Care Home: Ashdowne Care Centre

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What the care home does well People who are considering moving to a care home are given good information about Ashdowne Care before any decision to move in is made. A suitably qualified member of staff from the home will also carry out an assessment of individual health and social care needs before anyone is admitted to the home, to ensure their needs can be met. Not all people spoken to during this inspection were able to recall their admission to the home but all expressed complete satisfaction with the outcome. The home has drawn up individual care plans covering aspects of care needs. Risk assessments have also been drawn up on aspects of health and personal care and clearly show how the home identifies potential health risks and puts preventative measures in place. The home has good links with all relevant health professionals and treatment has been provided where needed. The care staff have completed daily reports showing that the care plan has been followed and outcomes are being met. Medications are stored safely and only experienced staff carries out the administration. Records of medicines administered have been well maintained. Evidence was obtained in various ways throughout this inspection to show that those living at the home are treated in a dignified manner and their privacy is upheld. Those who were able expressed complete satisfaction in the way they are treated by the staff. The staff were patient and helpful and assisted people in a friendly, caring and respectful manner. Care plans and daily reports showed that people could exercise choice and control of aspects of their lives and some people talked about how they are able to lead their lives just as they want, without unnecessary rules or restrictions. The home provides a range of activities. Arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. All people we spoke to praised the standard of meals provided. The menus are balanced, varied and nutritious and meals suit all individual dietary needs. The home has a range of policies and procedures that have been regularly updated and staff have been given training and instruction on the policies to ensure they are followed correctly. People living at the home and their relatives and visitors can feel confident that complaints and concerns will be addressed promptly and a satisfactory outcome reached. All areas of the home are clean, safe and hygienic. Good recruitment practices ensure people are safeguarded from abuse. Staff are competent and deliver care in a safe manner. The home is well managed. There is an open and positive atmosphere throughout the home. Good quality assurance procedures and systems to safeguard the health and safety of people living at the Home and staff are in place. In response to questionnaires sent before this inspection commented included: "Keeps next of kin up to date as to the condition of (relative) and any problems that have arisen and any appropriate action taken", another, in response to "what does the home do well" stated "look after the residents" and " take care of our needs very well", "Staff are always polite and respectful", "I find them (staff) sensitive and caring people," "I can get up and go to bed when I like", "There are no rules here, it`s my home" and "I haven`t got any complaints but if I did I would soon tell them". What has improved since the last inspection? Three requirements and 17 recommendations were made at the last inspection. The manager and staff have worked hard to meet these. All people living at the home have an assessment of their health and social care needs undertaken and these needs are included in care plans to enable staff to know how these needs should be met.( Please refer to "What the service could do better") Records are maintained of the administration of medicines made to any person living at the home to ensure they are given medicines as prescribed. Fire doors are no longer wedged open so that all people within the home are kept safe.( A door to the laundry was wedged open at the last inspection) Carpets that presented a trip hazard at the last inspection have been replaced to ensure people are kept safe. Information about people`s past interests and hobbie, and capabilities, is gathered to enable an activities co ordinator and staff to work towards providing meaningful and appropriate activities to enable everyone living at the home to have a fulfilling life. Improvements have been made to the environment and is planned to continue, to ensure people live in a comfortable, well maintained home. Arrangements have been be made so that each person has a lockable space for money and valuables. The premises are kept clean and hygienic throughout. Staff meetings are held regularly at the home and staff are encouraged to attend and put forward their views. Staff attend formal one to one supervision sessions at least 6 times a yea, since the last inspection. What the care home could do better: No requirements were made at this inspection. 14 recommendations for good practice have been made: Continued improvement in care planning should result in plans being more person centred and include details of people`s individual strengths and choices When people bring medications to the home, which are not included in pre admission assessments or in discharge details, if coming from a hospital, a check should be made to ensure the medication is still prescibed. When containers of creams or ointments are opened arrangements should be made to ensure they are not used beyond their shelf life. Records of when creams have been applied should be maintained. This is to ensure that people receive treatment as prescibed. It is recommended that staff ensure people have a call bell at all times when left unsupervised so that they can call for assistance at any time. Care plans should be reviewed regularly and involve individuals or their chosen representative.(This relates to a Care plan not being reviewed for 3 months.) Information about people`s needs should be confidential and not displayed openly.(This relates to information being posted on wardrobe doors and on walls.) Activities should be meaningful and appropriate to the individuals` capabilities so that everyone living at the home has a fulfilling life. When staff spend time with people they should try to engage with them in a meaningful way. A record should be kept of all complaints, investigations undertaken, outcomes and actions taken to address the issues. Assessments of risks presented by locks and some doors, which do not have handles on the inside, should be undertaken to ensure people living at the home are not restricted and are kept safe at all times. Consideration should be given to providing staff in such numbers to enable them to meet more than basic care needs for people living at the home. Staff should continue to receive training in topics that will be beneficial in meeting the needs of people living in the home (for instance activities/engagement with people with dementia.) Quality assurance surveys should include details of what actions have been taken by the service to address any issues raised. Results of surveys undertaken at the home should be published and made available to current and prospective users of the service, their representatives and other interested parties including the CQC. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashdowne Care Centre Ashdowne House & Pinnex Moor Orkney Mews Pinnex Moor Road Tiverton Devon EX16 6SJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Oliver     Date: 2 5 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 42 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 42 Information about the care home Name of care home: Address: Ashdowne Care Centre Ashdowne House & Pinnex Moor Orkney Mews Pinnex Moor Road Tiverton Devon EX16 6SJ 01884252527 01884242194 ashdownecare@onetel.