Care Home: Ashburnham House

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What the care home does well Ashburnam House provides a relaxed and family based environment which is unhurried and restful and the people living at the home are able to take life at their own pace. Staff appear relaxed and confident with the care requirements of the current people provided with a service. Staff confirmed that communication about individual needs is good between staff and management and that they feel well supported by management. Care plans were clear and looked at the background, hobbies and interests of the people living at the home as well as any religious or cultural needs. The environment is homely and well maintained with access to provided for all parts of the home via a passenger lift and stair lift. Comments from a relative included: `All the staff care about my Mum and do as much as possible to meet her needs. The owner of Ashburnham is very `hands on` and very easy going when it comes to visiting residents. He does not want my Mum to lose her liberties and treats staff and residents with respect.` Staff also made the following comments: `Warm homely environment` `We all get on well with each other and work well together.` The owner believes that the home environment should be similar to that lived in previously by the persons cared for in the home. The routines within the home are matched to the individual concerned with their choices and wishes taken into account at all times. There have been no new staff since the last inspection and the staff group is stable with the staff employed at the home for a number of years. What has improved since the last inspection? The registered provider has taken action on all the requirements and recommendations made at the last key inspection. All staff who provide medication assistance have received certificated medication training and in Infection Control. This ensures that the health and safety of the persons cared for is protected. A record is kept of any complaints and the details of any investigation and the outcome are recorded on a `Corrective Action Report.` This ensures that any problems are recognised and corrective action is taken where necessary. The Service User Guide has been reviewed and updated to provide current information about the service provided by the home and how to raise any concerns.Three members of staff have received certificated Dementia Care training and there are plans for all staff to attend the training. The carpets have been replaced in two of the bedrooms and new blinds have been purchased for the bedrooms and lounges. What the care home could do better: Although staff have received some training on the safeguarding of vulnerable adults from abuse, further training is to be arranged. In order to ensure the protection of the persons cared for within the home. All staff would benefit from certificated Dementia Care Training to ensure the specialised care necessary for persons with dementia. A relative also made the following comment: `A bit of armchair aerobics would do the residents some good. Just once a week and nothing too demanding.` Key inspection report Care homes for older people Name: Address: Ashburnham House 33/35 Westminster Road Morecambe Lancashire LA4 4JA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Dale     Date: 2 6 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Ashburnham House 33/35 Westminster Road Morecambe Lancashire LA4 4JA 01524413508 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: ashburnhamhouse@hotmail.co.uk Mr Nashir Kasmani care home 12 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 only - Code PC. To people 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 people who can be accommodated is: 12 Date of last inspection Brief description of the care home Ashburnham House is a small, family type environment providing residential care for up to 12 people of either sex under or over 65 years of age. At present, the home is registered to accommodate up to 8 people with dementia and up to 4 older persons. The home comprises of two terraced houses which have been developed into one large property and it is situated in the West End of Morecambe, close to local shops, amenities and the promenade. Information is available about the services provided by the home within a Statement of Purpose and a Service Users Guide and these Care Homes for Older People Page 4 of 26 Over 65 0 4 8 0 0 1 1 2 2 0 0 8 Brief description of the care home documents are made available to any interested person by the owner and manager of the home, Mr Kasmani. The current fees at the home are £420:00 per week. Care Homes for Older People Page 5 of 26 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: As part of the inspection process an unannounced site visit took place to Ashburnham House. This took place over a period of three hours on the 26th October 2009. Information was obtained by an Annual Quality Assurance Assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information gathered about the home since the last key inspection was also taken into account. Various documents were examined including, records belonging to the people provided with a service and staff records. The registered provider who is also the registered manager was spoken with and his daughter who also assists in the management of the home. Staff and people living at the home were spoken with. Surveys were sent prior to the site visit; one survey was returned from a relative and four from staff. The findings, comments and any issues arising from the surveys were discussed and incorporated within the report. Care Homes for Older People Page 6 of 26 The last key inspection took place on the 1st December 2008. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? The registered provider has taken action on all the requirements and recommendations made at the last key inspection. All staff who provide medication assistance have received certificated medication training and in Infection Control. This ensures that the health and safety of the persons cared for is protected. A record is kept of any complaints and the details of any investigation and the outcome are recorded on a Corrective Action Report. This ensures that any problems are recognised and corrective action is taken where necessary. The Service User Guide has been reviewed and updated to provide current information about the service provided by the home and how to raise any concerns. Care Homes for Older People Page 8 of 26 Three members of staff have received certificated Dementia Care training and there are plans for all staff to attend the training. The carpets have been replaced in two of the bedrooms and new blinds have been purchased for the bedrooms and lounges. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 26 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 26 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. Good information is available about the services provided by the home. The assessment process ensures that the services provided by Ashburnham House are appropriate and meet individual requirements. Evidence: The Service User Guide is also the Statement of Purpose and there is also a small leaflet that can be provided to any prospective new person. The documents provide information about the services provided by the home, staff and how to raise any concerns. There have been no new admissions on a permanent basis for a number of years, one person is currently receiving respite care. The assessment paperwork seen included obtaining as much background information as possible and would include a visit to the individual concerned in hospital or within Care Homes for Older People Page 11 of 26 Evidence: their own home prior to admission. The registered provider has attended some initial training on the Mental Capacity Act and the deprivation of liberty safeguards. The Act places the responsibility on Care services to ensure that people who lack capacity and are unable to make decisions for themselves are provided with care that is in their best interests. The home does not provide intermediate care. Care Homes for Older People Page 12 of 26 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 personal requirements of the people living in the home are being met in a caring way by the staff within the home. Evidence: The care plans contain sufficient detail for the staff to provide care that is effective for the individual concerned. The pro-forma for recording the care plan was user friendly, clear and divided into sections for ease of use. The care plans are reviewed on a monthly basis. At the last inspection a recommendation was made that staff should be provided with some training in Dementia Care that would assist them in their role to provide effective care. A couple of staff had received some Dementia Awareness training but there is still a need for all staff to receive some certificated training on the subject. The people living in the home have been receiving care for a number of years and very familiar with their needs. Comments received by staff included: Care Homes for Older People Page 13 of 26 Evidence: Care for each individuals needs. Warm homely environment. We all get on well with each other and work well together. There was evidence on the care plans of liaison with health care professionals and a record of weight is maintained. The medication records and storage of medication was examined and found to be in good order; currently there are no controlled drugs being administered. The registered provider/manager conducts an audit of the medication once a month. All the staff who provide medication assistance have now received accredited medication training. Staff are taught the importance of privacy and dignity at induction and it was observed that the staff members on duty were aware of the principles of care. People spoken with living in the home spoke well of the staff and the care received. A comment was received from a relative: All the staff care about my mum and do as much as possible to meet her needs. The owner of Ashburnham is very hands on and very easy going when it comes to visiting residents. He does not want my mum to lose her liberties and treats staff and residents with respect. All staff have received training in Equality and Diversity and each person is cared for according to their individual need. A priest has attended the home in the past for one of the persons cared for who has since died. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables the people living in the home to have a standard of lifestyle that meets their expectations and choices. Evidence: The care plans reflect individual routines and preferences. Some activities take place such as dominoes and dancing in an afternoon. The owner/manager goes out for a walk with any person who wishes to and if they are physically capable. Staff have plenty of time to provide individual attention and to sit down with them to chat and watch TV. One person goes to a local public house accompanied by staff once a week. Photos are looked at and there is an exercise that takes place with a mystery bag containing various objects for people to examine and remember items that were familiar to them in the past. Activities also include crafts such as making Christmas cards. A hairdresser attends the home once a fortnight. Some of the people in the home are taken out by their relatives. A relative made the following comment: A bit of armchair aerobics would do the residents some good. Just once a week and nothing too demanding. Care Homes for Older People Page 15 of 26 Evidence: The registered provider is aware of the Advocacy Service and has used the service in the past for one of the persons living in the home. Dementia Care training, as previously referred to in the last section, could provide staff with information about appropriate activities that could provide encouragement for people who lack interest. One person cared for who has a learning disability as well as dementia can be challenging but staff know her well and manage her behaviour effectively. Relatives and friends are able to visit the home at any time and are able to see the people living in the home in private if they wished. Individual routines are respected and staff are very familiar with the wishes and choices of the people living within the home. The staff member on duty prepares the lunchtime meal. The meals provided were confirmed as good and offered choice, special diets are catered for. A record is kept of all food and liquids consumed. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The policies, procedures and training provided ensure that the people cared for in the home are protected from harm within a risk assessment framework. Evidence: The home has a formal complaints procedure which is publicised in the Service Users Guide and is also on display. There have been no formal complaints to either the home or to the Commission over the last twelve months. Any concern is now logged on a Corrective Action Report that ensures investigation and action is taken for any concern. Staff have received some training in how to recognise the different types of Adult Abuse at their National Vocational Qualification (NVQ) training. Some additional training had been arranged but cancelled by the training provider, a new date is now being arranged. Risk assessments have been carried out in the past and the manager is aware of the need to strengthen the assessment process for any person entering the home for respite care. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable, safe and homely environment for the people living in the home. Evidence: A tour of the home confirmed that the home is well maintained and homely with two lounges and an open fire. The home was warm, clean and tidy. The rooms showed evidence of personal belongings and treasured items in place. The home has a passenger lift and stair lift in place. Most areas of the home are accessible although one person without mobility problems is located on the top floor where there is only access by staircase. In the bathrooms toiletries have now been placed out of reach of the persons cared for. The home does not employ a cleaner but all staff make sure the home is clean and night staff undertake the majority of cleaning duties. There is an outside space that provides seating for the people living at the home when the weather is good. Care Homes for Older People Page 18 of 26 Evidence: Since the last inspection refurbishment has continued with new carpets in two of the bedrooms. New blinds have been purchased for the main lounges as well as the bedrooms. Policies and procedures are in place with regard to Infection Control and staff have now received Infection Control training. A maintenance record is kept with the details recorded in the Corrective Action Reports. Care Homes for Older People Page 19 of 26 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. There are sufficient trained staff on duty to provide a good level of care for the number and needs of the current people living at the home. Evidence: Staff are on duty at a specific time that is not changed and they are therefore able to plan their home life more effectively. The registered provider and his daughter are available at all times because they live next door. Extra staff are employed for the busiest times which are: 7:30 till 8:15 am when there are three staff on duty, two staff until 11:00 am, one staff until 5:00 pm and then 2 staff until 6:00 pm. One staff member is on duty after 6:00 pm with the assistance of the registered provider or his daughter. Currently there are six people living at the home, one is on respite care and the majority are fairly mobile and their behaviour and needs are manageable. Staff confirmed that they have sufficient time to care for both the physical and emotional needs of the persons cared for. The home has a suitable recruitment policy and checks had been undertaken with the Protection of Vulnerable Adults Register (POVA) and the Criminal Records Bureau (CRB). There have been no new staff since the last inspection and the staff group is stable with the staff employed at the home for a number of years. The Care Homes for Older People Page 20 of 26 Evidence: owner/manager is appreciative of the staffs loyalty and considers various ways to thank them, currently he is looking at a Health Plan for the benefit of staff. Staff had all received induction training and staff training is recorded on a training matrix which clearly indicates the shortfalls in staff training as well as that achieved. Since the last inspection, there was evidence that staff have received training in Medication, Manual Handling and Infection Control. This training ensures that staff have the skills and expertise to protect the health and welfare of the persons cared for. There are currently five staff and all five have a National Vocational Qualification (NVQ) in Care at level 2 or above in Care. NVQ is the recommended qualification within the caring services. As previously mentioned all staff would benefit from some certificated dementia care training that will enhance their skills in providing specialised care for persons with dementia. Care Homes for Older People Page 21 of 26 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 well managed and the people living in the home are protected by the policies and procedures that are in operation. Evidence: The registered owner is also registered as manager and has obtained the Registered Managers Award. The home is managed as a family concern with the day to day management of the home covered by the owner and his daughter. Surveys returned by staff and comments on the day of the site visit indicated that staff feel well supported and are happy to work at the home. The persons cared for are part of one big family within a homely and cosy environment. Staff turnover is very low and the comments indicate that they feel well supported by management and enjoy their role. Any finances belonging to the people living at the home are dealt with by relatives and Care Homes for Older People Page 22 of 26 Evidence: the advocacy service would be contacted as necessary. There is a safe available for the safekeeping of any valuables. There was evidence that staff are receiving one to one supervision and the format used is clear and signed by both the supervisor and the supervisee. Informal discussions take place constantly over the happiness of the people living at the home who when spoken with expressed their satisfaction with the care provided. A formal quality assurance system is in place - ISO 9001 (International Standards Organisation) this is an independent agency that measures the level of quality support to the persons cared for within the recorded systems once a year. As part of this, surveys are provided to relatives twice a year for their comments about the homes performance. All the care records seen within the home were up to date and kept in good order. A record was seen to be kept of any accident or incidents occurring within the home. Care Homes for Older People Page 23 of 26 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 24 of 26 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 18 All staff should be provided with up to date training on the safeguarding of vulnerable adults. This ensures the health and safety of the persons cared for is promoted. All staff would benefit from certificated dementia care training to assist them in providing appropriate care to the people living in the home. 2 30 Care Homes for Older People Page 25 of 26 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. Copyright © (2009) Care Quality Commission (CQC). 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