishment of the kitchen, new cooker, radiators are all covered and new curtains and bedding. What the care home could do better: This was a positive inspection of Ashbourne. The information received from the people who use the service, relatives, staff, GP and the information we gathered from our site visit demonstrated the service is taking steps to improve the quality of life people experience. The most significant improvement Ashbourne must make is the appointment of a ‘Registered Manager’ for the home. This is important as all health and social care services must meet the registration requirement for the new Health and Social Care Act 2008, coming into force next year. We have made a number of good practice recommendations, which we discussed with the Interim Acting Manager and the Quality Assurance and Development Manager. The recommendations made have an impact on the quality of service people experience, information about the service, improvements to the home environment with regards to health and safety, quality assurance systems and ensuring staff skill-mix is maintained to meet the needs of the people using the service. Key inspection report CARE HOMES FOR OLDER PEOPLE Ashbourne 12 Neale Avenue Kettering Northamptonshire NN16 9HE Lead Inspector Ms Rajshree Mistry Key Unannounced Inspection 09:30 4th November 2009 DS0000070317.V378193.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.2 Page 2 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 Ashbourne DS0000070317.V378193.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbourne Address 12 Neale Avenue Kettering Northamptonshire NN16 9HE 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) 01536 513363 ashbourne@msaadacare.com Msaada Care Limited Manager post vacant Care Home 18 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (17) of places Ashbourne DS0000070317.V378193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following categories: Old Age - Code OP. 2. Dementia - Code DE(E) (maximum 1). The maximum number of service users who can be accommodated is 18. Date of last inspection Brief Description of the Service: Ashbourne is a registered care home providing care to 18 people over the age of 65 years. Ashbourne is owned by Msaada Care Ltd, which has a number of care services in the area. Ashbourne is situated on a residential street close to the edge of town with street parking to the front. It is close to a main road and approximately two miles from the town centre. There is good public transport and local facilities. Ashbourne is a large detached property, providing accommodation over two floors. All bedrooms have en-suite facilities and there is a passenger lift giving access to all areas of the home. There are a variety of communal areas including two lounges and a dining room. There is an enclosed garden to the rear and a patio area. The ‘Interim Acting Manager’ provided us with the fees charged. These range from £355.18 to £466.40 per week. There are additional personal expenses for hairdressing, chiropody, personal toiletries and newspapers. The fees are determined upon individual assessment of needs and requirements. People considering using Ashbourne should contact the home directly to discuss individual needs and requirements. Full details for Ashbourne and any specific requirements can be obtained in the form of the ‘Statement of Purpose’ and the Ashbourne DS0000070317.V378193.R01.S.doc Version 5.2 Page 5 ‘Service User Guide’. The latest Inspection Report from the Care Quality Commission is available at the home or accessible via our website: www.cqc.org.uk Ashbourne DS0000070317.V378193.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for Ashbourne is ‘2 star’. This means the people who use the service experience ‘good’ quality outcomes. ‘We’ as it appears throughout this Inspection Report refers to the ‘Care Quality Commission’ (CQC). This key inspection started with the review of the last key inspection dated 5th November 2008. We looked at the information we had about the management of Ashbourne and the events that affects the well-being of the people who use the service. This includes any concerns or complaints received about the quality of care people received and the management of the service. We received from the previous Acting Manager the completed Annual Quality Assurance Assessment (AQAA) document. This is the home’s self assessment of the standards within the home. We sent out 11 surveys to the people who use the service, which included relative’s surveys. We received 3 surveys from the people who use the service and 4 from relatives. The majority of responses and comments received indicated that people were satisfied with the quality of care and support from the staff, services and the facilities provided. The responses indicated people had the opportunity to live the lifestyle of their choice, participate in social events and activities arranged by the home, including observing their religious beliefs and practice. The responses also indicated people were confident to complain and have had their concerns addressed. The comments received are reflected in this Inspection Report. We sent out a ‘health care professional’ survey to the General Practitioner, which was returned. The responses received in the surveys indicated that they were satisfied with the how health and care needs were met for the people that lived at Ashbourne. We sent out 13 staff surveys, of which 4 were returned. The responses indicated staff recruitment was fair; staff receive supervision and training to meet the needs of people who use the service. The responses also indicated there is good information, records and communication systems in place to ensure people’s needs are met safely. The comments received are included throughout this Inspection Report. We visited Ashbourne on 4th November 2009, starting at 9:30am and lasted over 7 hours. The Interim Acting Manager and the Quality Assurance and Development Manager for Msaada Care Ltd assisted us during the site visit. