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Care Home: Ashfield Nursing and Residential Home

  • 3 Ashfield Wetherby Yorkshire LS22 7TF
  • Tel: 01937584724
  • Fax: 01937583015

Ashfield Nursing and Residential home was originally registered in 1984 and then re registered as a nursing home in 1991. It provides nursing and personal care and can accommodate thirty-two older people. This home is located in Wetherby; a market town situated approximately twenty miles from Leeds. It is convenient for public transport and a variety of destinations are accessible from the town centre. The building is a detached adapted property that has been extended to provide the current accommodation. There are a number of parking spaces to the front of the house and patio/seating areas are available. The remainder of the garden has borders and paved walkways. Communal areas are two lounges, a dining room and conservatory area. In addition, there are two double bedrooms and twenty-six single. Thirteen bedrooms have en suite facilities. There are a number of communal bathrooms and toilets situated around the home. Specialist equipment is fitted where necessary to assist those service users with mobility problems and other difficulties associated with advancing years. The laundry is sited in an annexe alongside an office/training area. The current weekly charges for people living permanently at the home are £557 plus £101 funded nursing. This charge does not include hairdressing, private chiropody or newspapers and magazines. The manager provided this information during the inspection visit on 4 October 2007.

  • Latitude: 53.93399810791
    Longitude: -1.3830000162125
  • Manager: Mrs Karen Dean
  • Price p/w: £557
  • UK
  • Total Capacity: 32
  • Type: Care home with nursing
  • Provider: Ashfield Nursing Home Limited
  • Ownership: Private
  • Care Home ID: 2047
Residents Needs:
Dementia, Terminally ill, Old age, not falling within any other category

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Ashfield Nursing and Residential Home.

CARE HOMES FOR OLDER PEOPLE Ashfield Nursing and Residential Home 3 Ashfield Wetherby Yorkshire LS22 7TF Lead Inspector Paul Newman Key Unannounced Inspection 09:30 11th October 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashfield Nursing and Residential Home Address 3 Ashfield Wetherby Yorkshire LS22 7TF 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) 01937 584724 01937 583015 info@ashfieldnursing.co.uk Ashfield Nursing Home Limited Mrs Karen Dean Care Home 32 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (32), of places Terminally ill over 65 years of age (4) Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The place for DE(E) is for the named service user only. Date of last inspection 12th September 2006 Brief Description of the Service: Ashfield Nursing and Residential home was originally registered in 1984 and then re registered as a nursing home in 1991. It provides nursing and personal care and can accommodate thirty-two older people. This home is located in Wetherby; a market town situated approximately twenty miles from Leeds. It is convenient for public transport and a variety of destinations are accessible from the town centre. The building is a detached adapted property that has been extended to provide the current accommodation. There are a number of parking spaces to the front of the house and patio/seating areas are available. The remainder of the garden has borders and paved walkways. Communal areas are two lounges, a dining room and conservatory area. In addition, there are two double bedrooms and twenty-six single. Thirteen bedrooms have en suite facilities. There are a number of communal bathrooms and toilets situated around the home. Specialist equipment is fitted where necessary to assist those service users with mobility problems and other difficulties associated with advancing years. The laundry is sited in an annexe alongside an office/training area. The current weekly charges for people living permanently at the home are £557 plus £101 funded nursing. This charge does not include hairdressing, private chiropody or newspapers and magazines. The manager provided this information during the inspection visit on 4 October 2007. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit carried out by one inspector that started at 9:30 and finished at 16:00 on 11 October 2007. A further visit was made the following morning to chat with people using the service and staff. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and that the outcomes for the people meet National Minimum Standards. Before the inspection, information collected about the home over the last year was reviewed. This included looking at any reported incidents, accidents and complaints. Survey forms were sent to the home before the inspection for the manager to give out to people living at the home, visitors, healthcare professionals involved in peoples’ care and the staff working at the home. This gives people the opportunity to comment if they want to. Information provided in this way may be shared with the provider but the source will not be identified. A good proportion of surveys were returned and some of the written comments that were made are included in the report to show what people think of the way the home is run. The manager had completed an Annual Quality Assurance Assessment (AQAA) before the visit to provide additional information. This is a self-assessment of the service provided and this gives a lot of information about how the home thinks it is meeting standards, how it has improved during the last year and what it intends to do in the coming year. All of this information was used to plan the inspection visit. A number of documents that the home must keep up to date were looked at during the visit. All areas of the home used by the people who live there were checked. Time was spent talking with the people and visitors, watching what was going, as well as talking with the manager and most of the staff on duty. What the service does well: The home is well managed and the staff team are trained in safe working practices, experienced and equipped for the job. They are happy in their work and committed to providing high standards of person centred care. The needs of residents are the focus of the staffs’ attention and residents looked happy and well cared for. Staff make sure that residents are treated with dignity. Staff are also good at supporting family members who visit the home. Information about the home is readily available. People are properly assessed before they come to live at the home. This helped to ensure a good care plan can be drawn up that identified peoples needs. The home works closely with Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 6 other healthcare professionals, makes referrals at an early stage and takes the advice that is given. These are some of the comments and responses made by relatives of people living at the home: • ‘I am impressed by the high degree of care given to my husband and, as far as I can see, to all the residents at Ashfield. The staff are extremely kind and competent.’ ‘I visit twice a day and staff are always attentive not only to my husband but to other residents’. ‘I think the love and care given to residents is superb’. • • These are some of the comments and responses made by healthcare professionals who visit the home: • ‘Service Provider always seeks advice from ICT. Usually they follow detailed care plans formulated by ICT staff, but in certain complicated/emergency situations don’t hesitate to seek help or contact GP’ ‘The home provides a satisfactory level of care to our patients – no complaints’. ‘I think they provide a good level of general care to their dependent population’. • • What has improved since the last inspection? There were eighteen requirements made at the last inspection and the manager and owners have shown a determination to get things sorted out. There is one requirement this time showing that things have moved on. Things that have improved are around detailed record keeping in care plans; record keeping for medication; the way the activities are recorded and what range is provided; laundry services; the way complaints are recorded; the training of staff in safe working practices and adult protection and health and safety monitoring. In addition further improvements have been made to the building that include: making sure the home meets current fire safety standards; reducing the number of shared rooms; increasing the storage facilities and ongoing decoration and refurbishment. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 8 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 Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. People have clear and accurate written information about the services provided at the home to help them choose about where to live. Peoples’ needs are properly assessed before admission. People who go to the home for intermediate care are properly assessed and helped by a team of healthcare professionals and staff from the home. EVIDENCE: The information provided to potential and actual users is accurate and is updated regularly with changes to the Statement of Purpose, display boards, and the Service User Guide The manager had addressed the comments made Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 10 in the last inspection report and it was recommended that a further review is made to reflect the range of needs that the home caters for. All permanent and respite users are required to have an introductory assessment and review period. This was evidenced in the four case files that were checked, two from intermediate care and two permanent. People are encouraged to contribute personally. Relatives/representatives are invited to view the home and no appointment is necessary. An open door policy is encouraged for potential users. The development of care plans and risk assessment are monitored closely. People are involved in the development of their care plans and key workers can provide a point of contact for all users of the service. The files showed that as much information as possible is provided before a person being referred for intermediate care is admitted. The manager is quite clear that people will not be admitted unless adequate information is provided. People are then seen by the relevant health care professionals within 48 hours of admission and care planning meetings take place within 7 days to discuss future care options. This was evidenced in one person who had been admitted for intermediate care the day before the inspection visit and was assessed in this way before the inspection finished. One relative of this person visited and staff dealt with her very sensitively, giving clear advice and detail about what the home would be trying achieve. This reassured the relative. The home staff use approaches identified in the assessments that are made by the healthcare professionals to encourage and promote independence, so that where possible, the person can return home. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. Peoples’ healthcare needs are met and care plans provide clear instruction for staff to follow. Staff are aware of peoples’ needs and there is good communication amongst the staff group and with healthcare professionals. Medication policies, procedures and practices are safe. People are treated with respect and in a dignified way. EVIDENCE: There was good evidence in the minutes of meetings that followed the last inspection that the manager was keen to address issues about health and personal care that were raised in the last inspection report. As a consequence of the work done, the care plan document templates were reviewed and amended and a big effort was made to make sure recording improved. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 12 Four care plans were checked and tracked. The two for intermediate care showed that sufficient information was sent to the home before a person was admitted and this included a range of information that included nursing needs assessments, functional assessments for things like transfers and personal care, falls assessment and a tissue viability assessment. The files showed ongoing assessment from healthcare professionals and daily recording made by the home. In one case the home had done well in identifying a pressure sore that had not been fully identified in the hospital discharge notes and nurses at the home had set up a care plan to help treat this. The care plans for the two permanent people that were checked showed that a pre-admission assessment had been made and a care plan developed for that information. Issues about the peoples’ care had been accurately identified and the plans were subject to monthly evaluations. There was also evidence that where a new need was identified, for example a skin tear, a care plan was established and completed. A range of risk assessments were seen on the files and these were also subject to review. The only advice that was given was to record in more detail in the ‘activities for daily living’ part of the plan so that the home could evidence in the records a more person centred and individualised approach. It was clear however from the observations made that