Care Home: Ashfield House - North Yorkshire County Council

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What the care home does well People have their needs assessed and are able to visit the home before moving in. This and written information that is available helps people decide if Ashfield House is the right place for them to live. In our surveys we asked people who live at the home if they had received enough information about Ashfield House to help them decide if it was the right place for them, before they moved in. Eight people answered `yes`. People`s care needs are recorded in their care records and people`s needs are met by polite and respectful staff. Comments made to us about the care people received included `staff are friendly and take care of my needs`, `all the staff are very good, they work so hard`, `the carers offer support and are attentive to my needs`, `very caring staff` and `the staff are very caring and helpful`. People have the opportunity to join in with some social activities, trips and events. Comments about activities included `Ashfield does very well in all aspects of caring for the residents, especially the events that are organised to raise funds for taking the residents on various outings` and `quiz lady is very good, just a shame that not many service users seem to want to join in`. A choice of meals and snacks are provided, with the home actively trying to improve the menus. Comments about meals varied from `good food` to `the meals could be better, the standard of the meals is poor, often cold and un-appetising` . Staff comments included `the food isn`t bad, there are always snacks out and we can get something anytime if someone is hungry` and `it`s getting a balance of what they like and what the nutritionist says they should have`. Complaints and concerns are seen as an opportunity to improve the service, are taken seriously and looked into properly. All nine people who live at the home and returned surveys said that there was someone they could speak to informally if they were not happy. We asked four health care professionals if Ashfield House had responded appropriately to any concerns that had been raised. Two people answered `always` and two answered `usually`. Ashfield House provides a safe place for people to live. All nine people who returned surveys told us that Ashfield House is `always` kept fresh and clean. Comments made to us about the home included `the home is warm and clean` and `provides a clean and safe environment for residents`. Staff are recruited safely and provided with the training and support they need to do their jobs. All seven staff who returned surveys told us that the required checks had been completed by the council before they started work. Staff we spoke to told us `we are well supported, we have regular supervisions and we are well trained, they encourage you to do as much as you can`. The home`s manager runs the home in the best interests of the people living there. Comments made to us about the manager included `very approachable and will always listen`, `very responsive to new ideas` and `the changes she`s made have been for benefit`. What has improved since the last inspection? Since the last inspection there have been a number of changes and improvements:The manager has reviewed the care plans and records at the home and helped staff to make them more detailed and personal. They now contain more information about people`s individual preferences and needs. A member of staff has been identified as `activities champion`, taking the lead on organising activities and events in the home. A relatives committee has also been set up, to involve relatives more in the home and what is going on there. A dietitian has been looking at the home`s menus to make sure that they are nutritious and varied. The manager has also made changes to the way food is served, to give people more choice and Independence at meal times. A new dementia care unit has been opened. This provides a small separate unit for people with dementia. What the care home could do better: Improving risk assessment processes could help staff to meet people`s needs in a more proactive and preventative way. The home doesn`t currently carry out risk assessments to identify people at risk of malnutrition or pressure damage. These assessments could help staff take more preventative action and reduce the chances of people losing weight of developing pressure sores. Some parts of the home, such as bathrooms, toilets and bedrooms need to be redecorated and refurbished in order to provide people with pleasant and homely facilities. Comments made by people who visit, live and work at the home included `clients rooms could do with updating`, `you wouldn`t want to have a bath in there would you?` and when asked what the home could do better another person said `modernisation of residents rooms`. Staffing levels and deployment need to be reviewed to ensure that staff can meet people`s needs and realistically fulfil their roles. This includes staff having time to undertake activities and social stimulation with people and the manager having `supernumerary` management time. Comments made to us about staffing levels included `sometimes there seems to be too much work for the staff. Some of the residents need so much help just to get out of a chair`, `Ashfield staff strive to give the best quality care possible, sometimes staffing is minimal making this very demanding and difficult`, `they get good care here, but they don`t get the quality time` and `we`d like more staff, it only takes one person to be off their feet and need hoisting and we`re scuppered`. The manager needs to register with us and should be given appropriate `supernumerary` management time. She currently works on a rota with the other team leaders and when on duty is