Care Home: Ashbourne House

What the care home does well Residents were complementary about the care and support they receive and the skills and personalities of staff. During this visit there was a relaxed and informal atmosphere, and residents appeared settled in their environment. People who were spoken to spoke highly of the staff team, and the way in which they supported them. Staff were observed as they engaged in meaningful conversations with residents, and where appropriate, they offered support and reassurance in a sensitive and caring manner. The environment was well laid out, providing several places for people to sit and relax. Encouragement is given to people to develop and maintain relationships with family and friends, and to be involved in the local community. This provides residents with a feeling of self-worth and belonging. Residents benefit by receiving care and support from a staff team that receive appropriate training to assist them in carrying out their duties. There are procedures in place that enable people using the service to make their views known, and there are policies and procedures to protect these people from abuse. People using the service said they felt confident in expressing their views, and in talking to the manager and staff about any concerns or complaints. Residents feel well supported by staff who know what they like, and understand their needs. Staff have the skills and training they need to support service users. Residents are involved in planning the support they need and are encouraged to decide their routines and choices. What has improved since the last inspection? The manager has introduced a new monitored dosage medication system which provides improved accuracy and accountability of the medication administered to residents. The home has obtained four star recognition in Stockports` scores on the doors scheme for food safety. The food safety award demonstrated excellent standards of food safety and hygiene throughout the year. Supper time menus have been further developed and an increased variety of snacks are available to residents at supper time. The garden has been refurbished and redesigned since our last visit with private seating in differing areas of the garden and a water feature and seasonal planting. An automated sun shield has been installed which covers the patio seating area. This provides residents with sheltered seating and promotes there comfort. The downstairs toilet has also been refurbished and new high level toilets have been installed to promote residents abilities.NVQ training is still high on the managers agenda with most of the staff having obtained the qualification or are working towards this. This ensures staff have the skills and knowledge they need to care for residents well. The manager has been successful in obtaining the registered managers award and the ongoing training and research undertaken at the home keeps him up to date with changing legislation and best practice. What the care home could do better: Good practice recommendations have been made on this inspection. There are no requirements as a result of this inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashbourne House 147/149 Gatley Road Gatley Stockport Cheshire SK8 4PD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jacqueline Kelly     Date: 2 0 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Ashbourne House 147/149 Gatley Road Gatley Stockport Cheshire SK8 4PD 01614911201 01614911201 ashbournehouse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Casequest Limited care home 23 Number of places (if applicable): Under 65 Over 65 23 old age, not falling within any other category Additional conditions: 0 The registered person 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 to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 23 Date of last inspection Brief description of the care home Ashbourne House is a care home for twenty-three older people, situated close to Gatley village. Public transport and the motorway network are within easy reach of the home. The accommodation within the home consists of nineteen single and two shared bedrooms. There are four domestic size lounges and a large dining room. The fourth lounge is used as a reading/visiting room and has no television. There is a loop system available for residents who are hearing impaired. The dining room overlooks a wellestablished, enclosed garden where garden furniture is available for residents and their Care Homes for Older People Page 4 of 29 Brief description of the care home visitors. The home provides a small, domestic sized kitchen in addition to the central kitchen, which is available for residents and their visitors to make hot drinks. There is a multi-purpose function room for hairdressing, chiropody and other consultations. The hairdresser visits the home on a weekly basis. Within the same room there is a public telephone available to residents. The weekly cost of residential care at Ashbourne House is 400 pounds a week per week. Hairdressing, private chiropody and newspapers are not included in the price. For those residents who are funded by social services there is a top up fee. An information pack is given to all prospective residents and a copy of the inspection report is available on request. The home has achieved the Investors in People Award. Care Homes for Older People Page 5 of 29 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 visit was unannounced, which means that the manager, staff and residents were not told that we would be visiting, and took place on 20th May 2009 commencing at 8:50am. The manager was available on the visit. The manager provided us with a lot of detail, information and support during the visit in addition to the support from staff and residents. The manager has a wealth of knowledge about residents and their needs and support. The inspection of Ashbourne House included a look at all available information received by the Care Quality Commission (CQC) about the service since the last inspection. Care Homes for Older People Page 6 of 29 We looked at the Annual Service Review (ASR) that was carried out on 1st May 2008. This is a review of good and excellent services that takes place between key inspections. Good services only have an inspection every two years and excellent services every three years. At that time we found no evidence to suggest