staff know the residents well. The home has also now included an ‘advanced care plan’ that looks forward to when a persons condition may deteriorate and they come towards the end of their life. This plan involves the relatives. In this respect, the home has enrolled for a new initiative in Leeds called CHESS - Care Homes End of Life Supportive Services Programme. This initiative aims to improve end of life care for your people by introducing multidisciplinary documents which are designed to help all residents, irrespective of diagnosis, to be cared for and die in the place of their choice whilst receiving first class quality care. The initiative provides expert facilitators, workshops providing education and training, designed to support care delivery, monthly support meetings and information packs for staff to increase their knowledge and awareness of end of life issues. There was good evidence of liaison with healthcare professionals some of whom have provided training for staff, some of this specific to intermediate care. The care plans showed timely observations and referrals to doctors or the intermediate care team. Some of the written comments made by healthcare professionals were: • ‘Service Provider always seeks advice from ICT. Usually they follow detailed care plans formulated by ICT staff but in certain complicated/emergency situations don’t hesitate to seek help or contact GP’ DS0000047591.V336639.R01.S.doc Version 5.2 Page 13 Ashfield Nursing and Residential Home • • ‘The home provides a satisfactory level of care to our patients – no complaints’. ‘I think they provide a good level of general care to their dependent population’. Some comments made by relatives were: • • • ‘I am impressed by the high degree of care given to my husband and, as far as I can see, to all the residents at Ashfield. The staff are extremely kind and competent.’ ‘I visit twice a day and staff are always attentive not only to my husband but to other residents’. ‘I think the love and care given to residents is superb’. Drugs are stored securely and the nurse was seen taking the necessary care in administering the correct drug to people. It was good to see that the nurse used this as an opportunity to have a conversation and check out any problems and to give reassurance. There was no overstocking of medication and appropriate disposal methods and records of this were seen. The drugs administration sheets for the four people whose care plans were inspected were checked. These were error free. There are monthly audits of medication carried out by the manager and records showed that the care plans had also been audited regularly. Staff spoken with had a good knowledge of the individual needs of people. A good proportion of time was spent in the lounge areas during the inspection visit, watching staff practices. This showed that they know the care needs and personal preferences of individuals and are good at identifying non-verbal behaviour that indicates when a resident is happy or unhappy. They were good at making sure nobody was isolated and got as much positive attention as possible. The relationships between staff and the people they care for are warm and friendly with some residents obviously enjoying some physical reassurance. Clothing was clean and all of the residents looked well cared for with their hair attended to, ladies ‘made up’ and nails polished. Staff were careful to make sure doors were closed at times when personal care was delivered and were seen knocking on doors before entering rooms. They were attentive to people and some overheard conversations showed staff to have a nice manner that people appreciated. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. Peoples’ social expectations and personal preferences are met and they are able to exercise choice in their daily routines. People living at the home are provided with a varied and nutritious diet. EVIDENCE: The home now employs an activity organiser who organises group activities on the ground floor and tries to spend time with people who stay in their rooms on a one to one basis. The home has taken on the recommendation made in the last inspection report about recording activities. People have an individual activities book that records what they have been involved in. Relatives are encouraged to look at and record things themselves. For example one relative had recorded a detailed description of a time he had taken his wife out and another had recorded that despite the best efforts off the activity organiser in card making, her husband had forgotten the wedding anniversary. People said that the activity organiser ‘is great’ or ‘lovely’ and one person talked about how she had been encouraged in card making. There is a weekly programme of Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 15 activities that provides a range of physical and mind exercising pursuits, some with an end product like card making, flower arranging and cookery. The activity organiser has attended a training course and will attend further training aimed at activities for people with dementia. The visitors seen and spoken with said that they were always made to feel welcome and the service user guide makes it clear that the home’s approach is relaxed and people welcomed at any time up to 9.00pm unless visiting a poorly relative. Some relatives choose to be involved in some aspects of care provision (mainly at mealtimes) and staff support them where necessary. The home has links with local churches and some people receive communion. There are also links with local schools with some work placements organised. It was clear through sitting in the lounge areas and chatting with people that they get up when they like and breakfast was available at everyones own pace. Overheard conversations showed that staff encourage people to say what they would like to wear ( with assuarances about how they looked when dressed), where they would like to be and what they would like to do. People spoken with said that they get up and go to bed when they want, can eat in their rooms if they wish and choose what activities they want to join in. The bedrooms seen showed that people are able and encouraged to bring things from home to personalise it and make it more individual and homely. People spoken with during the visit were full of praise for the food provided. This was also reflected in the surveys that were returned. People have access to food and drinks in between scheduled meal times. Where they do not want what is on offer, an alternative is offered. Meals can be served at different times of the day if a person wishes. The lunchtime meal was seen and this was done over two sittings. The first for more able and independent people the second for a smaller number who need assistance. This worked well and made sure that people got the attention and support they needed when they needed it. Menus are reviewed every 3 months. Prior to the new menus being written, the cook discusses any changes at the resident/relative meeting. A copy of the new menu is made available prior to it being started. The AQAA stated that positive comments are frequently made regarding the quality of food served and the choices for those on soft diets. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. There is a clear complaints procedure made available to the people at the home. The people who live at the home and their relatives feel confident that they will be listened to and that appropriate action will be taken when necessary. There are adult protection procedures that staff have awareness of and understand. People can be assured that they can feel safe at the home. EVIDENCE: Comments made in the last inspection report about making people more aware of the complaints procedure and improving the way complaints are recorded have been addressed. The AQAA stated that 9 complaints had been received. Records were checked during the visit and were properly recorded with detail of the way this was looked into with and the outcome. People were satisfied that matters had been dealt with properly. The complaints procedure has been reviewed but the one seen had very tight timescales and the manager may wish to extend the timescales. It is accepted though that the home likes to deal with things speedily so that matters are resolved amicably. People spoken with said that they felt comfortable in raising problems and the surveys also reflected this. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 17 There is an adult protection procedure. Since the last inspection two staff have been on training that equips them to provide in-house training to other staff. The staff spoken with have attended training and this had been identified in their one to one supervision session although these varied in their frequency. The training programme for 2007 clearly identified that this was a priority to meet inspection requirements. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. People live in a safe, comfortable and well maintained environment. EVIDENCE: At the time of the inspection visit there ware some improvements being made to the home. Additional storage facilities were being built at the rear of the building. This included a room to house freezers. Internally two of the largest of four double rooms had been divided to create single rooms. This is good and improves peoples’ opportunity for privacy. The owner did not inform the Commission of these improvements and was reminded that this must be done. Nevertheless, the work has been done to good effect and just needed lights to be fitted above the mirror and wash hand basin to meet standards. Work has also been ongoing to make sure the home meets current fire safety standards Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 19 and an appointment has been made for the Fire Officer to visit and check that he is satisfied. The owner was requested to write and confirm when all the alterations have been completed and the outcome of the Fire Officers visit. The tour of the building found standards of cleanliness good with good odour control. Bedrooms seen were comfortable and people had personalised these with their own belongings from home. General standards of décor and maintenance seemed adequate. Over the last year more profiling beds and pressure relieving equipment have been purchased. Redecoration of the home is ongoing. Whilst the home does not meet the environmental standards for intermediate care this must have been taken account of by the Local Authority that contracts with the home for three places. The manager said that the approach from the multidisciplinary team was to assess people in their own homes because this was the real situation. One relative’s survey said ‘Ashfield is an old well lived in house. It is homely and comfortable’. Other surveys said the home was clean and comfortable. The home has been successful in being awarded a Local Authority improvement grant and intends to improve an old unused bathroom with a ‘wet room’ with shower facilities that will give people a choice of bath or shower. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. People living in the home are cared for by experienced staff who are trained and qualified for the job. Recruitment procedures need to be more thorough to protect the people living at the home. EVIDENCE: During the inspection visit a large part of time was spent on the communal areas watching staff at work including during the meal-time. There seemed to be enough staff to make sure that people were looked after and where possible staff spent time with individuals. Most of the staff have worked at the home for a lengthy period and know the people they care for extremely well and this counts for a lot in the relationships and consistency of care. Most of the staff on duty were spoken to individually and some returned surveys. The surveys showed that staff felt that they had been properly trained and conversations with one who had recently started work at the home showed that she had been through an induction period. This was despite the fact that she had good experience and training in her previous job. The AQAA that was returned stated that staffing levels were good, but the fact that of the four staff surveys returned one said that were never enough staff on duty, two said sometimes Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 21 enough and one said usually. These were discussed with the manager following the inspection visit. This view was not reflected to that degree in the surveys that were returned by relatives and people living in the home and not at all in the surveys returned by healthcare professionals. This is something the manager should address at a staff meeting to check out why some staff are feeling this way. Staff spoken with during the visit reflected a good team spirit and confidence that they were able to do their job properly. At the last inspection the manager agreed that, at that time, the home was not fulfilling its responsibility to make sure that staff were properly trained for the job. Over the last year some staff have received training that equips them to facilitate training at the home. On the day of the inspection visit, staff were receiving a fire-training lecture. The records showed that safe working practice