Care Home: Ashcroft

What the care home does well What has improved since the last inspection? What the care home could do better: Further developments in care planning and more training pertinent to the residents` needs would enhance resident care further. Annual evaluation and continued development of quality audits and assurance and monitoring process will be beneficial to the service by informing future planning and improvements. The information provided in the AQAA should be considered to ensure it provides the most comprehensive details to assist the Commission in understanding how the registered persons understand the service strengths and weaknesses and how it will address these. CARE HOMES FOR OLDER PEOPLE Ash Croft Halstead Road Eight Ash Green Colchester Essex CO6 3QH Lead Inspector Gaynor Elvin Unannounced Inspection 29th January 2008 11:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ash Croft Address Halstead Road Eight Ash Green Colchester Essex CO6 3QH 01206 767367 01206 573970 barbara@ashcroftresthome.freeserve.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Noeline Barbara Crowley Mrs Noeline Barbara Crowley Care Home 30 Category(ies) of Dementia (30) registration, with number of places Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2007 Brief Description of the Service: Ash Croft is a family run home providing personal care for 30 older people with dementia. Owned and run by Mrs Crowley, and her daughter, the home has been open since 1986. Ashcroft is not registered to provide nursing care. A detached property, located in the village of Eight Ash Green, on the outskirts of Colchester. Residential accommodation is all at ground floor level. The home has a large secure garden to the rear of the property and ample parking to the front. The home has a Statement of Purpose providing information for prospective residents, which is available upon request. The current fee, confirmed at the time of inspection is £389 - £460 per week, according to assessed needs and reviewed annually. Hairdressing and chiropody services are provided at an additional cost. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection visit commenced on the 29th January 2008; and took ten hours spread over two days. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. The inspection process included reviewing documents required under the Care Home Regulations 2001. We looked at a number of records relating to the residents, staff recruitment, staff training, staff rosters and policies and procedures. Time was spent talking to Mrs Crowley, the owner and Registered Manager, Andrea Crowley, the deputy manager, the senior carer and care staff. Due to cognitive impairment and disorientation to time and place discussion with the majority of residents with regard to the quality of care delivery was difficult. This report has been written using accumulated evidence gathered prior to and during the inspection. This includes information provided in the Annual Quality Assurance Assessment (AQAA), a self-assessment that focuses on how well outcomes are being met for people using the service, completed by the home, and returned to us prior to visiting the home; and views expressed in comment cards returned to the Commission. We received comment cards from 16 relatives of people using the service and 2 healthcare professionals. Views expressed are included within the contents of this report. What the service does well: The standard of care at Ashcroft is good and the home promotes a warm and happy environment. The interaction observed between residents and staff was comfortable and relaxed. Comments received from relatives through questionnaires were positive and indicated general overall satisfaction with the service their relatives received, that they were always welcomed to the home at any time and were kept informed of their relatives changing needs and when medical intervention was required. The staff team is stable and turnover is low and staff training is generally good. The manager has an honest and open approach and is keen to address any issues raised. There is a happy and friendly atmosphere in the home, which both residents and staff enjoy. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 6 Comments from relatives include: ‘‘ They more than meet the needs of my (relative), the care they have given is second to none, … is a changed person since in their care, …. has come out of their shell and feels valued. They listen to their needs and we have noted that they are no longer uptight and aggressive but calm and happy – thanks to the staff at Ashcroft’’. ‘‘Ashcroft go the extra mile and the support and care given at every opportunity – we cannot fault Ashcroft or their staff, we can only commend them for their care and professionalism shown at all times’’. ‘‘ All aspects of the home and welfare of residents is 100 and I have no criticism of the service that the carers provide to my … who is extremely happy here ’’ ‘‘ I think that the staff at Ashcroft administer the care, comfort and attention to the general welfare of all their residents giving peace of mind to friends and relatives such as myself ’’. ‘‘ I feel the success of the home is due to the care and compassion given by staff and their dedication to improving the quality of life for their residents. The food is freshly cooked, the bedrooms are always clean and tidy, and the new garden will be amazing. The fact that many staff have worked there for a long time is testimony to the all round service ’’ ‘‘ The care at Ashcroft has exceeded our expectations, given our previous experience and knowledge of care homes ’’. ‘‘The home provides loving care – always seen on many unannounced visits. The food is good, the environment is improving and staff treat my relative as an individual’’. Comments received from a healthcare professional included ‘‘ I never fail to be impressed by the dedication and care given to the residents ’’. What has improved since the last inspection? Significant improvements have been made since the last inspection including record keeping, social care provision and quality assurance and monitoring. These aspects have all helped to improve outcomes for residents. The building works incorporating an extension for additional personal accommodation was completed. The bedrooms were completed and furnished to the highest standard and met the needs of the residents. An anticipated completion date for the end of February 2008 was given for the remaining Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 7 refurbishment of the home including the sensory garden designed to dementia related needs specifications. Relatives informed us that the building works had been managed appropriately ensuring residents’ care was not compromised. Comments included: ‘‘ The home does everything well including the highest standard of care maintaining their dignity and pride – the fact that the building work has not infringed on my relatives’ care or quality of life is a true testament to their high standards and professionalism ’’. ‘‘I wish to commend them…whilst building work was being carried out, the disruption was non invasive and their high standards of care was maintained throughout’’. