Care Home: Ashford Lodge Care Home

What the care home does well There is good quality assurance within the home, people are consulted about what happens and the owner is very `hands on`. There is clear direction within the home, they know what they need to do to make improvements, and have a clear plan of how it will be achieved. People tell us they get on well with staff and that staff are attentive to their needs. People tell us they enjoy living in the home and that the food is good. What has improved since the last inspection? Staff have worked hard to ensure they made the required improvements to care plans. Plans are more directive and risk assessments are now in place and regularly reviewed. The management of medicines has improved, staff are much better at recording in this area. Policies and procedures have been reviewed and fully updated so they reflect current legal requirements. Systems to reduce spread of infection have been introduced and new cleaning rotas are in place, to ensure that people are safer in the home. What the care home could do better: There needs to be a registered manager as there has not been one for over a year, this will improve accountability. Staff will need to ensure they transfer care updates from daily records into the plan of care, so that there is a planned approach to care giving. All staff need have fire and safeguarding training to help them keep people safe in the home. Also, recruitment checks on staff need to be tightened up to keep people safe. People told us they would like more activities outside the home, where they can access their local community. Key inspection report Care homes for older people Name: Address: Ashford Lodge Care Home 1 Gregory Street Ilkeston Derby DE7 8AE     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: Helen Macukiewicz     Date: 0 1 0 6 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 Lodge Care Home 1 Gregory Street Ilkeston Derby DE7 8AE 01159307650 01159307650 andy@carnachan.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Andrew David Carnachan care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Carpet highlighted at the site visit are to be replaced by 28th February 2007. The bathroom currently not used due to inaccessibility, will be converted to an accessible shower room by 28th February 2007. Date of last inspection Brief description of the care home Ashford Lodge is a large detached property adapted to meet the needs of 20 older people, primarily with nursing needs. The Home has 2 floors with bedrooms on both floors; the first floor is accessible by passenger lifts. There is a large conservatory, lounge and dining area, along with a smaller quiet lounge area. The Home has an accessible garden area and parking for 2 - 3 cars. Care Homes for Older People Page 4 of 26 Over 65 20 0 Brief description of the care home The Home provides nursing care and has a registered nurse on duty 24 hours a day. The weekly charges made for a room at Ashford Lodge Care Home range from 373.17 GBP to 487.24 GBP. Extra charges are for Chiropody, some personal toiletries and hairdressing. The registered person provided this information during the Inspection. A copy of the most recent Inspection report is kept in the foyer. Care Homes for Older People Page 5 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: 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: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people using the service and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provisions that need further development. Where possible, we include evidence from other sources, notably District Nurses and Social Workers. We also use information gathered throughout the year, to support our judgments. This may include notifications from the provider, complaints or concerns and the pre-inspection questionnaire, which the provider is required to complete prior to a visit to the service. The primary method of inspection used during the visit to this service was case tracking. This involved selecting three people and tracking the care they receive Care Homes for Older People Page 6 of 26 through review of their records, discussion with them where possible, the care staff and observation of care practices. We also spoke with staff and relatives who were also very helpful. We spent part of the day discussing records, documents and policies with the provider. All of the key standards were inspected on this occasion. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. 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 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 information they need to choose a home that can meet their needs. Pre-admission procedures ensure that people are not admitted inappropriately. Evidence: Information about the home was written into a Statement of Purpose and Service users Guide. These had been combined into one booklet, which was available in each persons bedroom. Information had been updated in May 2009 to reflect the current contact points for complaints, the new deputy manager and to include a section abut dignity. This ensured that people had accurate information about the home, including the range of fees payable. People had their needs assessed before admission, or soon after if they had been admitted as an emergency. Assessments were carried out by a qualified nurse. The forms used meant that people were properly assessed as to whether the home could meet their needs. Care Homes for Older People Page 10 of 26 Evidence: One relative told us that their family members had been able to look around the home before admission and that they were satisfied with everything. People said they were pleased with their choice of home. One relative said they couldnt find anywhere any better and one person living in the home said Im very happy here. 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. People receive the care they need in a dignified way. Evidence: Care plans had been improved since we last Inspected the service. Staff had clearly put in a lot of effort to ensure that all the required assessments of need had taken place, and that such assessments had been reviewed at regular intervals. The general content of care plans had also improved, with staff being given clear directions about peoples care needs. Again, the care plans had been reviewed at regular intervals. There was evidence that people had been involved in the planning of their care and were encouraged to attend monthly care reviews. Some care notes were kept in peoples bedrooms where they could easily access them. Some later additions to care plans were not dated and signed, or amended using a single line, dated and signed as is good practice. People had wound care plans Care Homes for Older People Page 12 of 26 Evidence: although staff were not using body maps or graphs to chart the progress of these. Some new areas of need were recorded in the daily progress notes, with the care