Care Home: Ashdale Lodge

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What the care home does well Staff are very open and friendly and have a good knowledge base about the people they look after. The home has a good retention record for staff employment and many have been working there for some years, giving good continuity of care to the people who live there. The Company ensures it keeps the staff group up to date with regular training sessions and they are then supervised to ensure they do their jobs well and safely. The care plan records are kept up to date and reflect the current needs of people living in the home. This ensures they are not being put at risk of harm and staff are aware of their needs and expectations. A varied programme of activities is on offer to ensure peoples social,religious and cultural needs and expectations are being met. This involves one to one sessions to ensure peoples interests and hobbies are maintained and group events both inside and outside the home covering a wider range of topics and events through out the year. Information about what services the home provides is clear and detailed. So people can make informed decisions about living in Ashdale Lodge. The environment is well maintained and people can make choices about how the home is decorated. Each person also being able to personalise their own bedroom space. What has improved since the last inspection? The care plan documentation has improved with regular evaluations taking place to ensure peoples current needs are known and being maintained. The medication records now clearly state when medication has been received and records indicate that people are receiving their prescribed medication. People living in the home told us that their needs were being met and there appeared to be sufficient staff on duty to meet peoples needs. Staff did tell us at times they are busy, so this will still need regular monitoring. More robust checks are now made when staff are recruited to ensure they are safe to work with people living in this home. For those using bed rails a risk assessment is now completed to ensure not only is the equipment safe to use but it is appropriate for this person to use. What the care home could do better: No requirements were made at this inspection but several good practice recommendations made. The daily record sheets staff complete do tell the reader of what has happened to that person that day, but could be expanded upon to give a fuller picture of their daily lives and not just record singular events. This would give a more accurate picture of a person`s life. The Company supplies a number of good documents for staff to use to record events for people they look after but not all staff follow the same process which could lead to important events being missed. There is very little storage in the home and the way equipment is stored could cause a hazard for staff when accessing items. This needs to be reviewed and alternatives suggested to staff. Although people living in the home told us their needs were being met, staff informed us at times it is busy and they felt rushed. The way staff are deployed and the numbers of staff on duty needs constant monitoring to ensure there are sufficient staff to meet peoples changing needs. Staff supervision records are in place but not all team leaders keep to the same process. This could result in staff not always being monitored to ensure they are safe to work with people in the home. Records are kept on the residents welfare fund but checks should be made to ensure this is used correctly for social activities and not to buy basic commodities used in the home. Key inspection report Care homes for older people Name: Address: Ashdale Lodge 2 Wheeler Street Anlaby Road Hull East Yorkshire HU3 5QE     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: Theresa Bryson     Date: 2 1 0 1 2 0 1 0 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 27 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ashdale Lodge 2 Wheeler Street Anlaby Road Hull East Yorkshire HU3 5QE 01482352938 01482574929 lynn.buxton@sanctuary/planhousing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sanctuary Care Ltd care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: To admit one named person under the age of 65, for this condition to expire when the person reaches the age of 65 or moves out of the home. Date of last inspection Brief description of the care home Ashdale Lodge is owned by Sanctuary Care Ltd and is situated about a mile west of Hull City Centre. It is close to a range of shops, pubs, post office, indoor bowling alley, churches and is on major bus routes.The home is registered to provide accommodation and personal care for up to thirty-six people over the age of 65, some of whom may suffer from dementia. Ashdale Lodge is a purpose built home and has thirty single and three shared bedrooms situated over two floors. The upper floor is serviced by a passenger lift and stairs. There is a large dining room and conservatory in the centre of the home overlooking an attractive and well maintained rear garden. The home has three Care Homes for Older People Page 4 of 27 2 3 0 1 2 0 0 9 0 0 Over 65 36 36 Brief description of the care home lounges and a small seating area on the landing, providing the residents with different places to sit. One of the lounges is used for activities and craft work. The home has four bathrooms and sufficient toilets throughout. There is car parking space to the front of the home. Information about the services the home provides can be found in the statement of purpose and service user guide available in the home. Fees are reviewed annually. Optional extras are chiropody, hairdressing, newspapers and toiletries. Care Homes for Older People Page 5 of 27 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 inspection took place over one day in January 2010. Prior to the site visit we sent out a number of survey forms. We received five back from people living in the home, seven back from relatives, five back from staff and one back from a health professional. We also checked the service history of this home and what they had been telling us had happened since the last inspection. During our site visit we looked at a number of records and documents and observed staff at work. We talked to people living in the home, visitors, relatives and staff. We also toured the home and grounds. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: No requirements were made at this inspection but several good practice recommendations made. The daily record sheets staff complete do tell the reader of what has happened to that person that day, but could be expanded upon to give a fuller picture of their daily lives and not just record singular events. This would give a more accurate picture of a persons life. The Company supplies a number of good documents for staff to use to record events for people they look after but not all staff follow the same process which could lead to important events being missed. There is very little storage in the home and the way equipment is stored could cause a hazard for staff when accessing items. This needs to be reviewed and alternatives suggested to staff. Although people living in the home told us their needs were being met, staff informed us at times it is busy and they felt rushed. The way staff are deployed and the numbers of staff on duty needs constant monitoring to ensure there are sufficient staff to meet peoples changing needs. Care Homes for Older People Page 8 of 27 Staff supervision records are in place but not all team leaders keep to the same process. This could result in staff not always being monitored to ensure they are safe to work with people in the home. Records are kept on the residents welfare fund but checks should be made to ensure this is used correctly for social activities and not to buy basic commodities used in the home. 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 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cam make informed choices about using the home with the information which is available to them. Evidence: We looked at the Statement of Purpose and Service Users guide which gave clear information about what type of services the home can provide and details about the staff and management structure. This ensures people wanting to use the home can make informed decisions about whether the home can meet their needs. We tracked the care plan records of the latest admission to the home, which had been an emergency admission. The preadmission details had only been scantily written but the care staff team informed us the were getting to know this person and developing a clearer understanding of their needs. In other peoples care plan records which we saw this pre-admission documentation had been completed. The manager will go out normally and see a prospective client prior to admission and will take one of the care officers with her, or sometimes the activities organiser. This Care Homes for Older People Page 11 of 27 Evidence: ensures all aspects of the persons needs and expectations can be recorded and the team can make a decision as to whether they can meet those needs. The home does not provide intermediate care and therefore Standard 6 is not applicable. Care Homes for Older People Page 12 of 27 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. Peoples needs and expectations are recorded and evaluated regularly to ensure they are not at risk of harm. Evidence: Prior to our site visit we sent out a number of survey forms and a number were returned. Five from people who use the service, seven from relatives, one from a health professional and five from staff. Each one made positive comments about the services being provided. Saying so satisfied with the service we are filling in the forms for a permanent stay and staff do every thing for me. Health professionals told us that they always receive information about people prior to their visits and when they have arrived staff know a lot about each person and will carry out instructions to aid a persons well being. During the site visit we were able to speak to six people who live in the home, three relatives and a visitor. Each one told us how much they like living in the home and that the staff do everything for me and I have almost one to one care each day for a large part of the day and everyone is so kind and patient. We tracked four care plans whilst on the site visit. The Company provides a Care Homes for Older People Page 13 of 27 Evidence: comprehensive range of documents to enable staff to adequately record the day to day care of people living in the home and regularly evaluate their current needs and expectations. Each document we saw had been evaluated regularly and in discussion with staff and people living in the home reflected their current needs. For example where someone was suffering from memory loss their mental state and cognitive understanding had been assessed prior to admission. A general assessment had then been made once staff had become to know this person better and they had settled into the home.. A core care plan was then put in place and a further mental health assessment made. When necessary a close observation chart had been completed for a short period of time to enable staff to ascertain whether this person was safe to leave to complete some daily tasks. Each part had been evaluated regularly. This has ensured this person is looked after safely and staff are aware not only of their physical needs but also their mental health state. In another care plan a person had been admitted to the home after a history of falls, making it unsafe for them to live alone. On admission a body map had been completed showing bruises on their body on admission and a statement saying whether staff felt by the colour of the bruise it was old or new. In the daily report record it detailed when a person fell in Ashdale Lodge, an accident form completed and where necessary, when a health professional had been called to attend, for example a flap of skin on the body, or even if paramedics had been called to assist this person for a check up in hospital. The core care plan was up dated when necessary and an accident falls observation chart completed to monitor the amount of falls, how they occurred and when. This has assisted staff in helping this person to maintain as independent a life as possible, within their capabilities. There was an accurate transfer of information in various parts of the documentation seen when health and social care professionals had been involved. for example visits by district nurses, GPs and Community Psychiatric Nurses. The daily records gave brief details of events which had occurred for each person, but this could be expanded upon to give a fuller picture of that persons life. Not all the records had been signed, such as the acceptance sheets after a care plan review, details in the initial admission sheets and the use of all the tools provided by the Company. So the management team should ensure there is better continuity in the use of the documentation and does not put people at risk of harm. We were able to observe staff assisting people living in the home with a variety of tasks through out the day, which they did in a calm and dignified manner. Giving help where required, such as walking and choosing clothes to wear. After a case review had taken place, staff were seen sitting with the person to reassure them and go over any concerns they may be having about the meeting. A senior member of staff was able to show us how medication for people is ordered or Care Homes for Older People Page 14 of 27 Evidence: returned and the processes in place to ensure people receive their medication as prescribed. We observed a staff member giving medication once during the day and safe practices appeared to be in place. All medication records appeared to be accurate