Care Home: Ashford House

What the care home does well All people that wish to use service benefit from a pre-admission assessment and the care plans are then generated from this initial assessment. The pre-admission assessment is kept in the person`s individual care plan folder. Care plans and risk assessments contained enough information about the people using the service that allowed staff to care for them appropriately.The registered manager told us that training had started with staff on person centred care planning and that would be incorporated into the care plans. The staff spoken to on the day were knowledgeable about the care needs of the people using the service.They were observed to be interacting and speaking appropriately to the people in a calm manner. Regular training takes place and this includes the NVQ (National Vocational Qualification) which all staff have access to. The registered manager and staff have a clear understanding of safeguarding policies and procedures. Documentation evidenced that complaints that are received by the manager are investigated appropriately. The manager communicates a clear sense of direction in what she is trying to achieve for the home and has a wealth of experience working in dementia care settings. During the day she demonstrated that she had a good knowledge of the people using the service and communicated easily with them. There are clear lines of managerial responsibility and the manager told us she has good support from her operations manager and deputy manager. What has improved since the last inspection? Following the inspection in August 2007 no requirements were made. The manager told us that she is constantly looking at ways she can improve the quality of life for the people using the service. Since the last inspection she has employed a new deputy manager to assist her. She told us the deputy works with the other nurses and carers to support the staff and ensure there is a good quality of nursing care being delivered. The deputy has also achieved her National Vocational Qualification (NVQ) at level 3 in management. The manager also told us that since the last inspection she has employed a new activities organiser who has good ideas on how to improve the quality of activities available within the home. She will soon be supported by an assistant. The manager has improved the working relationship with the surgeries of the local GP since she has been in post. What the care home could do better: No requirements were made following this key inspection. Key inspection report Care homes for older people Name: Address: Ashford House Long Lane Stanwell Middlesex TW19 7AZ     The quality rating for this care home is:   three star excellent 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: Lesley Garrett     Date: 2 0 0 8 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 26 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 26 Information about the care home Name of care home: Address: Ashford House Long Lane Stanwell Middlesex TW19 7AZ 01784425810 01784425889 ashfordhouse@barchester.com www.barchester.com Barchester Healthcare Homes Ltd care home 54 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 54. The registered person may provide the following category of service only: Care home with nursing - to service users of the following gender: Either Whose primary care needs on admission to the home are nursing within the following category: Dementia (DE) Date of last inspection Brief description of the care home Ashford House is a privately owned care home owned by Barchester Healthcare Homes Limited. Personal care and accommodation is offered for up to 54 service users with dementia. Ashford House is purpose built and is bright spacious and airy. Accommodation is arranged over two floors. Service users have their own single rooms with en-suite facilities. 54 Over 65 0 Care Homes for Older People Page 4 of 26 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: three star excellent 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 inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett, Regulation Inspector, carried out the inspection and the registered manager represented the service. We arrived at the service at 09:45 and were in the home for five hours. It was a thorough look at how well the home is doing. It took into account information provided by the home and any information that Care Quality Commission (CQC) has received about the service. The registered manager for the service supplied CQC with an AQAA (Annual Quality Assurance Assessment) and this document was used to assist with the inspection. The inspector also spent time talking and observing some of the people using the service and staff members. We looked at how well the service was meeting the key national minimum standards and complying with the regulations and have in this report made judgements about the Care Homes for Older People Page 5 of 26 standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, staff files, training records, and the homes safeguarding and complaints policies and procedures. From the evidence seen by us and comments received, we consider that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 7 of 26 No requirements were made following this key inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 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 9 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service benefit from a pre-admission assessment from a suitably trained person from the home to ensure that the home can meet their needs. Evidence: We looked at the service user guide and statement of purpose. They contained all the information required to enable people who wished to use the service to make an informed choice. All people who wish to use the service benefit from a pre-admission assessment. This assessment is carried out by the registered manager and her deputy or team leader. The assessment is thorough and takes into account the activities of daily living. The manager told us in the AQAA that the assessment takes place in the persons home whenever possible so that care can be planned to reflect existing routines. The manager tries to reflect the ethnicity and diversity of each person being admitted. Care Homes for Older People Page 10 of 26 Evidence: Each person wishing to use the service or their representative is asked to fill out a form which details their life experiences, interests, rituals and routines. The manager told us that a key worker