Care Home: Ashcott Lawns

What the care home does well This is a small and established home in an attractive village setting. The service provides individualised care in a comfortable and homely environment. People are encouraged to live as they choose. People are treated with respect and kindness. There is an established and committed team of staff who have received training and up-dates in all key areas in the past six months. The service is benefitting from the commitment and enthuisasm of the acting manager. People are offered a choice of appetising home cooked meals. Staff are vigilant and contact medical services promptly when needed. The environment is attractive and there are adaptations in place. The home has benefitted from the financial commitment of the owner resulting in appropriate updating and improvement of bathing facilities. There is a team of management and staff members who are committed to achieving high standards in the home that conform with CQC regulations. What has improved since the last inspection? There is an assessment policy in place with appropriate supporting documentation. There is a care planning system in place that is comprehensive and enables peoples changing needs to be recorded. Staff have received training in the Protection of Vulnerable Adults There is a staff structure that demonstrates accountability within the home. Staffing on night duty has been increased with the addition of a regular sleep- in carer. The medication system procedures in the home have been improved and training has been provided to staff. Menus have been prepared in advance and include consultation with people who live in the home. The home environment has been generally improved and stream lined with the removal of excess equipment and belongings. The bathing facilities in the home have been improved with the provision of lifting equipment in the main bathroom and the provision of a new wet room type shower. A programme of activities and entertainments has commmenced with a regular crafts and games session. What the care home could do better: There is still work to be done to ensure that staff understand and are competent with the care planning system. Staff will benefit from further training and following this the care plans should be audited and amended systematically so that best practice is gradually embedded. Staff training should continue to ensure that all staff are confident in all aspects of health and personal care required by people in the home. The recruitment and staff management structures in the home should be audited and improved in line wth best practice. A robust system of recruitment policies and practices must be put in place to ensure that when further recruitment becomes necessary it can be done effectively. An annual devlopment plan for the home that is based on the seeking of peoples views and is commited to the continued improvemment of the home must be established. Key inspection report Care homes for older people Name: Address: Ashcott Lawns Chapel Hill Ashcott Bridgwater Somerset TA7 9PJ     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: Shelagh Laver     Date: 0 4 0 8 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 25 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 25 Information about the care home Name of care home: Address: Ashcott Lawns Chapel Hill Ashcott Bridgwater Somerset TA7 9PJ 01458210149 01458210932 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Monica Diana Corbett care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Ashcott Lawns is registered with the Commission for Social Care Inspection to provide personal care only for up to 17 people over the age of 65 years. The home is not registered to provide nursing care. The registered provider/manager is Mrs M. Corbett. Mrs Corbett lives on the premises. The home has been converted from a Grade II house to provide a homely environment for service users. It has been adapted as far as possible to meet the needs of older people however, service users need to be ambulant as there are further steps to most first floor bedrooms and assisted bathing facilities are limited at this time. This period house is full of character and furnishings and fittings are in keeping with this. The home is located in the village of Ashcott where there are some amenities and village activities. Attractive gardens surround the home and there is ample parking. The current fee range is #430 to #530 per week. Additional charges include; hairdressing, chiropody, personal items Care Homes for Older People Page 4 of 25 Over 65 17 0 0 9 0 2 2 0 0 9 Brief description of the care home and some staff escorts to appointments. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection took place over one day and followed two Random inspections that have occurred since the last Key inspection on 24/02/09. It was clear at this previous inspection that the health of the registered manager was making it difficult for her to run the home alone. Mr Simon Ewingtion has been employed at the home since that time and is now acting manager. We (CQC) would expect him to register as manager within six months. An Annual Quality Assurance and Assessment document was requested and received on time. The AQAA provides factual information about the home and gives an indication of plans for the coming year. We sent questionnaires to people who live in the home and at the time of writing the report had received five. On the day of the inspection there were nine people living in the home and we (CQC) were able to speak with them. We made a tour of the environment and reviewed care and management documents. We have attended meetings with Somerset County Council Community Directorate to Care Homes for Older People Page 6 of 25 review the action plan supplied by the home and to monitor actions taken in response to the last report. We were not able to fully assess all National Minimum Standards. There has been limited recruitment since the last inspection. In future we will be able to assess the homes ability to recruit and induct staff according to the required standards. The people who live in the home have been living at the home since the last inspection and are very happy with the care they receive. We were not able to fully assess the homes ability to assess a person for admission and set up a new care plan. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: There is still work to be done to ensure that staff understand and are competent with the care planning system. Staff will benefit from further training and following this the care plans should be audited and amended systematically so that best practice is gradually embedded. Staff training should continue to ensure that all staff are confident in all aspects of health and personal care required by people in the home. The recruitment and staff management structures in the home should be audited and improved in line wth best practice. A robust system of recruitment policies and practices must be put in place to ensure that when further recruitment becomes necessary it can be done effectively. An annual devlopment plan for the home that is based on the seeking of peoples views and is commited to the continued improvemment of the home must be established. Care Homes for Older People Page 8 of 25 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 25 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 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The acting manager understands the importance of a robust assessment process for people before they come to live in the home. There is documentation in the home that can be used as the basis of an effective assessment. Evidence: The home has produced a brochure that gives information about the services that can be provided at the home. There is appropriate assessment documentation in place that can be used when an assessment is to be made. The acting manager was able to discuss the range of information such as hospital discharge information and single assessment documents that would be considered when making a decision to accept people in the home. There had been a recent enquiry regarding admission to the home. The acting manager had visited the person and demonstrated that he understood the issues involved in making a move to a residential home. Whilst on this occasion the person Care Homes for Older People Page 11 of 25 Evidence: decided not to complete the move all actions taken by the home were appropriate and helpful. People are welcome to visit the home for trial visits, respite stays or day care. This outcome area will be more fully assessed at the next inspection when there have been opportunities to admit people to the home. Care Homes for Older People Page 12 of 25 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. There has been a substantial improvement in the planning and recording of care in the home. Personal health care needs are recorded and give an overview of care needed. The delivery of care is individual and flexible, consistent and reliable. The home supports people in accessing the health services that they need. There is a medication system that is in place that is basically safe and efficient. Some staff need further training and support to become fully efficient in using both the new care planning system and the medication system. Evidence: There was evidence that the people in the home at the time of the inspection were receiving good health and personal care. Everyone who returned a comment card or spoke to an inspector during the random and key inspections said that they always received the care and support they needed and that staff were available when they were needed. People said that they received the medical care that they needed. The home has worked with the community nursing team and other health and social care Care Homes for Older People Page 13 of 25 Evidence: professionals to meet the particular needs of one person and documentation was seen. One person with poor sight had been visited by the GP and the optician and additional lights had been purchased to try and maximise her sight. Information and DVDs have been purchased by the home on Parkinsons disease to assist the staff in caring for one person. The home now has a comprehensive care planning system in place that is designed to comply with National Minimum Standards. There are risk assessments for pressure damage and nutritional assessments. There is a system of recording short and long term care needs and to up-date peoples needs. Plans had been commenced and information was being recorded however it was clear that some staff still required further training in the use of the system. There should be an actual care plan in place for everyone who comes into the home even if care needs are minimal. This refers to the person who came in for respite again. There was plenty of information about their needs and daily records demonstrated that the visit had been successful but an actual plan should be written in future. The home has changed the way medication is managed and is now supplied by Boots. We saw the new storage and administration system in place. The arrangements are now overall safe and professional. Staff have received training but there is a need to ensure that variable doses are always clearly marked and that any amendments made to the MAR charts by hand have two signatures. This was discussed with the home acting manager and supervisor. It was agreed that further training is provided to embed the system and that the home audits the MAR charts to ensure that all staff are fully aware of current best practise. Care Homes for Older People Page 14 of 25 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. People are able to make choices about how they spend their days at the home. Visitors are welcomed into the home at any time. There is a choice of appetising and wholesome food available. Evidence: People make choices about how they spend their day at the home. One person talked about being a night bird. Another talked about going out with her family. Families and friends are welcomed into the home at any time. Once a week an activities co-ordinator comes to the home and there is a games and crafts session which was enjoyed by people. The home is considering how the social events and activities can be developed further and is working toward a monthly programme. On the day of the inspection some people were playing cards and drinking coffee together. One person told the inspector about going out for a Chinese meal for the first time since she had come to live at the home. Two people go to church with the registered manager and a communion service is available monthly. Musical entertainment is provided occasionally. Most people come to the dining room at meal times although meals can be served in rooms when required. We saw examples of an interesting menu with choices clearly shown. People have Care Homes for Older People Page 15 of 25 Evidence: been asked about their favourite meals and these have been included in the menu. On the day of the inspection the lunch was a home baked steak and kidney pie with fresh vegetables. A choice of sweets includes fresh fruit salad. The menu is displayed in a folder and on a white board and it is worth ensuring that all people can easily see this. People returning surveys to us said that always liked the meals in the home and one person wrote We have very nice meals everyday. Care Homes for Older People Page 16 of 25 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 policies and procedures in place to keep people in the home safe. There is a complaints policy in place that people are aware of. Evidence: There are policies and procedures in place to protect people in the home. All staff have undergone safeguarding training recently using an e-learning package. The acting manager has attended a training day on Managing a Safeguarding Incident and the local guidance on safeguarding procedures is available in the home. The acting manager has worked with other professionals in a positive manner to ensure a satisfactory outcome to a safeguarding referral. All people who returned a comment card said that they knew how to make an informal complaint and that there was someone they could speak to if they were not happy. Care Homes for Older People Page 17 of 25 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. People live in a home that is appropriate to their needs. The home is well maintained and attractive. People who live in the home will benefit from recent improvements. Evidence: Overall the environment was clean and attractive