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.2 Page 7 The main method of inspecting we used was ‘case tracking’. This means looking at the range of health and personal care people receive that is met by the staff at the home. We selected five people to case track, all having differing needs, level of independence and included a person that was new to the service. We looked at how people’s rights, choice, dignity and independence, is promoted by staff. We spoke with those people and other people using the service. We read their care files containing information about their health and personal care needs, lifestyle and how these are met. We made observations of how people are treated and supported by the staff with regards to promoting and maintaining their independence and well-being. We spoke with a visiting relative during the site visit and a relative on the telephone after the site visit. The responses and comments received were generally positive with regards to the level of care their relatives received by the staff. The individual comments received are included throughout this Inspection Report. We spoke with staff on duty with differing roles to ascertain the recruitment process, training, staff skills and the management of the home. We made observations of how staff treat people who use the service and the deployment of staff to ensure needs are met. We looked at the staff files that demonstrated staff recruitment, training and the skill-mix of the staff. We looked at the accommodation offered to people who use the service. This included the communal areas, bathrooms and individual bedrooms. We read the information people receive about Ashbourne. We looked at how the policies and procedures are followed by the staff that ensures health and safety. We looked at the specific records that demonstrated the day-to-day management of the service and how people that use the service are informed and consulted about the quality of care they experience. The interim Acting Manager and the Quality Assurance and Development Manager also provided us with additional information to demonstrate the practice within the service. The Care Quality Commission has a focus on ‘Equality and Diversity’ and issues relating to these are included throughout this Inspection Report. What the service does well: Ashbourne is an established small care home providing personal care and accommodation to older people. The property blends in with the other private residential properties in the area. All the bedrooms are individual and have ensuite facilities, on the ground and first floor. There is a garden, which is used by the people using the service in summer and on warmer days. There is good information about the services and facilities at Ashbourne made available to people considering using the service. People are encouraged to visit and are involved in the assessment of needs process to ensure their needs Ashbourne DS0000070317.V378193.R01.S.doc Version 5.2 Page 8 can be met. People are involved in the development of the care plan, which ensures individual needs, requirements and preferences are met. People’s who use the service are supported to maintain their daily routines, choice of lifestyle and interests. People have a choice of communal areas that they can use in addition to the privacy of their bedrooms. All the meals are prepared at the home. There is a good choice of meals offered to suit individual dietary needs and preferences. The complaints procedure is clear and concerns are addressed promptly. The staff recruitment and training is good. There is a stable staff team who receive regular training for their job role and awareness training to support the people who use the service. There are good internal monitoring systems and checks in place to ensure the health and safety of the people who use the service, staff and visitors. Some of the comments we received in the surveys and from speaking with the people using the service, relatives and staff, included: “Its not a big place but it is homely” “They do respect me, my privacy is important to me” “I know dad likes the staff and the carers like dad too” “They fully respect my dad’s views and wishes” “We have no concerns about the care mother receives – it’s good and she’s happy” “I like to sit in my room and occupy myself with music and TV” “Girls are very good and ….. is here too” “Cannot fault the care and help they give me” “Promotes staff training in all aspects” “Good team work” What has improved since the last inspection? Ashbourne has addressed the requirements and the majority of recommendations made at the last key inspection of the service. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.2 Page 9 Care plans have been updated and are being developed into ‘person centred care plans’ taking into account individual routines and preferences. The management and storage of medication and controlled (very strong) medication is good using the approved controlled drugs storage. A Chef has been recruited to work full-time at the home. Some staff have attended the 3 day ‘dementia awareness’ training. There have been some environmental improvements made, which include the level access to the home, refurbishment of the kitchen, new cooker, radiators are all covered and new curtains and bedding. 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. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.2 Page 10 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 Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Standard 6 is not applicable. People using the 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 receive information about the service and are involved in the assessment process to ensure their needs are met. EVIDENCE: We wanted to find out what information and opportunity people have to help them decide to use this service. The information gathered from the selfassessment completed by the previous Acting Manager stated; people are provided with a copy of the home’s brochure known as the ‘Statement of Purpose’ and the ‘Service User Guide’. This contains good information about the range of service provided, the type of care and support needs people can expect to receive and the range of facilities within the home. It also set out the aims and objectives of the service, the key policies and procedures by which the service operates including the admission and complaints procedure. The Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 12 self-assessment indicated that this information is available in alternative formats such as braille, large print and on tape, showing awareness to the various forms of communication needs people may use. The Statement of Purpose and the Service User Guide should be updated to reflect the changes in the management of the service. The surveys we received from people who use the service and their relatives indicated they had