Care Home: Ashdown Nursing Home

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What the care home does well The home was clean and homely. Residents have their individual needs and wishes assessed and the staff team seen were kind and caring when dealing with residents. Residents are served good home cooked food. What has improved since the last inspection? The home is clean and hygienic and some new furniture has been purchased. Staff have received training to teach them how look after residents and keep them safe. The organisation of staff is better and the care records have improved. Residents are given nutritious food at regular intervals. Activities have improved but still need to be expanded. Arrangements have been made for another Director of the Company to undertake Regulation 26 visits. A Quality assurance system has been started but needs to be expanded and include a development plan. Some health and safety risks have been addressed. What the care home could do better: A registered manager with suitable experience and qualifications should be appointed. The rear garden must be made safe so that residents are able to use the facility. especially as the building work has compromised their outdoor communal space. Mr Beeharee must ensure that all work required by the West Sussex Fire and Rescue Service is carried out so that residents are not put at risk. Under Regulation 37 Mr Beeharee must inform The Commission without delay of any event in the care home which adversely affects the well-being or safety of any residents. Key inspection report Care homes for older people Name: Address: Ashdown Nursing Home 2 Shakespeare Road Worthing West Sussex BN11 4AN     The quality rating for this care home is:   one star adequate 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: Ann Peace     Date: 0 9 0 6 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 28 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 28 Information about the care home Name of care home: Address: Ashdown Nursing Home 2 Shakespeare Road Worthing West Sussex BN11 4AN 01903211846 01903208680 mgnewcare@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Newcare Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 40. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Ashdown Nursing Home is situated in a residential area of Worthing in West Sussex. The registered providers are Newcare Homes Ltd who purchased the home in 2004. The registered manager was Mrs Susan Green but we have been informed that Mrs Green has resigned. Mr Beeharee is acting manager until the post can be filled. Ashdown Nursing Home is registered for 40 residents over the age of 65 years Care Homes for Older People Page 4 of 28 Over 65 0 0 40 40 2 2 0 2 2 0 1 0 Brief description of the care home who have dementia. The communal areas consist of a lounge and a lounge/dining room on the ground floor and a second lounge on the first floor. There are other small sitting areas in the entrance hall and upper and lower corridors, which lead to bedrooms. A passenger lift is available for rooms on the upper floor. Remedial building work is presently being undertaken so some of the outside area and communal areas are not available for use although alternative communal arrangements have been made. There is a garden to the rear of the property, which is not currently available for use by residents but we were told that this will be cleared by 21st June 2010 so that residents are able to access it safely. The current scale of fees can be found by contacting the home. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: In order to plan for this inspection we looked at the last key inspection report dated 22nd February 2010 and the random inspection report dated 22nd April 2010. We also looked at other information that we have received about the home including recent information gained from safeguarding investigations being undertaken by West Sussex Adult Services Safeguarding Team and The West Sussex Fire and Rescue Service. The safeguarding team investigated 18 counts of alleged abuse, 13 of these were substantiated and Mr Beeharee was required to submit an improvement plan to Adult services. One member of staff was suspended and has now left the home. This unannounced visit was carried out by two inspectors at 9am on Wednesday 9th June 2010. There were 28 residents accommodated on the day of our visit. During this time we spent time with residents in communal areas and in their private Care Homes for Older People Page 6 of 28 bedrooms and we directly and indirectly observed staff caring for people. We spoke with care staff and ancillary staff on duty and we observed lunch the main meal of the day being prepared. Four residents care plans and supporting documentation were examined and tracked from records to delivery of care and equipment provided. We looked at evidence of how risks are assessed and managed and how people health care needs were being addressed. We looked at records including complaints and concerns, staff training, the staff supervision process and the quality assurance system. Following on from the key inspection of February 22nd 2010 where the quality rating for Ashdown was poor, one immediate requirement was made relating to poor practices regarding nutrition for residents. Twelve other requirements were made. Following this, Statutory Notices were served requiring the providers to improve standards in the home for residents and comply with legal requirements. A random inspection was carried out on 22nd April 2010 to follow up on the Statutory Notices that were served on the home on 18th March 2010. The notices served related to breaches in the following regulations: Poor infection control procedures, lack of staff training, lack of monitoring visits by the Registered Provider, fitness of premises including the lack of a sufficient hot water supply. During the random inspection we found that only one of the legal notices had been complied with by the due date. However we could see that arrangements were in place to meet the other two notices within two weeks of our visit. Because of the failure to comply with legal notices in time, we issued a Code B Notice in accordance with paragraph 6.7 of the Code B of The Police and Criminal Evidence Act 1984. Code of Practice for searching of premises and the seizure of property found on persons or premises. During this inspection on 9th June 2010 we also followed up the Statutory Requirements that were made in February 2010 to see if they had been complied with. Eleven requirements had been met, but following information given to us by the West Sussex Fire and Rescue Service there was evidence that one of these requirements is still outstanding, this relates to health and safety procedures at Ashdown Nursing Home. Two new requirements were made. Mr Beeharee had informed The Commission that Mrs Green had resigned as Registered Manager and has left the home. Mr Beeharee the provider is currently managing the home until a manager is recruited. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information about the services on offer and residents have their most of their needs and wishes recorded before being admitted to the home. Prospective residents and their representatives have an opportunity to visit the home before making a decision. Evidence: Information about the service is available and one relative we spoke to told us that they were given the Statement of Purpose and Service Users Guide. We were told that prospective residents are encouraged to visit the home prior to moving in there. From looking at records we saw most of the residents have their individual needs and wishes assessed and recorded and families are involved in the process where possible. We were told by Mr Beeharee that some were still in the process of being completed. We tracked assessments and care plans for four residents and we could see from Care Homes for Older People Page 10 of 28 Evidence: records and observation that identified needs are being met. Where a Deprivation of Liberty issue was identified, records were in place that indicated correct procedures are being followed. The home does not provide intermediate care. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are set out in an individual plan of care which have been updated. At present the home is promoting and maintaining residents health, but we would want to see that the improvements made can be sustained. There is a medication policy in place and staff adhere to safe procedures. Evidence: Residents health and personal care are set out in an individual plan of care and from records seen these have improved since our last visit. There were also night care plans in place and some, but not all had the wishes of residents recorded in respect of times for getting up and going to bed, it is important that this is recorded especially as many of the residents were asleep in their chairs at 9:30am and we could not see their routines for getting up recorded. There were clear instructions on how staff should carry out care and they had been Care Homes for Older People Page 12 of 28 Evidence: reviewed and updated. A recognised nutritional screening tool is being used for risk assessment purposes and residents are being weighed at regular intervals for monitoring purposes. Visits from other health care professionals are recorded with any new instructions related to the care of residents. There is a policy in place for the safe administration of medication which staff have to sign up to. We carried out a random check on medication found all to be in order and noted that monthly medication audits are being carried out. A covert medication policy dated 2010 is in place and all covert medication administration arrangements have to be countersigned by the GP. We saw staff treated the residents with respect and when we asked visitors they said they thought staff did respect residents and act in a caring manner. Although there have been improvements in the home and in the care given to residents, The Commission would want to see these improvements sustained over a period of time and in-bedded in the practice of the home to ensure consistent care is provided. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An basic activity programme is provided but by a member of the care staff because the activity co-ordinator post is vacant. Nutritional awareness in the home has improved and residents are offered good home cooked meals and monitoring records kept. Evidence: There is no activity co-ordinator employed at present so a member of staff is carrying out activities in the afternoons. Mr Beeharee told us that he is advertising for a new activity co-ordinator. At 9:30am in one lounge 4 out of 5 residents were asleep and in another lounge, 5 out of 6 people were asleep. We asked what time they had been woken up and were told it was about 7am. When we looked at care plans some, but not all had times that the residents like to get up in the morning, these do need to be completed so that residents can stay in bed longer if that has been their routine or if they wish. We could see that a social profile is being completed for each resident, when finished they will have their full background, life history and interests where possible. Care Homes for Older People Page 14 of 28 Evidence: Activities for the week were posted on a notice board and there is an activities book with a section for each person, activities recorded included :walk in garden, hand massages, nails painting, music, dance, quiz and ball games. There is a record in the daily records of which residents take part in activities. Due to building work the safe patio area that residents could wander in is closed for approx eight weeks. Although some work has started to clear the rear garden it is not yet suitable for residents to walk about in. Mr Beeharee told us that the garden would be fit for residents to safely access it by 21st June 2010. A requirement has been made. When the mid morning drinks and biscuits were served staff were respectfully supportive to residents who needed help and made sure all residents did have a drink. Since our last visit and following an immediate requirement being made residents are now offered a snack in the evening, we had identified there was too much of a gap between supper and breakfast so residents were not receiving adequate nutrition. We visited the kitchen and spoke to the chef. The menus looked well balanced and varied. Residents can have a cooked breakfast if they wish, there is a cooked meal at lunchtime with alternatives and residents can have a cooked or cold supper. The chef was making home made soup as one of the choices for supper on the day we visited. A roast dinner was being prepared for lunch while we were there and the records showed that a full roast dinner is on the menu twice during the week. Daily food records are kept for monitoring purposes. Two relatives told us that they thought the food served was very good. We saw from records and people told us that residents are able to have visitors at any time, visitors told us they were always made welcome when they visited. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although a safeguarding investigation is still open, the risks to residents has been reduced through training staff in safeguarding procedures and training them to understand Dementia. The home has a complaints procedure and people told us that they feel able to complain. Evidence: A safeguarding alert was made to West Sussex Adult Services early in 2010 alleging physical abuse, psychological abuse, institutional abuse and neglect to residents at Ashdown. A safeguarding investigation followed, undertaken by West Sussex Adult Services. They found 13 counts of abuse/neglect substantiated, 2 unsubstantiated and 3 inconclusive. The home has submitted an improvement plan and Adult Services are monitoring the home on a regular basis. Since our last visit all staff have had training in Safeguarding and Dementia awareness to minimise the risk to residents. We spoke to 4 staff who did know the safeguarding procedure and who said they would report any issues to the Providers or Adult Services. Care Homes for Older People Page 16 of 28 Evidence: Following the alert one member of staff was suspended and has now left the home. Mr Beeharee told us that he would be reporting this ex-member of staff to the Independent Safeguarding Authority, which had been created to help prevent unsuitable people from working with children and vulnerable adults. A new safeguarding alert has been made by the home, however after examining the information, Adult Services have decided that it can be resolved in-house by Mr Beeharee through the staff disciplinary process. Deprivation of Liberty training is also being undertaken by staff during the month of June 2010. The home has a complaint procedure, Mr Beeharee told us there were no outstanding complaints. Visitors we spoke to said they felt they would be able to complain if they had concerns. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and many improvements have been made as a result of Statutory Notices and requirements being served on the home and the home being monitored by Adult Services. The communal accommodation and outdoor facilities are not ideal due to the remedial building work going on, but the Providers have and are making alternative arrangements. A Requirement has been made. Evidence: The home is a large detached building over two floors there is a passenger lift which was in working order. Following the last key inspection carried out on 22nd February 2010 Statutory Requirement Notices were issued on the home for failing to comply with regulations in this section related to the fitness of the premises. Requirements were also made. The notices related to the poor supply of hot water to a number of rooms and poor infection control procedures which was putting residents at risk. Requirements made, related to unsafe furniture and poor quality bedding. All notices and requirements have now been complied with. Care Homes for Older People Page 18 of 28 Evidence: During our visit we saw that the home is now clean and that infection control procedures are in place, staff have also had training in infection control. Another bathroom which was unsafe has been renovated and is now usable. Some rooms had been re carpeted or new flooring purchased. New furniture including recliner chairs have been purchased and generally the home looked clean, tidy and homely. A safety gate which had been removed from a steep set of stairs has been re instated and risk assessments were in place regarding wandering residents and stairways. A conservatory had been built at the home without the correct building consent being granted, as a result the providers are having to have remedial building work undertaken to demolish part of the new build. This has meant that a safe patio area residents used to use and sit in is unable to be used for approximately eight weeks. There is also little natural light or ventilation which could be unsettling for residents. Two new sitting rooms one on each floor for residents to sit in have been established as the building work is encroaching on the communal space. There is a rear garden but this was unsuitable on the day of our visit for residents to wander around safely. We could see that some work has started to clear the garden but there was no work going on while we were there, Mr Beeharee told us that the garden would be finished and safely accessible for residents by 21st June 2010. A Requirement has been made. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Following Statutory Notices and requirements being served, the staff team have had the training and supervision needed to look after the residents accommodated in the home. There is a recruitment process that meets with legislation. Evidence: On the day of our visit there were the Provider/Acting Manager Mr Beeharee, a deputy manager, a qualified nurse and 6 carers plus ancillary staff on duty. During the visit we spoke to the carers and ancillary staff and all but one member of the ancillary staff had a good command of English but this member of staff could tell us about the training they had had and they did know about safeguarding. The carers now employed have been working at the home for a while now and when we observed them they looked as if they understood the needs of residents while caring for them. Following Statutory Notices being served on the home and requirements being made, all of the present staff have had up to date training in safeguarding, manual handling, Care Homes for Older People Page 20 of 28 Evidence: infection control, fire safety training and dementia awareness. Two thirds of the staff have had training in challenging behaviour and more is planned. Nine of the care staff have a National Vocation Qualification of level 2 and above. The notices and the requirements related to training have been complied with. In some cases overseas staff only stay in the home for a specific time limit and then new staff move in. In view of the problems in the home recently the providers will have to assure themselves that any new staff employed have experience and training in looking after people with Dementia to prevent a drop in standards and similar safeguarding problems occurring. Staff supervision records were available and indicated that staff are being supervised. Weekly case