is allocated to each person on the day of admission and they are then given special attention for that day to ease their admission into the home. The home does not offer intermediate care. Care Homes for Older People Page 11 of 26 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. The health and personal care of people using the service is good with staff knowledgeable about their needs. Care plans were well written with enough information available to allow staff to care appropriately for the people using the service. Evidence: Three care plans were sampled, one from each unit, and all contained detailed information about each person using the service. This allows the staff to deliver care using the supplied information. Risk assessments were also in place, these were clear and there was evidence that all had been reviewed and evaluated every month. People who use the service and their relative or representative are involved in the writing and reviewing of all care plans. Aids and equipment are provided to encourage maximum independence for people using the service and these are reviewed and replaced to accommodate peoples changing needs. The manager told us that they have some new beds that can be lowered to the floor which means they can reduce the use of bed rails in the home. Care Homes for Older People Page 12 of 26 Evidence: The manager said that people who use the service are registered with several local GP surgeries. The manager told us that she has worked hard to improve the working relationships with the practises and she now can register all new people with them without having to use the primary care trust as previously. She stated the practises are a good support to the home and the GPs will visit the home when required. Other healthcare professionals support the home. The chiropodist visits every six weeks and is in the home all week. This gives everyone the opportunity to visit if treatment is required. The manager told us that she is an holistic therapist and will also give the people using the service a foot massage. Treatments take place in a room that has been provided by the home so as to maintain the people who use the service privacy and dignity during treatment. There are medication policies and procedures in place. The manager told us that she has recently changed the pharmacy provider to a large chain organisation. She told us that they are a good support and available for advice if needed. Also they can deliver sometimes as late as nine in the evening if required. During a tour of the building it was observed that staff were speaking appropriately to the people using the service by their preferred name which had been documented in their care plan. All people were dressed in clothes appropriate for the weather with hair well groomed and nails clean. The hairdresser was visiting on the day of inspection and most people using the service enjoy this activity. One lady was very keen to tell us that she had had her hair done that day and to ask did we like it. Care Homes for Older People Page 13 of 26 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 who use the service are able to take part in social,and recreational activities and are able to exercise some choice in their daily lives. The standard and quality of the meals are good which means nutritional needs should be met. Evidence: The manager has recently recruited a new activity organiser who had been in post for two weeks. She will be joined very soon by an assistant. Although the new organiser has no activity experience the manager was impressed with her ideas and past experience in the work place during the interview. Her assistant was previously a senior carer at the home. A programme of activitys was displayed but these are under review and a new programme will be developed. The AQAA told us that theatre entertainment is arranged to visit the home three times a year and live entertainment takes place every week and is very popular. We also observed during our visit a range of CDs and DVDs that can be played for the people using the service. Large group and one to one activities take place and appear on the programme. Whilst sampling the care plans we observed a social care plan where participation and enjoyment of an activity is documented. The staff are beginning to compile a social history for each person using the service which will assist staff when Care Homes for Older People Page 14 of 26 Evidence: compiling the activity programme. On the ground floor the home has developed a sensory garden. This is decorated with art work that children from the local primary school designed for the home. The manager said that this outside area is well used in the good weather. A PAT dog visits the home regularly and this is enjoyed by the people using the service. The AQAA also told us that visits can take place by people from several different religious denominations as required. During the past year training has taken place for care staff in the importance of activities and there has been an increase in physical activity. Relatives are involved in suggesting ideas and this is discussed at the regular meetings. The manager told us that meals and mealtimes have improved at the home recently. With the co-operation of the chef the main meal of the day is in the evening with a lighter meal option at lunch time. The menus are also being developed. Choice is still available but that will also be prepared in a liquidised or pureed form as well as a normal choice. Finger food, soft diet and specialised diets will also be available. The manager and chef are in the process of developing these menus. Fresh fruit and vegetables are always available along with regular hot and cold drinks. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints are listened to and that they should be protected from abuse as the staff team have received training in safeguarding adults. Evidence: The manager said that during the last year they had received eleven complaints that had now been resolved. The complaints log was seen and the concerns had been appropriately investigated with timescales met. The home welcomes feedback from the people who use the service and their relatives or representatives and a log, is therefore, kept of the compliments also. The home has a clear complaints policy and this is available to all people and is clearly displayed. The manager told us that the home has had a difficult year following a large safeguarding alert raised through whistle blowers. The manager has followed the local authoritys procedures carefully and at every point has kept CQC informed of the progress. Staff moral for a time was low but the manager has now managed to improve the atmosphere at the home with all staff working together as a team. Documents sampled during the day demonstrated that safeguarding training has taken place for all staff. The staff that we spoke to on the day had knowledge of the procedures followed in the home. Care Homes for Older People Page 16 of 26 Evidence: Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people who use the service to live in a safe, well maintained, comfortable environment. Evidence: A tour of the home took place and the premises were seen to be well maintained and people who use the service able to access all parts of the home and grounds. The home on the day of inspection was seen to be clean and tidy and free from offensive odours. All bedrooms are single en-suite and all that were observed had been personalised. The AQAA told us that Barchester have an interior design team. They visit the home to advise on communal areas and the importance of bathrooms and toilet areas. The manager states that great care is taken to make the home homely and not institutional. There was a variety of equipment available which included profiling beds, wheelchairs and hoists for the comfort of the people using the service. The home employs three full time housekeepers who cover seven days a week and is also supported by a laundry person. The AQAA told us the home has a proactive infection control policy and audit. All staff wear uniforms and have showers available in the changing rooms. Gloves, aprons, hand towels and liquid soap are all available and staff have received infection control training. Care Homes for Older People Page 18 of 26 Evidence: Care Homes for Older People Page 19 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers at the home on the day of inspection were sufficient to meet the assessed needs of the people using the service. NVQ training for the care staff continues to ensure a good skill mix of staff on duty. Evidence: The home benefits from an experienced staff team and when sampling the staff rota it was observed that staffing levels were consistent. There is a nurse and senior carer per unit during the morning and afternoon period supported by carers. The deputy is supernumerary. The manager told us that when writing the rotas skill mix, gender and cultural mix is always taken into account. The numbers of staff can be increased if dependency levels increase significantly. The manager also told us that the home does not need to use agency staff as any gaps in the rota are filled by existing staff or their own bank staff team. The home has a programme of national vocational qualification training which all staff are entitled to enrol in following their induction training. Recently, the home has had a few staff vacancies to fill so NVQ trained staff have dropped slightly in numbers. Senior care staff have the NVQ at level 3. Four employment folders of newly recruited staff were sampled and all were found to Care Homes for Older People Page 20 of 26 Evidence: have all the necessary paper work to enable the home to employ those people safely. This ensures that the people who use the service should be protected by the homes recruitment procedures. Individual training files for the staff were viewed. This showed us that staff at the home have access to a variety of training to meet the needs of the people using the service. Mandatory training by the home is carried out yearly or when the certificate has expired. This includes Safeguarding adults, moving and handling, fire awareness, infection control and food hygiene. The manager told us that specialist training is also available depending on the needs of the people using the service. This has included a dementia course, person centred care planning and eating and dementia. Staff spoken to on the day confirmed the training that they have access to and confirmed this gave them confidence in the work they were carrying out. Care Homes for Older People Page 21 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home ensures the staff team is adequately supported and there are clear lines of managerial accountability. Quality assurance systems are in place which improve the quality of care offered to the people who use the service. Evidence: The registered manager has demonstrated good leadership qualities. Her management skills have been tested during the past year but she has received good support from her deputy and her operations manager. The manager has informed CSCI and now CQC of all issues relating to the safeguarding issue at the home. The AQAA told us that the manager keeps informed of changing regulations by visiting the CQC and associated web sites. She is a nurse and has achieved her registered managers award. The manager told us that she is also responsible for delivering some of the training within the home. The manager told us of various quality audit systems that were in place at the home. Care Homes for Older People Page 22 of 26 Evidence: This ensures that people using the service, relatives and staff have the opportunity to air their views. A resident meeting is held every three months during the day and a relative meeting is then held in the evening. Annual surveys are sent to all people using the service, relatives and healthcare professionals every year. The results of the surveys are sent to head office and then to the manager to devise an action plan for any short falls identified. We looked at the last survey results which were very positive and mostly complimentary about the service provided. Regulation 26 visits take place every month and these are held at the home and available for inspection. The home has a full time business administrator who assists with the paperwork for finances and recruitment. No person currently living at the home manages their own finances. The home also employs a full time maintenance person who has some health and safety responsibilities. An external body is also employed to carry out health and safety audits. No health and safety issues were identified during this inspection and records confirmed that the appropriate certificates were in place and current. Care Homes for Older People Page 23 of 26 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 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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