received enough information about Ashbourne to help them decide whether to use the service. The people who use the service and the relatives we spoke with also said they or their relatives had come to see the home to make sure it was the right place for them. Some of the comments received in the surveys and from speak with people included: “There was no science in choosing the home as it was an emergency place and it began with the letter A” “My daughter did the research and said this would be the right place but the owners were different then” “Basically we chose this home for mother because it felt homely and there were 2 cats” “Its not a big place but it is homely” The information we gathered from the self-assessment stated ‘people are fully assessed prior to moving in’. Three people who use the service, which included two that we case tracked, said they were asked about the help they needed. The relatives we spoke with also confirmed they were involved in the assessment process to make sure the home would be able to meet their needs The comments received included; “They asked me questions about what help I needed and as you can see, it’s very little” “My requirements are few, I have vegetarian meals and like keeping my brain active” “We were asked questions about my mother and what help she needed and so far have been happy that she is being cared for” We read the records of the people we case tracked, which included a person who was the newest. There was good evidence of the ‘initial assessment of needs’ undertaken with the person before they moved to the home. They gathered information relating to the needs, level of support required and preferred choice of lifestyle. There was a further ‘admission assessment’ undertaken, which was comprehensive, compliments the initial assessment and is used to develop the care plan. It contained more information relating to the Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 13 person’s medical history and medication, daily routines and lifestyle, dietary needs, physical and mobility needs, ability to make decision and mental wellbeing and communication. In addition there is now a ‘social assessment’, which highlights their social and leisure interests, family and friends and their life history. The care files also had copies of the statement of purpose, the service user guide, and also a signed contract with the terms and conditions of their stay. This showed there was a clear agreement in place for their stay. The Interim Acting Manager told us they are trained and responsible for undertaking all assessments of the person’s needs before someone moves into Ashbourne. We advised the Interim Acting Manager to ensure the assessment of needs takes into the new requirements under the Mental Capacity Act and the Deprivation of Liberty’s. This looks at how people who are unable to make decisions have their best interest and wishes considered. The staff we spoke with said they receive good information about the needs of the people who use the service. Staff said care files contain care plans and information is shared through the handover meetings between the staff. This was consistent with the responses in the staff surveys. Ashbourne does not provide intermediate care. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the 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’s personal care and health needs are met safely through improving care planning, monitoring systems and procedures and practice. EVIDENCE: We wanted to find out how the health and personal care needs of people living at the home were met. The information we gathered form the self-assessment stated ‘care plans are in place, reviewed, medication policy, staff training records, provision of specialist equipment and works with the health care professionals such as the General Practitioner (GP) and the District Nurse (DN)’. The survey response received from the people who use the service and relatives indicated people ‘receive the care and support they need’. This was consistent with what people who use the service told us. People gave examples Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 15 of individual experiences with regards to how staff supported them to meet their needs and maintain independence. People told us they were involved in developing the care plans. The relatives that we spoke with said they were invited to meetings where the care plan was being reviewed due to changes in the person’s health and well-being. This shows changing needs are met. We read the care files for the people we case tracked, all of whom had differing needs. We also looked at the care file for a person who was very poorly and was being cared for in bed with the support of the District Nurse. The care files contained the care plans, assessments of risks, daily records, health care record and social activities record. The care plans were developed with the person, taking into account their needs, the level of support they required and their wishes. The Interim Acting Manager told us they have developed some care plans that are ‘person centred’ and plan to revise all the care plans for the people using the service. The care plans reflected the safety measures identified from the assessment of risks. These were for moving and handling, falls and nutrition. This provided staff with the information to help them provide the care people needed, safely. The people who use the service told us that they attend health appointments and see the GP when required. Whilst some people preferred the staff supporting them to attend appointments, others preferred their relatives taking them. This showed the service encourages people to continue to have relatives being involved in their care, where appropriate. We were told the District Nurse was in the home seeing a person who was very poorly but they left before we were able to speak with them. The daily records completed by the staff reflected the care and support needs provided and their general well-being. Other records kept included visits from the Chiropodist, District Nurse and record of attending GP appointments. A record of the support provided from various health care professionals is kept but no other information with regards to the purpose, treatment or advice given is kept. We advised the Interim Acting Manager that a record should be made of this to ensure people’s health and well-being is monitored and promoted. We saw that staff were