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ashdown Care Limited care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Registered for 34 - Elderly General Nursing Care Registered for 34 - Elderly Mental Health Care The Home may from time to time admit up to three persons between the ages of 55 and 65 years of age. Date of last inspection 0 0 0 Over 65 34 34 34 Care Homes for Older People Page 4 of 42 Brief description of the care home Ashdowne is a purpose built nursing home, which opened in 1993. The present owner acquired the property in 2001. It comprises two units under one registration. The units have been linked by an enclosed corridor but continue to accommodate people with distinct types of nursing needs in each separate unit. Pinnex accommodates 26 people who are elderly with mental health needs. Ashdowne accommodates 34 elderly people requiring general nursing care. Kate Ley was Registered as Manager in August 2008 and manages the Home as a whole. The Home also makes provision for respite and convalescence care on Ashdowne unit. The sides and back of the property are garden areas and the front is a car park with a porta-cabin used for administration, training and meetings. The home is situated in a residential area of Tiverton. The kitchen is housed in Ashdowne and the laundry in Pinnex. The average cost of care is £ 398-750 per week at the time of inspection. Additional costs, not covered in the fees, include hairdressing and personal items such as toiletries, newspapers and magazines and private chiropody and taxis. Current information about the service, including CQC reports, which are accessible at the home, is given to people as required. Care Homes for Older People Page 5 of 42 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: The quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. This inspection was undertaken by one inspector over the course of 17 hours, over 2 days, spent at the Home. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent questionnaires to 10 people living at the home, 10 staff and 5 health care professionals. A number of questionnaires were completed and returned to us from people expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. Care Homes for Older People Page 6 of 42 To help us understand the experiences of people living at this home we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit. Very few of the people living at the home were able to communicate fully with us about their experience of living at the home. We also spoke with 12 staff including the manager, and ancillary staff individually. The inspector toured the premises freely, including all shared areas and the majority of residents accommodation. A sample number of records were inspected which included care plans, medication records and procedures, staff recruitment files, service and maintenance certificates and fire safety records. The inspector appreciated the time taken by the manager and all staff to assist with this inspection and the inspector found all staff very helpful on the day Currently the fees of between £398 & £750 are charged per week. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site /www.oft.gov.uk . Copies of the inspection report are available from the office. What the care home does well: People who are considering moving to a care home are given good information about Ashdowne Care before any decision to move in is made. A suitably qualified member of staff from the home will also carry out an assessment of individual health and social care needs before anyone is admitted to the home, to ensure their needs can be met. Not all people spoken to during this inspection were able to recall their admission to the home but all expressed complete satisfaction with the outcome. The home has drawn up individual care plans covering aspects of care needs. Risk assessments have also been drawn up on aspects of health and personal care and clearly show how the home identifies potential health risks and puts preventative measures in place. The home has good links with all relevant health professionals and treatment has been provided where needed. The care staff have completed daily reports showing that the care plan has been followed and outcomes are being met. Medications are stored safely and only experienced staff carries out the administration. Records of medicines administered have been well maintained. Evidence was obtained in various ways throughout this inspection to show that those living at the home are treated in a dignified manner and their privacy is upheld. Those who were able expressed complete satisfaction in the way they are treated by the staff. The staff were patient and helpful and assisted people in a friendly, caring and respectful manner. Care plans and daily reports showed that people could exercise choice and control of aspects of their lives and some people talked about how they are able to lead their lives just as they want, without unnecessary rules or restrictions. The home provides a range of activities. Arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. All people we spoke to praised the standard of meals provided. The menus are balanced, varied and nutritious and meals suit all individual dietary needs. The home has a range of policies and procedures that have been regularly updated and staff have been given training and instruction on the policies to ensure they are followed correctly. People living at the home and their relatives and visitors can feel confident that complaints and concerns will be addressed promptly and a satisfactory outcome reached. All areas of the home are clean, safe and hygienic. Good recruitment practices ensure people are safeguarded from abuse. Staff are Care Homes for Older People Page 8 of 42 competent and deliver care in a safe manner. The home is well managed. There is an open and positive atmosphere throughout the home. Good quality assurance procedures and systems to safeguard the health and safety of people living at the Home and staff are in place. In response to questionnaires sent before this inspection commented included: Keeps next of kin up to date as to the condition of (relative) and any problems that have arisen and any appropriate action taken, another, in response to what does the home do well stated look after the residents and take care of our needs very well, Staff are always polite and respectful, I find them (staff) sensitive and caring people, I can get up and go to bed when I like, There are no rules here, its my home and I havent got any complaints but if I did I would soon tell them. What has improved since the last inspection? Three requirements and 17 recommendations were made at the last inspection. The manager and staff have worked hard to meet these. All people living at the home have an assessment of their health and social care needs undertaken and these needs are included in care plans to enable staff to know how these needs should be met.( Please refer to What the service could do better) Records are maintained of the administration of medicines made to any person living at the home to ensure they are given medicines as prescribed. Fire doors are no longer wedged open so that all people within the home are kept safe.( A door to the laundry was wedged open at the last inspection) Carpets that presented a trip hazard at the last inspection have been replaced to ensure people are kept safe. Information about peoples past interests and hobbie, and capabilities, is gathered to enable an activities co ordinator and staff to work towards providing meaningful and appropriate activities to enable everyone living at the home to have a fulfilling life. Improvements have been made to the environment and is planned to continue, to ensure people live in a comfortable, well maintained home. Arrangements have been be made so that each person has a lockable space for money and valuables. The premises are kept clean and hygienic throughout. Staff meetings are held regularly at the home and staff are encouraged to attend and put forward their views. Staff attend formal one to one supervision sessions at least 6 times a yea, since the Care Homes for Older People Page 9 of 42 last inspection. What they could do better: No requirements were made at this inspection. 14 recommendations for good practice have been made: Continued improvement in care planning should result in plans being more person centred and include details of peoples individual strengths and choices When people bring medications to the home, which are not included in pre admission assessments or in discharge details, if coming from a hospital, a check should be made to ensure the medication is still prescibed. When containers of creams or ointments are opened arrangements should be made to ensure they are not used beyond their shelf life. Records of when creams have been applied should be maintained. This is to ensure that people receive treatment as prescibed. It is recommended that staff ensure people have a call bell at all times when left unsupervised so that they can call for assistance at any time. Care plans should be reviewed regularly and involve individuals or their chosen representative.