and the storage area was clean and tidy and regular temperatures recorded for the room and drug fridge to ensure medication was stored correctly. There was provision in the care plan documentation to record any special needs of people regarding their medication. For example on admission for one person it was stated how they liked to buy over the counter medication, which, according to the health professionals advice could be unsafe if these items were not checked as being safe to use with their prescribed medication. A risk assessment had been put in place to observe this person when on outings and discussions recorded with the person themselves, their family and friends to ensure all parties were aware of safe practice and this person was not put at risk. Care Homes for Older People Page 15 of 27 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. Food is prepared in a clean and safe environment and menus planned to suit peoples needs. A variety of activities are on offer to ensure peoples social, religious and cultural expectations are being met. Evidence: The Company employs an activities coordinator for 25hours each week to assist staff in arranging social events for people to take part in. The records showed a variety of events taking place including group events and one to one sessions to help people maintain their independence. Interests such as crafts, church services and choir visits were recorded, alongside of how someones interests in boating was being maintained and how well the poetry/reading group was progressing. People living in the home told us Im always reading and staff help me choose books and bring me papers and magazines and they also told us they will take me to the local (pub), Ive lived around here all my life and like to still feel part of the community, I think staff like coming out. A relative told us mum likes the entertainment and so do I, as I am encouraged to join in. The care plan documentation showed how peoples needs and expectations were recorded. A significant life events record is kept, with details of a persons formative years and their occupational history. It also included their current and past hobbies Care Homes for Older People Page 16 of 27 Evidence: and interests, their likes, dislikes and fears. People told us how staff were dedicated and sometimes came in on their days off, for special events Staff told us they tried to support each other to ensure peoples expectations could be meet. Most staff having been trained in dementia awareness and aggression management, as well as how to assess someones needs. We viewed a selection of peoples bedroom areas and found they had been personalised to meet their needs and tastes. Someone told us this had helped them settle into the home. A senior member of the catering staff showed us around the kitchen and we could see that food was being prepared in a clean and safe environment. At the last environmental health officers visit in December 2008 it had awarded the home an Agrade for safe practices in the home. All equipment was in working order expect the waste disposal, which had broken that morning but was being attended to. The menus are over a 4-week cycle and we were informed of the different needs of people in the home and how the catering staff were providing for those needs. They seemed confident of who to go to for advice, should the need arise. There was ample evidence of fresh produce being used such as fresh vegetables and fruit and examples of home baking. People living in the home told us you will never go hungry here, the food is beautiful and Im never hungry but I can always ask for more if I need it. The kitchen staff ensure that the dining room is well prepared for each meal and it appeared welcoming on the meal time we observed. The cook goes around each day to talk to people about the days menu and also checks on the weights of people. There was good liaising with the kitchen staff and care staff over meals and peoples needs and this was well recorded. Staff were observed assisting people over a lunch time meal and they were encouraging and informative to people to ensure they were able to maintain a balanced diet that day. Care Homes for Older People Page 17 of 27 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. People know how to raised concerns and know these will be investigated to help protect them. Evidence: Since the last key inspection there had been one concern raised which led to a safe guarding adults referral. This has now been completed. We looked at the complaints log in the home and three had been listed as being complete. Each had a recorded outcome for each concern which appeared to be satisfactory for all parties concerned. We looked at the policy manual for the home and the sections on complaints, safe guarding adults and whistle blowing had been reviewed. When we spoke to people living in the home they were aware they could raise any concern and said they felt confident the management team would deal with it promptly and in confidence. Staff were aware of how to refer issues to the safe guarding adults team and had been given training in recognizing abusive situations. This will ensure people can live safely in the home and be free from risk and harm. Care Homes for Older People Page 18 of 27 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 can live in a safe and clean environment suited to their needs. Evidence: During the course of the site visit we were able to tour the building and grounds. Many areas of the home had been refurbished since the last key inspection. With corridor area colours being chosen by people living in the home. Some parts of the home had new lighting and one of the main lounges had been completely refurbished. This has made the home look more airy and light. There were many homely touches such as tastefully arranged pictures and flower arrangements. All areas of the home were very clean and staff told us they work as a team to maintain these high standards. The laundry has two new washing machines and a dryer and new flooring, which enables this area to be kept clean. There were ample supplies of linen, all in a good standard of repair. We looked at all communal areas, all toilets and bathrooms and a selection of peoples bedrooms. Each area was hazard free and people were being encouraged to use all parts of the home and were seen using seating areas in corridors and the first floor landing, as well as being in their rooms. People living in the home and relatives told us they were happy with the standard of cleaning in the home and felt no restrictions were placed on them and they could have free access to all parts of the home. There is a secluded garden for people to use, which is accessible for wheelchair users Care Homes for Older People Page 19 of 27 Evidence: and a small car park, off the road, but also some on street parking. The local shops and public houses, people told us, they use regularly and they also stated they felt