monitoring the fluid intake for the person who was poorly and regularly turning them in bed, whilst they were being cared for in bed. This showed staff were following the instructions of the District Nurse. We did receive a survey back from the General Practitioner. The responses indicated that they were satisfied with the care people using Ashbourne received. The responses indicated people’s health needs were met, their privacy and dignity respected and were supported with their medication. People we spoke with said their privacy and dignity was respected and staff promoted their independence. People gave us examples of how they are Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 16 supported with their personal care tasks. The provision of en-suite toilet facilities also promotes people’s privacy and independence. Some of the comments received included: “They do respect me, my privacy is important to me” “I know dad likes the staff and the carers like dad too” “I visit several times a week, usually lunch time and they always tell me if there’s a problem or she’s not well” “My daughter takes me to appointments at the hospital or the GP” “They fully respect my dad’s views and wishes” “We have no concerns about the care mother receives – it’s good and she’s happy” We wanted to know whether the management system for medicine ensured people had their medication on time. The people who use the service all said that they get their medicines on time. Individual medication is recorded in the care file and the Interim Acting Manager is responsible for ordering medication. We observed the trained staff administer medication individually and the records completed accurately. The staff training records showed staff were trained in ‘medication awareness and administration’. They described the process and showed us the area for the storage of medicines. All medication is stored in the locked medication trolley in the medication room. There is now controlled drugs storage in place. We concluded the medication system and practice was good promoting people’s health. We observed staff responding to people’s requests in a respectful manner and showed they were aware of individual personalities and routines. Staff were sensitive, patient and responding to people by their preferred form of address. The staff we spoke with demonstrated a good awareness of the people who live at Ashbourne, their routines and how to make them feel good. For example, staff were aware of one person who is not a ‘morning person’, and with encouragement chose to get ready. This showed how they have put into practice learning from attending training when supporting older people and people with dementia. Staff were also aware of people who like to sit in the lounge and those who preferred the privacy of their room. Staff said they ‘key work’ with individual people who use the service, which has helped to get to know a person. Staff said care plans are in place and more recently, key workers have been involved in the care plan review meetings. This promotes people’s well-being and staff awareness of people’s needs. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the 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 experience a choice of lifestyle that suits them, take part in social activities, keep in contact with family and are offered a choice of meals to suit. EVIDENCE: We wanted to find out what social opportunities and activities are available to people who use the service. The information we gathered from the selfassessment stated, ‘residents supported to access the community including religious observance, family and friends, motivations and musical entertainment and promotes choice of daily routines and lifestyle’. The surveys responses received from the people who use the service and relatives indicated activities are arranged by the home. We also received some comments in the surveys showing what people preferred to do, such as; “….. has now organised weekly visits to the Salvation Army for lunch and service on a Sunday” Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 18 “I like to sit in my room and occupy myself with music and TV” Some people who use the service told us that they ‘like to sit in the lounge and see what is happening. A couple of ladies sat talking to each other and were rather curious about our visit and were keen to tell us what happens in the home. They said how they ‘had become friends since moving to the home at the same time and like to sit together’. They told us “someone comes to do exercise and music”, “there is a Sunday service”, “we watch television and like to chat and the staff do games and talk to us”. We saw two cats and the ladies were keen to tell us that “the cats live here too”. We saw a list of activities displayed on the notice board in the lounge, listing the social activities and entertained arranged at the home. These included the ‘motivation to music’ sessions until the end of the year, the dates for the ‘residents and relatives’ meeting, hairdressing and the Christmas Party. Later, whilst we were speaking to other people in the privacy of their bedroom, we saw people taking part in the ‘motivation to music’ session in the lounge. People were doing arm chair exercises and singing songs. A number of people said they have the daily paper delivered and ‘enjoy reading’. One person we spoke with told us they preferred to read the daily newspaper and watch television in their bedroom. We observed two people liked to walk and sit in the ‘parlour’, which is the smaller quiet lounge that leads out into the garden. We saw a couple of people enjoying the music and singing along to the songs before lunch. Although the main lounge was long, people said they were ‘quite happy with the layout’. People said with their walking aids, which meant, people were not prevented from getting up and going elsewhere in the home. We saw people receiving visitors and spoke with one relative during the site visit. They told us they visit regularly and have always been ‘made to feel welcome’. Several people we spoke with said whilst some people had visitors others did not but were happy to see other people being visited by their family. A relative said spoken with on the telephone after the site visit said, they did visit regularly and noted that “they use to offer visitors tea in china cups and saucers but that doesn’t happen now”. The care files read for the people we case tracked contained a ‘social assessment’. It had information about the person’s family, interests, hobbies, practising their faith, social and leisure interests and past times. We also saw a care plan for social and leisure interests that guided staff to promote stimulation and activities of interest. We saw evidence of the activities people had taken part in, recorded in the individual ‘activity sheet’ and the daily records. We discussed with the Interim Acting Manager that consideration should be made to offering stimulating activities to people who are being cared for in bed, making them feel valued and stimulated. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 19 The relatives we spoke with felt there could be more variety of social entertainment and activities arranged at the home. We shared this with the Interim Acting Manager who showed us some photographs of an entertainer that had recently been at the home and the programme of activities displayed in the lounge. The Interim Acting Manager and the Quality Assurance and Development Manager told us they are in the process of recruiting an Activities Co-ordinator, for the home. We wanted to find out what the meals were like. The information we gathered from the self assessment stated ‘there is a varied menu and dietary needs are met’. The survey received from people who use the service and their relatives indicated they ‘liked the meals’. The people we spoke with said they enjoyed the meals provided, some preferred to have their meals in the privacy of their bedroom. The comments received included: “The meals are very good and …. will always make something else if you want” “My father is vegetarian and they do try to cater for his diet” “They will cook something else if I don’t like what is on the menu” We spoke with the Chef, who said they were recently employed and found out what people liked to eat. They gave us information about people’s dietary needs and requirements, which was consistent with the information in the care files for the people we case tracked. This included people having vegetarian meals by choice and pureed meals due to health. We saw people who use the service make their way to the dining room independently, some with the support of walking aids. The meals were served individually at the dining table, in the lounge and for some, in the privacy of their bedrooms. The meals were well presented and looked nutritious. We saw a member of staff assisting one person in the dining room with their meal in a sensitive manner. There was a choice of pasta bake or chicken vegetable pie; all served with mash potatoes and vegetables followed by a fruit crumble with ice cream. The meal time experience was enjoyable with gentle music playing in the background. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the 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 are confident to complain, complaints are addressed and trained staff that ensure their safety and protection from harm, risk and abuse. EVIDENCE: We wanted to find out whether people were aware of the complaints procedure, confident to complain and felt safe and protected at Ashbourne. The information we gathered from the self-assessment completed by the previous Acting Manager stated, ‘there is a simple, clear and accessible complaints procedure with timescales of 28 days’. The complaints procedure is detailed in the ‘Service User Guide’ and the ‘Statement of Purpose’, which is given to people when they move to the home. It was also displayed at the entrance to the home. The complaints procedure clearly sets out the process and includes the contact details of the head office for Msaada Care Ltd, the local authority, the Care Quality Commission and the local Advocacy Service. The surveys we responses and comments received from the people who use the service and their relatives all indicated they know who to speak with and how to make a complaint. This was consistent with what people using the Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 21 service told us on the day. The responses in the staff surveys also indicated that staff knew how to deal with concerns raised by people using the service, their relatives or other health care visitors. The people we spoke with all indicated they were confident to speak with staff or the Interim Acting Manager. Some people said they preferred to share concerns with their relatives. The relatives we spoke with were confident to speak with the staff or the Interim Acting Manager. One relative gave us examples of having to report to the Acting Manager at the time of a broken toilet seat, which they felt staff should have reported it for repair. Some of the comments received included: “Yes, the manager rings me if any issues” “I have no concerns about the care and I know he is vocal” “I had to complaint about the toilet seat that was out of action” “I don’t think there’s anything to complain about I just talk to the staff, in fact they tell if mother’s not well” The information we gathered from the self-assessment and the complaints record viewed showed the service received 1 formal complaint. The records showed the actions that were taken to address the complaint in line with the complaints procedure. The Care Quality Commission received no complaints or expressions of concerns about Ashbourne. We spoke with the Interim Acting Manager with regards to the ‘Mental Capacity Act 2005’ and the ‘Deprivation of Liberty. This means, where a person cannot make a decision for themselves or might be able to make some decisions and not others, which is called ‘lacking capacity’. They told us they were booked to attend the ‘Liberty Safeguard Training’ on 17th November 2009. We wanted to find out if staff knew what ‘safeguarding issues’ issues meant and how to deal with any suspicions or allegations of abuse. ‘Safeguarding’ issues means promoting the well-being of people who use the service from harm, risk and abuse. Staff survey responses indicated staff knew about safeguarding procedures. The staff we spoke with demonstrated a good understanding of the various forms of abuse that could occur and were aware of their responsibilities to report concerns to the Interim Acting Manager. The staff training records showed staff had attended ‘safeguarding adults’ training and had policies and procedures in place to support them. Staff said they had ‘good communication and worked well as a team’. Staff were confident to raise concerns regarding poor care practices, using the ‘whistle-blowing’ procedure. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 22 The staff recruitment records viewed and the staff survey responses all confirmed they were recruited with satisfactory pre-employment checks. These included two written references and a criminal records bureau check (crb). This is a check to assess the suitability of the applicant to work with vulnerable people. This demonstrated staff recruitment procedures are following to ensure people are cared for by suitable staff that promotes their safety and wellbeing. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. People using the 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 live in a comfortable, clean and tidy home that promotes their wellbeing and independence. EVIDENCE: We wanted to find out what type of home and accommodation people live in. The information gathered from the self-assessment completed by the previous Acting Manager stated, ‘weekly maintenance list, regular health and safety checks, OT assessments and daily domestic staff employed to maintain hygiene’. We also received details of when the equipment such as hoists, heating, fire detections and electrical systems were last tested. The improvements made to the home included the better access, refurbishment of the kitchen, new cooker, radiators all covered and new curtains and bedding. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 24 Our observations confirmed this and showed the requirements made at the last key inspection have been addressed. The survey response received from the people using the service and relatives surveys all indicated the home was ‘fresh and clean’. The people using the service all said the home was clean and told us the house-keeper cleans the bedroom and the staff do their laundry. We saw the house-keeper cleaning the bedrooms individually. One person told us they “usually go to the lounge whilst the bedroom and the en-suite are cleaned”. The relatives we spoke with said “the home could do with freshening up, carpets and the decoration”. Another relative spoke about the long lounge that is ‘a thorough fare for staff’ and ‘the grass is not cut regularly as my father likes to sit out there’. However, the people using the service said they liked being in the lounge and seeing what people were doing and were able to move around the home, freely or with their zimmer frame or walking stick. The staff we spoke with also said the décor and carpeting could be improved in the home to benefit the people using the service. Staff gave us examples of how the patterned carpet affects one person who has dementia. They said, “…. sometimes steps over the patterns in the carpets, which they perceive to be a hole or an object”. We shared these comments with the Interim Acting Manager and the Quality Assurance and Development Manager. They told us there are plans to make improvements to the home and will make people aware nearer the time through the ‘residents and relatives meeting’. We were invited to see a number of bedrooms, which included a shared bedroom occupied by a couple. All the bedrooms have en-suite toilet facilities, on the ground and first floor and are close to toilets and bath/shower rooms on each floor. The upper floor is accessible by the passenger lift. All the bedrooms were individually decorated, had bedroom furniture and personalised. All areas of the home were clean, with ample lighting, warm and homely. We observed staff wearing protective clothing: gloves and aprons, when administering medication, serving meals and preparing to assist people with their personal care. Staff demonstrated a good understanding of infection control practices and the measures taken to prevent cross infection. Staff training records viewed confirmed staff have received training in health and safety and infection control. The laundry room located away from where the food is prepared. Staff said they now have laundry bags that they use to take people’s laundry to the laundry room. We read the monthly visit report conducted by the Quality Assurance and Development Manager on 21st October 2009 and the residents and relatives meeting minutes. There was evidence of people’s experience of the service with regards to the home environment and any concerns that need addressing. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the 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 who live at the home are protected and supported by robust staff recruitment and staff training that promotes their safety and well-being. EVIDENCE: We wanted to find out whether the staff recruitment process, the skill-mix and the staffing levels met the needs of the people who use the service. The information we gathered from the self-assessment stated, ‘there is a rigid recruitment procedures, staffing levels reflects the needs of residents, comprehensive staff training, supervision and team meetings’. The interaction of staff with the people who use the service, showed staff were knew the people who live at the home, individual routines, personalities and addressed them by their preferred name. Staff spoke politely and in a courteous manner. The people using the service spoke positively about the staff that worked at the home. The comments received were consistent with the comment received in the surveys, which included: “The girls are very good, they know me and how I am” Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 26 “Girls are very good and ….. is here too” “Cannot fault the care and help they give me” The majority of staff surveys indicated there was ‘usually enough staff on duty’. We looked at the staff rota showing there are a minimum of two staff on duty at all times. The Interim Acting Manager told us an extra member of staff is scheduled to work at busy times such as 10 – 1pm and 4pm to 9pm. This was also reflected in the staff rota. Staff told us this had been beneficial in meeting people’s needs promptly. This showed the management team recognised the need and made sure people’s needs are met promptly. Staff spoken with including the Chef, who was newly recruited, described the recruitment process they experienced and said pre-employment checks were carried out. This was consistent with the responses received in the staff surveys confirming staff were appointed after pre-employment checks were carried out. Staff told us ‘communication and team work was good’ and they were supported by the