Care Home: Asher House

What the care home does well Residents and relatives told us that they were generally very happy with the care and services at Asher House. A resident told us "One of the staff is so good I`m going to commend them to the manager". One of the residents said "staff are caring and supportive, always helpful and cheerful, Asher House is well run and has a homely atmosphere". Another resident said "I`m quite happy here". A relative said "Staff are very attentive towards the residents and treat them with loving care and respect". A member of staff said "theAsher HouseDS0000066638.V377054.R01.S.docVersion 5.2residents are treated as individuals". Residents and relatives were very complimentary about the cleanliness of the home. What has improved since the last inspection? The overall standard of care documentation had improved and was more personalised to the individual resident`s needs, abilities and preferences. A number of areas had been redecorated to improve the environment for residents. Three bedrooms had been redecorated. A bathroom, toilet and an en-suite room had new flooring fitted. The hallways had been decorated. New carpets had been fitted in two residents` rooms, the hallway and staff offices. A new cooker, freezer and fridge freezer had been purchased. The remaining radiators had covers fitted to reduce the risk of injury to residents. What the care home could do better: The driveway was full of potholes and the home had broken concrete steps and some peeling paintwork that did not give a very good first impression of the home. The deputy said that there were plans to make improvements to the front of the home and address the uneven driveway. Issues in relation to upholding residents` privacy and dignity were highlighted at the last inspection and this was identified as an area that still needed some improvement. Although the standard of activities had improved since the last inspection some of the residents wanted the chance to go on more outings and trips out of the home. A relative agreed saying "There is a real lack of mental stimulation and social outings for residents". Two of the residents told us that they would like the manager and deputy to visit them more frequently in their room for a private chat. The deputy said that they would ensure that they visited residents more regularly in their rooms. Key inspection report CARE HOMES FOR OLDER PEOPLE Asher House Third Avenue Walton on Naze Essex CO14 8JU Lead Inspector Francesca Halliday Key Unannounced Inspection 10th August 2009 09:00 DS0000066638.V377054.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Asher House Address Third Avenue Walton on Naze Essex CO14 8JU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01255 676100 01255 852846 Sentimental Care Limited Mrs Vera Francis Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 20 8th July 2008 2. Date of last inspection Brief Description of the Service: Asher House is a detached property situated in a residential area of Walton on the Naze. The home is within walking distance of the seafront and local amenities. Asher House has gardens at the rear of the building, which are only accessible to people living at the home. The home also has a small garden at the front of the building and adequate off road parking. Asher House can accommodate a maximum of 20 people over the age of 65 years who need care due to a physical disability. The home has 12 single rooms, seven of which have en-suite facilities and four double rooms. There is a stair lift for access to the first floor. The fees at the time of inspection in July 2009 were between £390 and £540 each week. The fees were dependant on the type of care package, the needs of the individual resident and also on the size of the room, whether it had ensuite facilities and whether it had a door into the garden. Additional charges were made for private chiropody, hairdressing, toiletries, sessions at the local day centre, newspapers, private phone installation and phone bills. For up to date information about fees please contact the home directly. Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means that people who use this service experience good quality outcomes. This key inspection was carried out on the morning of 10th August 2009. The manager and deputy were not available on this day so the inspection was concluded on 11th August when the deputy manager was present. The term resident is used throughout this report to describe people living in the home and the term we refers to the Care Quality Commission (CQC). All the key national minimum standards (NMS) for older people were assessed during the inspection. The report was written using evidence accumulated since the last key inspection on 8th July 2008, as well as using evidence found during the site visit. This included looking at a variety of records and inspecting parts of the premises. The report was written using evidence provided by the manager and this included the annual quality assurance assessment (AQAA) sent to us prior to the inspection. The AQAA is a self assessment required by law and provides an opportunity for the management to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvements would be noted, as this contributes to the inspection process and indicates the homes understanding of current requirements, changes in legislation and their own audited compliance. During the inspection we had chats of various lengths with five residents and four members of staff including the deputy manager. We sent out surveys prior to the inspection and we received eight from residents, five from relatives and four from staff. As a result of one of the surveys we had a telephone conversation with one relative. Comments from the surveys and conversations have been included in the report where appropriate. What the service does well: Residents and relatives told us that they were generally very happy with the care and services at Asher House. A resident told us “One of the staff is so good I’m going to commend them to the manager”. One of the residents said “staff are caring and supportive, always helpful and cheerful, Asher House is well run and has a homely atmosphere”. Another resident said “I’m quite happy here”. A relative said “Staff are very attentive towards the residents and treat them with loving care and respect”. A member of staff said “the Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 6 residents are treated as individuals”. Residents and relatives were very complimentary about the cleanliness of the home. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 5 (standard 6 is not applicable) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential residents know that their needs can be met before they move into the home. EVIDENCE: The home had a range of information for potential residents and their relatives or representatives. This included a statement of purpose and a service user guide. Prospective residents and their relatives were invited to visit the home as many times as they liked, or for periods of respite before making a decision about admission. A trial period of four weeks was also offered before a decision was made about taking up permanent residency in the home. Regular respite breaks were offered if a bed was available. Residents we spoke with Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 9 told us that they had not been able to visit the home before accepting a place but confirmed that their relatives had visited on their behalf. The home tried to obtain information from a variety of sources before residents were admitted to enable them to establish whether they could meet their needs. The manager carried out the pre-admission assessments but did not use a pre-admission assessment tool. The assessments we sampled were very brief and did not provide all the information that would be needed to draw up initial care plans on admission. Also the documentation used would not provide guidance if another member of staff carried out an assessment while the manager was on leave. This could potentially result in the appropriate equipment not being available on admission or the potential resident being admitted inappropriately. From the evidence we gained during the inspection no residents had been admitted inappropriately. Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive a good standard of care but their privacy and dignity may be compromised at times. EVIDENCE: Residents and relatives told us that they were generally very happy with the standards of care in the home. The majority of residents who responded to our survey told us that they “always” received the support and care they needed. Four residents told us that staff were “usually” available when they needed them and three felt that staff were “always” available when they needed them. Three relatives told us that the home “usually” met the needs of the resident they visited and two felt that staff “always” met their needs. One said “Asher House provides a homely atmosphere. The staff are very attentive Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 11 towards the residents and treat them with loving care and respect”. During the inspection we observed staff treat residents respectfully and in a very caring manner. We looked at the care documentation for three residents and found that the overall standard had improved since the last inspection. The home was in the process of updating all the care plans and moving from standard plans to plans that were personalised to the individual resident. The new plans were of a very good standard. The daily care records were generally detailed and gave a good indication about residents’ health, the care given and how they had spent their day. Staff told us that they were hoping to get carers to write the daily records of the residents to whom they had given care, rather than have the senior carers write all the records. The home had a range of risk assessments to assess the risk of residents developing pressure sores or malnutrition and the risks associated with moving and handling. The assessments were updated when residents’ condition changed but were not always used to assess their potential risk and take preventative action on a regular basis. A risk assessment was completed when one resident had fallen out of bed on two occasions and following the assessment they agreed that they would feel safer with bed rails in place. Another resident’s assessment was updated following a fall. The home used an abbreviated mental test to monitor residents with memory loss but this would have benefited from being expanded to monitor residents’ overall psychological health. This would have been particularly relevant for one resident with a degree of dementia who had occasional episodes of challenging behaviour. The home was part of the falls prevention scheme and completed a monthly falls register. The register included the circumstances of the fall, any injury and the action taken when appropriate. The majority of residents who responded to our survey told us that they “always” received the medical care they needed. Staff told us that they generally had very good support from the two local GP practices. A record was made of GPs’ and district nurses’ visits and changes to residents’ treatment or condition. Residents told us that they had regular chiropody and had optical and dental checkups when needed. The overall standard of medicines management had improved since the last inspection. The medicine administration records (MAR) were well completed. Two members of staff signed when they made hand written records or amendments to the MAR, which is good practice. Residents who selfmedicated had a lockable drawer in their room. Two residents were selfmedicating topical creams. Staff had not completed a risk assessment in relation to the self-medication but the deputy manager said that this would be done following the inspection. A member of staff told us that they did not use gloves when applying topical creams. However, when the creams contained a Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 12 prescribed medicine, such as an anti-fungal treatment, this would result in the member of staff receiving a dose of the medicine