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home is not registered to provide intermediate care and therefore Standard 6 is not applicable. Quality in this outcome area is good. People wanting to use the service can be confident that they are provided with information they need to make a choice and that their needs are assessed prior to admission to ensure the home can meet them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the home is provided to prospective residents and their relatives. Records examined, relating to the people most recently admitted to the home, showed that they had been admitted on the basis of a pre-admission assessment carried out by the registered manager or her deputy. This was in addition to the information received from social services or health care Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 10 professionals to ensure the home was able to meet the assessed needs of each individual. Introductory visits were not always possible for the prospective resident as most are admitted directly from hospital assessment unit following crisis intervention; but the opportunity is offered by the home. Family or representatives, in the main, view the home on their behalf. Recent assessments were reviewed and seen to focus on immediate presenting needs. The assessment could be developed further to ensure a more person centred approach including strengths and abilities. The deputy manager acknowledged this, but indicated that, at times, these were not always evident when the person is in a hospital setting. Shortly following admission the home sends out a pack to the representatives/families of new residents, confirming the home can meet the assessed needs. The pack includes the terms and conditions, a questionnaire and a request for additional information relating to the individual’s personal/family and life history. The terms and conditions informed the resident/representative of the total fees payable in respect of the resident for the provision of accommodation and care, including any individually assessed personal contributions if relevant. The questionnaire relates to the residents experience of the admission process and the information collated is used as part of the quality monitoring process. Information relating to the individual’s personal and life history helps the staff team to understand the person and their previous identity, and any anxieties related to previous life events and experiences. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. People who use the service can expect to have their physical and emotional needs met with dignity and respect and their health care promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst we were at the home, we observed and heard staff interacting well with residents. From observation and discussion with staff it was clear that they generally understood the individuals’ needs and provided a level of care that the residents appreciated. Comments from relatives included: ‘‘ The quality of care received is as good as that which my (relative) would wish for (themselves), (they) have as much dignity maintained as is possible ’’ Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 12 ‘‘The service couldn’t do better, they maintain the highest standard maintaining dignity and pride at all times’’ ‘‘ The staff care for the residents’ physical and emotional needs with humour and compassion ’’ ‘‘They cope well with all different levels of dementia with tolerance and patience’’ ‘‘ This care home looks after people with love and care, the residents are treated with respect however difficult some people may be, staff talk with them and encourage them ’’. There is a care planning system in place. We looked at a sample of three care files and each consisted of a personal profile; family history, care plan, risk assessments and health care records. Overall we found that these were up to date and more regular reviews had taken place. The care plans were written in a narrative style, like a story, providing detailed information about how staff should deliver the required care and support to the individual to meet their needs in a person centred way. However they did not identify the individuals’ strengths and abilities. This could be developed further to evidence that staff have a full appreciation of the diversity of their residents and enable their optimal independence to continue to be encouraged and monitored. Some good life histories had been completed by relatives and staff and we noted that excellent information obtained was not always subsequently used when care planning. The care plans were reviewed regularly and each review generated a new plan of care centred on the changing needs. We noted that by using this system current and relevant information was lost and for staff to provide continued care in those areas they had to refer back to previous documentation. Whilst it is acknowledged that staff are aware of the continued care and support needs, for consistency to continue, care plans must remain an active and live document. We noted that there was an absence in the care plans of detailed health related risk assessments and management strategies with regard to cognitive ability, dependency levels, mobility, continence, tissue viability and nutrition. Staff should be aware of information gained at the time of assessment that may require the need for a risk assessment to identify potential or actual risks in these aspects of dementia related care needs. A healthcare professional told us that ‘‘on first moving into the home each person is assessed very carefully and treated according to their need not their history’’. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 13 Information provided in the AQAA tells us that on admission the resident is observed closely for 72 hours to fully assess their needs. Recording of useful and critical information obtained from assessments could be improved and used to inform effective management strategies that are incorporated into the care planning arrangements. This would promote staff awareness and guide them in consistent monitoring and promptly identifying any change. Records show that the staff contact the GP and healthcare professionals proactively and in a timely manner if there are concerns. One healthcare professional commented ‘‘ it is important in the care setting to work with and have easy access to professional staff who can together improve the life of the individual. Ashcroft staff have built up an effective rapport which ensures that their residents get the appropriate care when they need it’’. Another commented that the staff were ‘‘good at seeking advice when needed’’. Relative feedback was positive about their involvement in their relative’s care and they were usually informed of any changes. One relative commented ‘‘ staff always discuss what course of action to be taken in any situation and ask if I am happy with the decisions ’’. We inspected the medication system and again found it to be well managed with clear and completed Medication Administration Records (MARs). Information in the AQAA tells us that following admission and when needs have been fully assessed the GP is requested to review all medication, particularly the necessity of any anti psychotic or sedative medication previously prescribed to see if these can be reduced or discontinued. One healthcare professional commented ‘‘the senior staff are very much aware that too much sedating medication can blight the life of a resident so we regularly discuss titrating (reducing) doses down, without compromising the individuals’ health, so that they become more aware and have a better quality of life’’. A relative commented ‘‘they cope admirably with (relatives’) form of dementia without relying on all the heavy sedation that was given in their previous home’’. The home is not registered to provide nursing. With the support of Community Healthcare professionals the management endeavours to offer a home for life to residents, providing palliative care with support, for as long as their assessed needs can be met. From conversations with management and staff, and information included in the notifications submitted to the commission with regard to the death of residents, it was evident that the home responded Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 14 appropriately to changing needs of the residents and provided all the care and support they were able, in collaboration with the Primary Healthcare multi professional team. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. People using the service benefit from a home that is open and welcoming to visitors; provides good quality food and opportunities to participate in activities within the home. However the extent to which the activities meet the needs of the residents varies according to their level of need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We observed good elements of practice, which included staff’s cheerful and positive attitude, continual short interactions and constant verbal exchange between staff and residents, giving gentle reminders of what was happening next, to give residents some conception of time. The social needs aspect of care within the home is continually being developed and has progressed well. The home has formed links and is a member of the Alzheimer’s Society, Colchester branch and many residents are supported to attend organised events. The last event attended was an evening of traditional brass band music including classical, songs from shows and old films. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 16 The deputy manager is currently undertaking a course titled the Provision of Activities in a Care Setting, at Otley College; and with the support of a lady volunteer coordinates, plans and delivers the activities in the home. A programme of group activities undertaken in January, and planned for February, was reviewed. Varied reminiscence sessions included pictures of classic film stars with film musical links; old coin collections, photos of old Colchester town, and Frank Sinatra prompted memories and initiated discussion. Activities such as cooking and bread making, and therapeutic sessions such as aromatherapy and visiting pets prompted sensory stimulation such as smell, touch and feel. Music and dancing initiated movement and memories. We observed the activity volunteer, staff and relatives participating in one to one activities with the residents such as jigsaws, puzzles and board games. Whilst separate records, completed after each group activity, showed us the level of participation, interaction and enjoyment experienced by those residents it was not clear as to how they linked into their social care plans. More work needs to be done on the completion of social care plans that identify individual social and emotional needs and how these are being met. This important information would enable appropriate planning and support provision for the frailer resident with more complex support needs, who are unable to participate due to their varying cognitive abilities. A more individualised approach would bring the social, emotional and psychological aspects of care together to improve outcomes for everybody in this area. Comments from relatives included: ‘‘ I feel that not only do they meet needs but provide many extras such as massaging and games to stimulate mind and body. The garden is being completely redesigned to include a sensory and pleasure area, which will be a huge advantage to us both in the spring and summer ’’. ‘‘ The staff support (relative) very well, if confused, tired or ill they take time to distract and entertain (relative). There are activities provided such as musicians, dancing and trips out as well as the usual daily activities’’. ‘‘ They always make us feel welcome and a lovely lady volunteer goes in regularly to spend time with those who want to play board games and do jigsaws etc ’’. The home has no restrictions on visiting and the management clearly stated to us that they strongly encouraged family and friendship links and took a partnership approach with family members, which was paramount to caring for people with dementia needs. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 17 This was confirmed by relative comments that included: ‘‘The care staff are professional and caring and always make me welcome. I feel encouraged and heartened by them and visit many times a week, always to be greeted and welcomed by the staff ’’ ‘‘ The staff at Ashcroft have kept us well informed and cannot be faulted for the level of information, help and consideration they give at all times’’. ‘‘ After the music afternoons, relatives and friends are invited to stay for a buffet – really lovely food ’’. ‘‘ They do so many activities and are in the process of building a sensory garden. They also encourage me to join in and give me a feeling of being part of a family ’’. The deputy manager was in the process of advertising a coffee morning for relatives, and a guest speaker from the Alzheimer’s Association will give topic related information. If these are successful they will be held on a monthly basis. Further developments in the home that will further benefit the residents were almost at the point of completion including a sensory garden and a sensory room. The sensory garden includes a fish pond, a herb garden, a chess patio, a bowling green, a band stand with piped music, whistling gnomes and night lights. A further area provides an area for planting and growing and maintaining chickens and a goat. The sensory room will provide a quiet and peaceful sanctuary for those who require it. Comments about the food from residents and relatives were positive. Information in the AQAA tells us that the menu has been altered to suit each individual preference so residents are able to enjoy a more balanced and varied diet by eating food that they want to eat. Close attention is given to providing foods that are rich in protein and high in fibre to meet nutritional needs of the older person, particularly with dementia. Nutritional records viewed confirmed this. Food stocks were plentiful including fresh produce. A choice of meal is offered daily. Meals are served from a heated trolley and this enabled residents to choose their meal visually and at the time it is being served. Management and staff told us that this practice was found to be the most suited to the residents. Pictures and menu books were tried and unsuccessful due to people’s cognitive needs. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People who use this service can be assured that satisfactory arrangements are in place to promote their protection from abuse and that any concerns they or their representatives may raise will be listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback from healthcare professionals who regularly visit Ashcroft stated they had not received any complaints about the home and that they were satisfied with the overall care provided to the residents in the home. Those comments, received by the Commission, from relatives of people who live there stated that they were aware of the home’s complaints procedure but have not had any cause to complain. They felt comfortable to discuss any concerns with the management and felt they were always listened to. Comments included: ‘‘ I was made aware complaints policy before (my relative) became a resident ’’ ‘‘ I cannot find one thing to complain about ’’ ‘‘ I am aware of the complaints procedure but cannot see that I would ever need to use it as they are so good and have not had any reason to have concerns ’’. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 19 ‘‘ The staff have always answered any questions promptly, and any slight changes needed to improve quality of life are put into place after discussion between myself and staff ’’. ‘‘ I am aware of the complaints procedure, my concerns have always been taken seriously even though some have been trivial ’’. We have not received any complaints with regards to this service since the last key inspection. The complaints policy meets the expectation of the Care Homes Regulations 2001 and is clear in the steps the service will take to respond to complaints. This is made available to residents and relatives on admission to the home. The manager has a system for logging and recording complaints or concerns, the action taken and outcome for complainant, including action for future practice and review. The manager had not received any formal complaints since the last inspection. An Adult Protection policy and procedure was in place, which ran in conjunction with Local policy guidelines. Records showed that staff had received training on issues relating to the protection of vulnerable adults accessed from Essex Vulnerable Adult Protection Committee on 25/01/08. Staff were observed to interact with the residents appropriately and residents appeared relaxed and comfortable with the staff. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. Resident’s benefit from an environment that meets their needs and provides a safe, clean and comfortable place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A large-scale building project had recently been completed that provided an extension to the back of the building providing five single and one double (for a couple) additional rooms with en suite facilities. The rooms were decorated and furnished to a high standard. Additional building works and refurbishment included the provision of new office and training facilities for management and staff, an additional lounge/sensory room for residents, new laundry and sluice facilities and bathroom. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 21 Although this scale of building works naturally causes some disruption to the home, residents and relatives informed us that the disruption was minimal and comments included: ‘‘The home has been excellent whilst the refurbishment has been undertaken with minimal disruption to residents and their care and daily routine’’. ‘‘I wish to commend them…whilst building work was being carried out, the disruption was non invasive and their high standard of care was maintained throughout’’. A partial tour of the home was undertaken, reviewing all the communal areas and a number of bedrooms, at random. The home was seen to be clean and no odours were noted. The residents’ bedrooms were personalised and comfortable. In the original building there are shared rooms with screens to provide some privacy. The manager stated that residents only share rooms once there has been an established relationship developed between the occupants and it is beneficial to the individuals concerned. An