(This relates to a Care plan not being reviewed for 3 months.) Information about peoples needs should be confidential and not displayed openly.(This relates to information being posted on wardrobe doors and on walls.) Activities should be meaningful and appropriate to the individuals capabilities so that everyone living at the home has a fulfilling life. When staff spend time with people they should try to engage with them in a meaningful way. A record should be kept of all complaints, investigations undertaken, outcomes and actions taken to address the issues. Assessments of risks presented by locks and some doors, which do not have handles on the inside, should be undertaken to ensure people living at the home are not restricted and are kept safe at all times. Consideration should be given to providing staff in such numbers to enable them to meet more than basic care needs for people living at the home. Staff should continue to receive training in topics that will be beneficial in meeting the needs of people living in the home (for instance activities/engagement with people with dementia.) Quality assurance surveys should include details of what actions have been taken by the service to address any issues raised. Care Homes for Older People Page 10 of 42 Results of surveys undertaken at the home should be published and made available to current and prospective users of the service, their representatives and other interested parties including the CQC. 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 set out 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 11 of 42 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 12 of 42 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. The home provides clear, detailed information to people considering moving in. People can be confidant that the care and support they need can be provided by the service if they do move into the home. Evidence: People who are considering moving to Ashdowne Care Centre are provided with sufficient information needed to enable them to make an informed choice before making a decision. This was confirmed in surveys returned from people living at the home prior to this inspection. The home has a written statement of purpose, which sets out the aims and objectives of the home, and provides information about the service in the form of a booklet and is available in the entrance of the home. An up-to-date Service user guide was seen in bedrooms, which included a quality of care survey for people to complete. Care Homes for Older People Page 13 of 42 Evidence: People are only admitted to Ashdowne House and Pinnexe Moor only after an assessment of their health and social care needs have been undertaken. This is to ensure that the service can meet the persons needs, in relation to staffing, staff knowledge and environment. During this inspection we looked at the admission records of six people, one of who had moved into the home within the last three months. We talked to them about how they chose the home, about the information that was shared with them, and about the discussions and agreements that were reached on the care they need. Not all were able to remember their admission clearly and generally their admission had organised by relatives. One person was able to tell about their admission to the home and told us that their relative had organised their move to the home but that they had been given ample information by their relatives to make a choice. We found that the manager had visited them to carry out an assessment of their health and social care needs and to give them information about Ashdowne Care Centre. The manager told us that the ethos of the home puts a high value on responding to peoples individual needs for information, reassurance and support. We saw that information had also been gathered from other sources including health care professionals such as doctors and district nurses. The assessment records were good and showed that information had been gathered to form the basis of a plan of care. Copies of comprehensive assessment and plans of care for people who are not privately funded and are admitted through care management are obtained. All prospective residents and, or their family or representatives are encouraged to visit the home, meet other residents and have a meal if they choose before the decision is made to make it their home. We sent questionnaires to 10 people living at the home and received responses from 7. All, except one, confirmed they had received enough information about the home to help them decide it was the right place for them. Seven people commented that they had received a contract when they moved to the home, which was confirmed when we looked at contracts in peoples files at the home. Those people who are funded by Devon Adult Service have a contract with them and are given a Statement of Terms and Conditions by the home. The home does not provide intermediate care. Care Homes for Older People Page 14 of 42 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 health needs are well met with good multidisciplinary working, and the management of medication is generally satisfactory, helping to protect peoples welfare. People feel they are treated with respect and that their privacy is upheld by caring staff. Improvement in ensuring that staff are aware of individual needs will further promote privacy and dignity. Evidence: Surveys received from 3 people living at the home showed that they always received the care and attention they needed, two people said they usually receive the support they needed and two did not comment. Four health and social care professionals contacted said that peoples needs were always or usually met by the service, one wrote, Tries hard to accommodate people and their family needs. Care Homes for Older People Page 15 of 42 Evidence: The manager told us the home is continually working towards improvement and care plans continue to improve. This means that staff will be provided with information about individual needs and wishes of people living at Ashdowne House and Pinnexe Moor. All 5 staff who responded to questionnaires confirmed they are always given up to date information about the needs of people they support or care for. One commented in a survey returned prior to this inspection The provision of, and access to, care plans and social and nutritional profiles for care assistants is very good and valuable. During this inspection six peoples files were looked at in detail, 3 for people living at Ashdowne and 3 for people living at Pinnexe, and all included information to enable staff to be aware of the support people need to meet their individual daily health and social care needs. However, people would benefit from their care plans including individual preferences as to how they wish their care to be delivered and also to include details of what people can do for themselves. This will further promote truly person centred care. For example; prior to this inspection a health care professional contacted the Commission with some concerns made by relatives in response to a survey undertaken by Devon Social Services. One concern raised was that residents are put in incontinence pads whether they require them or not. When we looked at assessments of needs in care plans there were no details of whether people, who wore pads, could be encouraged or supported to make it known that they needed to be assisted to a toilet. There was no information included in care plans to enable staff to be aware of any patterns of individuals behaviour, body language, routines or of any aims or strategies to reduce peoples dependence on pads and to support and encourage their independence and promote dignity. i.e. offering to take people to the toilet after drinks or meals or previous routines before they moved to the home. Staff told us they took people to the toilet to change their pads so that they were comfortable and people are given a choice of using the toilet at this time. We saw staff in a lounge deciding which people they would take to the toilet and in what order but this was not related to peoples wishes or needs. The plans are developed with people individually, depending on their abilities and wishes, and relatives are involved