Care Home: Asheborough House

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What the care home does well We looked at how the management of the home monitors and records the care provided to people who remain in their rooms because they are unwell and who are not able to summon assistance. We found that this had improved and clear records are now maintained of how people are care for and monitored. These records are stored in the persons room and staff complete them when care has been given. These monitoring records were a reflection of guidance given in the persons plan of care. We looked at staff rotas to establish how people who were employed with a Protection of Vulnerable Adults check but prior to the Criminal Record Bureau Check having been received, were supervised. We saw that the manager designate now includes the supervising person on the staff rota and so a clear record and audit trail is maintained ofhow staff are supervised during this period. The responsible individual was previously required to supply the Commission with a copy of the monthly Regulation 26 report which they undertake to monitor care at the home. We have now received the reports up to July 2010. No report is yet available for August 2010. The responsible individual must ensure that the date of the visit is recorded in the report. We required that all staff receive moving and handling training to ensure that safe practices were maintained at the home. Most staff have now undertaken this training. We requested to look at pre admission documentation to establish that the home undertakes appropriate assessments of people prior to admission to the home. This was not possible to assess because the home has not had any new admissions since the last key inspection, this area will be reviewed at the next inspection. We looked at risk assessments and care plans on our first visit on the 24th August 2010. We found them to be confusing and inaccurate and a result of several changes in process which resulted in large amounts of confusing documentations. We asked the management of the home to complete 10 care plans to an improved standard by the 9th September 2010. This was undertaken and the care plans and risk assessment were seen to be comprehensive and clear. The Commission appreciates the serious undertaking by the manager designate and staff to change the processes in place. We note that further development is needed to ensure that all the detail is included in the care plans and that risks seen are always appropriately actioned. The new risk assessments and care plans provide staff with a clearer direction and instruction to ensure that peoples needs can be appropriately met. We also noted that the manager designate has started to undertake life history books to enable staff to have an understanding of people using the service`s life, preferences and things which are important to them. We will review how this has progressed at the next key inspection. We made a requirement at the key inspection that bathing facilities were made available to all people using the service and that this provision is monitored to ensure people needs would be met. The hydrotherapy bath is now working and staff told us that whilst there is another bath available for people using the service with a higher level of independence, the hydrotherapy bath with hoist is used all of the time and is popular with people using the service. We made a requirement that the Controlled drug Cupboard be moved to a fixed wall in line with the Royal Pharmaceutical Guideline and the manager designate confirmed that this has now been done. We looked at the Medication Administration Records and saw that all hand transcribed medication had been signed by two people and that there were no gaps in any of the records where a signature or coded indicator should be. This means that staff are following correct procedure and ensuring that all prescribed medications are procured, recorded and administered correctly to ensure the safety of people using the service. We recommended that the capacity of people using the service be established to ensure that they could understand and agree to the administration of covert medication. The manager designate continues to develop a protocol which will clarify for staff the procedures to be followed to ensure that the administration of covert medication is appropriate. The protocol is not yet finalised and in place.We looked at the management of complaints and found that as a result of our inspection, a previous complaint had been gathered together and stored securely. We were told by the manager designate that no other complaints had been received by the management of the home and so this area will be reviewed at the next inspection. We had recommended that the complaints policy be displayed in the hallway of the home to enable people to know the procedure in place at the home. The manager designate has confirmed this is now in place. We required that all hot water outlets be monitored to ensure that they do not exceed the health and Safety upper limits and place people at risk of burns and scalds. The records were made available to us to demonstrate that this monitoring is now in place and all temperatures were within acceptable limits. We spoke with staff who told us that they are required to test the temperature of the water before each persons bath and record what that temperature was. The staff spoken with demonstrated an awareness of the appropriate range of temperatures. We required that staff undertake an induction process within a reasonable timescale before they work unsupervised at the home. We spoke with staff who are new to the home. They told us that they were well supervised and supported. They told us that they have an induction booklet which they work through with a senior member of staff. We were advised by the manager designate that no booklets were yet back from new staff and as such we will review this at the next inspection. We had previously recommended that a review take place of the perceptership supervision for newly qualified staff. This is required to support the development of newly qualified staff. We have found that whilst medication competency has been established no other areas of perceptership have been undertaken six months later. It is important that the management of the home understand the role of perceptership in the development of newly