that our quality rating had changed or that we needed to bring the inspection forward. We also sent Ashbourne House a form before this visit for them to complete and tell us what they thought they did well, and what they need to improve on. We considered the responses and information the manager of Ashbourne House provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). Ashbourne House was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to people staying and working at Ashbourne House, the views expressed in returned comment cards and those given directly to the inspector are included in this report. We got our information at the visit by observing care practices, talking with people staying at Ashbourne House, talking with the manager and staff. A tour of Ashbourne House was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Ashbourne House was meeting the needs of residents and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to two residents was looked at in detail to help form an opinion of the quality of the care provided. The term preferred by people consulted during the visit was residents. This term is, therefore, used throughout the report when referring to people living at Ashbourne House. A brief explanation of the inspection process was provided to the manager at the beginning of the visit and time was spent at the end of the visit, again with the manager to provide verbal feedback. We have received no complaints about this service or had any safeguarding referrals. What the care home does well: What has improved since the last inspection? The manager has introduced a new monitored dosage medication system which provides improved accuracy and accountability of the medication administered to residents. The home has obtained four star recognition in Stockports scores on the doors scheme for food safety. The food safety award demonstrated excellent standards of food safety and hygiene throughout the year. Supper time menus have been further developed and an increased variety of snacks are available to residents at supper time. The garden has been refurbished and redesigned since our last visit with private seating in differing areas of the garden and a water feature and seasonal planting. An automated sun shield has been installed which covers the patio seating area. This provides residents with sheltered seating and promotes there comfort. The downstairs toilet has also been refurbished and new high level toilets have been installed to promote residents abilities. Care Homes for Older People Page 8 of 29 NVQ training is still high on the managers agenda with most of the staff having obtained the qualification or are working towards this. This ensures staff have the skills and knowledge they need to care for residents well. The manager has been successful in obtaining the registered managers award and the ongoing training and research undertaken at the home keeps him up to date with changing legislation and best practice. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 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 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information, and have their needs assessed before deciding to move into the home so they know that their needs can be met. Evidence: The AQAA completed by the manager before the visit told us that they have introduced a single assessment process for prospective residents which gives them a greater insight into the needs and aspirations and a better prospective of residents future expectations and involves the resident, their family or friends and present carers. This fuller evaluation helps the manager and staff to reassure the prospective resident and their family that they are able to meet their needs. This assessment process is the start of the care plan on residents admission to the home. We asked residents if they received enough information about the home before they moved in so they could decide if the home was the right place for them. One resident Care Homes for Older People Page 11 of 29 Evidence: told us, Tour of, inspection and very friendly atmosphere, very useful advice. Prior visit by the home to the hospital to see if they were able to help effectively.One resident said, My relative viewed this home before I came to live here and brought me for visits. Im happy living here. We looked at the care files for two of the most recently admitted residents. We gave advice on the last inspection for the manager to look at an assessment form which was available on the Department of Health website which he has done. The manager has also combined this with the information he already asked on the homes assessment to provide an in depth assessment. This provides information to staff which includes all the areas of need that it should in line with the regulations and standards. The results of which gives staff a lot of information about the individual resident which gives staff more information about residents abilities and needs. This in turn supports staff to provide the care and support residents need in a way and a time that residents need. A relative said there cared for resident had a contract and added, initially terms and conditions of care were discussed and a comprehensive care assessment was made by Ashbourne House and the OT team from hospital and the carers she had. the relative went on to tell us, my cared for relative had a social worker who gave me comprehensive list of residential homes in the area. She had cares at home prior to her hospital stay that initiated residential care and community mental health team. I had also looked at Ashbourne House privately and it had been recommended by district nurses. It was very much a personal choice. Care Homes for Older People Page 12 of 29 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. People who live at Ashbourne House are involved with the development of their individual care plans so they receive the care and support they need in the way they prefer. Evidence: There had been developments in the care planning since the last inspection visit.All care plans had been rewritten,reviewed or updated and there was a strong emphasis on involving people using the service. The care plans were well organised and detailed residents care needs and how they are provided. Some residents have a life history within their care files,which provides staff with an insight into