with the persons consent. One person who recently moved into the home told us that said staff had spoken to them and their family, about their care plan. Another care plan had evidence that the views of another Care Homes for Older People Page 16 of 42 Evidence: persons next of kin had been included in a review of their care. Plans are initially based on an up to date assessment, undertaken prior to a person being admitted to the home, covering all aspects of their health welfare and social care needs. Not all care plans provided information relating to how certain situations could be managed. For example, problems of shuffling gait, inability to start, stop when mobilising, may not be able to judge distances. No information had been recorded of how this could be managed to promote the persons independence. Staff confirmed that they knew what was written on the care plan and were aware of the problem, but they had not been given any strategies for enabling the person in relation to this. When people are transferred from a hospital setting, information, (Nursing Referral), relating to their needs is forwarded to the home. We looked at one referral which included information about support a person needed for anxiety, monitoring of skin, mobility, eating and drinking and pain control. However, care plans did not reflect these needs fully. For example, psychological support required for bouts of anxiety no information had been gathered about what situations may cause this person to be anxious and what staff could do to prevent this or how they can care for the person if they become anxious. No care plans had been completed for this persons other assessed needs indicated on the referral. Gathering and recording relevant, up to date information means that staff will have the information to encourage people to lead purposeful fulfilling lives as independently as possible. Nutritional assessments are undertaken for all people living at the home and peoples weights are recorded and support and advice is sought from specialist health personnel such as dieticians if needed. During this inspection we saw several people being cared for in bed and all looked comfortable. One person did not have a call bell within easy reach. Details in their care plan stated that a call bell should be placed in their right hand when they were in bed. We noted that the call bell was not connected to the system and was coiled on a bedside table. Peoples dental, optical and chiropody needs are met according to peoples needs and we saw details of dentists, chiropodists and opticians visiting people at the home. Information relating to the involvement, and advice from health care professionals Care Homes for Older People Page 17 of 42 Evidence: such as skin care specialists and nutritionists were included in peoples plans of care. Records provided evidence that as well as visits from GPs, district and specialist nurses also visit people at the home and we also saw details of people attending outpatient and other health care appointments. This means that they benefit from the involvement of health care professionals to ensure that health care needs are met. The manager described a good relationship with health professionals such as district nurses, community psychiatric nurse, pharmacist and doctors. Surveys were returned from one General Practitioner, one specialist nurse, two social services care workers, an optician and a chiropodist. Comments about what the service included: open to advice and training and education. Appropriate referrals to speech and language therapist services, implements recommendations and feeds back any concerns or difficulties. Supports relatives in a caring and professional manner, staff are approachable and happy and willing to discuss any persons health and social care needs to the best of their ability and whether it be a health care assistant or a trained member of staff. Risk assessments were in place and generally reflected behaviour or situations which may cause harm to people, for example poor mobility, falls and the use of equipment such as bed rails. Moving and handling assessments and plans, skin care and tissue viability and continence assessments were in place and generally provided staff with the instructions needed to deliver care. Care plans are reviewed regularly, usually, on a monthly basis, or when changes occur, and appropriate changes are made to reflect changing needs and individual choice. Individuals and relatives are encouraged and supported to be involved in this review. We saw details of a relative being invited to a care plan review and the outcomes of that review. This means that people have an input into how they wish to lead their lives. One person in response to a survey commented that the home keeps next of kin up to date as to the condition of (relative) and any problems that have arisen and any appropriate action taken, another, in response to what does the home do well stated look after the residents and take care of our needs very well. The care plans we looked at all included reviews being undertaken apart from one for a person living in Pinnexe Moor. Records of reviews for this person indicated that their care plan had not been reviewed or updated for 3 months as it had been recorded that they had been Care Homes for Older People Page 18 of 42 Evidence: admitted to hospital. However, when we looked at the daily evaluation reports for this person there was no indication that the person had been admitted to hospital for the whole of this period of time. We also looked at a nutritional assessment undertaken for this person. Information gathered prior to their admission stated that they needed constant attention to skin and diet. Staff had recorded this persons weight shortly after admission to Pinnexe Moor and again 4 months later. Records indicated that during the 4 months the person had lost 8 kgs. The period during which this person was not weighed coincided with the time care plans were not reviewed. We discussed this with the manager and it was found that although this person had been admitted to hospital it was only for 2 weeks during one of the months the plans had not been reviewed. This means that care plans did not reflect up to date information about this person to enable staff to monitor and meet their needs. Medication is well managed at the home; records were accurate, up to date and indicated that it is appropriately administered. Photos of individuals are kept with the administration records to reduce the risk to people, who are not always able to confirm their identity, of receiving incorrect medication. The homes medication storage and records were looked at. Suitable arrangements are in place for the safe disposal of unwanted medication. Medicine Administration Records (MAR) were looked at; where hand written entries had been made, two signatures had been obtained to ensure accuracy, this is good practice. When medication is received at the home not all staff are recording the date it was received. Where variable doses of medication are needed, accurate records were available with the actual dose given. Some people are prescribed medication to be given when needed, however no details as to when these would need to be given had been recorded. This means that people could potentially at risk of not receiving medication when needed, or receiving it when not needed. Some people are prescribed creams to be applied daily. In some cases records were poorly complete indicating that this may not be happening. Cream and ointments, have a limited shelf life once open. We saw several containers of creams currently being used but which had not been dated to ensure they were used within the timescale suggested by the manufacturer. Care Homes for Older People Page 19 of 42 Evidence: Details of any changes to a persons medication are recorded in their plan of care. Registered nurses manage the medication needs of people living at the home. One nurse told us that they had not received any recent training and although they were competent and safe in the administration of medication they would value an update as medications had changed and developed such a lot since they last had an update. We saw this nurse administering medicines and it was done safely and competently. One care plan we looked at indicated that a person was having a pain relief patch applied regularly. When we looked at the information gathered prior to their admission there was