qualified staff to promote good care skills and practice. We required that all records relating to people using the service be stored securely. We What the care home could do better: The provision of social and community activities is not consistently provided, is not person centered and is not a process which develops the opportunity for individual meaningful activity. It is planned that a staff member will undertake a lead role in activity provision but this is not yet in place. The staff told us that some activity takes place inthe afternoons but that this is variable depending peoples ability and staff time constraints. We looked at records of activities. These are a tick chart which is not signed by the staff member completing it and so is not audit able for accuracy and content. There are further records which detail the content of the activity. We looked at the content of the activity and found that sometimes the ticks to confirm activity were not activities and were a reflection of staff recording that activity had been declined. We noted that for the month of August 2010 out of 31 days for 11 days no activity is recorded, for 2 further days two people had activity and for 5 days three people had activities. The management of the home must ensure that people are supported to engage in social and recreational activities, within their capabilities. Arrangements for this should be part of care planning. The records of these activities must be accurate and reflect the actual activity undertaken. We had made a requirement that all staff receive training in abuse awareness to support and protect the people using the service. We have been supplied with a training record which the manager designate confirmed as not being up dated to reflect accuracy. This record does not include staff employed from other homes in the extended relationship of the company. The record shows that only five out of the 28 staff listed had up to date abuse awareness training. This training must be undertaken by all staff to ensure that people using the service are safe. We looked at the recruitment files for three recently employed staff to ensure that the checks in place protected people using the service. At the random inspection on the 2nd August 2010 this area was reviewed and the management of the service had not met the requirements made. However, some improvement was seen and it was hoped by the Commission that the management of the home were to build on these improvements. At this inspection it was found that of the three files looked at, two people only had one reference in place and one person had an application form and 2 references from a different home, both dated in 2004. This person did not have a CRB or POVA check in place to work at this home. It is concerning that the management of the home continue to lack the understanding of the recruitment process and so may place people at risk. All recruitment checks must be in place prior to people starting work at the home with immediate effect. We required at the key inspection that staff must be trained and competent in all conditions which affect people at the home, especially dementia. We looked at the staff training records and found that eight staff had undertaken some training in dementia care. The home currently employs a mix of Registered General Nurses and two Registered Mental Nurses and so the staff training is particularly important to support people using the service when the RMN staff are not on duty. Further training is needed in dementia care to ensure that people using the service are supported and their specific needs met. We required that the homes brochure be made into an accurate reflection of care provided to ensure that people had an accurate and informed view of the services available at the home. We looked again at the brochure and found that the home now provides a safe garden and hydrotherapy bath described in the brochure. However, the brochure describes a sensory room which staff confirmed is not yet available. The brochure also has a picture and contact details for two homes which are not a part of Sheval Ltd. and may give the impression that they are. This information must be an accurate reflection of services and information provided.We previously recommended that staff receive training to ensure that terms of reference staff used for people are not `feeds` and `softs` and that appropriate names and reference are used. The manager designate told us that she works on the floor of the home and talks to staff daily and by staff meetings had dissuaded this practice. On the 9th September, we spent some time in the communal areas of the home and again heard these terms of reference being used when staff organised themselves for mealtimes. These terms were used within listening distance of people using the service. Training must be provided to ensure that this practice stops. Random inspection report Care homes for older people Name: Address: Asheborough House Asheborough House St Stephens Saltash Cornwall PL12 4AP zero star poor service 21/05/2010 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gail Richardson Date: 0 9 0 9 2 0 1 0 Information about the care home Name of care home: Address: Asheborough House Asheborough House St Stephens Saltash Cornwall PL12 4AP 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sheval Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 31 Number of places (if applicable): Under 65 Over 65 0 0 31 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 31 31 0 The maximum number of service users who can be accommodated is 31. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Mental disorder, excluding learning disability or dementia (Code MD) Date of last inspection 0 2 0 8 2 0 1 0 Care Homes for Older People Page 2 of 14 Brief description of the care home Asheborough House (previously called Beech House) is a detached property set in its own grounds with a lawned area to the side and rear. Car parking is available in the grounds of the home. Saltash is approximately five minutes away by car and has all the usual facilities of a small town. Accommodation and care to include nursing is offered at the home in the category of dementia or mental disorder. The home is entered via secured garden gates into an entrance with communal areas off to include a lounge and a dining room. A shaft lift is available to all the bedrooms in the home on the first and second floor. The laundry and kitchen are on the lower ground floor area of the home. Fees range from £550.00 to £700.00 per week (Fees correct as to the time of this report ). An additional charge is made for dry cleaning, visits from a hairdresser and chiropody. The Statement of Purpose and Service User Guide (available in an easy read format) are available on request. Care Homes for Older People Page 3 of 14 What we found: This was an announced inspection, which took place over two visits on the 24th August 2010 and 9th September 2010 by Compliance Inspector Gail Richardson.This inspection was undertaken as part of an ongoing monitoring of improvements and was in conjunction with associated health professionals. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. The last key inspection took place on the 21st May 2010 and had an 0 star rating. As part of that process an improvement plan was agreed between the management of Asheborough House, CQC, the Service Improvement team and the Continuing Care Co-ordinator, Mental Health NHS Cornwall. This improvement plan had agreed timescales in place. A further random inspection took place on 2nd August 2010 to look at recruitment and training practices at the home. Some areas were seen to have ongoing changes but further work was needed to ensure the safety of people using the service. We visited the home on the 24th August to review the improvement plan and assess how the statutory requirements had been met. We found that some areas had been met, however, areas including care planning and policies and procedures in place to protect people using the service and staff were not yet robust and as a result may place people at risk. We agreed with the management of the home to return on the 9th September to review action taken to meet these shortfalls. This report is relating to the visits on the 24th August 2010 and 9th September 2010 combined. Whilst at the home the Commission took the opportunity to review all the outcomes of actions taken to meet the statutory requirements made at the key inspection on the 21st May 2010. There are currently 22 people using the service. On the day of inspection on duty were the Manager Designate, a Registered General Nurse and six care staff. There were a further two staff doing breakfast service and administration staff, cooks and cleaning staff. The responsible individual was also available. What the care home does well: We looked at how the management of the home monitors and records the care provided to people who remain in their rooms because they are unwell and who are not able to summon assistance. We found that this had improved and clear records are now maintained of how people are care for and monitored. These records are stored in the persons room and staff complete them when care has been given. These monitoring records were a reflection of guidance given in the persons plan of care. We looked at staff rotas to establish how people who were employed with a Protection of Vulnerable Adults check but prior to the Criminal Record Bureau Check having been received, were supervised. We saw that the manager designate now includes the supervising person on the staff rota and so a clear record and audit trail is maintained of Care Homes for Older People Page 4 of 14 how staff are supervised during this period. The responsible individual was previously required to supply the Commission with a copy of the monthly Regulation 26 report which they undertake to monitor care at the home. We have now received the reports up to July 2010. No report is yet available for August 2010. The responsible individual must ensure that the date of the visit is recorded in the report. We required that all staff receive moving and handling training to ensure that safe practices were maintained at the home. Most staff have now undertaken this training. We requested to look at pre admission documentation to establish that the home undertakes appropriate assessments of people prior to admission to the home. This was not possible to assess because the home has not had any new admissions since the last key inspection, this area will be reviewed at the next inspection. We looked at risk assessments and care plans on our first visit on the 24th August 2010. We found them to be confusing and inaccurate and a result of several changes in process which resulted in large amounts of confusing documentations. We asked the management of the home to complete 10 care plans to an improved standard by the 9th September 2010. This was undertaken and the care plans and risk assessment were seen to be comprehensive and clear. The Commission appreciates the serious undertaking by the manager designate and staff to change the processes in place. We note that further development is needed to ensure that all the detail is included in the care plans and that risks seen are always appropriately actioned. The new risk assessments and care plans provide staff with a clearer direction and instruction to ensure that peoples needs can be appropriately met. We also noted that the manager designate has started to undertake life history books to enable staff to have an understanding of people using the services life, preferences and things which are important to them. We will review how this has progressed at the next key inspection. We made a requirement at the key inspection that bathing facilities were made available to all people using the service and that this provision is monitored to ensure people needs would be met. The hydrotherapy bath is now working and staff told us that whilst there is another bath available for people using the service with a higher level of independence, the hydrotherapy bath with hoist is used all of the time and is popular with people using the service. We made a requirement that the Controlled drug Cupboard be moved to a fixed wall in line with the Royal Pharmaceutical Guideline and the manager designate confirmed that this has now been done. We looked at the Medication Administration Records and saw that all hand transcribed medication had been signed by two people and that there were no gaps in any of the records where a signature or coded indicator should be. This means that staff are following correct procedure and ensuring that all prescribed medications are procured, recorded and administered correctly to ensure the safety of people using the service. We recommended that the