Care Home: Ashbourne Nursing Home

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What the care home does well The acting manager was good at visiting people before they moved in, to make sure the home could provide the care they needed. A person who had recently moved into the home who told us they were "quite happy with the move", "staff were very helpful and supported me when needed". They are also good at writing down what care people needed and making sure they received it. The residents at the home felt the care they received was good. Comments such as the staff are "kind" and "lovely" were made to us frequently. Meals and mealtimes were considered to be an important part of the residents` day. The dining rooms are nice places to sit, eat and meet with other residents. The residents said that they really enjoyed their meals. Residents were satisfied with the choice of meals and the way they were cooked and served. The home has an experienced and enthusiastic team of staff who work well together and enjoy taking part in training and development sessions. The staff are motivated and keen to ensure that residents receive high standards of care. The acting manager ran the home well. She made sure she checked out staff before they started working at the home and gave them training and support to make sure they did the job to the best of their ability. What has improved since the last inspection? All of the previous requirements and recommendations from the last inspection have been complied with. Record keeping has improved a lot. The acting manager can now demonstrate more clearly to us the care provided at the home. Care plans are well ordered and easy to read. This makes it a lot easier for staff to keep up to date with residents` changing needs. New records are being used to make sure that residents with poor appetites are checked regularly and the staff take any action needed. Staff supervision is now being recorded and sufficient support is provided to staff in developing their skills in writing the new style care plans being implemented. What the care home could do better: The environment of the home could be improved in several ways. There was smell of stale urine in the main lounge and action should be taken to eradicate this. The corridors are rather sparse and would benefit from pictures or prints being hung on the walls. The doors of the residents` personal accommodation would benefit from personal signage not only to aid the resident identifying their own room but also to improve the effect on the environment. Several residents asked if a facility could be created in the home for an area away from the main lounge, to have a quiet place to sit in and meet with their visitors. When the owner appoints a permanent manager, the new manager needs to apply to the Commission of Social Care Inspection to become registered, which is a legalrequirement to ensure that she is fit to manage the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashbourne Nursing Home Ashbourne Street Norden Rochdale Lancashire OL11 5XF     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: Bernard Tracey     Date: 0 8 0 1 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 28 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Ashbourne Nursing Home Ashbourne Street Norden Rochdale Lancashire OL11 5XF 01706639944 01706860629 christinekay@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bamford Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 43 Number of places (if applicable): Under 65 Over 65 43 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category/ies 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 The maximum number of service users who can be accommodated is : 43 Date of last inspection Brief description of the care home Ashbourne Nursing Home is a privately owned care home providing nursing and personal care for older people. It is situated in the village of Norden, two miles from Rochdale town centre. Accommodation is provided in 41 single and 1 double room. Nine of the single rooms have en- suite shower and toilet facilities. A large communal area provides lounge and dining facilities from which access to the garden and patio area is available. A car park provides space for 12 cars and further car parking is available in the lane at the side of the home. Care Homes for Older People Page 4 of 28 Brief description of the care home The home makes the following charges over and above the weekly care and accommodation fees that are listed after this section: Chiropody # 8.00 Hairdressing #4.00 to #30.00 Newspapers as charged Weekly fees charged by the home in January 2009 are in the range of: Personal care only 352.82 to 413.00 Personal care with nursing 466.05 to 513.00 Care Homes for Older People Page 5 of 28 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: The last inspection on this service was completed on the 18 January 2007. We (the Commission of Social Care Inspection) undertook this key inspection, which included an unannounced visit to the home. The staff at the home did not know the visit was going to take place. This visit was just one part of the inspection. We also looked at other information we had about the home. Before the visit the acting home manager was asked to complete a questionnaire to provide up to date information about Ashbourne Nursing Home. We sent our questionnaires out to people who live in the home, their families and staff in order to find out their views. Other information we had received since our last major inspection at the home was also reviewed. Care Homes for Older People