no indication that this medication was prescribed. Information in the nursing referral when the person moved to the home stated that they had no pain and if they had pain relief could be given in tablet form and did not give any information relating to the patches being prescribed. We were told that the person had brought this medication with them when they were admitted to the home; this was later discontinued by a doctor who was unsure of why it was being used. No enquiries had been made by staff at the home before this medication was administered, which potentially puts people at risk of being given medications which are not currently prescribed. People spoken with told us that staff respect their privacy and dignity, one person told us, Staff are always polite and respectful, another said, I find them (staff) sensitive and caring people. During our visit, staff were polite and friendly when delivering care. We saw staff knocking on peoples bedroom doors and addressing them in a respectful way. All health and social care professionals responding with surveys felt that staff respected peoples privacy and dignity. It was evident that staff had established a good rapport with people. However, details of how people are to be assisted, by staff, to move were displayed openly in peoples rooms. We also saw out of date details of how persons nutritional needs were to be met displayed on a wall behind their bed. This lack of confidentiality puts people at risk of the privacy and dignity not being respected. Care Homes for Older People Page 20 of 42 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Ashdowne Care Centre benefit from being provided with a balanced diet which takes into account the likes and dislikes and from being encouraged and supported to maintain contact with their family and friends. Evidence: People told us the routine at the home was fairly flexible, one person told us, I can get up and go to bed when I like, another said, There are no rules here, its my home. One of the people who responded to surveys told us that there were always activities at the home they could take part in; two people felt this was sometimes the case, two usually and two people did not answer. In response to what could the home do better a relative of a person living at the home commented more social interactions. The home employs an activities coordinator who also spends time on a one to one basis with those people who are not able to join in with group activities due to health needs or because they choose not to. Care Homes for Older People Page 21 of 42 Evidence: At the time of this inspection the activities coordinator was on leave. An activities programme, displayed on doors to the dining areas at the home, informed people of this fact and that activities would be limited during the coordinators absence. The programme indicated that 1:1 time would be spent with people on one day of the week and that a choice of games would be available on another day. The manager told us that prior to this inspection there had been a reorganisation of activities hours by one member of staff increasing their hours and the remaining hours being allocated to care staff as activity hours.We were told that staff have derived benefit from being involved in this aspect of the residents care so it was agreed this would continue. However, the activities organiser had been given annual leave prior to this change and whilst plans were made for care staff to have hours for activities this was not allocated as planned due to annual leave and sickness. During the first day of this inspection we spent the day at Ashdowne House where people with nursing needs live. Several people stayed in their rooms throughout the day either because they were unwell or because they chose to. We saw staff treating people in a kindly respectful manner but did not see staff spending time with them other than when responding to their personal care needs. Staff told us that there is not enough time as they would wish to spend quality time with people living at the home. Several people spent time in the lounge/ dining areas. We saw that televisions were turned on, some tuned to music channels but none of the people sat in the rooms were watching. Staff did stop and speak to people but only for a short time.(Please refer to standards 27-30 Staffing) During the 2nd day of this inspection we spent the majority of the day at Pinnexe Moor, where people who may have dementia live. We spent a period of time sitting in one of the lounges observing interactions between staff and people living at the home. Seven people were sat in the room at 10.10 am, one was eating breakfast, another was colouring in, 4 people were sleeping and one was staring at a television screen, which was showing a music channel logo. All people sat in the room had childrens colouring books and coloured pencils on tables in front of them but only one was engaged in the activity. A carer spent time in the lounge during the time we were there but did not engage any of the people in any meaningful activities or demonstrate good communication skills with the people in the room. This was discussed with the manager when Care Homes for Older People Page 22 of 42 Evidence: providing feedback to them at the end of the inspection. This means that although during this time a member of staff was available to spend time with people no time was spent engaging people in conversation or meaningful activities. A person came to the room after a while and told us that they had been asked on the first day of this inspection to come into the home today to do activities. They turned off the television, played some tapes, which we were told people particularly enjoyed, engaged people in conversation and encouraged them to look at magazines or to do some colouring. Within a very short time people were more alert and taking notice of what was going on in the room. We were told that there is currently a shortage of activities materials at the home, eg limited amounts of materials to undertake craft sessions. We were also told that outings are limited for people living at the home. Information provided prior to this inspection indicated that several people living at Ashdowne Care Centre use community transport for wheelchair outings with families and the service continues to encourage this. We saw photos of people taking part in activities, including visiting entertainers, donkey visits and ball games. We visited several people who stayed in their rooms throughout the day. We asked one person whether they chose to stay in their room and were told that they were not given the choice. They said they would like to go to the lounge and a carer agreed that they would assist them to the lounge, later, for morning coffee. However, the person was sleeping when morning drinks were being served. Staff told us that this person does vist the lounge when she asks. We looked at the care plans for this person and saw details of activities they had previously enjoyed, including embroidery, music and the piano. The person told us that they dont have any involvement with any of these since moving to the home. They said they do listen to the radio. When we asked what they would like to do they said watch a good film. We saw a varied selection of videos in their room but at no time was the person asked whether they would like to watch one, although staff had recorded that on occasions the person had watched videos. Information about peoples individual histories from the people themselves, relatives and friends have been sought. Details about a persons past life including occupations, relationships, religious beliefs, hobbies and interests and important dates will help to Care Homes for Older People Page 23 of 42 Evidence: enable staff to see people as individuals and support person centred care. Personal histories are particularly important for people who may have limited communication as it will provides staff with some insight into how to engage people meaningfully. Individual activity folders are maintained for people living at the home, which are planned to include a record of activities people have undertaken. We saw entries indicating that one person had gone out into the garden, the library service had been informed of their choice of books so that when the library next visited the home their choices would be available and that staff had taken some books to them in the meantime. The person told us they were