Care Home: Ashcroft Nursing Home

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What the care home does well The home has an open and stimulating atmosphere with family contact for people who there live actively encouraged. People`s individual needs and interests are comprehensively assessed and their care planned thoroughly. The homes approach to dementia care is purposeful with the peoples individual experiences being recognised and valued. The home offers a good training opportunities with a detailed programme o f training events throughout the year. The home is generally effectively run with a positive culture of monitoring the quality of services. The home has just achieved the Pearl award for its care of people with dementia. Families` spoke with during the visit spoke very highly of the home and the care their relatives receive. What has improved since the last inspection? Requirements from the previous inspection have been fully complied with by the time of this site visit. Requirements from the previous inspection have been fully complied with by the time of this site visit. What the care home could do better: The home needs to resolve current difficulties with staff turnover and problems in maintaining necessary staffing levels at all times. This has led to an increased use of agency staff and potential negative effects on the continuity of care. CARE HOMES FOR OLDER PEOPLE Ashcroft Nursing Home 18 Lee Road Hady Chesterfield Derbyshire S41 0BT Lead Inspector Nancy Bradley Unannounced Inspection 21st August 2008 09:00 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 Ashcroft Nursing Home DS0000002038.V370448.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. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashcroft Nursing Home Address 18 Lee Road Hady Chesterfield Derbyshire S41 0BT 01246 204956 01246 555524 ashcroft@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd 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 Lynda Hodgkinson Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (20) of places Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Tamaris Healthcare (England) Ltd is registered to provide personal care with nursing for service users whose primary care needs fall within the following categories: Dementia aged 65 years and over, not falling within any other category DE(E) 42 Old age, not falling within any other category (OP) 20 To be able to admit the named person of category dementia under 65 years of age (identified in the registration report dated 20/06/06) for the duration of their stay. To be able to admit the named person of category dementia under 65 years of age (identified in the registration report dated 11/03/07) for the duration of their stay The maximum number of persons to be accommodated at Ashcroft Nursing Home is 42 21st August 2007 2. 3. 4. Date of last inspection Brief Description of the Service: Ashcroft care home provides nursing and personal care for up to 42 people aged 65 years and over, 22 with dementia and 20 not falling within any other category. The home is purpose built and is located on the outskirts of Chesterfield close to a main bus route. The home comprises two units on two floors. Willow View unit is on the ground floor and Lea View unit is on the first floor. Stairs and a passenger lift access the floors. Each unit has it’s own staff group. The kitchen and laundry facilities are shared. People at the home have access to a garden. Details of how to obtain a copy of the inspection report were displayed in the main entrance. Information on fess is as follows: Premium rate from Derbyshire County Council£511.51 with a top up of £37 per week. Private rate is £525.00 per week. Continuing Care assessed individually 735.42. Podiatry £10.09. Hairdressing from £4.00 to £12.00. Ashcroft Nursing Home DS0000002038.V370448.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 was an unannounced key inspection and took place over a total of five and half hours. We spoke with the deputy manager, administrator, care staff and people living at the home. The inspection activity during this site visit was to assess the service against the key National Minimum Standards and these are identified through the report. We looked at all the information that we received or asked for, since the last key inspection. This included the following: The annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the home. Three people living at the home were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at care plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the person. Additionally, time was spent in preparation for the visit, looking at the service history and the previous inspection report. Records were examined relating to the people living there and the general running of the home. We sent out “Have Your Say” questionnaires and we received eight completed questionnaires from people living at the home. Family completed the questionnaires. They confirmed they were very happy at the home; they liked living there, had no complaints and were well looked after by the staff. Families commented they are always included in the decision made about their relatives care. At the time of this site visit the home had thirty-seven people in residence. We received five completed questionnaires from care staff. All were happy working at the home, and made very positive comments about the registered manager. One staff member stated they help people in vulnerable situations and give them both practical and emotional support. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 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. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 7 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 Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 8 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): Standard 3. Standard 6 is not applicable to this service Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure people’s needs are fully assessed prior to moving into the home; this ensures that all people’s holistic needs are appropriately met EVIDENCE: The three files examined contained assessments that provided sufficient information to enable the staff team to find out what people needed, in order to provide the required level of support and care. These showed that the home undertakes a suitable pre admission assessment of the needs of people and includes information on a range of physical and emotional health needs. There was also evidence of care plans and assessment documentation obtained from Social Services Departments and health services, which help to inform subsequent planning. The home has documentation that provides initial information on personal preferences, daily living routines and social interests, Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 9 which are obtained from people or their families. Areas of potential risk are also identified so that relevant risk assessments can be developed. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 10 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): Standards 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are involved in decisions that affect their lives and have an active role in the planning of their care, which ensures their personal, physical, emotional and social welfare is enhanced. EVIDENCE: The care records of three people living at the home were viewed in depth. The home has introduced a new assessment and care planning system All care plans seen were well organised and informative providing a good sense of each person’s individual care needed. Staff spoken with during the site visit had undertaken training in dementia care ‘mapping’, and there was evidence that a clear person centred approach was now being translated onto care records. As result of the new style recording and Dementia mapping the home has enhanced people’s physical and mental well-being. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 11 The home should be commended for the work undertaken with one person from the home, which has a result of their recording, highlighting where the care was required and a reduction in their level of medication. The home has ‘well being profiles’ and ‘ individual profile sheets’, which provided details of each persons experiences and how their needs can be met within this framework. There were storyboards for each person outside their rooms providing clear information on past life experiences. These had been compiled in conjunction with people’s relatives. Staff confirmed that the care plans were in place and provided sufficient detail for them to follow, and to enable them to met people’s needs. The records contained the required assessments to identity any risk’ and support requirements in relation to moving and handling, tissue viability, nutrition and falls. People from the home and their relatives confirmed that they have access to health care professionals when needed, and attended routine or specialist healthcare screening clinics. People confirmed that they are consulted about the monthly review of their care plans and are involved in any changes made to their care plan. There was evidence that care plans were monitored on a regular basis. Clear records are kept of health service contacts such as G.P., dental, optician and podiatry. Any wound details are clearly recorded and closely monitored as are any unexplained bruising or injuries and accident records are maintained. Medication at the Home was stored securely and suitably maintained with systems in place for the receipt and disposal of medicines. Examples of medicine administration records were seen and were generally correctly completed. However, there has been one error in medication, which is being investigated by the registered manager. At the time of this site visit there are only three people on controlled medication. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 12 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): Standards 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The planned activities and contact with families and friends enables people living at the home to have choice and control in their lives, and maintains their wellbeing. EVIDENCE: The home has an open and informal atmosphere with no undue emphasis on routines. Care staff have access to a wide range of information which details individual likes and dislikes and preferences around daily activities, including particular dietary requirements or tastes. Although many residents were highly dependent staff were observed regularly checking individual wishes. There were several relatives visiting the home on the day of the site visit and discussions with them confirmed that the home welcomes their involvement and maintains good communication with them through meetings and reviews. The Home employs an activity coordinator for thirty hours per week, who also has experience as a care worker. An activity programme has been developed to suit the needs of the people living at the home. The coordinator stated she often works with people on a 1:1 basis and has, in conjunction with families, Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 13 compiled personal histories on people who live at the home. The activities coordinator has recently completed a chair based activities course. The home arranges entertainment on a regular basis. Family members spoken with stated they regularly accompany their relatives on trips out. The home has a snoezelem room, which provides a calming, quiet area for people at the home. The home has clear policies regarding equality and diversity, though there were no people with specific cultural needs living at the home. Peoples’ religious interests are respected and local clergy visits the Home. Visiting hours at Ashcroft were flexible and people living at the home are able to receive their visitors within the communal areas of the home or within their privacy of their own room which ever they preferred. Relatives spoken with confirmed that they are made welcome by the home. Any restriction on contact is clearly recorded in peoples’ care records. Discussions with people living at the home and relatives indicated satisfaction with the meals provided. Care plans indicate that dietary requirements are monitored and people are supported in feeding when appropriate. Menus are varied and nutritious and are reviewed regularly. The cook had a clear knowledge of individual preferences and alternatives were offered. The home has just moved to moulded meals, which helps people recognise their food they are eating. Also a variety of high calorie snack boxes are available day and night. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 14 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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to safeguard peoples’ welfare and ensure that their concerns are listened to and acted upon. EVIDENCE: The complaints procedure was displayed in the main entrance area. Relatives confirmed that they received information on the home’s policy at the point of admission. Relatives spoken with stated they would feel comfortable in raising any issues with the management at the home, either at relative meetings or individually. The homes complaints records were viewed and indicated any concerns raised had been addressed. There have been no complaints made to us since the last site visit. The Home had appropriate policies in place concerning the safeguarding and protection of vulnerable adults. Staff spoken to confirmed that they have received awareness training in this area and evidence was also seen on individual training records and provided by way of the AQAA. There has been one incident of safeguarding since the previous site visit. This has been investigated under Derbyshire County Councils Safeguarding procedures. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 15 Completed questionnaires and discussions with staff confirmed they would report any concerns they had to the registered manager. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 16 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): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was well maintained and decorated so as to meet the needs of people through promoting their comfort, safety and orientation. EVIDENCE: We carried out a full tour of the home accompanied by the deputy manager. All communal areas were viewed and along with people’s bedrooms were found to be comfortable and well finished. The home was satisfactorily maintained and furnished with regular maintenance checks undertaken of the building as part of general health and safety audits. Since the last inspection there has been new carpeting in the lounge and dinning areas. The home has introduced themed corridor, which has proved invaluable in assisting people to explore their environment, to experience different textures objects and colours. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 17 The home was clean and free of any unpleasant odours on the day of the site visit. The home has its own laundry, which is satisfactorily equipped and maintained. The laundry area was seen and provided sufficient equipment to ensure people’s clothing could be laundered suitably and to meet with infection controls/ standards. People’s clothing appeared well laundered and they were happy with the laundry services provided. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 18 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): Standards 27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff receive the appropriate training to ensure the safety and welfare is maintained, of the people living at the home. However the lack of suitable and experienced staff may adversely affect the care people receive. EVIDENCE: Information in the AQAA indicated that there has been a significant turnover in staff since the last site visit. Although generally managing to maintain the usual staffing levels there have been occasions, when the home has had to operate on reduced numbers or use agency staff. The feedback from care staff and from completed questionnaires stated that this has been a difficult working situation. Discussions with relatives indicated that there was some concern about the staffing situation and a lack of continuity of care. Discussions with the registered manager after the site visit confirmed that the staffing is improving, as they have been able to recruit to the majority of staff vacancies. Only last week they did not need to use agency nursing staff. Information in AQAA indicated that the home has still to attain the minimum ratio 50 trained care staff with NVQ level 2 or equivalent. Robust recruitment procedures are in place, which ensures that staff appointed are suitable to work with vulnerable people. Several staff personnel records Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 19 were examined which confirmed that thorough employment checks were carried out. All new staff are required to provide two references, a full employment history, have a clear Criminal Records Bureau clearance and complete a probationary period. As part of providing a full employment history applicants need to provide an accurate chronology of their employment history with the days date month and year. From recent staff recruitment records examined, applicants were only providing the year in one instance. This area of shortfall was discussed with the deputy manager. The home maintains a record of all staff interviews undertaken although they were always signed and dated. The staff personnel records were well presented. From discussions with the Manager and from examination of records it appears the home is providing good training and development opportunities. Details are recorded in the AQAA. Completed questionnaires from staff identified the training opportunities as strength and one of the reasons they liked working at the home. All staff have a personal development plan. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 20 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): Standards 31,33,35, and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is effectively managed and run in the best interests of the people who live there. People’s health and safety is safeguarded and monitored. EVIDENCE: The registered manager has been at the home for several years and is suitability qualified and experienced in working with people with Dementia. Completed questionnaires and discussions with care staff indicated that the management of the home is open and supportive. The home has regular staff and house meetings. The registered manager also undertakes night visits to the home as part of the overall monitoring of the home. The home has a system in place for monitoring the quality of services it provides. An audit process is undertaken by the home and the results are then Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 21 made public. The home gave out questionnaires to family and friends and the response rate has been good. The responsible individual carries monthly-unannounced visits to the home. The home is responsible for handling people’s finances and a detailed secure system is in place. This was viewed and found to be satisfactory. Discussions with staff and completed questionnaires confirmed that staff receives regular supervision. The AQAA indicated that that safe working practices were in place at the home. Records showed that portable electrical appliance tests, waste disposal contract, bacteriology and legionnaires tests, service certificates for moving and handling equipment and electrical wiring certificates were in place. The AQQA was completed to a satisfactory level. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 22 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 23 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. 1. Standard OP27 Regulation 18 Requirement The Registered Provider must ensure the home as sufficient numbers of qualified staff to meet the assessed needs of the people who live there, including cover for sickness and absence. The home must 50 of staff with a NVQ level 2 or equivalent. All applicants must follow the homes policy on recruitment and supply a full employment history. Timescale for action 30/10/08 2. 3. OP28 OP29 18 Schedule 2. 19 31/12/08 30/10/08 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. 2. Refer to Standard OP29 OP29 Good Practice Recommendations Applicant should provides the days date month and year when providing a full employment history The home should sign and date all interview records. Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection 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 Ashcroft Nursing Home DS0000002038.V370448.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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