Interim Acting Manager. We looked at 3 staff files, all contained evidence of the pre-employment checks carried out. These included two satisfactory written references, criminal records bureau (crb) check and a protection of vulnerable adults (pova) check. These are checks to assess the suitability of the applicant to work with vulnerable people. The staff training records viewed showed staff had received induction training and a ranging of training for their job role. These included; food hygiene, moving and handling, , first aid, safeguarding adults, fire, nail care, medication awareness and administration, continence care, dementia awareness (3 day course) and one member of staff had attended the training on the Mental Capacity Act. Staff told us they receive regular training to keep their practice up to date with the current best practice and the comments received included: “I think we work well as a team” “Promotes staff training in all aspects” “Good team work” “All the important information is communicated verbally and in writing” Two staff we spoke with had attained the National Vocational Qualification (NVQ) level 2 in care and one was completing NVQ 3. The Quality Assurance and Development Manager was unable to provide us with the correct details of the number o staff with NVQ level 2 and the staff training programme on the day and was not received at the time of writing this report. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People using the 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 are consulted and protected by management systems, supervised staff and would benefit with a manager for the home. EVIDENCE: We wanted to find out whether the management of Ashbourne protects and promotes the well-being of people who use the service. The information we gathered from the self-assessment completed by the previous Acting Manager stated, ‘experienced manager, regular staff meetings and supervision, the manager and deputy attend the residents meeting and maintain residents financial records and communication’. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 28 Since the completion of the self-assessment we were notified that this Acting Manager left employment. The Interim Acting Manager and the Quality Assurance and Development Manager currently oversee the day-to-day management of the service, whilst an ‘acting manager’ is recruited. The Interim Acting Manager had already worked at Ashbourne as the Deputy Manager and was familiar to the people using the service and the staff. The staff told us they were happier and confident having the Interim Acting Manager working at the home until an ‘acting manager’ is appointed. Staff also said that they have ensured the people using the service have not been affected and provided stable environment with regular staff. The people using the service also acknowledged that they were aware of the changes in management but felt this had not affected them. A relative we spoke also felt the care their relative received was consistent but they did express concerns about the number of managers the service had in 3 years, which we shared with the Interim Acting Manager. We discussed with the Interim Acting Manager and the Quality Assurance and Development Manager the registration requirements for all health and social care services for the new Health and Social Care Act 2008, coming into force next year. Therefore, further highlights the importance of the service having a ‘Registered Manager’. At present, the service is in breach of the Care Standards Act 2000 whilst it has no ‘Registered Manager’ in post. We requested that a copy of the management and staff rota for Ashbourne is submitted to us (CQC) until further notice. This would show us how the service is managed whilst they appoint an ‘acting manager’. We wanted to find out how people using the service are consulted. The Interim Acting Manager told us there are monthly ‘residents and relatives meetings’ and the dates were displayed on the notice board in the lounge. The people using the service confirmed they do take part in these meetings. We read the minutes of the meeting held on 29.10.09, which showed the topics discussed including the Riverside Dance Show, care plans, interviewing of manager and deputy, new cook appointed, social activities and the Christmas Party. The two relatives told us they were aware of these meetings taking place, but one relative said they had not been invited to the recent meetings. We shared this comment with the Interim Acting Manager to address. The Quality Assurance and Development Manager told us that a quality assurance survey was completed in March 2009. They provided us with the report reflecting the positive experiences of the service and the action plan to address areas for improvement. We discussed with the Quality Assurance and Development Manager that some consideration should be made to making the report available to the people using the service, relatives and stakeholders. We also suggested that consideration should be made to measuring the outcome of the quality assurance against the ‘statement of purpose’. This would show if Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 29 people’s experiences and expectations of the service are consistent with what the service has stated as the aims and objectives. We read the monthly visit report, carried out by the Quality Assurance and Development Manager on behalf of the Responsible Individual on 21st October 2009. It demonstrated people who use the service were consulted; records were checked such as care files, menus, residents and staff meeting minutes and health and safety checks on the environment, safe storage of medicines and fire checks. The report was concluded with an action plan that was given to the Interim Acting Manager to address. We read a folder of the compliments received by the Ashbourne, in the form of cards, saying, “thank you for the care given to ..