residents past life and history.This could be completed for all residents involving the residents and their friends and relatives to give more information to assist in the provision of care. Care Homes for Older People Page 13 of 29 Evidence: A record is maintained on individual residents files of visits by or to the doctors,nurse support and chiropody and optical tests.This record enables at a glance to see what health care needs have been provided. An annual review with residents GP would further demonstrate that service users health care needs are met and medication prescribed is reviewed. It was apparent in discussions and observations that staff have a good awareness of the individual needs of each person,and the approach to use depending on their preferences and personalities. Ashbourne House had developed good working relationships with health and social care personnel and there was evidence to demonstrate that residents had access to specialists services according to their specific needs.Daily routines were flexible and personal support was provided in private. Risk assessments are in place which identify when people are at risk of falling and what action can be taken to minimise that risk. These were recorded as having been reviewed and changes made to meet the individual residents needs and abilities. This is how it should be to make sure residents are kept safe. Staff administer medication to residents.The detail within the records was up to date with only two gaps in the records.The manager said he takes the lead in ordering medication and checking that staff have administered it correctly and the records are up to date. The records seen were well maintained and evidenced that residents received their medication as prescribed by their doctor.When medication wasnt given the reason was indicated by a recognised code.Staff were observed giving out medication.Time and patience was shown towards residents when administering medication.The manager was aware of the circumstances of the two occasions when a prescribed medication was not signed as administered when it should have been. The manager said he would deal with this omission. There were handwritten medication details on the medication administration records. This is when the residents doctor prescribes medication after the records have been printed by the pharmacist. Best practice is that staff write these records then sign them and ask another member of staff to check the record for accuracy and also sign. This needs to be arranged. Care Homes for Older People Page 14 of 29 Evidence: Creams that are prescribed to residents are recorded when administered by staff.This practice ensures that they are administered as needed and provide a complete record of prescribed medication. A resident told us, (I am)very contented and happy and thoroughly appreciative. Another resident said, I would recommend this home to anyone , and have in fact. Another resident said, I am well looked after and happy to be here. A further resident commented, Everything is very acceptable. A resident told us, I am very comfortable here. A relative told us, the care schedule is great. I am contacted regularly and immediately if need be when hospital admissions are needed contact is immediate. Physical and mental health support has been needed during my cared for relatives stay. The staff are aware of her needs and contact doctors and relevant specialists as required. A relative said, pleased with the care their (cared for relative) was receiving and added, I feel my (cared for relative) is pleased in the most part too. Unfortunately her mood varies daily and her attitudes to life are so variable and this varies to how she is feeling. I worry that this is not measurable because of this. Her mood swings are such that this applies not only to staff, her situation but also her family. We were told, doctors, mental health teams and past care have been fantastic. We asked staff what they felt the service does well, one member of staff commented, It supports the residents well. Another said, Keeps residents happy and well looked after. Care Homes for Older People Page 15 of 29 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. Social activities and meals are both well managed and provide daily variation and interest for people living at Ashbourne House. Evidence: The AQAA completed by the manager before our visit indicated, Prior to and during admission we try to ascertain individuals cultural and social preferences and try to address them within their care plan. Further gathering aspirations through relationships made through the key worker system. Expectations and aspirations are addressed during our residents committee meetings and care plan reviews where we ask residents to assist us in planning all our in house activities, exercise, social gatherings and outings. The manager has a dedicated volunteer who assists staff on a weekly basis with whatever the residents want to do from flower arranging to painting, dominoes, knitting or bridge club. The home has been awarded the Heart Beat award which recognises businesses that are committed to offering greater choices to residents through the provision of a healthy environment and healthier food. Care Homes for Older People Page 16 of 29 Evidence: The home had also had a recent inspection by Stockport Environmental Health Officers assessing the home for an award which is called, awards on the doors. This is a scheme which is their way of assessing standards of food hygiene. The scheme scores out of five. Ashbourne House was awarded 4 stars which is very good. One resident commented about the food saying, Meals are superb with very good selection and cooked excellently. Another resident said, I am a vegetarian and my meals are always provided. A relative said their(cared for relative) always says the meals are great. I was concerned that the evening meal was sometimes a snack. The main meal is at lunch time. The home has won awards for the food it serves. I always take things they might like as a supplement when we visit. But generally the food is lovely and varied. Nutritional assessments are undertaken for residents and this includes triggers for nutritional risk, dietary assessment, eating environment, which means where residents like to eat their meals, any dietary requirements including likes and dislikes and residents preferred portion