responsible for being the team leader for that shift, as well as being the home`s overall manager. This makes it difficult to develop management systems and make the necessary improvements, without doing significant work in her own time. Key inspection report Care homes for older people Name: Address: Ashfield House - North Yorkshire County Council Carleton Road Skipton North Yorkshire BD23 2BE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Martin     Date: 1 6 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Ashfield House - North Yorkshire County Council Carleton Road Skipton North Yorkshire BD23 2BE 01756792881 01756795519 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.northyorks.gov.uk North Yorkshire County Council Name of registered manager (if applicable) Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category/ies 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 and Dementia - Code DE. Date of last inspection Brief description of the care home Ashfield House is owned and managed by North Yorkshire County Council. The home is located within a short drive of the centre of Skipton and is set in large grounds and has enclosed gardens. It is a purpose built two-storey care home, which was built approximately thirty-five years ago. It is registered to provide a service for up to thirty-two older people and people who have dementia. At the time of this inspection Care Homes for Older People Page 4 of 35 Over 65 0 32 32 0 Brief description of the care home the homes fees were £407 per week, with peoples contribution towards the cost of their care being determined by a financial assessment. Up to date information about fees and terms and conditions should be sought directly from the home. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of Ashfield House. The site visit was completed on 16th July and was completed by one inspector. We looked at a selection of records, observed care practice and meal times, looked around the building and talked to people who live at the home, the staff and management. Before our inspection visit we reviewed all of the information we had received about the service since the last inspection and we asked the home to complete a selfassessment. This was completed well and returned to us on time. It provided the information we had asked for and told us what the home did well and what could be improved. We also sent surveys to a selection of people who live at Ashfield House, a selection of staff and some of the health care professionals (such as doctors and district nurses) who work with the home. Nine people who live at the home, seven staff members and four health care professionals completed and returned surveys to us. The results from these surveys have been included in this report where appropriate. Care Homes for Older People Page 6 of 35 Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Since the last inspection there have been a number of changes and improvements: Care Homes for Older People Page 8 of 35 The manager has reviewed the care plans and records at the home and helped staff to make them more detailed and personal. They now contain more information about peoples individual preferences and needs. A member of staff has been identified as activities champion, taking the lead on organising activities and events in the home. A relatives committee has also been set up, to involve relatives more in the home and what is going on there. A dietitian has been looking at the homes menus to make sure that they are nutritious and varied. The manager has also made changes to the way food is served, to give people more choice and Independence at meal times. A new dementia care unit has been opened. This provides a small separate unit for people with dementia. 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. Care Homes for Older People Page 9 of 35 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 10 of 35 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 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed and are able to visit the home before moving in. This and written information that is available helps people decide if Ashfield House is the right place for them to live. Evidence: In their self assessment the home manager told us we assess all potential clients to ensure that the service we offer can meet their individual needs. We have a clear statement of purpose. We reassess permanent clients, who are admitted to hospital prior to their return to ensure we are still able to meet their needs. Where possible, new clients and their families are encouraged to visit the home before admission. In our surveys we asked people who live at the home if they had received enough information about Ashfield House to help them decide if it was the right place for them, before they moved in. Eight people answered yes and one said they didnt know. When we asked people if they had received a contract five people said yes, Care Homes for Older People Page 12 of 35 Evidence: one person said no and three people said they didnt know. We also asked health professionals if Ashfield Houses assessment arrangements ensured that accurate information was gathered and that the right service was planned for people. One professional said always, one said usually and two said sometimes. During our we talked to some people who had recently come to live at the home and looked at their care and assessment records. The records showed that people had been assessed before moving into the home and people told us that they or their families had been able to come and look around before moving in. Care Homes for Older People Page 13 of 35 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 care needs are recorded in their care records and peoples needs are met by polite and respectful staff. However, improving risk