Care Home: Ashby Court Nursing Home

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What the care home does well The home provides a safe staff to look after the residents who are recruited thoroughly and receive comprehensive training. The staff is committed to the care of the residents and look after the residents in a dignified, caring and considerate way. The home provides a safe,comfortable and homely environment for the residents to live in. The residents are given choice in their meals that are presented well. The residents receive activities that suit their needs and take into consideration their previous interests. Visitors to the home are made very welcome. What has improved since the last inspection? There were no requirements or recommendations made at the last inspection on 24th July 2007. What the care home could do better: That all of the residents identified needs are documented with the care to be given. That where there are needs such as weight and nutritional, these are reviewed and updated regularly. That permission is sought to photograph areas of the body other than head and shoulders. The home should make sure that there are sufficient staff available to assist residents with their meals with dignity and to be able to answer call bells in a timely manner. The manager must make sure that there are enough staff on duty at all times to meet the needs of the residents. That staff views are obtained and discussed, about the care home and how the residents are cared for. That all of the staff receive regular, formal supervision at the intervals required by the National care Standards That the views of the residents received through surveys and meetings are acted upon. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashby Court Nursing Home Tamworth Road Ashby de la Zouch Leicestershire LE65 2PX     The quality rating for this care home is:   one star adequate 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: Anthea Richards     Date: 2 1 0 7 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Ashby Court Nursing Home Tamworth Road Ashby de la Zouch Leicestershire LE65 2PX 01530560105 01530560173 coalesr@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (BNH) Ltd care home 60 Number of places (if applicable): Under 65 Over 65 0 60 0 dementia old age, not falling within any other category physical disability Additional conditions: 60 0 60 The maximum number of persons to be accommodated at Ashby Court nursing home is 60. The registered persons 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 are within the following category: Old age, not including any other category (OP) 60. Physical disability - (DE) 60. Dementia (DE) 60. Date of last inspection Brief description of the care home Ashby Court is a purpose built care home providing nursing care for up to 60 older people. The home is situated on the outskirts of Ashby in a residential area that is easily accessed by public transport. The home is close to a large shopping centre and a number of pubs and restaurants. The home provides residential and nursing care for sixty service users whose care Care Homes for Older People Page 4 of 28 Brief description of the care home needs fall within the categories of Older Persons and or Physical Disability or terminal illness. The home employs registered nurses and care staff to look after the residents. Accommodation is on two floors and can be reached by the stairs or the passenger lift. The ground floor has a large lounge and dining areas that are well decorated and suitably furnished. The dining room opens out onto the patio, which has been developed by the staff to include a herb and sensory garden. The home has fifty-four single bedrooms and three double bedrooms. All of the bedrooms have en-suite facilities and the residents are able to bring their own belongings into the home with them to personalise their rooms. The fees charged are arranged on an indivdual basis according to the needs of the resident. A copy of the last inspection report was available at the home, together with an up to date registration certificate and a current certificate of public liability insurance. 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: 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 of a care home for older people, which ended with an unannounced visit to the service. Before the visit we [throughout the report the use of we indicates the Care Quality Commission], spent five hours reviewing information received by the Care Quality Commission [CQC] since the last annual service review on the 23rd July 2008. The visit took place on the 21st July 2009 and lasted eight hours. During the visit we checked all the key standards as identified in the National Minimum Standards. Care Homes for Older People Page 6 of 28 This was achieved through a method called case tracking. Case tracking means that we looked at the care provided to four of the residents. To achieve this we spoke with the staff supporting their care and looked at the records relating to their health and welfare. We spoke with the residents and visiting families. With their permission the residents bedrooms were looked at. We also checked how the home was run and organised. This included looking at staff records, training and how the staff are organised. We looked at health and safety records, menus, minutes of meetings and the quality audit. The policy for handling complaints and how the home dealt with them was seen. We looked at how prospective residents and their families are given information about the services the home can offer and whether they are suitable for them. During the visit we spoke with the manager, the residents, the staff and families visiting the home. We checked the Annual Quality Assurance Assessment (AQAA) that the home had sent to us when we asked for it. We looked at the surveys that we had sent out and had returned to us by the staff, the residents and relatives of the residents. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 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 9 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. The residents needs are always assessed before moving into the home and they have good information to help them make the right choice about the home. Evidence: The residents and the families spoken with, told us that they had received a Statement of Purpose and a service user guide. The residents and the families spoken with told us that they had had a visit from someone from the home and had the information that they needed to make a decision whether to come into the home. The Statement of Purpose and Service Users Guide gives people the information that people need to know about to help them make a decision about the home. All of the residents who were case tracked had thorough, completed pre admission assessments in their care plans. These had been completed by the manager or a senior member of staff. Care Homes for Older People Page 10 of 28 Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are aware of the residents needs and they give good, individual care, where they can, with privacy, dignity and respect. Evidence: We case tracked four of the residents records and these were found to have individual evidence of the care being given to the residents and reflected most of the care that they needed. We spoke with many residents and families who all told us that they received the care that they needed and that they were happy that they