comfortable. Bedrooms are very pleasant, varying in size and outlook. People have brought their own possessions and some furniture. The communal dining room and lounge are homely and comfortable. There have been several major improvements to the environment since the last Key Inspection. The kitchen has been completely refitted. There is a new wet room shower and toilet downstairs. Upstairs there was evidence that the new bathroom is now in use. There is a bath chair in place. One person confirmed that she was still having her daily shower. Minor alterations to the home such as additional grab rails have been made at the request of people who live in the home. There is a stair lift to access the upstairs rooms and we observed people being assisted to use it. The home is surrounded by attractive and accessible gardens and there is garden furniture available to encourage people to go outside. People have received training in infection control and evidence of systems of infection control were seen. Care Homes for Older People Page 18 of 25 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. People in the home benefit from a team of established staff who have received recent training and up-dating. The recruitment procedures in the home are being reviewed and further developed. Evidence: A four week staff rota showed that there are a team of established regular care staff. There is now a waking member of night staff supported by a sleep-in member of staff. There has been a comprehensive training programme provided for staff in the previous six months. Staff have completed an E-Learning programme in Safeguarding Adults, Dementia Care, Mental capacity Act ans Deprivation of Liberty. Further training in personalisation of care is planned. Staff have received training in Basic Food Hygiene Awareness and Manual Handling. There re plans to increase the number of staff with national Vocational Qualifications. There must be further staff training in the use of the new care planning system and the new medication system. Since Mr Ewington has been acting as manager there has been limited staff recruitment. The systems of recruitment in the home are being revised and formalised in line with current best practise and will be reviewed at the next inspection. An audit has been undertaken with regard to existing staff and files have been established. It was emphasised during the inspection that all new staff must undergo the same recruitment procedures including close family. Care Homes for Older People Page 19 of 25 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 run in the interests of people who live in the home. There are systems in place in the home to maintain the health and safety of people who work in the home but there are plans for further development. Evidence: The home has a registered manager who has many years of experience in running the home. The home recently celebrated 22 years of operation with a garden party. Since May 2009 Simon Ewington has been the acting manager and intends to be registered as the manager of the home in approximately six months. Mr Ewington is an experienced manager and is currently completing his National Vocational Qualification in Leadership and Mangement in Care Services. A recent assessment for this qualification confirmed that 70 of the award had been achieved and that competency and knowledge had been demonstrated throughout the course. Minutes of staff meetings showed that Mr Ewington had involved staff in changes in the home, offered a wide range of training and individual support when required. Records seen during the inspection were organised and comprehensive. There is still Care Homes for Older People Page 20 of 25 Evidence: work to be done in some areas of administration which Mr Ewington is aware of and has plans to complete. There is a staffing structure and accountability chart that includes a supervisor and shift leaders with NVQ care qualifications. Mr Ewington has addressed most the requirements made at the Key and Random inspections and plans are in place to make further improvements in the systems in the home. There is a service user request form in place that enables people to formally record any issues they would like to have addressed. For example a private telephone has been requested by one person and was now connected. Another person requested an extra grab rail and quarter turn taps, both requests were responded to very promptly. The home should now implement a formal quality assurance system that includes an annual development plan of the home and includes surveys of the wishes of people who live in the home and other stakeholders. Mr Ewington is is revising and up-dating the safe working practices in the home . Staff have received training in manual handling. The AQAA confirms that there is a contract for the servicing of the hoist and stair lift and that fire detection and and alarm systems are in place. All staff have received training in Food Hygiene and Infection Control. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person must 20/12/2009 ensure that a thorough recruitment procedure is operated ensuring the protection of the service user. Recruitment procedures that are not thorough may enable people to work at the home who are not suitable and may place people at risk. Initial requirement made 20/03/09 Since this requirement has been made there have been no external staff changes. 2 33 24 The registered person must establish and maintain an effective quality assurance system which will seek the views of service users, their representatives and any other interested stakeholders. Requirement due 15/04/08 Some work has commenced and people who live in the home and their families have been consulted about the care provided. 15/12/2009 Care Homes for Older People Page 22 of 25 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 7 16 The manager must ensure 01/12/2009 that care plans are maintained in line with guidance provided in National Minimum Standards and apropriate regulations. Care plan systems are in place and must be maintained by all staff. 2 9 13 The registered person must ensure that all staff adhere to the procedures for administration of medicines by providing further training and implements an audit system. The home has implemented a new and efficient system of medicine administration however some staff require further training in aspects of best practice. 01/09/2009 Care Homes for Older People Page 23 of 25 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 3 31 8 The plans to complete the 11/02/2010 registration of the acting manager must be completed as soon as possible. The acting manager has taken day to day responsibility for the running of the home. 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 12 The home should continue to develop the programme of activities and social events it has commenced by researching peoples interests. The acting manager should conduct an audit of the health and safety procedures and policies in the home to ensure that the service is meeting the requirements of all regulatory agencies including Environmental Health and the Health and Safety Executive. 2 38 Care Homes for Older People Page 24 of 25 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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