assessment processes could help staff to meet peoples needs in a more proactive and preventative way. Evidence: In our surveys we asked people if they received the care and support they needed. Seven people said always and two said usually. When we asked if staff listened and acted on what people said three people said always and six said sometimes. In surveys we asked health professionals who visit the home is staff respected peoples privacy and dignity. Two said always and two said usually. During our visit we watched staff providing care and support. They treated people in a polite and pleasant way. Comments made to us about the care people received included staff are friendly and take care of my needs, all the staff are very good, they work so hard, the carers offer support and are attentive to my needs, very caring staff and the staff are very caring and helpful. The manager and staff told us how they have been working on the homes care Care Homes for Older People Page 14 of 35 Evidence: records to make them more detailed and individual. We looked at a selection of care records. We found that the records contained some good information about peoples care needs, including information about their abilities and preferences. They gave staff a good idea of the assistance and support people needed on a day to day basis. Some records were more detailed than others, but this is because staff are still learning how to complete them. The manager is providing training and support to help staff develop the care records further. We saw that everybodys weight monitoring records were being kept collectively in a separate file. This practice doesnt really support each individuals privacy and confidentiality. Having information about peoples care needs in different places also makes it more difficult for staff to access and analyse information, for example, when completing reviews. In our surveys we asked people living at Ashfield House if the home made sure that they got the medical care they needed. Seven people said always and one person said sometimes. We asked health care professionals who visit the home if Ashfield House sought advice and acted on it in order to meet peoples health care needs and improve their wellbeing. Two answered always and two answered usually. We also asked if peoples health needs were properly monitored, reviewed and met by the home. One person said always and three said usually. Peoples care notes showed that they had been visited by their doctor, nurse or other professional if needed. However, we did notice that the home is not currently completing nutritional assessments or skin integrity risk assessments. These are assessment tools that help identify people who are at risk of malnutrition or of developing pressure sores. They help care staff identify people at risk so that they can take more preventative action, rather than waiting until someone has lost weight or developed a red or sore area before action is taken. In their self assessment the manager told us we operate and maintain effective policy, procedure and practice guidelines when dealing with medication. We keep a full record of the safe keeping, storage and disposal of controlled drugs. If a client is able to self medicate we strongly promote this and ensure that lock up facilities are in place too enable the client to do so. A pharmacist from the local PCT has recently completed an audit on the homes medication systems. The manager has implemented the pharmacists suggestions and has implemented a monthly audit of medication practices to make sure things are being done safely. During our visit we looked at the storage of medication,checked a selection of records and saw staff giving out medication. The records we looked at were accurate and indicated that people were being given their medication appropriately. We checked the controlled drugs register and the balance of controlled drugs that were available. These were accurate and the recording in the controlled drugs register was neat and tidy. The records also showed Care Homes for Older People Page 15 of 35 Evidence: that systems were in place to make sure that staff were always aware of changes to the prescribed dosages of warfarin and that medication records were kept up to date with these changes. Medication that needed to be stored in the refrigerator was being stored appropriately and the fridge and room temperatures were being monitored by staff. However, the temperature records showed that staff were not always checking and recording the fridge and room temperatures on a daily basis. This is important, because it helps to make sure that medication is always stored at safe temperatures. Care Homes for Older People Page 16 of 35 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 have the opportunity to join in with some social activities, trips and events. A choice of meals and snacks are provided, with the home actively trying to improve the menus. Evidence: In their self assessment the home manager told us we now have an activities champion; she is a member of staff who assists with the activity program and organises trips etc following consultation with residents and with assistance from other staff. We are currently setting up a relatives committee. We have also sought assistance from the community with befriending and for one resident help with writing his childrens stories. They also identified providing more personalised activities, a daily activities programme, more staff trained to drive the mini-bus and easier access to activity equipment as some of the things they would like to improve in the next year. We spoke to the activities champion about the social activities and events available at Ashfield House. Her activities role is carried out in addition to her care work, with no additional paid hours being