…. in her closing moments”. There was also a formal commendation from a Dietician, complimenting the care given to an individual using the service, ‘for the nutritional assessment, monitoring and the staff for the conduct and nutritional assessment’. The Interim Acting Manager showed us the documentation and described to us the system, where ‘spending money’ is held in safe-keeping for the people who use the service. The financial records we looked at clearly showed that people’s money held is managed with clear recording systems. The people using the service and the relatives we spoke with said, “I have enough money to pay for the chiropodist and the hairdresser” “If I need anything my daughter brings it in for me” “There is a system whereby my mother has enough money and if the account is getting low, very rarely, …… lets me know” “Mother doesn’t want for much but I like to make sure she doesn’t go without like having her hair done” The staff surveys received indicated staff receive support from the ‘manager’. The staff files contained supervision records and staff we spoke with also confirmed they receive timely supervision from the Interim Acting Manager and supervision meetings booked for the year. The dates for the staff meeting are displayed. Staff told us staff meetings had re-started since the Interim Acting Manager has been managing the service. We read the minutes of the meeting held on 21st October 2009. The topics discussed included the new manager and deputy, key worker, medication fridge, the waking and night cover. We concluded staff are supervised and kept informed on matters that affect them. The information we gathered from the self-assessment detailed the programme of routine maintenance, servicing and testing of equipment. We saw records of the fire tests and checks carried out on equipment in the home. People using the service said staff tell them when the fire alarm is being Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 30 tested. The monthly visits carried out on the home by a representative of the Responsible Individual also showed records and the home environment was checked. We received a copy of the letter sent by the Fire Officer to the home, following their inspection. The letter indicated the majority of the requirements had been addressed. The letter also identified new issues such as a lock on the door not working, missing door panel and door seals. A member of staff showed us around the home when we started the site visit and we checked these areas and found the repairs had been carried out. The Quality Assurance and Development Manager also sent to us following the site visit a copy of the ‘Emergency Light Testing’ certificate, which had not been completed at the time of the Fire Officer’s visit. One person, who has some visual and hearing difficulty told us they had spoken with the Fire Officer during the Fire Inspection and was told that they should have a fire door guard fitted on the door, as they like the door left open. We brought this to the attention of the Interim Acting Manager and within 2 hours a fire door guard was fitted to the bedroom door. Whilst the individual was impressed how quickly this was done it highlighted the need for risk assessment to be completed for everyone using the service. This assessment should consider providing suitable aids or equipment dependent upon individual health and disability that promotes their safety. The care plans read for the people we case tracked also reflected the safety measured staff should follow to ensure people’s safety. The Interim Acting Manager said the care plans and risk assessments would be reviewed on a monthly basis. The staff training records viewed should staff had received training in moving and handling, infection control, health and safety, which includes using equipment such as a hoist. This showed staff have been trained to ensure people’s need would be met safely and in line with current best practice. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 31 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 3 3 3 X 2 Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 32 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 OP31 Regulation 8 Requirement The registered person must appoint a suitably qualified and experienced person to the position of an ‘Acting Manager’ for the service. The details of the appointed Acting Manager and start date must be provided to CQC. This would ensure the service is managed and protects the people health, safety and wellbeing. Timescale for action 01/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The home’s Statement of Purpose and Service users Guide should be kept up-to-date to reflect the changes in the management of the service. DS0000070317.V378193.R01.S.doc Version 5.3 Page 33 Ashbourne 2 OP3 3 4 5 6 OP8 OP12 OP12 OP24 7 8 9 10 OP30 OP30 OP31 OP33 11 OP38 The assessment of needs should be reviewed and updated to take into account the ability and capacity of people to make decisions in accordance with the ‘Deprivation of Liberty’ and the ‘Mental Capacity Act 2005’. The records for any health care support and treatment provided are recorded to ensure people’s health and wellbeing is promoted. The home should consider recruiting a dedicated activities co-ordinator to engage and promote a range of social activities and entertainment at the home The home should consider offering a range of activities and stimulation to people who may be cared for in bed or prefer individual activities. The home should consider providing furnishing such as carpets that would promote the independence of people due to poor sight, cognitive impairment or dementia. In addition, should consider seeking information and advice for organisations that support and promote the needs of people with visual impairment and dementia. The home should work towards having all the staff trained to NVQ level 2 and above in care. There should be a staff training programme developed to support staff maintain their skill-mix, knowledge and practice in line with the current best practice. The Acting Manager should submit an application form to the CQC to become the ‘Registered Manager’ for the service. To consider: • Developing a report on the findings from the quality assurance survey that is shared with the people who use the service; and • Measuring the findings from the quality assurance survey against the statement of purpose to ensure people’s expectations and experiences of the service is consistent with the aims and objectives of the service. This would also assist in the review and updating of the statement of purpose. Assessments of risks should be completed to appropriate aids and adaptations are made for the safety of people who may have a sensory impairment to alert them any danger such as fire. Ashbourne DS0000070317.V378193.R01.S.doc Version 5.3 Page 34 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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