Page 6 of 28 During our visit, we looked at various records and walked round the home. We spoke with a number of people who live at Ashboune Nursing Home including relatives who were visiting whilst we were there and staff. They gave us their views about the home. We have received one complaint about the service from Social Services. The contents were discussed with the acting manager and Area Manager. The complaint centred around lack of staff causing disruption to the lives and choices available to residents. We are assured that following a successful recruitment of new staff this has now been resolved. An Expert by Experience was also used at this inspection. This is a person who, because of their shared vision of using services and ways of communicating, visit a service with us to help us get a picture of what it is like to live in and use a service. The expert stayed with us for most of the day and spoke to the people living here to get their views about what it was like. We have included some of the things residents told the expert in the body of this report. What the care home does well: What has improved since the last inspection? What they could do better: The environment of the home could be improved in several ways. There was smell of stale urine in the main lounge and action should be taken to eradicate this. The corridors are rather sparse and would benefit from pictures or prints being hung on the walls. The doors of the residents personal accommodation would benefit from personal signage not only to aid the resident identifying their own room but also to improve the effect on the environment. Several residents asked if a facility could be created in the home for an area away from the main lounge, to have a quiet place to sit in and meet with their visitors. When the owner appoints a permanent manager, the new manager needs to apply to the Commission of Social Care Inspection to become registered, which is a legal Care Homes for Older People Page 8 of 28 requirement to ensure that she is fit to manage the home. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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. Admissions are not made to the home until a full needs assessment has been undertaken to confirm that they can meet the needs of the individual. Evidence: Admissions are not made to the home until a full needs assessment has been undertaken. Care files contain relevant paperwork, including social work assessments and reports from health care professionals prior to a person choosing to stay at the home. The manager also carries out an assessment, which includes a visit to see the person in his or her own home or while in hospital. These measures ensure that admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. This results in successful placements. Care Homes for Older People Page 11 of 28 Evidence: We spoke with a person who had recently moved into the home who told us they were quite happy with the move, staff were very helpful and supported me when needed. Standard 6 does not apply to Ashbourne Nursing Home, as they do not provide intermediate care services. Care Homes for Older People Page 12 of 28 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. The health and personal care needs of residents are being met and are addressed in detailed care plans. Evidence: Individual records are kept for each resident and contain comprehensive information relating to all aspects of health, personal and social care needs of the residents. From this information an individual plan of care is drawn up with the involvement of the resident or their relative to ensure that the care needs are met. Significant progress has been made in relation to the care plan documentation and methods of recording how the needs of the residents will be met. Risk assessments were in place and covered such areas as moving and handling, nutrition, pressure sores, the use of bed rails and falls. Risk assessments and the care plans were evaluated as and when required but at least on a monthly basis. Care Homes for Older People Page 13 of 28 Evidence: The residents were weighed in accordance with their nutritional risk assessment but at least on a monthly basis and the weight recorded on a chart kept in their care plan. Staff at the home have good policies and proceedures for storing and giving medicines Staff follow robust systems to make sure that medication records are fully completed, contain required entries and are signed by appropriate staff. Staff were observed delivering care in a sensitive and respectful manner, addressing residents by their preferred name, knocking on doors and enabling residents to maintain as much independence as possible. Inspection of the care files identified that the residents had access to health care professionals, such as dentists, opticians, chiropodists Tissue Viability Nurse and district nurses. Equipment necessary for the prevention and treatment of pressure sores was readily available within the home. Continence aids were in use and the staff were aware of how to contact the continence nurse advisor for advice, if deemed necessary. Care Homes for Older People Page 14 of 28 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 provide daily variation and interest for people living in the home. The dietary needs of the residents were well catered for with a balanced and varied selection of food being served. Evidence: The residents involvement in social activities varies greatly according to their abilities and needs. Some of the residents spoken to preferred to stay in their own bedrooms and enjoyed