Care Home: Ashbourne House Nursing Home

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What the care home does well Ashbourne is a large home providing spacious accommodation for people living there. This has been enhanced with recent redecoration and refurbishment. The staff team has remained fairly stable, offering continuity in the support provided. Residents appear to enjoy a good rapport with staff. Comments were received from residents about living at the home. People said; `I have a routine, the meals are good and they keep my warm, clean and happy` and `good food`. One person spoken with during the visit said of the new activity worker, `she has brought happiness to the home`. A staff member also expressed, `there have been a lot of improvements`, `the atmosphere is better` and `the activities are great`. The activity worker said she had settled well and was `enjoying the role`, `staff are very helpful` and `if I ask for anything I get it`. What has improved since the last inspection? A new manager has been employed. Although she had only been in post 3 weeks some improvements had been made particularly in relation to the medication concerns. The manager appears enthusiastic and keen to make improvements in the service delivery. Many areas of medication handling have improved, we saw that all residents were able to have their prescribed medication because checks on stock levels ensured it no longer `ran out`. The employment of an activities worker has provided residents with more variety to their day, affording them with opportunities to take part in various social and leisure activities. Recent redecoration and refurbishment within some areas of the home has enhanced the appearance providing people with more comfortable accommodation. More thorough recruitment checks are undertaken when employing new staff so that only those people suitable to work at the home are employed to do so ensuring people are kept safe. Staff are now being provided with relevant training. This will be enhanced further with on-going plans ensuring the team has the knowledge, skills and competencies needed to fully support those people living in the home. What the care home could do better: As no new admissions had been made at the home we were unable to assess the admissions process therefore the requirement made following our last inspection remains outstanding. The registered person must ensure that comprehensive initial assessments are completed prior to admission ensuring the suitability of placements so that peoples needs are safely met.Information within the care files needs to be specific to each person so that records reflect their current needs and wishes. Individual risk assessments must reflect the specific needs of each person and the support required so that people are not place at risk of harm. Effective monitoring systems need to be established where risk to health has been identified so that peoples health and well being is not affected and timely intervention is made. Further improvements must be made in safe handling of medication especially around record keeping and training. Further opportunities for people to take part in a variety social and leisure activities should continue to be developed so that all people, irrespective of their support needs, are afforded a choice to their daily routine. The registered person must ensure that all members of the team complete training in adult protection so that they are aware of their responsibilities and what to do should an incident arise ensuring people are kept safe. The registered person is asked to confirm in writing that the final stages of work to the environment have been completed. On going staff training must be provided to ensure their continuous personal and professional development. This will ensure that people living at the home are supported by competent staff team who are able to meet their needs. All new staff must complete the Skills for Care induction ensuring they are fully aware of the policies and procedures within the home so that they can carry out their duties safely. All staff must receive on-going supervision so that they are clearly supported and directed in carrying out their duties effectively. The registered person must forward to CQC reports completed following his monthly monitoring visit in line with regulation to show that the service is being monitored ensure a good quality service is being provided. The registered person must ensure that all incidents, which affect the health and well being of residents are reported to us to show that appropriate action has been taken to ensure people are being kept safe. The registered person must ensure that application is made to the commission to register the manager ensuring the day to day running of the home is undertaken by someone with skills and experience to support and direct the staff team. The registered person must ensure that all relevant management training is provided so that the manager is up to date with good practice guidance and legislation relevant to her role.An effective system of auditing and monitoring the service delivery needs to be implemented to support on-going and sustained improvement to the service. Findings should be used to inform the homes annual development plan so that outcomes for people living at the home continue to improve ensuring they receive a good service. Copies of the report should be made available to all relevant parties. Key inspection report Care homes for older people Name: Address: Ashbourne House Nursing Home 376-378 Rochdale Road Middleton Manchester Lancashire M24 2QQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lucy Burgess     Date: 1 6 0 6 2 0 1 0 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Ashbourne House Nursing Home 376-378 Rochdale Road Middleton Manchester Lancashire M24 2QQ 01616432060 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Silverdale Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. 