capacity of people using the service be established to ensure that they could understand and agree to the administration of covert medication. The manager designate continues to develop a protocol which will clarify for staff the procedures to be followed to ensure that the administration of covert medication is appropriate. The protocol is not yet finalised and in place. Care Homes for Older People Page 5 of 14 We looked at the management of complaints and found that as a result of our inspection, a previous complaint had been gathered together and stored securely. We were told by the manager designate that no other complaints had been received by the management of the home and so this area will be reviewed at the next inspection. We had recommended that the complaints policy be displayed in the hallway of the home to enable people to know the procedure in place at the home. The manager designate has confirmed this is now in place. We required that all hot water outlets be monitored to ensure that they do not exceed the health and Safety upper limits and place people at risk of burns and scalds. The records were made available to us to demonstrate that this monitoring is now in place and all temperatures were within acceptable limits. We spoke with staff who told us that they are required to test the temperature of the water before each persons bath and record what that temperature was. The staff spoken with demonstrated an awareness of the appropriate range of temperatures. We required that staff undertake an induction process within a reasonable timescale before they work unsupervised at the home. We spoke with staff who are new to the home. They told us that they were well supervised and supported. They told us that they have an induction booklet which they work through with a senior member of staff. We were advised by the manager designate that no booklets were yet back from new staff and as such we will review this at the next inspection. We had previously recommended that a review take place of the perceptership supervision for newly qualified staff. This is required to support the development of newly qualified staff. We have found that whilst medication competency has been established no other areas of perceptership have been undertaken six months later. It is important that the management of the home understand the role of perceptership in the development of newly qualified staff to promote good care skills and practice. We required that all records relating to people using the service be stored securely. We looked at a new lockable cupboard in the staff office which is to be used to store care plans and records requiring confidential storage. The process of moving them in to this lockable facility is yet to be undertaken. We recommended that lockable storage facilities be provided for people using the service to ensure that personal items could be stored securely. We have been advised by the manager designate that furniture has been purchased and reallocated to provide some of the people using the service the facility to lock personal belongings away. We recommended that all staff receive a contract of the terms and conditions of their employment and also a job description to enable them to know the boundaries of their role. This process is underway but copies of both documents have not yet been provided for staff and will be reviewed at the next key inspection. What they could do better: The provision of social and community activities is not consistently provided, is not person centered and is not a process which develops the opportunity for individual meaningful activity. It is planned that a staff member will undertake a lead role in activity provision but this is not yet in place. The staff told us that some activity takes place in Care Homes for Older People Page 6 of 14 the afternoons but that this is variable depending peoples ability and staff time constraints. We looked at records of activities. These are a tick chart which is not signed by the staff member completing it and so is not audit able for accuracy and content. There are further records which detail the content of the activity. We looked at the content of the activity and found that sometimes the ticks to confirm activity were not activities and were a reflection of staff recording that activity had been declined. We noted that for the month of August 2010 out of 31 days for 11 days no activity is recorded, for 2 further days two people had activity and for 5 days three people had activities. The management of the home must ensure that people are supported to engage in social and recreational activities, within their capabilities. Arrangements for this should be part of care planning. The records of these activities must be accurate and reflect the actual activity undertaken. We had made a requirement that all staff receive training in abuse awareness to support and protect the people using the service. We have been supplied with a training record which the manager designate confirmed as not being up dated to reflect accuracy. This record does not include staff employed from other homes in the extended relationship of the company. The record shows that only five out of the 28 staff listed had up to date abuse awareness training. This training must be undertaken by all staff to ensure that people using the service are safe. We looked at the recruitment files for three recently employed staff to ensure that the checks in place protected people using the service. At the random inspection on the 2nd August 2010 this area was reviewed and the management of the service had not met the requirements made. However, some improvement was seen and it was hoped by the Commission that the management of the home were to build on these improvements. At this inspection it was found that of the three files looked at, two people only had one reference in place and one person had an application form and 2 references from a different home, both dated in 2004. This person did not have a CRB or POVA check in place to work at this home. It is concerning that the management of the home continue to lack the understanding of the recruitment process and so may place people at risk. All recruitment checks must be in place prior to people starting work at the home with immediate effect. We required at the key inspection that staff must be trained and competent in all conditions which affect people