very happy with the way their social care needs were met. However, no details of whether a person who, according to their wishes and those of their relatives, chose to have massage and pedicures regularly had been recorded. There is no restriction on visiting times and throughout the day visitors came to the home and were made to feel welcome. Relatives told us that they could visit at any time and that they felt welcome at the home. One told us, I am encouraged to visit anytime that suits me. Relatives said the home kept in touch with them and informed them of any changes or events affecting their relative. In response to a survey one relative wrote, Keeps next of kin up to date as to the condition of (relative) and any problems that have arisen and any appropriate action taken. Five people responding with surveys felt that staff listened and acted on what they said, two said this was mostly the case. We saw staff offering people choice during both days of this inspection, for example what they wanted to eat and drink. Surveys showed that four people always or usually enjoyed the food served at the home, three did not respond to the question. People who were able to communicate told us how good the food was. They described the choices available and were full of praise for the chefs. We spoke to the chef during this inspection, who was knowledgeable about peoples dietary needs and preferences. We saw clear information about the various diets people needs and lists of individual likes and dislikes and size of meals preferred. People can choose where to have their meals; several people choose to eat in the dining room. People can choose when to have their breakfast and many people have breakfast in their room. During our time spent at Pinnexe Moor we saw people enjoying breakfast, some having a cooked breakfast and other choosing fresh fruit, Care Homes for Older People Page 24 of 42 Evidence: cereals, toast and a wide selection of spreads. Staff were helpful and patient and the atmosphere was cheerful and much laughter was heard. We spent time in one of the dining rooms during lunch; the atmosphere was convivial and tables were nicely laid with menus and condiments. Staff were available to assist people in a discreet manner where needed. The lunchtime meal was very well presented and appeared to be well balanced and nutritious and we heard staff offering people a variety of drinks. Those people requiring a pureed diet had each component of the meal separated on the plate, which looked appetising and colourful. Staff let people know what is planned for lunch the following day when they serve evening drinks. We saw several people who, although they had made a choice the previous evening had either forgotten or changed their minds. Staff were patient and simply served what the people asked for at the time. The kitchen was well stocked with supplies, including fresh fruit and vegetables and a good supply of dried goods. Care Homes for Older People Page 25 of 42 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 living at the home can be confident that any issues raised will be taken seriously and that they, and staff, are protected from abuse by robust policies and procedures. Not all issues dealt with and responded to by the service with outcomes and actions taken, are recorded. Evidence: Not all people living at the home were able to tell us whether they were aware of the homes complaints procedure. Those who could tell us knew who to speak to if they have any concerns or complaints and most were aware of the complaints procedure. One person told us, I havent got any complaints but if I did I would soon tell them. Care staff said they would advise people to report concerns or complaints to the nurse in charge, or would pass the concern,complaint on to the nurse themselves. The home has received five minor complaints,concerns within the last year, and records show that these were dealt with in a professional manner and that people were happy with the outcome. The Commission has received one concern from a relative, which was referred to Social Services to address. Care Homes for Older People Page 26 of 42 Evidence: Prior to this inspection two health care professional contacted the Commission with concerns. We were told that one concern had been discussed with the manager; however, this had not been included in the record of complaints maintained at the home although records of actions taken had been recorded in the persons care plans. Staff spoken with said they had received training to help them recognise any poor practice or evidence of abuse and all were aware of their responsibility to report any concerns. Staff spoken to gave examples of unacceptable practice, including verbal abuse, and knew they must report this to senior staff. During this inspection several staff attended a training session on Safeguarding Adults, presented by an outside training provider. Information provided prior to this inspection indicates that the service is aiming to provide training on the Mental Capacity Act (MCA)for all staff, develop care plans in relation to MCA, plan meetings with GPs, professionals and relatives to agree individuals capacity in order to make best interest decisions and uphold the law. Care Homes for Older People Page 27 of 42 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 living at Ashdowne Care Centre benefit from a comfortable well maintained environment. Locks, fitted to promote peoples privacy, and the lack of some door handles, could potentially restrict peoples access. Evidence: Ashdowne Care Centre consists of two units, Ashdowne House and Pinnexe Moor. Both units have separate entrances but are also connected by a covered way so either can be accessed from the other. The entrance to Ashdowne House has an open, welcoming reception area from which the corridor links it to Pinnexe Moor. Information such as the homes statement of purpose, service user guide, most recent inspection report and details relating to fire safety and insurance can also be found here. Both units have bedrooms and a lounge/dining room on each of the ground and first floors. Decoration in some parts of both units is generally reasonable but some areas are looking tired and would benefit from being redecorated and brightened up. We Care Homes for Older People Page 28 of 42 Evidence: discussed this with the manager, who told us that redecorating and refurbishment is on going, and replacements are being made to some furniture and equipment. We were told that the service plans to continue improving the decor throughout the home, including peoples individual rooms, and that rooms are decorated and re carpeted when they become vacant. Many of the bedrooms in both units had been personalised with items of furniture, ornaments, photographs and pictures. The home provides the necessary equipment to assist people and meet their needs. Aids, hoists, and assisted toilets and baths are installed, which are capable of meeting peoples individual needs. Staff told us they had the equipment they needed to ensure that care was provided safely. A toilet seat in a ground floor toilet in Ashdowne House was insecure and two toilet roll holders had not been cleaned effectively. This was discussed with the manager at the time of the inspection. Two corridors in Pinnexe Moor were cold on the day of this inspection although the thermometer on the wall said the temperature was 20 degrees C. This was also noted during the last inspection. The weather at the time of this inspection was warm and radiators were not turned on anywhere in the home but the corridors were colder than other parts of the home. Doors to peoples rooms in Pinnexe Moor have been personalised with their names printed on them and are decorated in an individualised way using themes which have a particular meaning for each person. For example one person has various pictures of their favourite football team, another has a selection of horses and another, bears. This helps people recognise their rooms and have ownership. Bathrooms and toilets are similarly decorated with large pictures, which enable people to access them more easily. The manager told us that people living at the home, staff and relatives have been asked for assistance in naming corridors and lounge areas in Pinnexe Moor. Several rooms at Pinnexe are fitted with Yale type locks. We asked the manager whether these could be unlocked if locked from inside the room. The manager