reading, listening to music and watching the television.The home has a very pleasant friendly atmosphere. The activities person has given thought to arranging social activities to suit individual needs and preferences. Social needs are assessed in detail when a resident is admitted and residents spoken with were pleased with the varied programme of social events. We did note that in the lounge there were two television sets showing the same programme about house buying with no evident interest from any of the residents. One comment made was that background appropriate music would be appreciated. Visitors can be seen in the privacy of the residents bedroom although many choose to Care Homes for Older People Page 15 of 28 Evidence: sit in one of the communal areas. Residents told us that a quiet area away from the main lounge would be appreciated to give the opportunity to sit quietly and read or to meet with visitors without going back to their personal accommodation. Residents are encouraged to bring personal possessions into the home. Many of their bedrooms were highly personalised with small pieces of their own furniture, pictures, photographs and ornaments. One of our colleagues, called and Expert by Experience, dined with the residents and observed breakfast and lunch being served in the dining area. The meals served were of ample portion and looked appetising. The tables were nicely set with napkins, cruets and cold drinks. Staff discreetly assisted some residents to eat.There was always a choice of meal at lunchtime and evening. The menus were inspected and they looked varied and nutritious. morning and afternoon drinks were served and milky drinks were provided at supper time. A discussion with the residents showed that they were very happy with the choice and quality of the food provided. Care Homes for Older People Page 16 of 28 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. There is a clear complaints procedure and residents and their families know action will be taken to resolve their concerns. Evidence: There is a clear complaints procedure, which told people how and who to make any complaint to. The procedure was well advertised to relatives and visitors to the home. Records showed that any complaints made had been fully investigated and responded to appropriately. A staff member said, If a resident wanted to make a complaint, I would go to the manager and give her the information. A visiting relative said if necessary she would talk with the Manager or any of the staff as I feel they would act on what I was concerned about but said that matters were usually dealt with straight away, so there was no need to complain. One complaint has been made directly to the Commission for Social Care Inspection. The details were discussed with the manager on our visit and concluded that the complaint was partly substantiated and remedial action has taken place to resolve the issues Not all staff have undertaken training in relation to the Protection of Vulnerable Adults, but records examined indicated that staff needing this training have been given a place on the courses run by Rochdale Metropolitan Borough Council. Care Homes for Older People Page 17 of 28 Evidence: There is an abuse policy and whistle blowing procedure. The staff training record evidenced abuse awareness training for a number of staff and the staff we interviewed had an understanding of how to report an alleged incident. There was a copy of the Rochdale Guide for the Protection of Vulnerable Adults. Care Homes for Older People Page 18 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Areas in the home where odours are present need to be addressed to provide a comfortable and pleasant environment for the residents to live. Evidence: The home is purpose built and accommodation is provided on two levels. It is fully accessible to people who are physically disabled and is fitted with aids and adaptations to promote independence. The main entrance hall is spacious and there is ample information available regarding the home and the service it provides. The home is well maintained, decorated to a good standard and was seen to be generally clean and tidy during the site visit. There is a garden and car parking space to the front and the home has a central patio area with easy access on all sides of the home. A partial tour of the building was undertaken, two bathrooms, a shower room and six bedrooms were viewed. The corridors were seen to be emulsioned and none had pictures or prints on the walls. Some bedroom doors had the name of the resident but more thought should be given to personalising the individuals accommodation. Bedrooms viewed had individual items and were homely. A resident said, My room is lovely and I have all the comforts I need Bedrooms have door locks and storage space for valuable items. All rooms have a call system with a hand held buzzer to call for assistance. The bathrooms were clean and tidy and hot water temperatures are Care Homes for Older People Page 19 of 28 Evidence: recorded each month to ensure the hot water is delivered to a safe temperature. The main lounge was comfortably furnished but there was a stale smell of urine present in parts of the sitting areas. Two T.V. sets were switched on at opposite ends of the lounge but we were unable to find anyone who was interested in Homes under the Hammer. Background music may be preferred to the constant T.V. We asked several of the residents, who had lived there a few months, what changes would they like, none of them wanted organised activities, but all of them would appreciate a quiet