at the home, especially dementia. We looked at the staff training records and found that eight staff had undertaken some training in dementia care. The home currently employs a mix of Registered General Nurses and two Registered Mental Nurses and so the staff training is particularly important to support people using the service when the RMN staff are not on duty. Further training is needed in dementia care to ensure that people using the service are supported and their specific needs met. We required that the homes brochure be made into an accurate reflection of care provided to ensure that people had an accurate and informed view of the services available at the home. We looked again at the brochure and found that the home now provides a safe garden and hydrotherapy bath described in the brochure. However, the brochure describes a sensory room which staff confirmed is not yet available. The brochure also has a picture and contact details for two homes which are not a part of Sheval Ltd. and may give the impression that they are. This information must be an accurate reflection of services and information provided. Care Homes for Older People Page 7 of 14 We previously recommended that staff receive training to ensure that terms of reference staff used for people are not feeds and softs and that appropriate names and reference are used. The manager designate told us that she works on the floor of the home and talks to staff daily and by staff meetings had dissuaded this practice. On the 9th September, we spent some time in the communal areas of the home and again heard these terms of reference being used when staff organised themselves for mealtimes. These terms were used within listening distance of people using the service. Training must be provided to ensure that this practice stops. 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 2. Care Homes for Older People Page 8 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 3 The registered person must ensure that information supplied to prospective people using the service is an accurate reflection of the services provided. This will enable people to make an informed decision about the services and facilities available. 15/10/2010 2 2 14 The registered person must 15/10/2010 ensure that a pre admission assessment is undertaken for all new admission to the home. The pre admission assessment must be made available to staff prior to admission. This is required to ensure that the home is suitable for the purpose of meeting the needs of thep prospective person using the service. 3 12 16 The registered person is required to develop a programme of meaningful activity for each person. This actvity should be recorded to further develop activity to support people choices and preferences. 15/10/2010 Care Homes for Older People Page 9 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 4 12 16 (2)(m) People must be able 15/10/2010 to engage in local, social and community activities, within their capabilities, and as they wish. Arrangements for this should be part of care planning. So people can live a fulfilled life and are not socially isolated. 5 16 22 The registered person must 25/06/2010 ensure that complaints are managed in line with the homes complaints procedure. All complaints must be investigated and a record maintained of actions taken. This is required to ensure that there is clear evidence of the management of complaints. 6 18 12 The registered person must ensure that all staff have received training in abuse awareness. This is required to ensure the protection of people using the service. 15/10/2010 7 27 18 The registered person must ensure that there are sufficient numbers of staff consistently available to meet the needs of people using the service. The means to measure service user dependency must be taken into 25/06/2010 Care Homes for Older People Page 10 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action consideration when providing staffing levels to ensure that the levels of staff are correct to meet peoples needs. 8 29 19 The Registered Person must ensure that all appropriate recruitment checks are in place prior to people commencing employment at the service. This must include a full employment history and appropriate police checks. This is to ensure that people using the service are not at risk of harm. 9 29 19 The registered person must 01/10/2010 ensure that all staff have recruitment checks in place which include two references, this is to include one from the most recent employer or the reason why this is not possible. This is required to ensure the protection of people using the service 10 30 18 The registered person must 15/10/2010 ensure that all staff complete an induction program within a reasonable timescale before they work unsupervised in the home. This is required to ensure the safety of people using the service and staff members. 11 30 18 (1)(c) Staff must be trained 15/10/2010 Page 11 of 14 01/10/2010 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action and competent in all conditions which affect people at the home, especially dementia. So that people receive appropriate and effective care. 12 37 12 The registered person must ensure that accidents are recorded and audited. This audit is then used to promote accident prevention. 15/10/2010 Care Homes for Older People Page 12 of 14 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, 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 The registered person is recommended to implement staff training to ensure that the terms of reference staff used for people using the service are not feeds and softs and reflect their preference of name. The registered person is recommeded to review and improve the management of investigates related to mediaction errors to ensure that they are managed clearly and safely. The registered person is recommended to establish and record the capacity of people to understand and agree to the adminstration of covert medication. The registered person is recommended to provide all staff with a contract of terms and conditions of employment and a copy of their job description. This will enable staff to be clear about their role at the home. The registered person is recommended to review the use of Perceptorship supervision for newly qualified staff. 2 9 3 9 4 29 5 30 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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