provided by the County Council. However, she told us about the quizzes, crafts, volunteers and other things she helps to organise, saying that she tries to do something every day she is on duty. During our visit a volunteer was visiting the home and holding discussion groups with people who Care Homes for Older People Page 17 of 35 Evidence: lived there. In addition to this people at the home can visit the day centre if there are spare places. However, this is only available on a first come and as and when available basis. In our surveys we asked people if there were activities provided at Ashfield House that they could take part in if they wished. Five people said always, two said usually and two said sometimes. Comments about activities included Ashfield does very well in all aspects of caring for the residents, especially the events that are organised to raise funds for taking the residents on various outings, quiz lady is very good, just a shame that not many service users seem to want to join in and (when asked what could be done better) more trips out and entertainment. I would like some talking books and talking newspapers for blind people. People we spoke to generally felt that although staff tried hard to provided entertainment, opportunities for activities and social stimulation on a day to day basis could still be developed further. In their self assessment the manager told us mealtimes are seen as a social event and therefore encouraged to be relaxed and not rushed. Snacks and drinks are available at any time if wished and residents are able to eat in their own rooms if desired. We are working together with the PCT to improve nutrition and menus. We asked people in our surveys if they liked the meals at Ashfield House. One person said always, five said usually, two said sometimes and one said never. Comments about meals varied from the meals could be better, the standard of the meals is poor, often cold and un-appertising to good food. Staff comments included the food isnt bad, there are always snacks out and we can get something anytime if someone is hungry and its getting a balance of what they like and what the nutritionalist says they should have. One resident told us how they were asked about the standard of meals in meetings and how the quality of the meat had improved recently, after he raised some concerns with the manager. We observed the lunchtime meal and tried the food that people were eating. There was a choice of sausage or beef burger, with mashed potatoes, peas and carrots or cheese salad. We thought that the food we tried was of a reasonable standard. Staff asked people what they wanted to eat when they were sat at the table. However, the kitchen ran out of beef burgers before everyone had been served, meaning that some people didnt get their first choice of meal. Vegetables were served in serving dishes on the tables and this enabled people to help themselves (with staff support if needed), giving more choice and independance. There was a sweet trolley that went round for dessert. This provided people with a large choice of puddings, including fresh fruit, icecream, yoghurts, orange sponge with custard, fruit and cream and small iced buns. The staff served people in a friendly and polite way, offering people choices Care Homes for Older People Page 18 of 35 Evidence: and providing assistance when it was needed. Staff were keeping records of what some people were eating and drinking. This was because they were worried about some peoples nutritional intake and needed to monitor what they ate. However, the records werent always being completed properly. For example, records for some meals or snacks were left blank and others didnt state how much of something the person had actually eaten or drank. Care Homes for Older People Page 19 of 35 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. Complaints and concerns are seen as an opportunity to improve the service, are taken seriously and looked into properly. Evidence: In their self assessment the manager told us clients, staff and others are very aware of the complaints process, leaflets/posters are distributed throughout the home and residents are reassured that they can make either verbal or formal complaints. This is highlighted in residents meetings or one to one sessions with clients. We look to resolve complaints sensitively, quickly and effectively and give feedback on the outcome. We use complaints as a tool for learning within the team & would apply any learning to future situations. All nine people who live at the home and returned surveys said that there was someone they could speak to informally if they were not happy. When we asked if they knew how to make a formal complaint six people said yes and three people said no. We asked four health care professionals if Ashfield House had responded appropriately to any concerns that had been raised. Two people answered always and two answered usually. Seven out of eight staff who returned surveys told us that they knew what to do if someone had concerns about the home. People we spoke to at the home said that they were able to raise any problems with staff and we observed one person talking to the manager about a concerns hed raised recently about the quality of meat. He said that this had improved since he raised the problem. Care Homes for Older People Page 20 of 35 Evidence: There have been no formal complaints made directly to us since the last inspection. The managers self assessment told us that there had been a total of eight complaints and concerns made directly to the home in the last year. All of these had been responded to within 28 days and two of the complaints had been upheld. Staff training was being provided on safeguarding adults and reporting suspected abuse. Staff we spoke to were aware of the need to report any concerns they had to the appropriate people. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ashfield House provides a safe place for people to live. However, some part of the home need to be redecorated and refurbished in order to provide people with pleasant and homely facilities. Evidence: Ashfield House was purpose built by the local authority approximately thirty-five years ago. There are plans that the service will be replaced by a newly built extra care housing scheme in the future, but there are no definite dates currently available for when this will happen. In their self assessment the homes manager told us there is an ongoing programme of improvement as set out in the service improvement plan; the home ensures that equipment for individual clients needs are in place. They also told us that their plans for improvement in the next twelve months included request funding for ongoing improvements and continue to consult with the clients regarding further refurbishment of the home. All nine people who returned surveys told us that Ashfield House is always kept fresh and clean. Comments made about the home included the home is warm and clean. However, some professionals who work with the home commented clients rooms could do with updating and provides a clean and safe environment for residents. Care Homes for Older People Page 22 of 35 Evidence: When asked what the home could do better another professional said modernisation of residents rooms. During our visit we looked around the home and were shown around by the manager. There was evidence that some areas of the home had been redecorated. For example, the main lounge, dining room and dementia care unit. These areas looked bright and provided people with comfortable places to spend their time. Peoples bedrooms were individualised with their own belongings. For example, people had brought in pictures, ornaments and small pieces of furniture from their homes. Some bedrooms had also been redecorated recently. The manager showed us some of the equipment that has been purchased to help people live independently and to help staff manage peoples needs. For example, pressure sensors and alarms are used so that staff know when one person who is at risk of falls during the night gets out of bed. This means that they can go and check on the person and help prevent any falls. However, other parts of the home look old and worn and need to be redecorated and refurbished so that people have facilities that are pleasant to use. For example, the bathrooms look old and dated, with the enamel on some baths chipped and worn and old fashioned tiles. They looked institutional and were not pleasant or homely places for people to use. A staff member we spoke to commented you wouldnt want to have a bath in there would you?. Peoples bedrooms contain old fashioned vanity unit with sinks and storage space. These looked old, worn and some of the sinks were discoloured or marked. In some of the recently decorated bedrooms these units had been painted white to try and brighten them up, but this is only really a temporary solution. We also noticed that some of the rooms are small and do not allow much room to move about, especially if people need to use walking frames or wheelchairs. We talked to the manager about this and she told us that they were very careful when assessing peoples needs and sometimes have to refuse admissions if people need to use hoists, because the lack of space means they cant use them safely. Unfortunately this sometimes means that people whose needs change can not return to their home at Ashfield House or need to move on prematurely, because the rooms available arent big enough to accommodate their increased manual handling needs. The manager is exploring ways of improving this situation, such as the installation of a limited number of ceiling track hoists that will make it easier to meet peoples needs. Throughout the day we found the home to be clean and tidy and we did not notice any unpleasant smells. We saw domestic staff on duty who were cleaning the home and we spoke to the laundry assistant. Appropriate infection control systems are in place. For example, staff use gloves and aprons and dissolving laundry bags are used so that staff dont have to handle soiled laundry. The manager told us of plans to start Care Homes for Older People Page 23 of 35 Evidence: washing each persons laundry individually, to increase hygiene, privacy and reduce the chances of peoples personal clothes getting lost or being used by other people. Maintenance files showed us that the homes equipment was regularly serviced and well maintained. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited safely and provided with the training and support they need to do their jobs. Staffing levels and deployment need to be reviewed to ensure that staff can meet peoples needs and realistically fulfil their roles. Evidence: In surveys we asked if staff were available when people needed them. Three people said always and six said usually. Comments made about staffing levels by people living at the home or their relatives included sometimes there seems to be too much work for the staff. Some of the residents need so much help just to get out of a chair, when assistance is needed help is readily available and everything here that we need, always someone at hand. When we asked staff if there were enough staff working at the home to meet peoples needs, two people said usually, five people said sometimes and one person said never. Comments made to us about staffing levels included Ashfield staff strive to give the best quality care possible, sometimes staffing is minimal making this very demanding and difficult, they get good care here, but they dont get the quality time and wed like more staff, it only takes one person to