size. This gives staff valuable information about the individual residents likes and needs and ensures residents get what they like to eat in the right quantity. Residents spoken to said they had enough to do during the day and looked forward to the entertainers coming in. Residents spoke about the homes plans for a garden party and shopping trips. Some residents go out with their friends or family while others if they choose go out periodically with staff. Residents committee meetings are arranged. These meetings provide residents and their relatives or friends with an opportunity to express their views and opinions about the service provided at Ashbourne House and put suggestions or changes forward for discussion. A mobile library comes to Ashbourne House and they have a collection of books including large print publications. This enables residents with failing eyesight access to novels. In relation to activities one relative said, there (cared for relative), enjoys when entertainers arrive at Ashbourne House and loves to sing with entertainers and visiting religious groups. I know she would like to go out more but as her moods alter she has declined trips in the past, theres are infrequent and probably very difficult with the residents. Care Homes for Older People Page 17 of 29 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. Good safeguarding procedures help to ensure that people remain safe at Ashbourne House. The complaints procedure is clear and accessible meaning that people who use the service and their representatives feel listened to and taken seriously. Evidence: Residents spoken with all confirmed that they could speak to staff if they had any concerns and that action would be taken in response to their worries. Residents were clearly comfortable approaching staff to ask questions or seek reassurance and the availability of the manager was appreciated by those we spoke with. A record is maintained of all comments or complaints made and the action taken to remedy the problem. Discussions with staff and training records confirmed, that staff receive a wide range of training, including adult protection,and understand their role in protecting residents. One resident told us that they knew who to speak to if they were not happy and added, Nothing too much trouble, but had no complaints to date.Another resident told us, I have no complaints. One residents said their relative would deal with any Care Homes for Older People Page 18 of 29 Evidence: complaints and added, I had none so far. A relative said the manager and under manager are always contactable and I am happy to speak freely to them.And added, If I felt there was a problem and needed to complain I would write to the home and probably contact social services. Thankfully this has not been needed. Care Homes for Older People Page 19 of 29 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. Ashbourne House provides a safe and comfortable home that is well maintained and decorated and furnished to a good standard. Evidence: Ashbourne House can accommodate 23 residents. There are two double bedrooms and nineteen single rooms. All the bedrooms have wash hand basins and fitted wardrobes. The home is situated in a residential area and is about ten minutes walk away from Gatley Village. There are four lounges and a large dining room overlooking the garden. The dining room is also used for concerts and activities.There are televisions in the lounges and a loop system is in place to help those residents who wear hearing aids.This helps residents who do have difficulty with their hearing to watch the television in comfort. A number of adaptations have been made to the building over time to assist residents with reduced physical mobility such as handrails being fitted in corridors and since our last visit two high level toilets on the ground floor near to the lounge. This approach demonstrates that Ashbourne House address the diversity of the resident group and promote their independence. Care Homes for Older People Page 20 of 29 Evidence: There is a rolling programme of redecoration and time is spent replacing items of furniture or furnishings in residents bedrooms to make them appealing, clean and to the comfort of the individual resident. All residents spoken to expressed satisfaction about the house and there bedrooms. One resident said they slept well and had a comfortable bed. The house appeared homely, clean and a pleasant place to be. One resident said they, liked to spend time in there bedroom they said I am a private person and it suits me. The garden has been landscaped since our last visit and a new larger patio areas has been designed and the access to the garden has improved by the replacement of the conservatory door so residents are able to access the garden independently. Residents commented on how nice the garden was looking and said it provided them with all year interest. Residents were observed freely accessing and using all parts of the home.One person said they enjoyed sitting in the conservatory and spending time in the garden. There was evidence of an ongoing routine maintenance programme. On a tour of the home the house was found to be well maintained, pleasantly decorated, clean and hygienic and no unpleasant odours. There is a hairdressing room on the ground floor, the hairdresser visits twice each week. This room is also used by visiting district nurses and the chiropodist. A public telephone is also available for residents use in this room. There is a kitchen available to residents or their visitors so they are able to help themselves to drinks independently. The kitchen has been totally refurbished since or last visit with new kitchen cupboards, redecoration and new non slip flooring. We were told that residents had identified in one of their committee meetings that the kitchen needed a face lift and this has now been done to a good standard. Relatives told us that they use the kitchen and make themselves a drink when they come and they dont have to wait to be asked if they want a drink. A resident said the home is, spotlessly clean and always fresh smelling and welcoming.Another resident said, After inspecting numerous homes this was by far the cleanest and friendliest. A relative told us, I have no complaints about the cleanliness of the home. It is always clean and fresh , tidy and homely. Care Homes for Older People Page 21 of 