Care Home: Ashbourne House

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What the care home does well Ashborne House offers a "family" environment where individuals receive care of a good quality with staff who are clearly committed to the work they do. There is a real sense of staff knowing the people that live in the home as individuals. A positive is the continuity of care from a stable staff group. Individuals we spoke with told us "I am very lucky to find such a caring home" "its an amazing place to be always a lovely atmosphere" "made me feel at home since I came here to live". In talking with the manager it was evident that there is a real effort to provide care to individuals who have at times changing care needs and where ever possible continue to provide care and avoid individuals having to move to nursing or hospital care at the end of their lives. There are good systems in place in terms of care planning and information about individuals needs and this is improving with an emphasis on care being more person centered. Staff clearly work well together and individuals we spoke with were very positive about the approach and support staff provide "staff very very good, all very kind" "they treat me as I would want and respect me" "we are given excellent care at all times". What has improved since the last inspection? We did not make any requirements at our last inspection. What the care home could do better: We have made a number of requirements as a result of this inspection. The home needs to improve it care planning through the use of assessment tools relating to diet, nutrition and skin integrity. This too reflect the changing and increasing care needs of individuals who live in the home and increased frailty of those coming to live in care homes. Risk assessments must be completed for all individuals around risks of falls and personal environment. These should identify the level of risk and ways of possibly alleviating the identified risk. To reflect individual needs and record those needs individuals should have as part of their care plan health record showing any health intervention. There must be night time care plans to outline where individuals need support during the night time. This will also provide evidence that the night time period staffing arrangements meet the needs of individuals living in the home. With regard to medication arrangements any changes recorded on administering records must be signed by the individual making the change (wherever possible the GP) or staff member. This would then provide a audit trial for this change. A returns book must be in place to evidence the returning of medication. With regard to records the home must improve the quality of its record keeping specifically daily records. These must be completed on a regular basis at a minimum weekly to evidence care provided and other events in the individuals life. Their presentation must be of a professional standard. Key inspection report Care homes for older people Name: Address: Ashbourne House 2 Henleaze Road Durdham Down Bristol BS9 4EX     The quality rating for this care home is:   two star good 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: John Clarke     Date: 0 7 1 0 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: Ashbourne House 2 Henleaze Road Durdham Down Bristol BS9 4EX 01179628081 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ashbourne House Care Homes Limited care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Ashbourne House is a listed Georgian property, which is situated opposite the Downs in Bristol. It is registered to provide accommodation and personal care for up to 17 people who are 65 years and over. The house is close to local facilities and amenities, including public transport. The premises are over three floors, all of which are accessible by a lift. Some of the bedrooms have en suite facilities. The communal areas consist of a lounge and dining room, which are located on the ground floor. Whilst there are some aids and adaptations throughout the premises, the home is not purpose built and as such has some limitations. The house is not ideally suited for people who use a wheelchair. The cost per week to reside at Ashbourne House ranges from #359.00 to #445.00. Fees are reviewed annually. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities Care Homes for Older People Page 4 of 25 Over 65 17 0 Brief description of the care home available at the home. 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: two star good 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: This was an unannounced visit to the home as part of our inspection. During our visit we looked at records relating to the quality of care provided at Ashbourne House. These included assessments, care plans, daily records, staff recruitment and training, health and safety. We also looked at the the arrangements for managing and administering of medication in the home. During our visit to the home there was an opportunity to talk with a number of individuals who live in the home and members of staff. We also received responses from 5 individuals living in the home and 6 members of staff to our Have Your say questionnaire. Care Homes for Older People Page 6 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. Care Homes for Older People Page 7 of 25 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. The home undertakes assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. Evidence: We looked at a number of assessments which the home has received as part of the admission information for those individuals. They included the health and social care needs of the individual. thre was additional information which has the home has obtained from the individual specifically about the daily routines, likes and dislikes of the individual. Care Homes for Older People Page 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of individuals are met. However there are areas where improvement would lead to better monitoring and protection of individuals health and welfare. Arrangements for managing medication are generally good and make sure that individuals health needs are protected however there are areas for improvement which would ensure greater protection of individuals health and welfare. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. Evidence: We looked at a number of care plans for individuals living in the home. we found that there was good information about the care needs including daily routines for personal care, mobility. Moving and handling assessments had been completed as had risk assessments. However for one individual who had history of falls there was no falls or environment risk assessment. For another there was a risk assessment about their Care Homes for Older People Page 11 of 25 Evidence: diabetes though there was no written guidance about how to response to hypo or hyper attacks. We spoke to staff about about what they would do if this individual had low sugar level and they were accurately able to tell us the actions they would take. The care plans we looked at had all been reviewed monthly by the keyworker and in addition the manager holds reviews. There were no Health records, dietary or nutritional assessments. The home has no waking night staff and there were no night time care plans. There was limited information about the personal history and circumstances of the individuals however the manager told us this was an area they were improving and some care plans now included this information. We looked at the arrangements for the management of medication in the home. Administering records for a period of four weeks were examined and we found no gaps in recording. However there were handwritten changes to the record and these had not been signed by a staff member. At present there are no individuals who require control drugs we advised the manager of the need to have a controlled drug cupboard installed. There was no record of medication returned to the pharmacist and there was a substantial amount of medication which was not being stored or administer from a blister pack. We advised the manager to discuss this with the pharmacist. We examined eye drops which were being administer to an individual there were 3 opened bottles none of which had the date of opening. This medication has limited life once opened. Records such as daily records showed that individuals have access to community health services such as nurses, chiropody and dentist as required. We received 5 responses to our Have Your Say questionnaire from individuals living in the home and all said they always receive the medical care they need. We spoke with one individual who told us that they can see the doctor whenever I wish I only have to ask. Care Homes for Older People Page 12 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. The arrangements for meeting the social and recreational needs of individuals who live in the home are good and there are opportunities to maintain links with family, friends and the local community. The homes practice and routines are flexible and enable individuals to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. Evidence: We spoke with a number of individuals living in the home and they told us there was enough activities taking place. One person said staff are very good at keeping us entertained. On the day we visited there was exercise activity taking place. Other activities arranged in the home include bingo, outside entertainer, cards. One individual told us in their questionnaire response a few more outings and it would be good to have something to do after tea like a quiz. All of the respondents to our questionnaire said that the home always arranges activities I can take part in if I want. Individuals we spoke with all said they can have visitors whenever we want and the home is very friendly staff always make my family feel welcome. We also spoke with a relative who was visiting the home and they told us the home was very welcoming and how the home always keeps in touch about how his relative is staff Care Homes for Older People Page 13 of 25 Evidence: always sit and have a chat about how they are. We spoke to a number of individuals about their daily routines particularly about their ability to make choices. They told us it was up to us and one individual who spent alot of time in her room told us its not a problem its my choice. We asked another individual if they could choose when to go to bed and get up and they told us the staff are very good and I can always say if I dont wont to get up. We asked individuals about the meals in the home: the food is very good theres always a choice and they will get me anything I fancy. Individuals who responded to our questionnaire said they always like the meals in the home. On the day of our visit the meal was well presented and looked appetizing. There was a relaxed unhurried atmosphere and staff were available to assist individuals if this was needed. Care Homes for Older People Page 14 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 clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. Evidence: We spoke with individuals about what they would do if they had any concerns or were unhappy about anything. They told us they would speak to the manager who they said would listen to us and feel safe to talk to her about anything. They also told us that all the staff were people they could talk with about anything. They told us that they knew they could make a complaint if they wished and those that responded to our questionnaire said they knew how to make a formal complaint. The home has not received any complaints since we last inspected the home and we have not received any concerns or complaints about the service they provide. The home has Safeguarding procedures in place and staff receive Safeguarding training. we spoke with staff and they were very clear they would definitely do something tell the manager or inform CQC if they had worries about possible abuse. Care Homes for Older People Page 15 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. The home provides a safe and hygienic environment for people who live in the home and staff members. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. Evidence: In looking around the home it was noted that there is generally a good standard of decoration and the home is well maintained. Individuals told us that the home is always clean and tidy and one told us its very well kept. Since our last inspection the dining room has been re-decorated and is now a bright and inviting room. There is on going decoration of individuals rooms. With regard to equipment it was noted that there is no equipment available for staff to assist individuals who may have fallen on the floor. Other facilities are available including assisted baths. The home has infection control procedure in place and provides protective clothing where this is needed. We spoke with staff about what their practice was to protect individuals from cross infection. They were able to tell us about measures they would take including the use of hand wash, gloves and protective clothing and routines to protect individuals such as barrier nursing and safe disposal of possible contaminated clothing. Care Homes for Older People Page 16 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. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. Evidence: There are two care staff on duty at all times with two sleep-in and staffing rota confirmed this is the normal arrangement. As noted in our previous inspection the home has no waking night staff and in talking with individuals they confirmed they did not need help during the nighttime period. Individuals told us I get the care I need..definitely if ever I want anything its there. All of the respondents to our questionnaire said they receive the care they need. We looked at the recruitment and selection records for a member of staff and found that the necessary checks had taken place. A Criminal Record Bureau check had been obtained as well as POVA1st, two references had been received. It is noted that the home has a good record of retaining staff over a number of years. Training records for three members of staff showed that they had completed the mandatory training: moving and handling, Safeguarding, First Aid, and health and safety. It was noted that for a number of staff they will need to undertake refresher Care Homes for Older People Page 17 of 25 Evidence: moving and handling in the next 12 months. Staff have also undertaken End of Life Care, Dementia training. No staff have completed Mental Capacity Act training. Over 50 of staff have NVQ professional qualification. Staff told us they do all the training we need. Staff who responded to our questionnaire said they receive the training relevant to their role and helps them to understand and meet the individual needs of people. One staff member commented excellent management who provide above all the best training and advice needed. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for individuals who live in the home and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected. Evidence: The manager has had extensive experience of working in a care home for older people and has managed Ashbourne House for eleven years. She has NVQ 4 Registered Managers Award. Individuals we spoke with were all very positive about her approach and the support they receive: can always talk to her about anything very supportive and approachable very hands on any questions we can always ask(staff members). In looking at daily records it was noted that these were not completed on a regular basis and there were significant period of up to 3 weeks where no entries had been made. They were in the inspectors view not completed in a tidy and professional manner and some entries were eligible. Care Homes for Older People Page 19 of 25 Evidence: Individuals who live in the home complete questionaires about the care they receive and these were looked at and responses were positive and illustrated satisfaction with the care provided. Health and Safety records were looked at relating to fire drills, equipment tests and servicing of equipment. These all take place as required and all staff have undertaken fire drills. Environmental Health visited the home and awarded 5stars for food hgeine practice. Care Homes for Older People Page 20 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 21 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 13 The registered manager shall make sure that unnecessary risks to the health and safety of individuals living in the home are identified and so far as possible eliminated. This refers to undertaking risk assessments in realtion to risk of falls and individuals environment (accommadation) 30/11/2009 2 7 12 The registered manager to make sure that the care home is conducted so as to promote and make proper provision for the health and welfare of individuals living in the home. This refers to the need to include health records and use assessment and monitoring tools associated with dietary and nutritional needs. (MUST) 01/11/2009 Care Homes for Older People Page 22 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 3 9 2 The registered manager 30/11/2009 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines in the home. This refers to the need to record date of opening of medication where there is limited lifespan once said medication is opened. Further to make sure any changes handwritten on administering records are signed by the staff member recording the change. There must be suitable secure storage for controlled drugs. 4 22 23 The registered manager shall make sure there is such equipment as may be required are provided for individuals living in the home. This refers to the need to have equipment to safely assist individuals from the fall if they have had a fall. 30/11/2009 5 30 18 The manager to make sure that persons employed to work at the care home receive training appropriate to the work they are to perform. 29/01/2010 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 This relates to all staff and manager to undertake Mental Capacity Act and Deprivation of Liberty (DOLS) training. 6 37 17 The registered manager 02/11/2009 shall make sure that records are maintained and are kept up to date. This refers to the completing of daily records of events and well being, care provided, on a regular basis. They must be eligible and professional in their presentation reflecting the fact that they are evidence of all aspects of care provided in the home and could be seen as legal documents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 In the event individuals require controlled drugs a controlled drug register is used to record the administer of this medication. Staff to undertake training about the care of older people specifically around physical health such as Stroke, Parkinsons, Mental Health Awareness. 2 30 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. 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