be off their feet and need hoisting and were scuppered. When we asked people what the home could do better responses included more staff when people living at home have a hospital appointment, also so staff could take people out for a walk or in wheelchair, more Care Homes for Older People Page 25 of 35 Evidence: staff, Id like there to be more staff i.e. relief workers to ease situation for all staff and residents and employ more staff. Currently there are no additional staff hours provided to develop activities or social time, with staff having to fit these things into their care hours or give up their own time. When on duty the manager works as one of the team leaders, having to carry out the team leader role, with no supernumerary time to fulfil the role of registered manager. We spoke to the manager about these comments and the staffing levels and deployment at the home. She was aware that staff felt stretched and has been reviewing staffing levels and staff rotas to try and make better use of staff time. For example, looking at shift patterns, putting more staff on duty at busy times and considering the implications of having to staff a separate dementia care unit. It is important that this review is completed and that appropriate staffing levels, which meet the needs of the people living in the home and realistically allow staff to fulfil their roles, are put in place. We asked to looked at two staff recruitment records, to make sure the home were employing suitable people for the job. However, the recruitment records of staff were not available at the home, as they are now kept by the councils personnel department. On request we were provided with the information we needed to establish that two written references and a criminal records bureau disclosure had been obtained for both staff. All seven staff who returned surveys told us that the required checks had been completed by the council before they started work. However, the council needs to consider how all of the required recruitment information will be made available for inspection in the future. New staff complete a basic induction checklist at the home and we saw records of this in peoples records. The council also provides an in depth induction programme for staff, which is based on the Skills for Care induction standards. However, staff we spoke to told us that it can be difficult getting staff onto this course within a reasonable period of time. For example, two staff had only just completed their induction training and they had started work in the home in 2008. In our surveys we asked staff if their induction training had covered everything they needed to know to do their job when they started. One said very well, five said mostly, one said partly and one said not at all. One of the homes team leaders is responsible for coordinating staff training, putting staff forward for training with the councils training department. There was evidence that she was monitoring what training staff needed, was putting them forward for training courses and that staff did eventually receive the training they needed to do Care Homes for Older People Page 26 of 35 Evidence: their jobs. However, staff we spoke to also felt that there were sometimes long delays between being put forward for a course and actually completing the training. All seven staff who returned surveys told us that they were provided with training which is relevant to their job, keeps them up to date and helps them understand peoples needs. Staff we spoke to told us we are well supported, we have regular supervisions and we are well trained, they encourage you to do as much as you can. Records we saw confirmed that new staff had received regular reviews during their probationary period and had then received supervisions and an appraisal. In their self assessment the manager told us that twenty-three of the homes twenty-nine permanent care staff had achieved an National Vocational Qualification (NVQ) in care. Care Homes for Older People Page 27 of 35 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. The homes manager runs the home in the best interests of the people living there. However, she needs to register with us and should be given appropriate supernumerary management time. This will help to make sure that appropriate management arrangements are in place. Evidence: The home has a new manager, who has been working at the home for approximately six months. She has worked as a registered manager in another home and has appropriate experience and qualifications. We were notified about the changes in management at the home when they happened. However, the new manager hasnt yet applied to be registered with us, but has told us that she intends to apply for registration as soon as possible. This is important, because anyone managing a care home on a day to day basis must register with us. People we spoke to were complimentary about the new manager and the work she was doing, with comments made to us including very approachable and will always listen, very responsive to new ideas and the changes shes made have been for benefit. In our discussions with Care Homes for Older People Page 28 of 35 Evidence: the manager we were impressed with the changes she had made at Ashfield House and felt that she knew what improvements were needed and had plans in place to carry them out. We talked to the manager about her role and found that the current staffing arrangements do not allow her any specific time to carry out the role of registered manager. For example, she currently works on a rota with the other team leaders and when on duty is responsible for being the team leader for that shift, as well as being the homes overall manager. This makes it difficult to develop management systems and make the necessary improvements without doing significant