training has been a priority and the staff spoken with said that they had attended sessions or these were planned. The manager is going to nominate a training coordinator and said that her deputy was going to take on the role. This is a good way forward to make sure that staff are individually up do date with things. The numbers of staff having achieved National Vocational Qualifications far exceeds the 50 targets set in National Minimum Standards. A notice on the staff notice board was advertising in house training up to the end of November that included care planning, CHESS, assisting with eating and drinking and fire training. The files of two staff were checked to make sure that they had been appointed properly with the necessary referencing and checking that must be done. Both the files seen were people originally used through an agency. Both had application forms and details of training and experience and a contract of employment with job description. However, in one case, although there were two references there was no record of a Criminal Records Bureau (CRB) check other than an entry on the staff file that the agency had confirmed that this was satisfactory. In the other case there was simply an entry to state the agency had confirmed references and would send these and that CRB was satisfactory. Where a member of staff is to be appointed the home must itself send for references and must also send for an up to date CRB. The CRB is not transferable. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is well managed. The interests of the people who live there are seen as very important to the manager and her staff. There is a clear approach to resident care that is person centred and puts the best interests of individual residents central to staff practice. Regular auditing and checking of facilities, equipment and services make sure the home is a safe place to live. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 23 EVIDENCE: The conversations with staff, people living at the home, CSCI surveys show a high regard and appreciation for the manager. She was described several times as ‘very approachable’. The manager has achieved the Registered Manager’s Award. She is a qualified nurse who regularly updates her training and working practices. Staff meetings are held on a regular basis and minutes are made available. In the conversations with staff they said that they felt that communication was good. The shift handover during the afternoon was observed and good quality information was passed on so that the oncoming staff were aware of people who may need some additional oversight for one reason or another. There are resident/relatives meetings held regularly and minutes of these were available. To make sure it is achieving its aim, the home conducts its own annual quality survey. The manager has been looking at new survey questionnaires that she feels may be more user friendly and is about to introduce these as it is just over a year since the last survey was done. The new documents cover a range of issues that are based on outcomes for people living at the home and link to National Minimum Standards. The surveys cover admission and ongoing care and are sent to people using the service, their relatives or advocates and professional visitors The feedback from these will be formulated into a summary report and action plan. Staff were seen to be checking how people were throughout the observations made during the inspection visit. There was evidence seen of regualr audits of care plans and medication. There were minutes of meetings that had discussed and agreed action in respect of the things identified as needing attention in the last inspection report. The AQAA stated and the manager confirmed that the home does not currently handle or look after any money for individuals. Lockable items of furniture are in bedrooms and people either manage their money themselves or a relative or advocate does this. The AQAA also stated that the home had reviewed its weekly charges and business plan. The home has found it hard to make desired improvements and the AQAA stated ‘the current local authority fee does not meet the costs of the home and this has impacted on what we have been able to achieve in the past 14 months, therefore some areas of improvement or upgrade to the building have had to be put on hold’. This is currently being discussed with the Local Authority and may go to litigation. Each area of the home is risk assessed and those areas checked were up to date. Regular fire drills take place and the fire alarm system is checked regularly. The AQAA identified that other regular checks are made of the Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 24 facilities, equipment and services. There has been a big effort to make sure that staff are up to date with safe working practice training. Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 25 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 26 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 OP29 Regulation 19 & Schedule 4 Timescale for action The registered person must 31/12/07 ensure all the required information is obtained before a carer can commence work at the home and must do this retrospectively for the staff appointed through an agency. Identified in the previous inspection report. New issues identified and timescale set. Requirement Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 27 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 OP7 Good Practice Recommendations In respect of the recording of ‘activities for daily living’ efforts should be made to include more detail about the person so staff have a clear knowledge of the personal likes, dislikes and preferences of an individual. The manager should continue to encourage the activity organiser in building an expertise in providing activities for the range of peoples’ needs living at the home. In the next staff meeting, the manager should discuss staffing levels and working relationships with the staff team and assess the views that were expressed in surveys that were returned. The manager should carry out the newly devised quality survey as soon as possible and make a summary report that is published and available to all connected with the home. The manager should make every effort that one-to-one staff supervision sessions are held six times a year for every individual working at the home. 2. 3. OP12 OP27 4. OP33 5. OP36 Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashfield Nursing and Residential Home DS0000047591.V336639.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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