encouraged by staff to decorate their personal rooms as they wished. During the course of our site visit the lift had broken down, which has been a recent constant problem for the home and requests made by the local management team for this to be looked into by the Company. Measures had been put into place to ensure people were safe until the lift could be repaired. There is a lack of storage space for staff to use. Although the home was free from hazards in the corridor areas, some storage areas were cluttered and this needs some thought to ensure staff can access equipment when needed and not worry about these areas being a hazard for them to work in. The safety certificates were seen for all equipment in use, fire checks, water temperature checks and the on going maintenance of the building. All certificates were valid, ensuring it was a safe place to live and work. Care Homes for Older People Page 20 of 27 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. A robust recruitment process is in place and after commencement of employment are trained to do their jobs. Evidence: When we sent out surveys prior to our visit five staff returned them and all made positive comments about working at Ashdale Lodge. We were also able to speak to ten members of staff during our site visit. They told us how much they liked working at the home and felt the manager was approachable. They also told us how supported they feel by the management team and their colleagues and said any problems were sorted out quickly. All staff referred to the excellent training prgrammes and how much choice there is and that the sessions described to us had helped enhance the care they give. This included sessions on palliative care, dementia awareness, record keeping, epilepsy and infection control, to name a few. The training records showed that all mandatory training was up to date and some service specific topics had also taken place or were being planned, with the written evidence given to us. This ensures that staff are being allowed to keep up to date with their skills to ensure they can look after people safely. Where staff need specific skills or help this was seen to be recorded in their supervision records. We looked at all the different working staffing rotas currently in use. Although people using the service told us there needs were being met over a 24hour period and staff Care Homes for Older People Page 21 of 27 Evidence: promptly came to their aid, staff told us at times it was busy and we sometimes feel rushed The management team were able to show us how they had arrived at the current staffing levels in the home but need to ensure this is kept up to date, alongside the continuing changing needs of people in the home. This will ensure peoples needs can always be met and they are not at risk of harm. We tracked six staff personal files, which showed sufficient evidence to support staff had received adequate safety checks prior to the commencement of their employment and were safe to work with people living in the home. Care Homes for Older People Page 22 of 27 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. Peoples views are sought to ensure the home is meeting their needs and expectations and that with supervision of staff it is a safe place in which to live and work. Evidence: We were able to speak to the Registered Manager during our site visit who was able to inform us of the current Company structure. We saw copies of the Regulation 26 site visit reports made by Company representatives who come to check the home. The last one on file was dated October 2009 and appeared to be completed approximately monthly up until this time. The manager also keeps in touch with other services in the Company by trying to attend the monthly managers meetings. Ashdale Lodge, as a service with in this Company is a long way, geographically, from any other service, so this is not always easy. We were informed there is regular telephone and Internet contact. The Manager informed us that audits on various parts of the home are completed quarterly but that the November to January one had been missed. We were able to see the last two sets of audits and found that peoples views had been sought and Care Homes for Older People Page 23 of 27 Evidence: action taken where necessary. There is a comprehensive system in place to ensure all aspects of running the home are checked regularly and this should be maintained to ensure it is being run for the benefit of the people living there. We tracked four peoples personal allowance money and found the money in hand was a true amount as recorded on the records. We found it necessary to query certain items which had been bought from the residents welfare fund. This included wet wipes, flea spray and bins. This we would consider to be part of an operational budget and not come from the funds raised for peoples social activities. The manager volunteered to look into the reasons why they had been taken out of this fund. To the best of the managers knowledge we were told there were no bad debtors accounts but that the Head Office team deal with these and have not notified lately any concerns. Staff were able to tell us how often the receive supervision and told us this has helped them understand their jobs and plan for the future. The staff are split into three teams and team leaders arrange the sessions themselves. The records seen were better kept in some teams than others and the differences highlighted to the manager. Most staff had received the minimum six sessions and showed some observational supervision as well as discussion time. There was good follow through from session to session. This allows staff to see their possible shortcomings and a plan made to help them improve, where necessary, their delivery of care to vulnerable people living in the home. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The daily record sheets kept on each person should be expanded upon to ensure an accurate record is kept of each persons daily life. The Company provides a comprehensive range of documentation to record peoples needs and expectations, with details of how these should be completed. Staff should ensure they follow these processes for continuity of recording on each person living in the home. The storage areas for equipment should be reviewed to ensure items are stored safely and in such a way to ensure staff can access items easily with out risk of harm. The management team should ensure that there are sufficient staff on duty at all times to meet the needs of people currently living in the home. The Residents Welfare fund should be audited regularly to ensure all entries are accurate. The system in place for supervision of staff should continue to be maintained and audited to ensure all team leaders are keeping to the process to ensure staff can do their jobs. 2 7 3 19 4 27 5 6 35 36 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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