29 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. The people living at Ashbourne House are supported by well trained, efficient staff who have gone through a thorough recruitment process, so residents needs are met,and they are safe from possible harm or poor practice. Evidence: Policies and procedures are in place for the recruitment of staff. Two newly appointed staff files were examined and contained all the necessary documentation in line with the regulations and standards. This practice safeguards residents and staff. The home experiences a low staff turnover which provides continuity of care for residents living at Ashbourne House. All staff employed by the home have a Criminal Record Bureau (CRB) check in place.Staff confirmed that relevant background checks were carried out before they were recruited, and induction training was provided to them to help them do there job well. It was evident that staff have a good knowledge of the needs and personalities of individual residents. Communication between staff is good. The information about residents provided to staff was detailed and helped to ensure good continuity of support for residents. Care Homes for Older People Page 22 of 29 Evidence: Training needs were identified through the staff supervision programme. All staff who were spoken to said they had plenty of opportunities to access ongoing training and development opportunities. 82 of the staff team have obtained NVQ training at level 2 or above which exceeds the national minimum standards and enables staff to have the knowledge and expertise to provide the right level of support and assistance in the right way to residents.Two further staff are scheduled to undertake NVQ 3 during 2009. There was sufficient staff on duty to care and support residents living at Ashbourne House. The deployment of staff was good with residents commenting that staff are available to them.A resident said, staff are available when I need them. One resident said, very friendly staff who know the residents well and their needs because they are predominantly long serving which must indicate good employer/staff relationships.A relative told us, I always find the staff accessible and helpful. Care Homes for Older People Page 23 of 29 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. Ashbourne House was well run and a high level of consultation with residents and their families,friends and advocates meant that they could contribute to its development. Evidence: Since our last visit the manager has been successful in obtaining the Registered Managers Award as required by the standards. Residents at Ashbourne House benefit from a committed staff team.The manager operates an open management style and encourages residents and staff to make use of the open door policy.At the heart of this style of management is a person centered approach,where the focus is on how the individual resident wants their care needs to be met. Discussions with the manager provided evidence of an open and transparent management style, where any issues highlighted in the inspection visit were seen as Care Homes for Older People Page 24 of 29 Evidence: an opportunity to improve the service. There was a strong focus on developing the staff team and an emphasis on consulting with residents, informally and formally in order to improve the service. All residents spoken to expressed satisfaction on the way the home was run and the quality of the services delivered by the staff at Ashbourne House. The Manager demonstrated,along with the staff a high level of competence and knowledge. Residents, relatives and staff described an open and friendly atmosphere in which peoples views are listened to and acted on. A quality assurance system is in place that seeks and acts upon the opinions of residents, in terms of their day to day experiences and improvements that could be made. Staff are supported by the manager and there was evidence of an ongoing supervision programme for staff. This ensures that the manager monitors the performance of staff and any training needs are identified. Staff files provided evidence that staff received regular supervision and appraisals which examined staff performance in delivering care and identified any training needs. One member of staff confirmed that they received regular supervision and that there was a rolling programme for training. They went on to say that they felt staff were supported and encouraged by the manager to maintain good practice and work towards achieving positive outcomes for residents. The manager provided information stating that policies and procedures have been updated and that staff had completed training in health and safety, fire, food handling and first aid, ensuring that the well being of residents and staff were protected. One resident told us, Excellent management much involved with the residents in a jovial manner. A relative said, I feel we have chosen the right place for (my cared for relative) her views do vary, so sometimes I worry, but this is regarding her mental state. If she says she is unhappy I do worry about her but this will always be the case. A member of staff told us, Ashbourne House is a well run home. All staff work well together to make it homely and friendly for our residents. All residents seem happy and all aspects of care given. Audits of procedures within the home were being carried out routinely.This is to ensure Care Homes for Older People Page 25 of 29 Evidence: and maintain best practice. These were structured in line with the National Minimum Standards for Older People. Stringent infection control procedures were in place,and staff confirmed that they had received training in this area and supplies of personal protection equipment were always available to them. Care Homes for Older People Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 When handwriting medication onto the medication administration records staff need to sign and also have a second person sign the record who can confirm that the record has been copied correctly. This safeguards residents and staff. Ensure that all medication is signed for as administered on the medication administration records in accordance with the residents doctors prescription and any omissions are indicated by the recognised symbol. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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