said that they could be unlocked from outside, with a key, unlike similar domestic locks. These were not checked at the time of this inspection but we asked the manager to undertake assessments of the risks presented by the locking devices. We noted that several doors at Pinnexe Moor, although fitted with handles on the Care Homes for Older People Page 29 of 42 Evidence: outside, did not have handles fitted on the room side. We were concerned that although a lock had been fitted, the knob of the lock was relatively small and may be difficult for people to use to let themselves out of their rooms. This means that people may not be able to leave their rooms if the door is closed. No risk assessments had been undertaken to manage the locks or the lack of handles as we were told by the manager, staff and a cleaner that this had not been noticed before. The home is secure with key coded entry, which allows people living at the home to freely move around the home in a safe way. Both units have a passenger lift which means that all parts of the home can be accessed by all living, visiting and working there. There was a lack of call bells in lounges; during the two days of this inspection we did not see people in any of the lounges having access to a bell to alert staff to any needs. The home is well maintained, with pleasant, comfortable communal areas for people living there to enjoy. However, all chairs in a lounge on the first floor of Pinnexe Moor, which has views of the surrounding countryside from large windows, were facing in towards the centre of the room, as were the chairs in the other 3 lounges at Ashdowne Care Centre. At the time of this inspection the home was clean and fresh. In response to surveys 5 people confirmed that it was always or usually like this, two people did not respond. Good infection control is maintained through staff training and practice. Staff have the necessary protective equipment, such as gloves and aprons and liquid soap, sanitising gel and disposable towels are provided in sluices, toilets and bathrooms to promote good standards. The home deals with clinical waste appropriately. The laundry for both units is situated at Pinnexe Moor. The laundry area was well organised, generally clean, well equipped and managed by dedicated laundry assistants 7 days a week. The necessary equipment is available including two washing machines and two dryers. A red bag system is used for any soiled laundry ensuring staff are protected. The laundress takes great care with peoples personal items of clothing. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. Care Homes for Older People Page 30 of 42 Evidence: Care Homes for Older People Page 31 of 42 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. People benefit from having skilled, experienced and friendly staff that has a good understanding of their needs. Staffing numbers are generally sufficient to ensure that peoples basic care needs can be met but do not always allow staff the time to engage with people other than when undertaking basic care tasks. People living at the home are protected by the homes robust recruitment procedure. Evidence: Four people living at the home responding with surveys said that there were enough staff available when needed; three felt that staff were usually available when needed. One person commented sometimes there are staff shortages, for example; if two assistants are needed to take a resident to the toilet the other residents are on their own. Also sometimes there will be a senior nurse in the office and two assistants downstairs but only one assistant upstairs. When the upstairs residents are taken to the toilet one of the downstairs assistants will come up to help leaving only one assistant downstairs. Another person, in response to what could the home do better, wrote More staff. Care Homes for Older People Page 32 of 42 Evidence: Two staff, in response to questionnaires, felt there are usually and three sometimes enough staff to meet individual care needs of people living at Ashdowne Care Centre. One staff member wrote if staffing levels a little higher then more time could be spent talking to residents or taking them out in a wheelchair. This depends on dependency and whether residents are in need of bed side care on a daily basis depending on whether they are really ill. Some residents are really frail as well so staff are stretched where to give priority at times. Another member of staff stated I feel that we are understaffed, we are often rushed and sometimes cannot give people the time they deserve. A health care professional, who responded to a survey, commented Increased staffing levels would improve the time available for supporting residents with communication and feeding needs. Staff currently have the will and the skills to do this but always the time. Prior to this inspection two health care professional contacted the Commission. One told us that although they were reasonably happy with the care provided for one of their clients at the home, carers are slow to take the person to the toilet at the weekends and has reported that they sometimes has to wait an hour. We looked at separate duty rotas for both Ashdowne and Pinnex during this inspection, which show the skill mix and staffing levels maintained at the units throughout the day and night. The service aims to have 2 carers on each of the 2 floors in each of the 2 units and and one RGN on each unit throughout the day. Throughout the night the service aims to provide 2 carers and an RGN on each unit. The manager is usually supernumerary and is supported by domestics, laundry staff, catering staff, administrator, home services manager, activities organiser, maintenance person and gardener. During this inspection staff on both units told us that in their opinion there were not enough staff on duty to meet the needs of people living at Ashdowne Care Centre and that that they were always rushed. We were told that when staff come on duty at 8am they assist people with breakfast and personal care. This was usually completed by about 11.30 when they begin to make beds and tidy rooms. This is generally completed in time to begin preparing for lunch. They told us they have little or no time to spend with people just to chat, do their nails or keep them company. At the time of this inspection we were told that Care Homes for Older People Page 33 of 42 Evidence: only one person was independent and did not need help to go to the toilet. During this inspection we saw staff still assisting people with personal care at 11:50 am on the first floor of Ashdowne House. An RGN told us that it takes between 1-2 hours to give medications to people, they then have dressings or other clinical tasks to undertake so do not usually have time to assist people with personal care. During both days of this inspection staff were busy and had little time to stop to speak to people but when they did were kind and helpful. The manager discussed the recruitment procedure at the home and how it has been developed so that it considers the needs of people living at the home. She stressed the importance, and time taken, to make sure that only good quality carers are recruited so that a high standard of service is offered at the home. We looked at three recently employed staff files. All included evidence that the home had conducted a robust recruitment procedure. Files included details of past employment, application form, previous training, evidence of identity, police checks and at least 2 references. This procedure means that people living at the home are protected by the homes recruitment procedure. All newly employed staff undergo a period of training when they start working at the home to enable them to get to know those living there, the homes philosophy of care, safety and care procedures and the general layout of the home. The time taken to complete this training will depend on past experience and individual ability. Individual staff files include confirmation of all training undertaken and planned. This means that all staff are provided with training to enable them to be kept up to date with current good practice. All staff also confirmed that checks, such as police checks ( CRB) and references, were undertaken before they started employment at the home.Two staff confirmed the induction training covered everything they needed to know about the job when they first started and two felt it mostly covered everything. Three staff, who