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, Dementia - Code DE. The maximum number of service users who can be accommodated is: 29. Date of last inspection Brief description of the care home Ashbourne House Nursing Home is a converted and extended home located a short distance from the centre of Middleton, owned by Silverdale Care Homes Limited. The home is registered to care for up to 29 people with personal care needs, nursing Care Homes for Older People Page 4 of 32 Over 65 0 29 29 0 2 5 0 1 2 0 1 0 Brief description of the care home needs and those with dementia. Accommodation is provided over two floors, the majority of it on the ground floor. Part of the first floor of the building is not available to residents because of structural defects that are being repaired but repairs have not yet been completed. The range of fees at the time of our key inspection were 347.71 pounds to 460.32 pounds per week. Additional charges are made for Chiropody and Hairdressing Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection visit, which included a site visit and took place over one day by an inspector and a pharmacy inspector. The service did not know that the inspectors were to visit. Due to our findings at our key inspection on the 25 January 2010 we held a management review meeting to consider what further action we needed to take. A Statutory Requirement Notice was served on the 4 March 2010 due to serious concerns regarding poor medication practice. We also met formally with the Registered Provider, Area Manager and Acting Manager on the 15 March 2010 to discuss other areas of concern in relation care planning and assessments, staff training and development, staff recruitment and levels, routines, health and safety and management and conduct. The Provider was requested to provide us with information about how they intended to make the improvements Care Homes for Older People Page 6 of 32 needed. We contacted the Local authority and advised them of our concerns in line with the Safeguarding Policy and Procedure. A random inspection was undertaken on the 12 May 2010 to look at compliance with Statutory Requirement Notice as well as progress is other areas. We found that little progress had been made and the Statutory Requirement Notice remained unmet. Two immediate requirements were also made with regards to people being provided with the medication they are prescribed and a satisfactory electric circuit certificate. Following this visit a further management review was held with our enforcement team to consider what further action was required. The home was sent their Annual Quality Assurance Assessment (AQAA) on the 2 February 2010 and asked to complete and respond by the 2 March 2010. A reminder letter was sent on the 11 March 2010 with a further timescale to response by the 18 March 2010 as this had not been returned within the specified timescale. A completed document was received on the 22 March 2010. The Registered Person is reminded that this is a legal requirement and requests must be responded to in a timely manner. Following our January visit the Acting Manager submitted her application to register with us. A fit person interview was conducted however prior to a decision being made the Acting Manager withdrew her application. Since the 24 May 2010 a new manager has been employed to work at the home. The current quality rating for the home is 0 stars, outcomes were judged as being poor following our key inspection in January 2010. Due to this and other concerns the Local Authority are currently not making placements at the home. The purpose of this visit was again to assess what progress had been made to address outstanding areas of concern. During the visit time was spent looking at records in relation to care files, staff recruitment, training and development, meals and health and safety. Time was also spent looking at the environment as well as observing peoples daily routines and interactions with staff. Our pharmacist completed a full audit of the medication system. As part of our inspection process we sent out feedback surveys to people living at the home and staff. We received 7 completed responses. Comments have been added to the report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: As no new admissions had been made at the home we were unable to assess the admissions process therefore the requirement made following our last inspection remains outstanding. The registered person must ensure that comprehensive initial assessments are completed prior to admission ensuring the suitability of placements so that peoples needs are safely met. Care Homes for Older People Page 8 of 32 Information within the care files needs to be specific to each person so that records reflect their current needs and wishes. Individual risk assessments must reflect the specific needs of each person and the support required so that people are not place at risk of harm. Effective monitoring systems need to be established where risk to health has been identified so that peoples health and well being is not affected and timely intervention is made. Further improvements must be made in safe handling of medication especially around record keeping and training. Further opportunities for people to take part in a variety social and leisure activities should continue to be developed so that all people, irrespective of their support needs, are afforded a choice to their daily routine. The registered person must ensure that all members of the team complete training in adult protection so that they are aware of their responsibilities and what to do should an incident arise ensuring people are kept safe. The registered person is asked to confirm in writing that the final stages of work to the environment have been completed. On going staff training must be provided to ensure their continuous personal and professional development. This will ensure that people living at the home are supported by competent staff team who are able to meet their needs. All new staff must complete the Skills for Care induction ensuring they are fully aware of the policies and procedures within the home so that they can carry out their duties safely. All staff must receive on-going supervision so that they are clearly supported and directed in carrying out their duties effectively. The registered person must forward to CQC reports completed following his monthly monitoring visit in line with regulation to show that the service is being monitored ensure a good quality service is being provided. The registered person must ensure that all incidents, which affect the health and well being of residents are reported to us to show that appropriate action has been taken to ensure people are being kept safe. The registered person must ensure that application is made to the commission to register the manager ensuring the day to day running of the home is undertaken by someone with skills and experience to support and direct the staff team. The registered person must ensure that all relevant management training is provided so that the manager is up to date with good practice guidance and legislation relevant to her role. Care Homes for Older People Page 9 of 32 An effective system of auditing and monitoring the service delivery needs to be implemented to support on-going and sustained improvement to the service. Findings should be used to inform the homes annual development plan so that outcomes for people living at the home continue to improve ensuring they receive a good service. Copies of the report should be made available to all relevant parties. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 32 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 11 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At present no new placements are being made at the home until such time the standard of care provided has improved ensuring residents needs are fully met. Evidence: At our previous key inspection in January 2010 we found that initial assessments completed prior to people being admitted did not include all relevant information to enable the home to make an informed decision about the suitability of placement. Over the last year 6 months no new placements have been made at the home due to issues identified in relation to the standard of care provided. The Local Authority made the decision to suspend placements at the home until such time they were satisfied that people would receive a good standard of care and were kept safe. Due to this we have been unable to review the assessment process along with information gathered prior to people coming to live at the home. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about how people wished to be cared for needs to be expanded upon so that records clearly direct staff in meeting the current and changing needs of people. People were being given their medicines as prescribed and their health was not at risk. Evidence: Care files were examined for several individuals including those previously seen during our last visit. Not all issues identified during the last inspection had been addressed. We did find that files were orderly and had been reviewed on a monthly basis. Records included a care plan, risk assessments, record of health appointments, diary sheets, weight records and general correspondence. Care plans outlined the support needs of people however were generally repetitive in each file. Generic risk assessments were also still in place. This information did not reflect the individual needs of each person. Care Homes for Older People Page 13 of 32 Evidence: Where nutritional assessments had been completed and identified additional monitoring was required ie, weekly weight monitoring, this had not been. Information also lacked detail about the use of any supplements, how these were to be used and when they were offered. Again there was no evidence that where assessments identified referral to health care professionals should be made that this had been done. This was discussed with the new manager, who was aware that further improvements were needed so that information was more person centred and reflected peoples current and changing needs. The manager stated that she intended to review each of the files expanded on the information provided, both nursing and care staff were to be involved and daily records are to be linked with activities of daily living detailed in the care plans. This will ensure that information about each person reflects their support needs so that they are supported in a way they would wish. During this inspection the specialist pharmacist inspector looked at how well medicines were handled to make sure that residents were being given their medicines properly and that all medication could be accounted for. This was because at previous inspections medicines had not been handled safely and residents health and welfare was at risk from harm. During this visit we looked a sample of records about medication together with medicines currently available for those people. We also checked to see if the requirements which had been made after our two previous inspections had been met. We saw that the new acting manager had made many improvements in all areas of medication handling. At our last inspection we were very concerned that some residents did not have all their medication available, because it had run out. However at this inspection all residents had enough medicine available to ensure that they could have the treatment prescribed. The acting manager had looked carefully at the stocks of medication held in the home for residents and had made adjustments to the orders so that medication did not run out and made sure that there was not too much medication in the home. She had also arranged for the large overstock of medication to be disposed of. At the last inspection, we found that it was probable that medication such as pain relief was being shared between residents. At this inspection we had no such concerns and found that each person was given their own medication form their own individual Care Homes for Older People Page 14 of 32 Evidence: supply. We also had concerns at the last inspection, that residents were not being given their medicines as prescribed for a variety of reasons, at this inspection we found no such concerns and residents were being given their medication as prescribed by their doctor. At the last inspection we saw evidence of very poor practice where nurses ignored the information printed on the labels of dispensed medicines, at this inspection we found no evidence of poor practice continuing. During this inspection we found all medication was kept securely and the return of excess medication had freed space in the cupboard for the order of new monthly medication to be stored safely. There was good storage for controlled drugs and a lockable fridge was provided for medication which needed to be kept cool. We noted that some medication stored in the fridge did not need to be and the manager removed it during the inspection and made sure it was stored at the correct temperature. Although significant areas of medicines handling had improved we found other areas which needed further improvement. Some areas of record keeping had improved but some of the records were still inaccurate. Records of medicines which came into the home and were disposed of were mainly accurate however there was a failure to record medication which had been carried over from the previous month and some items of medication which were in the home had not been recorded as being in the home. Some of the records about medication