themselves. The deputy told us that this practice was contrary to the training staff had received and that they would all be reminded about the appropriate practice. The date of opening had been recorded on the medicines in the medicine trolleys but was not always recorded on topical creams in residents’ rooms. Staff were trying to record the amount given when residents were prescribed a variable dose but this was not always clearly visible when written next to their signature. The deputy said that they would investigate an alternative method of recording the actual amount given. The temperature of the medicines fridge and the room where medicines were stored was being monitored and were within the safe range for the storage of medicines. A medication audit had been carried out by the home’s dispensing pharmacy in the past year and another was due to be undertaken in the near future. All of the senior staff had received regular medication training, which included an assessment of competence. Refresher training was booked for September 2009. One resident told us that staff respected their privacy in their bedroom. There was evidence that staff respected the wishes of a resident who did not like being checked up on and disturbed during the night. A resident told us “Staff are respectful and consider the residents’ needs and wellbeing”. However, a member of staff walked into a resident’s room without knocking while we were speaking with the resident. The resident said “that’s one thing I don’t like, you don’t get a lot of privacy”. Another resident told us that one of the care staff did not always remember to put the lid on the commode. This obviously considerably embarrassed the resident and did not respect their dignity. A resident told us that they would like a key for their bedroom door and for the door that opened on to the garden. The deputy manager said that they would make sure that the resident was given the keys following the inspection. Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered nutritious meals and their independence is encouraged. EVIDENCE: The range of activities and stimulation in the home had improved since the last inspection. Two members of staff usually took responsibility for offering residents activities. Games such as quizzes, scrabble and bingo were played and the home was hoping to purchase Wii fit. The local library now visited the home and books in Braille were being ordered for a resident who was registered blind. A fitness instructor visited the home fortnightly to hold exercise sessions to music and a singer visited and sang “down memory lane” songs. A church service was held once a month in the home and staff contacted ministers of religion if residents wanted a personal visit. Residents had the option of attending a local day centre. One resident attended regularly. Some residents attended the Walton carnival and the Clacton air Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 14 show every year. The deputy manager said that they were hoping to arrange visits to the local theatre. Five residents who responded to our survey told us that there were “sometimes” activities they could take part in, two considered that there were “always” and one said that there were “usually” activities they could take part in. One resident told us “I would like to go out more”. Relatives told us “more activities could be arranged” and “there is a real lack of mental stimulation and social outings for residents”. The deputy manager said that they were trying to source some training in activities and was aware that this was an area that could be developed further. The deputy was also aware that residents who did not go out regularly often became very anxious about going out and could end up refusing to go at the last minute. The deputy manager told us that they were setting up links with a local church that had a minibus. Members of the church had offered to include residents in some of their outings. The home had joined with two other homes in a consortium and they were putting their name forward to share a beach hut on the sea front. The home had open visiting and a resident confirmed this saying “We can have visitors when we like”. A relative told us “There is always a positive atmosphere in the home and we are warmly invited to participate in meals/refreshments and whatever is happening in the home”. Residents told us that they got up and went to bed when it suited them and spent the day and had their meals where they liked. Two residents told us that they would like the opportunity to have more than one bath a week. A relative said “Residents are only offered a bath once a week; this should be more frequent when residents wear pads”. The deputy manager said that she would speak to residents and reassure them that they could ask for additional baths when they wanted but did say that occasionally residents asked for a specific carer to provide a bath and refused if that carer was not available. The majority of residents we spoke with told us that the food was very good. Five residents who responded to our survey told us that they “usually” liked the meals and three said they “always” liked the meals. Although one resident told us that the standard could be variable and added “you don’t get a choice at weekends”. The menus we looked at showed that there were choices offered at all meals apart from on Sunday when they served a roast dinner. However, staff confirmed that residents could have an alternative at any meal if they did not like what was on the menu. The menu stated that fruit, soup, sandwiches and snacks could be provided on request at any time. The deputy manager told us that they made seasonal changes to the menus and varied the choices following regular feedback from residents. The lunch we saw looked very nutritious. We observed a member of staff serving meals that varied in portion size and content and demonstrated that they were meeting the specific requests and needs of individual residents. Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their concerns will be promptly addressed and they will be protected from abuse. EVIDENCE: The home had a complaints procedure that was on display in the entrance hall. The deputy manager said that the procedure was being updated to reflect the changes to the regulator, the new contact details of the Care Quality Commission and the role of social services to investigate complaints when appropriate. Staff told us they knew what to do if anyone had concerns about the home. Verbal complaints and concerns were now being appropriately documented and provided evidence of the actions taken to address the issues raised. The deputy said that they would record only very basic details in the bound book in future and keep confidential information about individual residents and members of staff in their personal files. There was a form in residents’ rooms for residents or relatives to use if they wanted to make a more formal complaint. Five residents who responded to our survey told us that staff “always” and two that staff “usually” listened and acted upon what they said. The majority of relatives considered that staff responded Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 16 appropriately to any concerns they raised. One resident we spoke with said “I’ve had no problems at all”. Another told us “I’ve only had very minor concerns and they sort them out very fast”. The home had a policy for safeguarding vulnerable adults (SOVA) and a policy on reporting suspected cases of abuse or poor care practices (whistle blowing). The majority of staff had received SOVA training and further training was being booked. Residents told us that they were comfortable with the style of care provided and felt “safe” in the home. One member of staff we spoke with had a good understanding of the types of abuse that could occur and told us that staff were very happy to report any concerns about poor practice because of the open attitude within the home. Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well maintained, clean and homely environment. EVIDENCE: The home was generally in good decorative condition and residents told us that some of their rooms had new carpets and had been redecorated. Many of the rooms had been well personalised with residents’ belongings. New flooring had been fitted to a bathroom, a communal toilet and an en-suite room. New carpets had been fitted to the hallway and staff offices as well as to two bedrooms. The deputy manager confirmed that radiator covers had been fitted to the remaining radiators in the home in order to make them safe for Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 18 residents. A new large television was due to be installed in the main sitting area, new carpets were due to be fitted to five more bedrooms and there were plans to install a greenhouse and a summerhouse in the garden and refurbish the kitchen once a grant from Essex County Council was received. The home had a secure back garden with benches, tables, chairs and parasols for residents to use. The driveway of the home had numerous potholes and the front of the home had broken concrete steps and peeling paintwork which gave a poor first impression of the home. The deputy manager told us that there were plans to improve the front of the home and address the uneven driveway. One resident told us that they banged on their table to call staff when they were in the sitting room. There were call bell points but no leads in the room. The deputy manager confirmed that additional longer leads had been ordered for both the communal rooms and some bathrooms and toilets. The home had three bathrooms but only one fully met the needs of current residents. Staff told us that one of the baths, a walk in bath, was not suitable for the majority of residents as the seat in the bath was too low and they found it difficult to get up again. The home did not have a walk in shower or “wet room”, which might be more suitable and give residents a choice of bathing facilities. One resident told us that they would like the opportunity to have a shower. The majority of residents told us that the home was “always” clean and fresh. Two relatives commented very positively on the cleanliness of the home. The home had a cleaner for four hours on five days a week. The home was very clean on the day of this unannounced inspection and there were no unpleasant odours. The laundry room was small but appeared adequate for the number of residents at the time of inspection. There was a washing machine with a sluice cycle and red plastic bags were available for handling and washing soiled linen. There was no hand wash basin in the laundry room for staff to wash their hands when carrying out laundry duties. This could potentially increase the risk of cross infection to staff and potentially to residents. Liquid soap had been installed in all areas where staff carried out personal care. The deputy manager said they were trying to find small paper hand towel dispensers to fit in residents’ en-suites and by their basins in their rooms. Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have care provided by competent and well trained staff. EVIDENCE: Staffing on the day of inspection was three care staff, one cook and one cleaner during the day and one care staff at night with one on a sleep-in for fourteen residents. This was the usual staffing level during the week days. At the weekend the usual staffing level was three care staff and a cook during the day with one of the managers on call. The majority of staff considered that there were enough staff to meet residents’ needs. Four residents told us that staff were “usually” and three residents considered that staff were “always” available when they needed them. One resident told us “They’re not long coming when I press the buzzer”. Staff told us that they had all the checks carried out before they started work. We looked at the files of three staff who had been recruited since the last inspection. They generally demonstrated a sound recruitment process. All staff had a criminal records bureau (CRB) check and a check with the Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 20 protection of vulnerable adults (POVA) list. Two references had been obtained and staff had signed a health declaration and a declaration in relation to any previous convictions. Identification and photographs were held on file. The application form did not contain a large enough section for applicant to record a full employment history and there was not always a CV on file, so that the person carrying out the interview would not be able to explore gaps in employment history. The home did not use set questions or keep a record of their decision making in line with good equal opportunity practices. The home followed the skills for care induction and there was evidence that all new members of staff received an induction in relation to the role they were to undertake. Two staff considered that their induction covered all they needed to do the job when they started and two staff said that the induction “mostly” covered what they needed. The home put an emphasis on training to ensure that staff had the appropriate knowledge and skills to meet residents’ needs. Staff told us that they were given training that was relevant, helped them to meet the needs of individual residents and kept them up to date with new ways of working. Three staff had completed national vocational qualification (NVQ) at level 2 or equivalent. Three staff were working towards NVQ level 2 and four staff were working towards NVQ level 3. The majority of staff had completed moving and handling, infection control, fire safety, food hygiene, health and safety and first aid training. Additional training had been booked for those who needed training or an update. Since the last inspection some of the staff had completed training in care of ageing skin, blood glucose monitoring, basic awareness of diabetes, safeguarding of vulnerable adults from abuse, first step wound care guidelines and dignity and respect. The manager had completed training in the Mental Capacity Act and the manager and deputy had received training in deprivation of liberty and safeguarding, using skills for care knowledge sets and discipline and grievance. The deputy manager said that they were hoping to arrange training in person centred care, care planning, nutrition and in care of the older person with Parkinson’s disease. Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well run home. EVIDENCE: The manager had a background in nursing, had considerable management experience and was an NVQ assessor. The deputy manager was in the process of completing the NVQ in management and care at level 4. Staff told us that communication worked in the home, they felt well supported and met the managers regularly to discuss their work. Residents who responded to our Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 22 survey described the home as “well run” and “very well organised”. One relative described the home as “very well organised and very clean”, another said “the manager of Asher House is first rate”. Two of the residents we spoke with told us that they would like to see the manager and deputy more frequently in their room for private chats. One resident said “they just pass information via the carers”. The deputy said that they would ensure that they visited residents more regularly in their rooms. The home carried out surveys of residents and relatives. The provider carried out monthly visits in line with Regulation 26 in order to monitor standards in the home. There was evidence of an increase in audits and monitoring of standards within the home. The pharmacist had completed a medication audit. The manager had carried out an assessment of residents’ rooms and the communal areas in order to identify any repairs or redecoration needed. Bed rail maintenance and safety checks were carried out monthly. Water temperatures in outlets used by residents were checked monthly to ensure that the water was within a safe range for residents to use without the risk of scalding. There was evidence that taps were adjusted when out of the safe range. The home held a small amount of cash for residents’ personal use. Receipts were available for all purchases or services such as chiropody and hairdressing. We checked the balance of two residents’ monies and both were correct. The deputy manager told us that audits of the monies were carried out on a regular basis. We saw evidence of systems in place for maintenance and servicing of equipment to ensure that it was safe for residents to use. A fire risk assessment and a risk assessment of the premises had been completed. Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP10 Regulation 12(4)(a) Requirement Staff must knock and wait for a response before entering residents’ rooms and handle used commodes in a manner that respects their dignity. In order to respect residents’ privacy and dignity. This requirement had a previous timescale of 08/07/08 that was not met. 2. OP26 13(3) A hand wash basin must be fitted in the laundry room. In order to reduce the risk of cross infection to staff and potentially to residents. 01/11/09 Timescale for action 14/09/09 Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations A pre-admission assessment form should be developed in order to ensure that the assessment is comprehensive, to reduce the risk of residents being admitted inappropriately and so that staff other than the manager can carry out the assessment in a consistent manner. Risk assessments should be used to assess potential risk to residents and preventative measures put in place when appropriate rather than only updating the assessment when residents’ condition changes and their risk has already increased. The application form should have sufficient space for a full employment history, or a CV should be requested in order that the full employment history can be explored at interview. The manager should consider using set questions at interview and recording the answers and decision making process in line with good equal opportunity practices. 2. OP8 3. OP29 Asher House DS0000066638.V377054.R01.S.doc Version 5.2 Page 26 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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