received it. The care plans contained most of the required information, but complete records of the residents needs and how they should be met were not always in them. The home had obtained permission for the residents to have a photograph of their head and shoulders to identify them but they had not not got permission for Care Homes for Older People Page 12 of 28 Evidence: photographs to be taken of other areas of their bodies. This is important as they may wish to take photographs of an area with a sore to make sure that it is healing. The staff spoken with and seen with the residents, were aware of each individuals needs and were carrying out appropriate care. There was evidence that the care plans are regularly reviewed but there was little evidence that the residents and the families had been involved. When we spoke with them they said that they had been involved and were happy with the care, but this had not been documented. The care staff were seen to be treating the residents individually with dignity, respect and consideration when talking to them and giving them care. When we spoke with the staff and from comments in their surveys returned to us they felt that they were doing their best but could not always give the care that they wanted to because the staffing levels were not enough for the needs of the residents. This was seen on an occasion when a call bell had been used and it took at least ten minutes to be responded to, although members of staff passed by. Comments received included: Looks after me well The staff are dedicated to the care There are records of the involvement of G.P.s, chiropodist, optician, where needed in the care plans, showing that thorough health care is being provided for the residents. The daily record of care was up to date making sure that the residents receive the right care and the staff know what has happened to them during the day or night. There are records of the residents nutritional needs and weight, which makes sure that they are eating well and are not losing or gaining large amounts of weight. One care plan looked at had not had this information updated for several weeks despite the person having needs for this. There were risk assessments in place to cover some of the identified risks for the residents and how the staff should manage those risks. All the risks for the residents should be identified to make sure that the residents and the staff are protected from any risks that have been identified, without restricting their activities. Care Homes for Older People Page 13 of 28 Evidence: There were Getting to know you forms in the records that told of the residents past lives, what they were interested in and what they would like to be called. Medication records for the case tracked residents were in order. Medicines are given by the trained nursing staff who have regular updating and supervised medicine rounds. We saw that the medicines were administered individually and the residents were seen to be taking them. Medicines are supplied in a monitored dosage system where each tablet is in a separate pop out card, which is a safe method of administration, helping to make sure that the resident is always given the right medicines. The staff spoken with were knowledgeable about the medicines and where to obtain information. They were also aware of the requirements for the receipt, storage and disposal of medicines. All of the residents have a self medicating drug assessment to identify people who are able to look after their own medicines and those who are not. There were no residents responsible for their own medicines at the time of the visit. The manager carries out a regular written audit of the medicines and the medicine sheets to make sure that they are correct. The controlled drugs,held in the home were checked and found to be correct. Two nurses check the controlled drugs twice a day to make sure that they are always correct. 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. The home provides activities for the residents to enjoy and take part in and meets their spiritual and nutritional needs. Evidence: The home has recruited an activities organiser who, with the staff, provides the activities in the home. We were told by the residents and their families that they felt that the activities had improved since she had been employed. The care plans describe the residents past life and their interests so that the home can help them continue those interests if they wish to. Activities include craft work, newspapers, nails, hairdressing, card games, board games, discussions and outside entertainment such as singers. Comments received on the day of the visit and from the surveys from the residents and their visitors told us that they were happy with the amount and variety of activities. Visitors are welcomed into the home at any time and are invited to attend social Care Homes for Older People Page 15 of 28 Evidence: functions and the regular resident/family meetings. I enjoy the activities A newsletter has been developed to let the residents know about the activities and anything else happening in the home together with recipes and items of interest. The menus seen gave choices of meals and the cook and the staff were aware of individual needs and choices. We spent time with the residents during their lunch, which was well presented and they told us that they were enjoying. The staff were seen to be sitting with the residents to help them with their meals and talking with them. There was one incident seen where a member of staff was seen to be helping two residents with their meal at once,which is not very dignified for them. The chef told us that menus were planned with the residents and that each home had individual menus. She also told us that she received regular good quality deliveries of food. The food is good and we can have a choice An hairdresser visits the home weekly and is very aware of the residents needs. Religious needs are catered for by the residents having a monthly service in the home or by visits from a local minister. 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 are good systems in place to support and protect residents and staff are aware of the processes. Evidence: There is a complaints policy in place which gives the details of how to complain and who to complain to in the home if they needed to. The policy could be made available in a large print and other languages if it was needed, which makes that as many people as possible could read it. The complaints form was clear and easily followed. Neither the home or the the Care Quality Commission have received any complaints since the last annual service review on 23rd July 2008. The residents, the families spoken with and the surveys told us that they were aware of how to make a complaint and were happy that it would be dealt with properly. The staff were aware of how to deal with a complaint and were happy that they would be dealt with correctly. The staff spoken with were able to describe how they would deal with an allegation of abuse, knew the areas where abuse could happen and could describe the process that Care Homes for Older People Page 17 of 28 Evidence: they would go through if they suspected any abuse. They confirmed that they had had training in safeguarding adults and whistle blowing and the manager and the records seen supported this. They were confident that the management would handle any issues correctly. The residents spoken with told us that