awaiting collection for destruction were also not always accurate. If medication is not accounted for it is possible it could be mishandled in some way. Most records about administration were clear and accurate and medicines were signed for at the time they were given. However some records about creams only had ticks so it was not possible to tell if the cream had been applied or who had applied it. We found that good information was recorded when doses of medication changed so that nurse could safely given the newly prescribed dose. Records also showed that when residents, with swallowing problems, had been prescribed a thickener to help them swallow liquids safely that it had been used properly. As at our last two inspections we found that other records about medication needed improving because there was no information for nurses to follow about how to give Care Homes for Older People Page 15 of 32 Evidence: medicines which were prescribed as a variable dose or when medication was prescribed when required. We did see some improvement in this type of record keeping in that one resident had recently been prescribed an additional dose of a medicine to be given when required and the acting manager had recorded good information for nurses to follow when giving that medication. This type of information must be extended for all as required medicines to protect residents health. There was also very poor information available about where to apply creams. At this inspection we did not find that any residents were looking after their own medicines or that creams were kept in their rooms, so there was no need to record that people could do so safely. At our last inspections we had concerns that many of the failings in medication handling were because nurses did not have up to date training. We made a requirement that training about medicines handling was accessed and that nurses had their competency, ability, in handling medicines checked. The acting manager told us that nurses had not received any training. The concerns about medication must be addressed by accessing good quality comprehensive medication training. The acting manager told us that nurses had not yet been assessed competent, to administer medicines safely but she told us that she had accompanied nurses when they had given medicines out to make sure they were doing so. Proper formal competency checks must be done to ensure the safety of residents is protected. The manager had done some audits but felt that they were not very effective in picking up the concerns highlighted in this part of the report. She told us that she would be looking at developing a more effective auditing system. Care Homes for Older People Page 16 of 32 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. Routines within the home had improved. In consultation with residents these could be enhanced further affording people more opportunities and variety to their day. Evidence: Observation made during our last visit found that residents had little stimulation or variety offered to their daily routines. Since that visit an activities worker has been employed on a part time basis. In the feedback surveys returned by people living at the home comments were made about their routines. people said, I would like to be visited by a minister, I have a routine, the meals are good and they keep my warm, clean and happy, good food, and were not taken out often. We spoke with the new worker who told us about the activities they had introduced as well as their future plans. Activities include arts and crafts, fun and games, movie afternoon, baking and pamper sessions. The hairdresser also visits on a weekly basis. Arrangements were being made for 2 residents to attend the local Blind Club each week as well as exploring other community based activities. Fund raising ideas were also being considered to cover the cost of outings. The manager also told us that that Care Homes for Older People Page 17 of 32 Evidence: arrangements for people to attend a place of worship, should they wish to, was being looked into. Through observations made we found that there was a better staff presence with time spent chatting and assisting people. People looked better cared for and their general appearance had improved. The manager told us that the hairdresser had not been to the home that week however she was going to purchase some hair products so staff could assist people if necessary. We did see one staff member support a lady to curl her hair. One person spoken with during the visit said of the new activity worker, she has brought happiness to the home. A staff member also expressed, there have been a lot of improvements, the atmosphere is better and the activities are great. The activity worker said she had settled well and was enjoying the role, staff are very helpful and if I ask for anything I get it. The home has an open visiting policy. People are able to meet with their visitors in the privacy of their own rooms or in one of the communal areas. Meal arrangements remain unchanged. At present all residents are sharing the lounge/dining room on the dementia unit. People either take their meal in the lounge or the dining room. The main meal is served at lunch time with a lighter meal in the evening. People were seen to be offered a choice, extra helpings and plenty of drinks. Those people requiring support from staff were assisted appropriately. Care Homes for Older People Page 18 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place with regard to reporting and responding to complaints however staff training must be providing ensuring staff know what to do should an incident arise so that people are kept safe. Evidence: Policies and procedures are available within the home to cover these standards. Following our visit in January 2010 we raised several issues with the local authority in line with their safeguarding procedure. This was due to concern about the care of people at the home and the safe administration of medication. Since our last visit we have received one compliant, which we asked the Provider to investigate. A formal response has been provided. We looked at training provided for staff in relation to safeguarding. The training matrix showed that 10 staff members are scheduled to attend relevant training between April and August 2010. The registered person must ensure that all staff complete this training so that they are aware of their responsibilities in this area and know what to do should an incident arise. We discussed with the