people were being given, but the new problems had not been updated into a plan of care. This would have ensured a planned and co-ordinated approach to new areas of need. However, there was written evidence to support that such needs had been met and that people were getting the medical attention they required. One visiting professional, in their completed pre-inspection survey wrote that the home has a reputation for caring for people with complex needs very successfully. Visitors told us their relatives were receiving the care they needed. One said their relative was well cared for, they look after her alright. One person living in the home also said Im well looked after. People also told us that staff cared for them in a dignified way, treated them with respect and upheld their privacy. One person confirmed that staff knocked on their bedroom door to request permission, before entering. The management of medicines had improved since we last inspected. All medications that had been given were recorded and a brief stock check showed that people had received their medication when needed. There were some hand written entires on medication records that gave instructions for staff. These could have been written into care plans, so that medication records remained unchanged. Some prescriptions on the medication charts had been discontinued and they had been crossed off without explanation. One persons prescribed cream was found in a bathroom cupboard, it was removed by staff immediately as it could have been accessed by others. 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 lead a varied lifestyle of their choosing, although better access to the community would further enhance this. The food provided meets peoples individual needs. Evidence: People had their social needs assessed and recorded into a plan of care as to how staff would meet those needs. The assessment considered peoples previous lifestyle, preferred routines and social interests. Due to peoples physical limitations, most activities took place within the home. People told us they read, watched television and went out with their families. Staff told us that when staffing levels allowed, they did take people out on short walks. However, not many people were accessing the local community on a regular basis, and this is what people told us they would like to do more of. Staff kept various records of events that had taken place. Photographs were displayed where staff had undertaken themed events such as Easter and Valentines parties. Staff were attentive to peoples individual needs. A television had been provided in an alternative location, as one person wanted to watch different programmes to everyone else. One visitor told us how staff had helped them to celebrate a special event at the Care Homes for Older People Page 14 of 26 Evidence: home, which would have passed by without celebration if it hadnt been for the efforts of staff. There were plenty of visitors coming and going throughout the day and people who chose to, could spend time in their bedrooms. There was outdoor seating provided. A visitor from a local church came to see people, the owner told us that this was a regular occurrence. People told us that the food was good. One visitor said their relative had told them that they had really enjoyed Sunday lunch that week. One person said food is very good here. People told us there was a choice of food each day. A menu review took place this year. This was done following consultation with people using the service, visitors and catering staff. This recorded that people had asked for more fish fingers on the menu. These were included as both a daily alternative option and as a standard set menu item on one day of the new four week menus, supporting that people were being listened to. 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 have their rights upheld and are kept safe through effective procedures. Evidence: People told us they knew how to complain and the complaints procedure was on display in the foyer, and provided in each bedroom within the residents guide. There had been no formal complaints made at the home. One relative told us they had no qualms about the home and that their relative was happy living at the home and would tell them if they werent happy about something. Staff had access to procedures to help them keep people safe from abuse. Most staff had also received training on this subject. There was a regular programme of training to ensure that those people who had not yet attended, could do so. Some staff had also received training on Deprivation of Liberty and the Mental Capacity Act. There was written guidelines in the office for staff in this area, and the owner told us that more staff training was planned. There was a risk assessment in place, and written consent obtained for people who needed bed rails on their beds. Care Homes for Older People Page 16 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. People live in an environment that is suited to their needs. Evidence: We found that there was continued investment in the environment. A programme to refurbish all bedrooms was underway and several rooms had already been completed. Although some parts of the home were still in need of redecoration, and some windows in need of replacement, there was a steady programme of improvement and a planned approach to identifying and actioning improvements that were needed. One visitor told us their relatives bedroom was very comfortable and said its a lovely room. The home was clean and tidy with each bedroom having a daily cleaning rota, which had to be signed off by staff. There had been a lot of investment in improving infection control throughout the home. New clothing stations had been provided at various points around the home, to ensure staff had access to protective equipment when needed. New laundry equipment had been provided, and that enabled washing of soiled laundry. There was an active infection control link person for the home and they ensured staff had access to the latest guidelines. There was information for staff around the home on how they could maintain good infection control. Care Homes for Older People Page 17 of 26 Evidence: We saw that a quantity of incontinence pads were being stored in a communal bathroom, and that hoists were being stored in sluice areas, this increases the risk of spread of infection and should be removed. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by sufficient numbers of supervised staff. Gaps in recruitment practice and staff training has the potential to adversely affect wellbeing. Evidence: Staffing rotas showed that there was always a registered nurse on duty and that generally there were between two and four care staff on each day shift, and one care staff on nights. A cook, kitchen assistant and cleaner were also employed. The owner was also in daily contact and provided general support to the manager with the running of the home. We received no concerns about the staffing levels at the home or about the availability of staff. People told us they got on well with staff. One said the staff are all so very kind, another described them as very good. In their completed pre-inspection survey one relative told us they show my wife love and affection, she is happy with them all and her surroundings. One visiting professional, in their completed pre-inspection survey wrote that the staff are flexible and people are treated as individuals and that they were always impressed by how well staff know the residents. Staff told us they had received loads of training. All staff except one had completed or were undertaking National Vocational Qualifications to levels two or three. A training matrix, kept by the owner, provided a clear snapshot of what training staff Care Homes for Older People Page 19 of 26 Evidence: required and what they had received. Individual training records were also kept to support what people had done. Some staff had also undertaken dementia training, diabetes training and continence training. Future training dates were displayed in the office and additional training opportunities were advertised, such as NHS courses. Four staff had not completed safeguarding training, although there was a programme in place for this. Six staff had not undertaken fire training, the owner had an instructional DVD and agreed to ensure staff had access to this until formal fire training could be given. We saw recruitment files for three staff. This showed that people were not employed until they had received police checks. Although two references had been sent for, only one had been returned for one member of staff. Also, a reference had not been requested for a former job involving work with vulnerable adults, as is required. Both other staff files were all compliant with legal requirements. Where people had started work, they were supervised and undertook a comprehensive induction programme. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively managed in peoples best interests. Evidence: Due to unforeseen circumstances the manager for the home had not yet completed her registration with us. This had been submitted to us previously and the owner had retained the paperwork. He agreed to ensure this process was completed as soon as the manager returned to work. The manager had a registered managers award and is a qualified nurse. A new deputy manager had been appointed and she was covering the managers absence at the time of this visit. The owner was also in day to day contact with the home and offered support. The owner and manager sent us an Annual Quality Assurance Assessment for the home when we asked for it. This was well completed and provided us with a clear and accurate snapshot of what areas the home does well and what needs to be improved. Care Homes for Older People Page 21 of 26 Evidence: This is referred to as the completed pre-inspection self-assessment in this report. There were several quality assurance initiatives ongoing. Surveys had been sent out to people in March 2009. Feedback had been sought and received from relatives and people living at the home. Most people felt the outcomes of the home were good and indicated they were satisfied with all areas. Issues covered included food, cleanliness, staff helpfulness and information. One relative told us they had been asked to fill in surveys and it is all favourable. Although the owner was in day to day control of the home, he undertook regular monitoring of the service and wrote management reports monthly or bi-monthly. The last one was undertaken in March 2009. Reports showed that he had discussions with people who live in the home and staff to gain their views. Things that have been attended to were also recorded, along with clear action points for improvement. These showed a clear audit trail between what needed doing and what had happened. An annual refurbishment and renewal plan dated January to December 2009 was seen. This covered planned refurbishment of all areas of the home and when work was completed. A quarterly review of the service was also completed, the last one was dated January to March 2009. In addition, an ongoing business plan looked at strengths of the service and identified weaknesses that may be a barrier to achieving improvements. We saw that peoples personal finances were being appropriately managed. A full new set of policy guidelines had been purchased for the home and the owner confirmed that staff had all seen these. A risk assessment for the environment was undertaken in February 2009. In their completed pre-inspection self-assessment the owner/manager told us that all equipment had been regularly serviced within required time scales. Care Homes for Older People Page 22 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 23 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 1 7 15 2b) Care plans must be updated as changes to care needs are identified within the progress notes. To ensure a planned and coordinated approach to new areas of need. 31/07/2009 2 29 19 and schedule 2) A second 31/07/2009 reference and written verification as to reasons for leaving, from the former employee, where they worked with vulnerable adults must be sought for the member of staff identified on the Inspection. This is to ensure people are fully protected from unsuitable workers. 3 30 18 ci) All remaining staff must receive fire and safeguarding training. This is to ensure people are kept safe at the home. 31/07/2009 Care Homes for Older People Page 24 of 26 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 4 31 8 There must be a registered manager for the home. This is to ensure better accountability within the home. 31/08/2009 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 Alterations to care plans should be accompanied by a signature and date. deletions should be made using a single line, dated and signed, to comply with professional guidelines for record keeping Use of body maps and graphs should be used in wound care plans to help staff assess progress, site and development of any new wounds. Hand written entries on medication charts should be kept to a minimum. Discontinued prescriptions should be removed from pre-printed medication charts at the earliest opportunity to make these clearer. Prescribed creams should be stored safely and not in communal areas, to prevent people accessing medication they are not prescribed. 2 7 3 9 4 5 6 12 19 26 People should be supported to access their local community and have trips out to enhance their lifestyle. The refurbishment programme for the home should continue until all required improvements are completed. Hoists should be stored away from sluice areas and incontinence pads should be stored in individual bedrooms to reduce the risk of spread of infection. 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). 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