work in her own time. In their self assessment the manager told us that regular team and staff meetings are held to ensure good communication and we are currently setting up a relatives committee. Working together we hope this will open up/improve communication, involve residents and relatives more in the daily running of the home and continually improve the lives of those who use our service. During our visit we saw records of staff and resident meetings, relative committee meetings and saw evidence of people living at the home being asked their opinions. A senior manager visits the home each month to monitor the service and the new manager has already put in place new systems for monitoring and developing the service. For example, inviting the PCT pharmacist into the home to complete a medication audit and organising regular internal audits. We looked at the systems the home has in place to help people manage small amounts of personal money. Records and receipts were available and peoples money was stored in a secure place. We looked at the records for one person and found these to be accurate. The records were regularly being checked by different people, including the councils financial team. This helps to make sure that people are protected and their money is used appropriately. In their self assessment the manager told us staff are encouraged to work within health and safety procedures. This covers manual handling, fire safety, first aid, food hygiene and risk assessment training. We are constantly striving to update training in these work practices according to legislative guidelines. The home employees a maintenance man for two days each week. We checked a selection of the homes maintenance records. This confirmed the information provided in the homes self assessment and showed us that the homes fire alarm and lifting equipment had recently been serviced and inspected. We also looked at the regular checks that are completed to make sure that equipment is working safely. For example, the home Care Homes for Older People Page 29 of 35 Evidence: carries out and records a weekly fire alarm test and regular checks to make sure that hot water is at a safe temperature. There is also a system in place for recording and monitoring accidents and the manager had updated the homes COSHH information (information about hazardous substances used in the home) file in June 2009. Care Homes for Older People Page 30 of 35 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 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Assessments to identify 31/10/2009 people who are at risk of pressure damage, must be carried out and reviewed regularly. Appropriate interventions to minimise any identified risks should be put in place and recorded in the persons care plans. Regular risk assessment and review will allow staff to identify people at risk of developing pressure damage and allow more proactive preventative action to be taken. 2 8 13 Nutritional assessments 31/10/2009 must be undertaken and reviewed regularly (including records of weight gain and loss). Appropriate interventions needed to minimise any identified risks should be put in place and recorded in the persons care plans. Page 32 of 35 Care Homes for Older People 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 Regular risk assessment and review will allow staff to identify people at risk of dietary problems and allow more proactive preventative action to be taken 3 19 23 A full programme of redecoration and renewal needs to be completed, so that people have pleasant, reasonably maintained facilities that meet their needs. Some parts of the home do not currently provide people with pleasant and homely facilities. This needs to be rectified until the proposed extra care housing facility is available. 4 27 18 Staffing levels and deployment need to be reviewed, to ensure that at all times sufficient numbers of staff are on duty to meet the needs of the people living at the home. Staffing levels and deployment must be sufficient to meet the needs of the people living at the home at all times and allow staff to fulfil their roles. 31/10/2009 30/04/2010 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care records should be stored and kept individually. This is important for confidentiality and so that staff can access and use all relevant care information easily. The safe temperature checks of the medication room and fridge should take place daily. This is important to make sure that medication is always being stored at safe temperatures. Opportunities for daily and individual social activities and social stimulation could be developed further. This includes ensuring that staff have time to develop these things in addition to their care work. Food and fluid intake charts should always be fully and accurately completed. They are of no practical use if staff leave blanks or do not say how much of something someone has eaten or drank. The council should consider how they can improve facilities so that people whose manual handling needs change, meaning that they need to use hoists or other equipment, can return to their home at Ashfield House and do not need to move home prematurely. The information and evidence needed to demonstrate that staff have been recruited in accordance with the National Minimum Standards and Care Homes Regulations should be kept at the home. Training should be provided promptly once staff have been identified as needing it. The homes manager should apply to CQC for registration without further delay. The manager should be given appropriate supernumerary management time to carry out the role and responsibilities of registered manager. 2 9 3 12 4 15 5 19 6 29 7 8 30 31 9 31 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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