Care Home: Ashbourne House

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What the care home does well The standard of support and facilities continues to improve and the atmosphere in Ashbourne House was relaxed and welcoming. The manager continues to makes sure that information about the health and emotional needs of people is available to staff prior to admission, so that plans are in place to meet their needs and enable a successful move.The manager has maintained a good rapport with people receiving care and their relatives. Routine and specialist health monitoring is made available and specialist and routine health care is arranged so that people are as healthy and comfortable as possible. Monitoring of people`s social needs is effective and the manager is confident about contacting Social Services when needs begin to change. People at Ashbourne House are supported in achieving a good level of personal care and grooming. People at Ashbourne House are encouraged to make choices about the life they lead there. People at Ashbourne House have plenty to do so that they remain motivated, have good social interaction and learn new things. The meals at Ashbourne House are wholesome and enjoyed by the residents. The manager has developed a good rapport with people receiving care and support at the time of the inspection. Routine health care and checks are made available to service users, and specialist care is provided to a satisfactory level. Staff are provided with training opportunities so that they know how to do a good job. Generally, the owners and the manager do what the Commission for Social Care Inspection asks them to do in order to improve the outcomes for residents. People`s overall opinion of Ashbourne House can be summed by the following comments: `I have found the care home to be patient and sympathetic to the people in their care. My (relative) appears very happy here`; `We cater for all the clients` needs individually all staff work well together as part of a team.` And, `I am very happy with everything concerning my stay here.`Ashbourne HouseDS0000005486.V363727.R01.S.docVersion 5.2Page 7 What has improved since the last inspection? Since the last inspection the personal care for people living at Ashbourne House has improved further and we saw this. Since the last inspection a comprehensive programme of daily activities has been introduced for people to participate in, so they are better occupied during the day. Since the last inspection areas of the home have been refurbished and provide a comfortable environment for people living in the home. Since the last inspection staff training has been better organised so that the manager can be sure that staff are receiving the training opportunities they need to better support people. What the care home could do better: The service could improve if daily records clearly demonstrated that they related to the needs being met as laid down in people`s care plans. Medication administration would be safer if, when there is an option, for instance one or two, staff recorded the actual number or dose of medication given. The manager should make sure that the home`s adult protection is reviewed and this information is fully understood by all staff. The manager should make sure that people are aware of how their contribution to home`s quality monitoring system has influenced the development of the service. CARE HOMES FOR OLDER PEOPLE Ashbourne House 230 Lees New Road Oldham Lancashire OL4 5PP Lead Inspector Michelle Haller Unannounced Inspection 28th May 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbourne House Address 230 Lees New Road Oldham Lancashire OL4 5PP 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) 0161 624 1013 0161 665 2413 ashbourne230@tiscali.co.uk Werneth Lodge Limited Michelle Maylor Care Home 35 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (17), of places Physical disability over 65 years of age (4), Sensory impairment (4) Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 35 service users to include:*up to 17 services users in the category of OP (old age not falling within any other category); *up to 18 services users in the category of DE(E) (dementia over 65 years of age); *up to 4 service users in the category of PD(E) (physical disability over 65 years of age); *up to 4 service users in the category of SI(E) (sensory impairment over 65 years of age). 3rd January 2008 Date of last inspection Brief Description of the Service: Ashbourne House is a large detached property, set in it’s own grounds, located on the outskirts of Lees, approximately three miles from Oldham town centre. The home is registered to accommodate up to 35 people aged 65 years or above. The majority of rooms are single and have en-suite facilities. The home has three lounges a dining room and a room used for functions. Werneth Lodge Ltd owns the home. The home charges £360.00 per week. The previous CSCI inspection report is available in the lobby of the building. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection that included an unannounced visit to the service. This means the manager did not know in advance that we were coming to do an inspection. During the visit we looked around the building, talked to residents, relatives and staff, including the registered provider. We observed the interactions between people living at Ashbourne House and examined care plans, files and other records concerned with the care and support provided to people in the home. We also looked at all the information that we have received or asked for since the last inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how Ashbourne House has managed any complaints and any adult protection issues that may have arisen. What the manager has told us about things that have happened in the home through ‘notifications.’ We also received 19 Commission for Social Care Inspection (CSCI) surveys, which were returned to us by people using the service and from other people with an interest in the service, such as staff and relatives. Comments from the surveys have been used in the report. What the service does well: The standard of support and facilities continues to improve and the atmosphere in Ashbourne House was relaxed and welcoming. The manager continues to makes sure that information about the health and emotional needs of people is available to staff prior to admission, so that plans are in place to meet their needs and enable a successful move. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 6 The manager has maintained a good rapport with people receiving care and their relatives. Routine and specialist health monitoring is made available and specialist and routine health care is arranged so that people are as healthy and comfortable as possible. Monitoring of people’s social needs is effective and the manager is confident about contacting Social Services when needs begin to change. People at Ashbourne House are supported in achieving a good level of personal care and grooming. People at Ashbourne House are encouraged to make choices about the life they lead there. People at Ashbourne House have plenty to do so that they remain motivated, have good social interaction and learn new things. The meals at Ashbourne House are wholesome and enjoyed by the residents. The manager has developed a good rapport with people receiving care and support at the time of the inspection. Routine health care and checks are made available to service users, and specialist care is provided to a satisfactory level. Staff are provided with training opportunities so that they know how to do a good job. Generally, the owners and the manager do what the Commission for Social Care Inspection asks them to do in order to improve the outcomes for residents. People’s overall opinion of Ashbourne House can be summed by the following comments: ‘I have found the care home to be patient and sympathetic to the people in their care. My (relative) appears very happy here’; ‘We cater for all the clients’ needs individually all staff work well together as part of a team.’ And, ‘I am very happy with everything concerning my stay here.’ Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 8 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 House DS0000005486.V363727.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 standard 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People have their needs assessed before moving into Ashbourne House, this means that they benefit from support that is arranged before they arrive and provided as soon as they move in. EVIDENCE: We found that the manager understood the importance of pre-admission assessment, and made sure that assessments about people’s needs were carried out before or, in the case of emergencies, very soon after they began to live at Ashbourne House. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 10 We examined five care files and all held a detailed assessment outlining, health, social and psychological needs. The notes made by the manager following a pre-admission visit were read. These records confirmed that the manager had assessed the additional specialist input that was required to meet health for this person if they were to move into the home. It was noted that, when dated, assessments were dated prior to the date of admission recorded by the home. People are encouraged to visit the home when they can; the manager stated in the AQAA that ‘We give the client opportunity to come and spend the day with us and have a meal or just to look around.’ The residents who returned surveys all felt that they or their family had been confident that the home could meet their needs before admission. One wrote: ‘‘Michelle (registered manager) came to see me.’’ Each file held a contract signed by the person or their relative on or near admission, such as charges. Seven members of staff returned CSCI surveys and six felt that they received enough information in order to meet people’s needs. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at Ashbourne House receive health and personal care that is responsive to their individual needs in a manner that promotes good wellbeing. EVIDENCE: We examined the information held in care files, care plans and other records for five people. There was a lot of information available about each person’s care needs. Notes and updates confirmed that these had been reviewed monthly. Each file held a document with the title ‘care plan’. This document did not always have all the information that staff needed to meet all needs, the document highlights the same needs for everyone, and the manager or person developing the care plans then makes relevant additions, as identified during initial and ongoing assessments. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 12 When this was discussed with the manager, she said that all documents containing information about people’s needs are the ‘care plan’. In this case, the manager should consider simplifying some of this documentation so that staff can easily find all the information they need they need about day to day support needs. The daily records for some people were read through. These were written with respect and showed that staff cared about the comfort of people living at Ashbourne House. The information in the daily records did not always fully relate to the person’s care plan or confirm that issues had been managed in keeping with the care plan. Other evidence, however, such as the key worker weekly checklist report, the monthly care plan update, notes from general practitioner visits, discussion with service users and observations during the day confirmed that care plans were followed and appropriate health care provided. Other documents and correspondence that confirmed that appropriate health monitoring and care was provided included letters, notes confirming telephone referrals, bathing check lists, weight records, and prescriptions from the general practitioner and opticians. Risk assessments were in place for falls, the effect of diabetes and to monitor skin integrity. These were read through and assessed as providing staff with clear information about the actions they must take to keep people safe and promote their independence. People funded through Social Services have a yearly review and records of attendance showed that residents were encouraged to participate. There was also evidence that the manager contacts the Social Services department for a reassessment if it is apparent that a person’s needs change before a review is due. During the inspection a district nurse visited the home, she had a good rapport with the staff and people were seen in the privacy of their own rooms. Throughout the day it was observed that staff related to people in a positive and professional manner. Things were explained to people and permission was asked before any procedures, such as moving and handling, commenced. The staff dealt with people calmly and they were friendly and encouraging at all times. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 13 People at Ashbourne House were supported to achieve a high level of personal grooming and were well presented. People’s clothes were well laundered and ironed. Men were shaved neatly. People’s hair looked clean and combed. No one had matted hair. Personal items, such as slippers and spectacles, were clean and clothes were colour co-ordinated. People looked cared for. Many people wore outdoor shoes and, at times, it was difficult to tell people living at the home from those who were visiting. Each person has provided the home with information for a ‘preference’ checklist, which includes information about bathing personal care, such as a preference for baths or showers, and how frequently these should occur. It was found that the staff are flexible as people said they could have a bath or shower when they wanted. The medication records were examined and there were no unexplained gaps. The manager needs to make sure that staff record the number of tablets given when the prescription states ‘one or two’. The guidance for the management of controlled medication was checked, and two carers administer this medication. The training calendar and corresponding certificates confirmed that staff who handle medication had received training between January 2007 and April 2008. Staff have also received training concerning skin care and dealing with small wounds. People who returned surveys said: ‘They see you get the right medication’. People interviewed on the day of inspection said: ‘They keep a good check and don’t let things carry on - they’ll go back to the doctor time and again if necessary’ and ‘Yes they get the doctor.’ One person also explained that routine operations had been arranged for her relative living at Ashbourne. This shows that people living at Ashbourne House are able to access ‘non-emergency’ health care that will improve their quality of life. Other relatives felt that the care provided in the home had helped their relative to improve in all aspects of life - ‘She is walking now, able to speak more and is taking an interest in what is going on.’ In the main, staff felt that communication was good, their opinion is summed up in this comment: ‘We have change over at the beginning of each shift and staff always able to discuss things with their manager.’ Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. People at Ashbourne House are able to experience a stimulating lifestyle through access to a variety of activities and events that they enjoy, and nourished by food that they like. EVIDENCE: The activities calendar for May 2008 showed that a variety of activities had been facilitated,including: an exercise club, craft classes, birthday celebrations, visits to a garden centre and gardening at Ashbourne House, quizzes, karaoke nights, themed film nights, lunches out and visits to the pub and local places of interest, such as museums. In addition to this, people are able go out with staff to the local shops and entertainers are brought in. People are also encouraged to try new things, such as making ‘smoothies’ (drinks made of pulped fruit) or cheese and wine tasting. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 15 There were pictures on display of people enjoying activities that had occurred since the previous inspection. These pictures showed that the activities on offer were varied enough to attract different people, so that people did not feel left out. Celebrations and activities recorded by photograph included the meal out for Christmas 2007, St Patrick’s Day, Easter and St George’s Day celebrations 2008. Staff recorded in the activities folder and daily record those who had participated in an activity. During the inspection people were heard recounting events they had enjoyed in previous weeks. They also discussed future activities and events. Near the entrance to the home there is a display table with pictures and reminiscence items, such as grocery cartons and bottles, historical photographs of the local area and coins. All staff have a responsibility for organising the activities that have been planned. Although it is acknowledged that people have different strengths. On the day of inspection staff organised a card game using large playing cards, which was enjoyed, and, after tea, a karaoke was organised. People said that they enjoyed the evening activities, as this helped to ‘pass the time’. It was observed that staff also sat and talked to people. Newspapers are delivered to the home. There is also a shop where people can buy small items, including birthday cards for their relatives. People are able to join in a Christian act of worship that is organised at Ashbourne House. People said that this was enjoyable. All respondents confirmed that there were activities in which they could participate if they wanted; people said: ‘I like the trips out to the pub. We have a good time.’ A relative also noted ‘They always celebrate birthdays - I think it’s nice, even if the person is confused the staff make an effort to celebrate.’ Discussion with the manager and notes in daily records confirmed that, where possible, residents are encouraged to participate in the lives of their family through giving presents and cards. This is important because it helps to maintain a sense of self-worth, status and pride, in being able to continue to contribute in family life. People said that they could receive visitors freely; comments included: ‘Yes I can have visitors any time but they have to check in case I’m going out.’ Relatives who returned surveys all confirmed that they could keep in touch without any problems and a person who was interviewed said: ‘They are always nice with visitors when they come in.’ Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 16 The dining area at Ashbourne House is clean and tables were set with tablecloths, flowers and condiments, the tables and chairs were clean. There is enough space in the dining room for all people to eat their meals together. The breakfast menu on the day of inspection was cereal followed by poached eggs on toast. The midday meal was casserole, cabbage and mashed potatoes, or fish fingers. Followed by rhubarb crumble and custard. Staff asked people what they wanted for lunch on the day. It was observed that if people did not want what was offered, an additional alternative would be suggested. The main meal of the day is served at about 12 midday. This was observed for a short period. The meal looked appetising and people were seen enjoying the food. If people needed to use a bowl and spoon to maintain their independence and dignity, this was provided. Staff asked permission and explained what they were doing before assisting. The menu for four weeks was looked at as a part of the inspection. Dishes include cheese and onion pie, shepherds pie, roast meats, casseroles and stews, fish dishes, pies and puddings; dessert included milk puddings, cakes, tarts and pies. Fresh fruit was readily available in the home and there was a stock of fresh fruit and vegetables in the larder. People were very complimentary about the food and discussed with the manager the fresh fruit they had recently enjoyed. This included a smoothie making party that involved pulping large quantities of fruit and making it into drinks. All who returned CSCI surveys confirmed that they always enjoyed the food. Comments included: ‘I love to eat them’; ‘Nice variation and wholesome’ and ‘I am very happy and all meals are good’. The person who required a special diet felt that the meals were ‘good’. The weight of the people who were case tracked had been recorded monthly. People whose weight was checked had maintained a stable weight since admission to the home. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at Ashbourne House know how to complain and are confident that they are listened to and staff are made aware of the actions they must take to keep people safe from harm. EVIDENCE: The complaints record was discussed. One complaint had been recorded since the previous inspection. The notes confirmed that this had been fully investigated with Social Services and that action had been taken to resolve the situation. People who returned CSCI surveys confirmed that they always knew who to speak to if they were unhappy. No-one who was spoken to or who returned surveys said they had made official complaints. Comments included: ‘if it’s possible they put things right your request is always seen to’ and ‘I have no complaints about this place it’s smashing, if I had anything I would tell.’ The home’s adult protection policy and guidelines are detailed and in line with those developed by the local authority. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 18 No safeguarding investigations have been carried out at Ashbourne House since the previous inspection. We found that the training records and certificates on display confirmed that the majority of staff, including the cook and domestic, have received protection of vulnerable adult training within the last two years. The manager also said that she uses videos and questionnaires to remind staff of their responsibilities in relation to adult protection. According to the training records, the majority of staff have also achieved National Vocational Qualification (NVQ) level 2 in care. The NVQ trainer who visited Ashbourne on the day of inspection confirmed that adult protection is a compulsory unit on this course. Discussion with staff confirmed that they were clear about the actions required if they witnessed abuse involving staff or visitors to the home, they described the home’s whistle-blowing protocol, and said they felt confident about contacting outside agencies in order to safeguard residents if need be. When questioned about safeguarding issues between residents, staff were able to describe techniques that they would use to defuse situations and were aware that people needed to be made safe, but they were less clear about recording and reporting incidents. This was discussed with the manager who said that she was currently updating this policy. It is was clear to staff the behaviours between residents that must be treated seriously, recorded and reported to senior staff so that they can prevented. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Ashbourne House is clean and free from unpleasant odours and provides a homely and accessible place for people to live. EVIDENCE: The inspection process included a tour of the communal and private areas. Since the last inspection some new cleaning equipment has been purchased for the home and the rooms facing the front of the building have been fitted with blinds. During the tour it was observed that of the exterior of the building and grounds were well maintained. The garden areas were tidy and accessible to residents who now enjoy a gardening club. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 20 There are two non-smoking lounges and one smoking lounge which are fully accessible to people living at Ashbourne House. The majority of bedrooms have en-suite facilities. In addition, there are toilets, washbasins and specialist bathing facilities on each floor of the property. All the bedrooms entered were cosy and homely, people had been able to make them personal through putting up pictures and photos. Ornaments and furniture from home were also in place. People who were interviewed were satisfied with their rooms, which had been personalised with their own belongings. People were observed moving freely and safely around the home both independently or using walking sticks, walking frames and handrails. A cleaning roster is in place. The carpets and furniture looked clean and free from stains. The there were no offensive odours. The home uses a sanitizer machine that cleans and purifies the air. Staff were observed cleaning all the chairs and tables in the dining room once breakfast had been served. They did the same in the main lounge while people were having lunch. Staff were observed using infection control measures, such as wearing aprons and washing hands before dealing with food. People who returned surveys said that the home was almost always fresh and clean. Comments about the environment included: ‘Very satisfactory’. People interviewed on the day of inspection said ‘It’s clean and comfortable.’ Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The staff at Ashbourne House are well-trained and supervised and are available in sufficient numbers to support people successfully. EVIDENCE: On the day of inspection there were 27 people living at Ashbourne House and the staffing level for the morning was seven in total, comprising of the manager, four care staff, a cook and a domestic. The atmosphere on the day of inspection was relaxed and unhurried. Staff were observed spending time sitting and talking with people; they also organised games and activities. The manager allocates staff to residents using a keyworker system. This has proved effective in making sure that people have the same opportunities to experience support that is individual and personal to them. Residents who returned CSCI surveys felt that there were almost always sufficient staff on duty to meet their needs. One person commented that there were ‘Always staff on hand’. Staff who returned surveys also felt that there was almost ‘always’ enough staff on duty. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 22 During the tour of the building a call-bell was activated and a member of staff calmly responded within 30 seconds. Relatives said that they found staff to be ‘very efficient’. The training record showed that every member of staff had completed at least one course pertaining to their area of work since the previous inspection and 18 of the 21 staff employed have achieved NVQ level 2 or above. The training record and certificates confirmed that, since the last inspection, staff have completed the following training: manual handling facilitators and refresher courses; first aid; dementia care; National Vocational Qualification (NVQ) in care levels 2, 3 and 4; Malnutrition awareness (MUST) training; skin care; health and safety; medication handling and infection control. The observation of staff practice in respect of moving and handling, distribution of medication and infection control demonstrated that this training was having a positive effect on practice. Staff were pleasant, friendly and kind towards people. One person said ‘The carers are nice, nobody shouts at me.’ The majority of staff who returned surveys said that the training prepared them for the work they did. Staff were very complimentary and content with the training opportunities; they said: ‘I feel that my induction was very helpful and all of my questions where answered fully’ and ‘Any training which I feel is helpful to my job, I have been able to enrol on with no problems.’ The NVQ independent assessor from Oldham College was interviewed. She was complimentary about the way the home encouraged and supported staff through attaining their NVQ’s. She also assessed that staff from Ashbourne House usually started their courses with a good foundation of knowledge about social care. Three staff files were examined and it was noted that evidence of Criminal Record Bureau Checks(CRB) (numbers) were available, the start date for each person was available and evidence that two references and proof of identification were in place for each. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The management of Ashbourne House aims to be open and accessible; a quality assurance system is in place and people living at the home make a contribution and their views influence how the home is run. EVIDENCE: The manager stated that she has completed the Registered Manager’s Award and is waiting for her certificate. She also said that she is due to begin NVQ level 4 in care. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 24 The manager stated, in relation to service users’ money, that people were given receipts for all transactions, and that individual balances were recorded and the books were audited by the registered provider. People involved in the home were complimentary about the management of the home and feel that they are listened to. The manager holds resident meetings and staff meetings. Topics discussed included the menu, possible activities, issues regarding the laundry of clothes. All staff who returned CSCI surveys confirmed that the manager regularly met with them to discuss important issues and how they could improve what happened in the home. The staff were proud of their achievements and felt they provided an effective service, comments included: ‘I feel we provide a home from home environment – we are friendly and approachable, I feel that both service users and their friends and family are very comfortable with staff - and we are like a big family. I feel we provide all the support and have plenty for our service users to spend the days doing to ensure we give them the best quality of life possible. I am very happy in my job and place of work and feel I get 100 satisfaction.’ The home uses a questionnaire for its quality monitoring. Those completed in 2007 were discussed with the manager and registered provider. The questionnaires provided useful information about how people felt about the living in the home, including how they were treated, food, activities, the conduct of staff and the environment. The manager was able to give verbal feedback about the action taken in response to this information. This could be improved if the manager analysed the information received and if people were informed about the outcome of the quality monitoring exercise. The manager provided dates confirming that all appliances and equipment had been maintained and serviced in keeping with the recommendation of the manufacturer or relevant regulatory body. The stickers on equipment seen during the tour of the building confirmed that this information was accurate in respect of fire safety equipment and small electrical items. An area for improvement is that the manager needs to become more analytical about the running of the home. This will help her to identify and plan how the service can offer improved outcomes for people. Comments from staff concerning the good things about Ashbourne included: ‘The service works well because all the staff work as a team and understand what goes on each shift, also meets the needs of all client.’ Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 25 Residents and their relatives were also happy with the running of the home and said: ‘Everything, (is done) level of care excellent, my grandma is always clean, fed and always looks smart. Her room is always clean and tidy and staff are always lovely’, ‘I think they’re brilliant’ and ‘I’m happy that mum’s happy considering that she always said she‘d never go in a home. But she really is happy.’ Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 26 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP9 OP18 OP33 Good Practice Recommendations The registered person should make sure that daily records confirm that staff have completed the instructions detailed in people’s care plans. The registered person should make sure that staff record the actual amount of medication they administer to people. The manager should ensure that staff are made fully aware of the home’s updated safeguarding adults guidelines. The manager should make sure that she can show how the home’s quality monitoring system has influenced the development of the service. Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Area Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashbourne House DS0000005486.V363727.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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