they felt safe and protected in the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in a well maintained and attractive home and are well protected by the policies and procedures in the home that provides a safe environment to live in. Evidence: Ashby Court is a purpose built two storey, care home close to the town of Ashby De La Zouch in Leicestershire. The home is on two floors with bedrooms, bathrooms and lounges and dining rooms on both floors. The first floor can be reached by the stairs or by a passenger lift. The lounges and dining rooms were well decorated and were equipped with suitable furnishings and seating for the residents. All the bathrooms seen were clean and well equipped, one had been decorated with sea and beach scenes that the residents liked. The bedrooms of the case tracked residents that were seen, with their permission, were clean, bright, well decorated and personalised. The residents spoken with told us that they were pleased with their rooms and that they were kept clean and decorated. Care Homes for Older People Page 19 of 28 Evidence: I can have my own things in my room. There was evidence of equipment in the home to help the residents, such as wheelchairs, special mattresses and hoists. The kitchen has had a recent Environmental Health Officer inspection and was given three stars and a good rating. There are well maintained and attractive gardens that have seating areas and are easily accessible for the residents to use. Fire alarm testing, drills and instruction were found to be up to date, this was confirmed by the records seen, the staff spoken with and the manager. Hot water temperature records were found to be up to date and within recommended levels. The residents and the families spoken with were happy with the cleanliness of the home, and told us that the staff worked hard to keep it clean. There are staff employed to complete the cleaning in the home and they have had training in health and safety. The cleaning products are stored in a locked cupboard, which we saw. This was confirmed by the staff spoken with, the records seen and by the manager. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are protected by the recruitment and training practices in the home, but this may be put at risk by inadequate numbers of staff to meet their needs. Evidence: We looked at three staff files and all of them contained the documents that are required. These include two written references, a Protection of Vulnerable Adults check and a Criminal Records Bureau check. The staffing rota reflected the number of staff on duty and the numbers were adequate for the numbers of residents but not for the level of needs of those residents. The residents, the families spoken with all felt that the staff were well trained to do their job and were excellent, however they did feel that they were sometimes short of staff. The staff spoken with and the surveys received told us that the staff morale was low as they felt that they were not able to look after the residents as well as they would like to. This was because there were not enough staff to meet the residents needs as they felt that they should be met. They told us that they felt unsupported by the senior staff, that their comments were ignored and they did not have the opportunity to have formal supervision with their line manager. Care Homes for Older People Page 21 of 28 Evidence: The staff spoken with confirmed that they had received recent training in moving and handling, challenging behaviour, safeguarding of vulnerable adults, first aid, health and safety, medicine training and care planning. This was confirmed by the records seen and the manager. The manager holds a training matrix showing when courses would be held and which staff needed to attend. 50 of the care staff hold a National Vocational Qualification [NVQ] at level 2 or above or are completing the award. The National Vocational Qualification is a qualification for care staff to make sure that they receive training in the needs of the resident group whom they are caring for. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents safety is protected by the practices in the home, but their and the staffs views are not always taken into account. Evidence: The manager has worked for BUPA for many years and has achieved her Registered Managers Award. She was available throughout the visit. There are regular meetings held for the residents and for their families, to discuss activities and menus in addition as to how the home is meeting their needs. These were confirmed by the residents and their families and by the minutes that we saw. There is an annual quality questionnaire sent to the residents and their families and the questionnaires that we saw on the visit confirmed this. The families and the residents told us that they had completed the questionnaire. We did receive some comments that they felt that suggestions that were made were not always put in place. Care Homes for Older People Page 23 of 28 Evidence: We received some positive comments from the residents and the families at the visit, although during the visit and from the questionnaires that we sent there were several comments that the staff were very good but didnt always have enough time. The residents accounts were seen and found to be in order and had two signatures on each entry. This makes sure that the resident and the member of staff handling the money are protected. We saw that receipts were obtained for purchases. There was evidence from the staff spoken with that they are not having regular, formal supervision with their line manager. The manager could not find any records to support any supervision. Formal supervision of the staff would give them and their line manager the opportunity to discuss work and training issues and needs. There are regular staff meetings held, confirmed by records held and by the staff spoken with. However all of the staff spoken with felt that any opinions or suggestions that they might raise at these meetings were, largely ignored. The manager completes a regular audit of any accidents that have happened in the home to make sure that if at all possible they could be avoided. The areas of health and safety such as hot water temperatures and fire alarm testing were found to be in order. 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 32 21 That staff views are obtained about the conduct of the care home. To make sure that staff views are listened to and acted on where appropriate. 30/09/2009 2 36 18 (2)That all of the staff receive regular, formal supervision at the intervals required by the National care Standards. To allow staff and their line manager to have time to discuss work and training issues. 30/10/2009 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 7 7 That permission to photograph areas other than head and shoulders should be obtained. That all of the residents identified needs are documented Care Homes for Older People Page 26 of 28 with the care to be given. 3 4 5 6 8 8 15 33 That the staff respond to call bells in a timely manner. That where there are needs such as weight and nutritional, these are reviewed and updated regularly. The home should make sure that there are sufficient staff available to assist residents with their meals with dignity. That the views of the residents received through surveys and meetings are acted upon. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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