presentations to staff about the conditions some of the residents and how to care for them in the home have re commenced. We spoke to four visitors and they all said that the staff were kind, caring and friendly. During our visit we noted that there was a pleasant and calm atmosphere in the home, staff were working well together as a team, being respectful to residents and were offering help to each other without knowing they were being observed. The recruitment files for two new staff were examined, all records were in order to meet regulatory requirements and completed induction records were present. We saw the minutes of staff meetings where Mr Beeharee had been honest with the staff about the problems and what was needed to rectify past mistakes. Some of the items discussed and recorded were: Residents were to be offered food and drink throughout the 24 hours especially before going to bed. Residents should not be woken up at a set time to suit staff. Night time fire safety checks were to be undertaken every night. Room checks were to be carried out by staff every week and anything that needed addressing reported. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An improvement plan for the home has been submitted by Mr Beeharee to Adult Services following the safeguarding investigation. The home is presently being managed by Mr Beeharee the provider until a manager is recruited, although standards have improved, there are still some deficiencies and the improvements have only taken place following action by West Sussex Adult Services and The Commission. We would want to be assured that these improvements are sustained to achieve the essential standards of quality and safety for people who use the services. The staff team are being trained and supervised to ensure residents receive the care they need. Some, but not all health and safety issues have been addressed and West Sussex Fire and Rescue Service have made requirements to make the home safe. Care Homes for Older People Page 22 of 28 Evidence: Since the last key and random inspections both carried out in 2010, the previous registered manager has resigned. Mr Beeharee the provider is managing the service until a manager is recruited. Mr Beeharee told us he has people interested in the post and was planning to start interviews the week of our visit. Mr Beeharee is aware that any new manager must have satisfactory experience/training in managing and nursing people with Dementia. We are aware that West Sussex Adult Services have been monitoring the home and they did require Mr Beeharee to submit an improvement plan for the home. We noted that the atmosphere and organisation in the home has improved since our last visits, there was a sense of direction which has been missing for a while resulting in a falling of standards and residents being put at risk. A Quality assurance system has been started and we could see some audits had been carried out. Mr Beeharee is aware that in time audits need to be collated and turned into a development plan to ensure the home constantly improves. We were told that the home does not look after any money on behalf of the residents. Record keeping has improved in the home so we were able to track residents care records and staff recruitment and training records easily. In the majority of cases the health and safety for residents and staff has improved and records were in order to evidence this. However The West Sussex Fire and Rescue Service carried out an inspection on 7th June 2010 two days before our visit. They issued a notice of deficiencies such as : A suitable fire risk assessment had not been carried out. Means of escape from the premises were insufficient. Measures to mitigate the effects of fire are not in place. They require that electrical installations are inspected immediately. All fire resisting doors to be adapted to make safe and other work was required related to stopping the spread of fire. They also found that the portable fire fighting equipment was inadequately maintained. Care Homes for Older People Page 23 of 28 Evidence: They required Mr Beeharee to inform them when all work was completed and they will follow up with another inspection. We visited two days after The Fire Services inspection but we were not told about the inspection or the work that was required to make the home safe. During our visit we looked at the fire safety records and they were up to date and had not reflected the problems that the Fire Service found. The Commission were only made aware of the problems because The West Sussex Fire and Rescue Service sent us a copy of their inspection report. Mr Beeharee was required to inform the Commission under Regulation 37 (1) e any event in the care home which adversely affects the well being or safety of any service user. A requirement has been made. We have since spoken to Mr Beeharee who told us that the remedial fire safety work has been started. As Mr Beeharee is now acting manager for Ashdown, another director from the company will undertake Regulation 26 visits and records events about the home as required. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 38 23 23. 1 and 2 The registered 17/04/2010 manager must ensure that all health and safety issues are addressed and that includes risk assessments for unguarded stairs and safety of the environment This is to ensure that service users are kept safe and that there are processes in place to monitor their care and safety at all times. Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 External grounds which are 21/06/2010 suitable for, and safe for use by, service users are provided and appropriately maintained. So Service users are able to go outside into the garden in safety. 2 31 8 Ashdown Nursing Home must have a Registered Manager. That people have their needs met because their care is managed by an appropriate person. 30/09/2010 3 38 37 The Registered Provider 31/08/2010 shall give notice to the Commission without delay of the occurrence of - any event in the care home which adversely affects the well-being or safety of any service users. The Provider did not inform Care Homes for Older People Page 26 of 28 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 the Commission of the inspection by the Fire Safety and Rescue Service and the work needed to make the home safe. 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 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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