responded to surveys, confirmed the manager meets with them regularly, one often and one sometimes to give support and discuss how they are working. Staff confirmed they feel they always or usually have the right support, experience and knowledge to meet the different needs of people living at the Care Homes for Older People Page 34 of 42 Evidence: home. All staff who responded to surveys, confirmed they are being given training which is relevant to their role and helps them understand and meet peoples individual needs. One member of staff did not think think they were given training that gave them enough knowledge about health care and medication. According to information received prior to this inspection training undertaken in the last in last 12 month includes managing aggression, safeguarding adults, health and safety,Mental Capacity Act and Deprivation of Liberty training,infection control and food hygiene, manual handling and fire safety. Several members of staff are also completing Dementia Awareness training run by Exeter College. We have also been told that since the last inspection three RGNs have updated clinical skills, diabetic checks are now done by RGNs, working with other health care professionals and a carer, who has attained an NVQ level 3, supports new carers and assists them working through Skills for Care Induction Programme. Training planned to take place during the next 12 months include first aid refresher, food hygiene and manual handling. This ensures that well informed staff care for people living at the home. Care Homes for Older People Page 35 of 42 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. People benefit from living in a well managed home that is working hard towards trying to make sure the home is run in their best interests. Health and safety is well managed. Evidence: Mrs Ley was appointed as the acting manager of this service in September 2007 and was Registered as Manager in August 2008. Mrs Ley is a Registered General Nurse, holds a teaching and assessing in clinical practice qualification and has experience of working with older people both in a hospital setting and care home setting. One member of staff commented I think we have a very good manager who is very helpful in any way she can, she has always given me her time when I have needed her. Prior to this inspection the manager sent us information about the management of the Care Homes for Older People Page 36 of 42 Evidence: home and how the home has carried out improvements since the last inspection. Records are securely stored and would be made available to people living at the home, or their representative, with their consent. Records are kept in lockable filing cabinets, and those seen were up to date. Peoples feedback about such things as the quality of their life at the home, staffing, meals, cleanliness and activities is sought on a daily basis. Comment cards are put in reception areas twice a year and feedback acted on. Meeting are held 6 times a year when people living at the home and relatives can voice their views and have their say in the running of the service. An annual quality assurance survey has been undertaken by the home since the last inspection and the outcomes of the survey are available to relatives of people living at the Home. We discussed including the results of surveys in the homes statement of purpose to make them available to other interested parties. We looked at the outcomes of the surveys and noted that they did not indicate actions that had been taken to address issues raised by people. Suggestions made on surveys included more crisps at teatime, decor of bathroom to be more homely, more variety of sandwiches, need roof on veranda for wet weather and maybe burgers at teatime. The manager assured us that actions had been taken to address these suggestions. Completed comment cards included wonderful food, wide choice and very well presented and staff very kind to my (relative) and most caring and willing. The manager told us all staff engage with visitors when they visit the home and try to implement individual requests as they occur. Some people living at Ashdowne Care Centre choose to have personal money dealt with by the home. This means that a float is kept so that day to day items such as toiletries, hairdressing, papers and magazines can be bought as people wish. We saw records and receipts kept by the home; these were accurate and up to date. All staff that responded to questionnaires, and those spoken to during the inspection, confirmed that the manager, or one of the RGNs, met with them regularly to give support and discuss how they were working. Comments included Our manager is very supportive and will make time for the staff, we can discuss our strengths and weaknesses, share concerns, ideas and receive support, discuss further training and discuss how we feel generally. Care Homes for Older People Page 37 of 42 Evidence: Records are kept of accidents that occur at the service. We looked at records for both Ashdowne House and Pinnexe Moor. All reports were clear and accurate. Individual reports had not been removed from the Accident Reports book as directed. Records confirm that fire alarms and emergency lighting tests have been carried out regularly. An assessment of identified hazards and associated risks relating to the environment, including fire hazards, has been undertaken. Information received before this inspection indicated that all equipment is well maintained regularly, all of which contributes toward ensuring that Ashdowne Care Centre is a safe place for people to live. Care Homes for Older People Page 38 of 42 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 39 of 42 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 8 Information about peoples needs should be confidential and not displayed openly. This relates to information being posted on wardrobe doors and on walls. 2 8 Care plans should be reviewed regularly and involve individuals or their chosen representative. This relates to a Care plan not being reviewed for 3 months. 3 8 It is recommended that staff ensure people have a call bell at all times when left unsupervised so that they can call for assistance at any time. Continued improvement in care planning should result in plans being more person centred and include details of peoples individual strengths and choices. Records of when creams have been applied should be maintained. This is to ensure that people receive treatment as prescibed. 4 8 5 9 Care Homes for Older People Page 40 of 42 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 6 9 When containers of creams or ointments are opened arrangements should be made to ensure they are not used beyond their shelf life. When people bring medications to the home which are not included in pre admission assessments or in discharge details, if coming from a hospital, a check should be made to ensure the medication is still prescibed. This relates to a person being administered a pain reliever when no details of this being prescibed had been recorded. 7 9 8 9 12 12 When staff spend time with people they should try to engage with them in a meaningful way. Activities should be meaningful and appropriate to the individuals capabilities so that everyone living at the home has a fulfilling life. A record should be kept of all complaints, investigations undertaken, outcomes and actions taken to address the issues. Assessments of risks presented by locks and some doors, which do not have handles on the inside, should be undertaken to ensure people living at the home are not restricted and are kept safe at all times. Consideration should be given to providing staff in such numbers to enable them to meet more than basic care needs for people living at the home. It is recommended that staff continue to receive training in topics that will be beneficial in meeting the needs of people living in the home (for instance activities/engagement with people with dementia.) Quality assurance surveys should include details of what actions have been taken by the service to address any issues raised. Results of surveys undertaken at the home should be published and made available to current and prospective users of the service, their representatives and other interested parties including the CQC. 10 16 11 19 12 27 13 30 14 33 Care Homes for Older People Page 41 of 42 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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