room. They are free to stay in their rooms whenever they wish but do not like to be isolated. The general wish seemed to be for a room without TV for residents to be able to sit quietly with their visitors or with other residents to chat or maybe read. Three residents told us that laundry was done regularly and returned to their rooms with no problems. The home has a well equipped laundry and there was evidence of gloves and aprons for staff use. Infection control training is given to staff and infection control policies are available. Fire risk assessments of the building are in place and emergency lighting is provided throughout. The grounds were tidy and accessible to residents. CCTV cameras are in operation at the entrance of the home to monitor security. Care Homes for Older People Page 20 of 28 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 deployment of staff throughout the day is sufficient to meet the needs of residents. The homes recruitment procedures are robust and these provide safeguards for the protection of residents. Evidence: We examined three staff files and found that they contained all the information required, confirming that the recruitment procedures had been followed. The manager is in the process of re-organising all of the personnel files so that they are easier to read and information contained in them more accessible. A newly recruited carer said she had been given an induction to the home and spoke about the content of the programme and the support she had received. The carer felt the induction process was well organized and thorough enabling her to get to know the residents in the home as well as becoming familiar with the way the home was run. We examined the rotas and found that the staffing levels were sufficient for the number of residents in the home and to meet their needs. Training is high on the agenda and comprehensive records are kept of the training undertaken by staff as well as planned future courses. Staff spoken to confirmed to us the training that they had done and of planned future Care Homes for Older People Page 21 of 28 Evidence: training. They stated that they are encouraged to attend courses and given the time and support to do this. The home has approximately 60 trained to at least NVQ Level 2 with 3 more staff working towards the qualification. Staff spoken to said that they were clear about their role and work well as a team to ensure the individual and collective needs of the residents are met. Relatives and residents interviewed spoke warmly of the staff team and confirmed to us that they felt well cared for. Relatives told us that the staff always keep them informed of any changes that may affect the well being of the resident. Comments received included; All staff within the home are very approachable, and my mum who visits more regularly likes all the staff and finds them very approachable. The atmosphere on entering the home is very friendly. Care Homes for Older People Page 22 of 28 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. The home is managed and run in the best interests of residents. Evidence: The manager has been in post for approximately four months, having previously been the deputy manager of the home. She has yet to submit a completed application to the Commission for Social Care Inspection to be registered as manager of the home. She is a trained nurse and has many years experience working in the care home setting and has successfully completed the Registered Managers Award. Resident and relative meetings are held on a regular basis. The manager offers an open meeting for relatives one evening each week but is also available at other times. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. Residents their relatives and staff agreed that they are able to express ideas criticisms and concerns without prejudice and the Care Homes for Older People Page 23 of 28 Evidence: management team will take action, where necessary, to bring about positive change. The manager operates a quality assurance programme made up of audits and satisfaction surveys to gain feedback on the quality of the service offered at the home. The responses to the latest survey had not been collated as yet but showed that respondents were very happy with the care provided. Staff supervision files show that individuals receive formal supervision with the home manager on a regular basis. Records required for the protection of residents and the running of the business are in place, reviewed and updated as required. Care Homes for Older People Page 24 of 28 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 25 of 28 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 26 16 The lounge areas must be kept free from offensive odours So the residents can live in a comfortable environment 28/02/2009 2 31 9 An application for a registered manager must be submitted to the Commission of Social Care Inspection So that the Commission is assured that the home is being managed by someone competent to do so 02/03/2009 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 2 19 19 Consideration should be given to provide a quiet area for residents to use within the communal lounge The corridors of the care home should be more homely in character for the benefit of the residents in the home Care Homes for Older People Page 26 of 28 3 19 Residents should be provided with adequate personalised signage to identify their personal accommodation Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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. 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