improvement programme of redecoration and refurbishment to the original building was taking place including the provision of new furniture, bedding and curtains for all bedrooms. The manager told us that the installation of grab rails and radiator covers in the original building would be completed by the end of February 2008, which would help to reduce the risks to resident’s safety. Consideration has been given to the decoration of the new building including colours and signage to promote residents’ independence and support their understanding of the use of rooms. The manager told us that this is to be continued throughout the premises within the improvement programme. Infection control arrangements such as waste management and hand washing facilities were seen to be good. Information in the AQAA tells us that all staff have received in house training in the awareness of infection control. We noted a gate, normally used for children, installed in a bedroom doorway. We were informed that this was at the request of the resident. Having the gate in situ relieved their anxiety in that their door could remain open but at the same time their personal space was ‘protected’ from other residents wandering in. The management informed us that advice was sought from the fire safety officer. A risk assessment had been undertaken. Although it is not recommended practice the home considers that the residents cognitive ability is as such, at this time, to make an informed decision with support in relation to their personal safety. The situation must be closely monitored and reviewed and at such time when the resident is unable to open and close the gate independently it must be removed. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. People who use the service can expect to be safeguarded by the homes recruitment practices and supported by a stable staff team although they cannot be sure that all staff have the understanding, knowledge and skills to meet their specialised needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota showed us, and management confirmed, that there are four care staff on duty throughout the day. In addition to this the manager and deputy manager are in the home daily and take a ‘hands-on’ approach. The manager advised us that staffing levels are being reviewed as staff have requested that they need additional help. One healthcare professional commented ‘‘the service will always improve with more staff to stimulate the resident doing meaningful pursuits’’. As reported under other outcome areas in the contents of this report the feedback received by the Commission regarding the staff team was positive in that staff were seen to be caring, friendly and helpful. We reviewed the recruitment procedures at the home and found that they remain robust and that all required staff checks and documentation is in place to help ensure suitable staff are appointed for the job. Recruitment of overseas staff was handled by an external agency that ensured all references and Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 23 documentation was validated. All files contained references and satisfactory Criminal Record Bureau and Protection of Vulnerable Adults (POVA) First checks. The AQAA informed us that the manager had registered with Skills for Care and completed the National Minimum Data Set. This information feeds into the National database providing the national statistics of all known trained staff working in the care sector. Information in the AQAA also told us that 56 of the staff team hold a recognised qualification in care to National Vocational Qualification (NVQ) level 2/3 or equivalent. The manager told us that included in these numbers were staff from overseas with qualifications equivalent of NVQ level 3. A sample of staff training records showed us that all new staff complete an induction programme. The manager advised us that the in house service induction is made up of modular assessments underpinned by the National Occupational Standards, and in areas selected that are dementia care related. Information in the AQAA told us that an internal and external comprehensive staff training programme is provided in order to increase staff knowledge and skills base. We noted that the majority of training in mandatory subjects such as infection control, health and safety, first aid, fire safety and food hygiene as well as basic dementia awareness continues to be delivered in house, through open learning with documentation and DVDs and assessed through multiple choice question papers and short essays. As detailed in previous inspection reports, this level of training is adequate as an induction level of training to support staff in provision of a care service. Discussion took place with the manager about references in the previous two inspection reports in relation to ensuring this basic level of training is complimented by further initiatives such as structured training and assessment of competence in translating theory into working practice. The AQAA also told us that they ‘could do far more training if the budget allowed it and hands-on staff were more committed to completing their courses after starting them’ and that ‘ records of training could be improved’. The AQAA also told us that ‘we have created far more external training opportunities in the last 12 months’. It was noted that some training was planned from the Alzheimer’s Society. Training and development plans for staff individually and as a group is an area still to be addressed. Elements of specialised practice such as validation and reminiscence therapy, communication, ‘life histories’, activities and person centred planning need to be developed to enhance the staff’s level of understanding of dementia care. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 24 Particularly as a high number of the staff workforce do not have English as their first language. A healthcare professional commented ‘‘excellent management and good senior carers, some junior staff lack language and cultural understanding of the residents’’. A relative commented ‘‘ the home can improve by language and communication. All staff are from ethnic backgrounds, the residents receive very poor stimulation because of this’’. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 and 38. Quality in this outcome area is good. People who use the service can be sure that they live in a home that is well managed and run in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager, Mrs Crowley, has operated Ash Croft for many years. Mrs Crowley is a qualified Registered Nurse and has successfully completed NVQ level 4 in care and management. The staff felt well supported in their roles and confirmed any issues identified were dealt with as they arose. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 26 Mrs Crowley, the Proprietor and Registered manager resides in close proximity to the home. Staff confirmed that there was good contact during the day and night between the manager and the staff and the residents. The Registered Manager is dedicated to the care of the residents in her home. She operates an open door policy to residents, their representatives and staff. Comments from relatives and healthcare professionals expressed satisfaction with the home and felt welcomed and included in their relatives care. ‘‘The staff at Ashcroft have kept us well informed and cannot be faulted for the level of information, help and consideration they give at all times’’ ‘‘ They are exceptional and very caring, they let us know immediately if there is a problem and do all they can for us – we are most impressed with Ashcroft and the staff ’’ ‘‘ The home always phones me and has always been forthcoming with information and significant events have always been relayed to me straight away’’ ‘‘ I visit about 4 times a week and when greeted at the door I am always told how (my relative) is and what they’ve been doing and am able to ask any questions I may have ’’ Information provided in the AQAA told us that the management felt there was a disproportionate value placed on evidential records and documentation in comparison to the resident’s experience of care delivery. During the visit to the home the registered manager was advised of the regulatory requirement to have evidential records in place to demonstrate the understanding and delivery of appropriate, consistent and individualised care and support. We found a marked improvement in record keeping and hope that this improvement will be sustained and developed further. We noted a pro-active approach to the previous inspection report and Mrs Crowley and her deputy has addressed a wide range of development work in the home. One relative commented ‘‘ the home is improving all the time – always thinking of new ways to improve quality for residents and staff ’’. The deputy manager is currently working towards a BSc in Dementia Studies. From her studies she has developed new skills, which she is transferring into the workplace including Dementia Care Mapping. This is a tool used to consider the well being of people with dementia and how they perceive their daily experiences. She informs us that she proposes to fully implement Dementia Care Mapping as part of the quality assurance and monitoring system to look at care practice and outcomes for residents with a focus on the quality of life for people with dementia at Ashcroft. We look forward to seeing the results of this development during the inspection process. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 27 The manager and staff were progressing in developing quality assurance and monitoring systems to provide sufficient evidence to demonstrate an open and analytical review of the care and support currently provided at Ashcroft. A range of internal quality audits were being undertaken to identify weaknesses as well as strengths in service provision in areas such as the admission process; activities and the environment to inform action plans for improvement in outcomes for residents. Records of staff meetings showed us that subjects discussed included policies and procedures, changes in the home and safe practice issues. Innovative ideas from staff were invited and welcomed. The manager does not manage the financial affairs of any of the people living there. Where residents are unable to manage their own finances this is managed by nominated persons outside of the home. There was appropriate security and procedures in place for the safe storage for small amounts of personal monies for everyday use – such as toiletries, hairdresser and chiropody. Receipts are held for expenditure and records confirmed by signature. The procedures were adhered to and amounts held were confirmed as correct. Records show that the three senior carers had undertaken a Fire Marshall’s training course and we were informed that they delivered fire safety training to other members of staff. Records showed us that checks of fire safety equipment such as alarms, automatic doors and smoke detectors were carried out on weekly basis. Although there was no record, we were informed that maintenance and inspection of fire safety equipment had been carried out on 23/01/08. A fire safety visit was undertaken by Essex County fire and rescue in February 2007 who found a satisfactory standard of fire safety. We noted that the homes fire risk assessment was completed in 2006 and was now due for review particularly in relation to updating an escape plan and procedure incorporating the new building and additional occupants. Fire drills had not been carried out. A visit by Environmental Health in relation to health and safety in the workplace and food hygiene was undertaken on 10/10/07. The home operates the Safer Food Better Business self-assessment system ensuring food hygiene and safety, and records were in order. There were no immediate concerns brought to light in relation to health and safety during this visit to the home. Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations There remains scope for developing care plans further, with a greater focus on identifying more preferences, maintaining strengths and abilities and detail on promoting independence and self worth. The home would benefit from the implementation of a training and development plan for staff individually and for the team as a whole, to ensure weaknesses and strengths in staff’s skills individually and as a group are addressed and planned for throughout the year. A staff group who receive training that continues to develop their understanding, knowledge and skills would support residents further. Reviewed and updated risk assessments, management strategies and procedures with regard to fire safety would help to ensure residents in the home are protected. 2. OP30 3. 4. OP30 OP38 Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ash Croft DS0000017750.V359449.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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