administrator arrangements in relation to the management of residents finances. Only a small number of people are supported with their personal allowances. Generally people are supported with their affairs by family members or an Care Homes for Older People Page 19 of 32 Evidence: appropriate representative. For those people where money is held, records were maintained along with receipts for any items purchased. Care Homes for Older People Page 20 of 32 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. Improvements had been made to the environment, which have enhanced the appearance of the home providing more comfortable accommodation for people living at the home. Evidence: Since the key inspection in January 2010 work has been carried out within the home, which has improved the overall appearance of the home. During our random inspection in May 210 we found that rooms to the front of the home were near completion. The lounge had been repainted and new carpet fitted. A new large wall mounted television was on order as well as new seating. The dining room was being painted and new tables and chairs had been purchased. The hallways had been repainted and new carpeting fitted. The shower and bathrooms had also been refurbished and cater for the physical needs of people at the home. The nurse station had been removed creating a waiting area for visitors, new seating had also been ordered for this area. The small office downstairs was now being used by nursing staff and a second office had been created downstairs for the manager and administrator. This had created a better working environment for people and ensures information is held more securely. Further work had been identified with regards to a new kitchen. Consideration was being given to how this will be done so that little Care Homes for Older People Page 21 of 32 Evidence: disruption as possible is made. During this visit we found that people were still being accommodated in one of the communal lounges and conservatory dining room however delivery of the new furniture was being made the week following the inspection. A quote had also been sought for new radiator covers in these areas. Due to all the redecoration and refurbishment, work to kitchen had been delayed slightly. The administrator told that this would now take place in July. Repairs were also needed to the front door as the hinge had come loose. Again arrangements had been already been made for this to be repaired the day following our visit. The Provider is asked to confirm that above areas have been completed as well as providing a plan of work, including timescales for completion of the kitchen. Whilst looking round the home, we found rooms to be generally clean and tidy. As previously identified the home employs 2 domestic staff and a laundry assistant. There is also a part time handy man who deals with any general repairs within the home. Staff were seen to wear protective clothing when assisting people with certain activities i.e. meals or personal care and hand washing provisions were also available in areas where personal care is provided. Care Homes for Older People Page 22 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure staff are safely recruited. Further progress is needed with regards to staff training and development ensuring they have the knowledge, skills and competencies needed to meet peoples needs. Evidence: Since our last visit there has been little change to the staff team. Staff rotas were examined to look at the ratios provided throughout the day and evening. Based on the current occupancy levels and needs of people, sufficient staff were on duty. The manager was aware that this would need to be kept under review should occupancy increase. Staff recruitment records were examined for two staff, one of which was the new manager. Information was again found to be orderly and included an application form, written references, Independent Safeguarding Authority check, (ISA, previously known as POVA), criminal record check (CRB). Checks to confirm nursing staff hold a current personal identification number (PIN) are made through the Nursing and Midwifery Council (NMC). All checks were in place prior to people being offered employment. A previous shortfall found with regards to a carer had been offered employed through an agency had been addressed. Staff training and development was again reviewed to see what plans had been made. Care Homes for Older People Page 23 of 32 Evidence: We found that recent training had been completed in moving and handling. Infection control training had been scheduled for July. Medication training was to be arranged with Boots. Further plans had also been made for some members of the team between April 2010 and August 2010 to attend courses on food hygiene, mental capacity, adult protection and dementia care. NVQ training is also provided to members of the team. The registered person must ensure all staff receive training relevant to their role and responsibilities so that people are supported by a competent staff team. We discussed with the manager arrangements in relation to the induction of new staff as well as supervisions. The manager was aware that induction information in line with the Skills for Care specification was available within the home. She was also aware that periodic supervisions needed by undertaken with all staff. These need to be implemented so that staff are informed and supported in carrying out their duties. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service needs a period of consistent and stable management enabling them to make sustained and on-going improvments so that people receive a good quality service. Evidence: Following our last key inspection in January 2010 the Acting Manager submitted her application to register with us. A fit person interview was conducted however prior to a decision being made the Acting Manager withdrew her application. She has since left her employment at Ashbourne House. A new manager has now been appointed and commenced her employment on the 24 May 2010 The new manager is a qualified nurse and has previously worked in nursing homes both in a nursing capacity as well as management roles. The manager told us that she had previously completed the registered managers award training, evidence of this should be provided. We also discussed other training that should be undertaken to inform her role. This should include an update on adult protection as well as mental Care Homes for Older People Page 25 of 32 Evidence: capacity training and deprivation of liberty safeguards. It was acknowledged that the manager has only worked at the home for 3 weeks prior to our visit. On examining the rotas we noted that her hours were split with time spent as the nurse on duty and supernumerary management hours. Whilst it is recognised that this gives her the opportunity to get to know the needs of people living at the home as well as develop working relationships with staff, the Provider must ensure that the manager is provided with sufficient time to make the improvements needed. We were however pleased to note that some of the serious concerns regarding medication had improved. Systems in relation to quality monitoring need to be improved. Over the last few months the Provider has fulfilled his commitment with regards to monthly monitoring visits in line with Regulation 26. Copies of the reports for January through to April have been provided to the Commission as requested. The Provider is reminded that these should be sent to us each month to evidence he is monitoring service delivery. Where areas of improvement are needed, these should be detailed within the homes business plan and reviewed periodically. Without this there is no assurance people are receiving a quality service. Copies of the report should be made available to all interested parties. During our random inspection in May 2010 we found that incidents had occurred involving the health and well being of residents including a medication error and someone needing to attend A&E. These had not been reported to us in line with regulation 37. Two further incidents had occurred since that visit which had also not been reported to the Commission. The Provider is reminded that this information must be forwarded to us to show that appropriate action has been taken to ensure people are being kept safe. This was also discussed with the manager. It was agreed that she would take responsibility for forwarding relevant notifications to the Commission. No issues were identified with regards to servicing certificates. Information provided during our last visit was again confirmed. All checks were up to date. The administrator also confirmed that incidents of the fire alarm sounding had been addressed. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 3 14 Initial assessments 30/03/2010 completed prior to people being admitted to the home must include all relevant information as well as support currently being from health care services so that this is reflected in the care plan. This will ensure that all relevant support continues to be provided so that person care needs are fully met. 2 9 13 There must be effective 25/03/2010 information recorded to enable staff to administer medication safely and know how to store medication safely. To prevent peoples health from being harmed by the misuse of medication. To prevent peoples health from being harmed by the misuse of medication. 3 9 13 There must be effective systems in place to ensure staff that handle medicines are trained in medicines handling and are competent to do so safely. To help make sure that people who live in the home are kept safe. 25/03/2010 Care Homes for Older People Page 27 of 32 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 4 9 13 There must be an effective 25/03/2010 auditing processes are in place to ensure that managers are confident that medicines are being handled safely. To help make sure that people who live in the home are kept safe. Care Homes for Older People Page 28 of 32 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 8 12 Individual risk assessments must reflect the specific needs of each person and the support required so that effective monitoring systems are in place ensuring people health and well being is not affected. 30/07/2010 2 30 18 The registered person must ensure all staff receive appropriate training as outlined in the homes training plan ensuring they have the knowledge skills and competencies needed to carry out their duties safely. 30/08/2010 3 31 9 The registered person must ensure that all relevant management training is provided 30/07/2010 Care Homes for Older People Page 29 of 32 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 so that the manager is up to date with good practice guidance and legislation relevant to her role. 4 31 9 The registered person must ensure that application is made to the commission to register the manager ensuring the day to day running of the home is undertaken by someone with skills and experience to support and direct the staff team. 5 38 37 The registered person must ensure that all incidents, which affect the health and well being of residents are reported to us to show that appropriate action has been taken to ensure people are being kept safe. 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 30/07/2010 30/06/2010 1 7 Information within the care files needs to be specific to each person so that records reflect their current needs and wishes. Further opportunities for people to take part in a variety social and leisure activities should continue to be developed Page 30 of 32 2 12 Care Homes for Older People 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 so that all people, irrespective of their support needs, are afforded a choice to their daily routine. 3 19 The registered person should confirm in writing to us that outstanding work identified within the report with regards to the environment has been completed. All new staff should complete the Skills for Care induction ensuring they are fully aware of the policies and procedures within the home so that they can carry out their duties safely. The registered person should forward to CQC reports completed following his monthly monitoring visit in line with regulation to show that the service is being monitored ensure a good quality service is being provided. An effective system of auditing and monitoring the service delivery needs to be implemented to support on-going and sustained improvement to the service. Findings should be used to inform the homes annual development plan so that outcomes for people living at the home continue to improve ensuring they receive a good service. Copies of the report should be made available to all relevant parties. Arrangements should be made for all staff to receive regular supervisions so that they feel supported and directed in carrying out their duties effectively. 4 30 5 33 6 33 7 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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