Care Home: Ashgate House Nursing and Residential Home

What the care home does well There continues to be well established and varied activities offered to residents at the home. These are well documented for each resident and part of their plan of care. Unusually the home has taken ownership of two Shetland Ponies that the residents said they liked very much. The food at the home offered routine choice with a good range of vegetables, it was well presented and staff took time and care when helping residents to eat. Residents said they liked the food at the home. What has improved since the last inspection? A number of bathrooms have been fully refurbished which has improved the facilities offered. A system of implementing staff supervision including staff having supervision contracts has begun to ensure staff are supported to do the job of providing care for residents.Surveys of relative`s satisfaction of the home have been completed and other quality assurances processes have been introduced. This included audits of accidents and `walk through`s` of the home to identify Health and Safety issues or maintenance required. Significant work has been completed on implementing policies and assessments relating the Mental Capacity Act into the care planning documentation. Staff spoken to seemed familiar with this and the implications for residents and the decision making process. What the care home could do better: Some work has been completed on ensuring that residents/relatives have copies of the terms and conditions contracts but this has not yet been completed. The documenting of staff training was not fully up to date and it was therefore difficult to accurately assess what training staff had completed and what was due to ensure they had the skills to meet residents needs. Particularly where staff worked on a bank basis at the home record and certificates of training courses were not seemingly kept. Where staff hand write medication administration records these should be checked by a second staff member and signed to ensure that they are accurate and residents their medication as it is prescribed. On occasions where variable dosages are prescribed staff are inconsistently recording the actual dosage given. CARE HOMES FOR OLDER PEOPLE Ashgate House Nursing and Residential Home Ashgate Road Chesterfield Derbyshire S42 7JE Lead Inspector Bridgette Hill Unannounced Inspection 28th April 2008 09:15 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 Ashgate House Nursing and Residential Home DS0000066966.V363231.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. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashgate House Nursing and Residential Home Address Ashgate Road Chesterfield Derbyshire S42 7JE 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) 01246 566958 01246 566216 Ashgate Care Limited Manager post vacant Care Home 34 Category(ies) of Dementia (34), Dementia - over 65 years of age registration, with number (34) of places Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following categories of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Dementia - Code DE Dementia over 65 years of age - Code DE(E The maximum number of service users who can be accommodated is 34 10th May 2007 2. Date of last inspection Brief Description of the Service: Ashgate House is situated on the western outskirts of Chesterfield, within the area of Ashgate, Chesterfield. It is a large converted building, rather than purpose built. The bedrooms are of various sizes and situated on the ground and first floor. The lounges and dining room are located on the ground floor. The home now provides accommodation for 34 older people with Dementia and is registered to provide personal and nursing care. Some bedrooms at the home are shared but the majority are singles. The fees charged at the home range from £343.20- £1415.00 per week extra charges apply for chiropody, hairdressing, toiletries, personal newspapers, specialised laundry and outings. The higher figure represents where additional hours are funded for some residents. This information was given to us at the inspection. The inspection report from the last Commission for Social Care Inspection visit was available on request from the office but not openly available although a range of information published by the Commission for Social Care Inspection was located in the reception area. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit which focused on assessing compliance to previously listed requirements and on assessing all key standards. The visit took 9 and a half hours over two days. As part of the inspection a sample of service users care files and a range of documents were examined. The communal areas were viewed along with some bedrooms and the bathrooms. During the visit opportunity was taken to have discussions with management, a range of staff and residents. Due to having dementia some residents were not able to tell us what it was like to live at the home. Before the visit the Acting Manager completed and returned to us a Annual Quality Assurance Assessment (Aqaa) which gave us some information about the service this was considered as part of this inspection. The Acting Manager Susan Bennett was on duty throughout the inspection. What the service does well: What has improved since the last inspection? A number of bathrooms have been fully refurbished which has improved the facilities offered. A system of implementing staff supervision including staff having supervision contracts has begun to ensure staff are supported to do the job of providing care for residents. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 6 Surveys of relative’s satisfaction of the home have been completed and other quality assurances processes have been introduced. This included audits of accidents and ‘walk through’s’ of the home to identify Health and Safety issues or maintenance required. Significant work has been completed on implementing policies and assessments relating the Mental Capacity Act into the care planning documentation. Staff spoken to seemed familiar with this and the implications for residents and the decision making process. 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. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are not admitted to the home unless sufficient assessment information is in place to ensure that needs can be met. A range of information is available to ensure residents and representatives can make informed decisions EVIDENCE: The care files examined had assessments in place from Care managers and the Free Nursing Care Assessors (where nursing care was required). It could not be established from some of the records seen if the home had completed their own assessments. It was established that at least for one resident a pre admission assessment by the home hadn’t been completed but assessments had been obtained. The admissions had been arranged under previous Managers. A discussion with the Acting manager was held regarding the current approach to pre admission assessments. The Acting Manager said that they always did visits to prospective residents and recorded a detailed Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 9 assessment. Where there was delay in admissions taking place, for example if a bed was not immediately available, it was also stated that a reassessment would be arranged to assess if needs had changed. Prospective residents were said to be offered the opportunity to visit the home although the Acting Manager said that largely it was relatives and advocates who visited and made decisions for residents and that all residents were initially admitted on a 12 week trial period. Residents spoken had poor recall of their experience at the beginning of their admission. A range of leaflets and information was made available to visitors of the home in the entrance foyer. This included the most recent inspection report and the homes Statement of Purpose. A note was also on the inspection report to let readers know a copy of this was available on request. The Acting Manager in post had completed an audit of resident’s files to establish if terms and conditions contracts had been issued. A list of these was available and copies had been sent to relatives and advocates where residents were unable to understand these. As yet not all of these had been returned but it is accepted that there is some action being taken to address the previously requirement relating to this. This home does not offer intermediate care as defined by National Minimum Standard 6. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are completed and are individualised to demonstrate that residents’ health, personal and social care needs are being met. EVIDENCE: A sample of three service users care files were examined to assess how standards were being met. The care plans in place were typed and easy to read where changes occurred these were initially handwritten in and there were records of where care plans reviewed had taken place. The content of the care plans was well written and personalised giving specific details of equipment, types of incontinence aids to use and preferences and daily routine records were available although in some files not wholly completed. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 11 Where equipment was included in care plans such as specific beds/mattresses these were found to be in place in resident’s rooms. Only one care plan seen was not as detailed as could have been in describing the level and frequency of observation a resident required. There were records available to indicate where additional hours were funded that additional care and observations were being made. Daily records were kept for each shift and were well written and informative. As well as in house reviews of care plans, multi agency reviews were completed and fully documented. Care files contained a range of risk assessments that were generally reviewed monthly. These indicated potential risks in a range of areas including skin viability, nutrition, dependency and falls. Care plans were in place for any risks that were identified along with any special equipment such as pressure mats where residents were at risk of wandering at night. One of these placed under a fitted carpet to alleviate any trip hazard to the resident. Since the last inspection significant work has been competed on introducing assessments, policies and procedures relating to the Mental Capacity Act. All care files examined had completed assessment formats in them and staff spoken to were aware of possible conflicts in one residents care and the correct process to refer this to. The storage and administration of medicines was examined at his visit. The home uses the Medidose system for medication. No residents administer their own medication. A record is kept of staff signatures and they were found to match the signatures on the medication administration records. No gaps were found on the medication administration records and codes were used if for any reason medications were not administered as prescribed. Where changes had occurred the GP’s instructions were recorded. Some handwritten medication administration records had not been checked and verified by a second staff member to ensure they were accurately transcribed. Some inconsistent practice was also evident where variable dosages were prescribed as not all staff recorded the actual dosage given. Individual supplies of medicines are used for each resident and eye drops were dated on opening to ensure they were not used after 28 days. Some controlled drugs were suitably stored and documented with a sample of the balances checked correctly matching the supply available. There was now a dedicated staff member who had taken responsibility for organising chiropody, optician and dentist appointments. Files were set up to record these and the dates and prescriptions in the file indicated that there had been recent appointments made. Where residents had outpatient appointment the Care Manager at the home said staff escorted residents and often made an occasion of it by going for a coffee somewhere as well. The home uses 6 GP Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 12 practices and where residents have a local GP these are retained if they wish. The home reported a good supportive relationship with GP’s. Records of health changes and consultations with GP’s were documented. Residents spoken with said that staff were ‘kind’ when being helped to bath they always made sure water didn’t get in their eyes and residents said that sometimes they chose the clothes they wanted to wear but sometimes staff chose but said ‘they know us well and what we like’. Some care files had residents post death wishes recorded and others it was apparent that attempts to ascertain these from relatives had been made but no information had been received. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ wellbeing was enhanced by the range and frequency of social and recreational activities provided. EVIDENCE: The home has a dedicated and enthusiastic activities coordinator who works for 30 hours per week. A board is available which details information and what activities are offered. The care files examined had a social need care plan which detailed preferences and likes. Each resident also had a sheet which recorded what activities they had been involved with. The activities coordinator tailored activities according to individual preferences and needs. The range of activities offered was very wide ranging from ambitious productions of the Wizard of Oz which was reported in local press to crafts, sing a longs, baking, reminiscing using old fashioned items, quizzes, individual sessions of hand care and nails, chats, sewing (including production of costumes for the plays) and some outings. More outings initially a trip to Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 14 Chatsworth was being arranged. Photographs of events were on some walls as well as local black and white photographs. A fete and some fund raising coffee mornings are held and the activities coordinator said they routinely tried to get to know relatives as well as residents. Another pantomime is also planned. Occasions such as Easter were well celebrated with Easter bonnets and Birthdays are celebrated with a gift to the resident and a cake. One resident spontaneously said that they had a lot of fun with the activities and other residents obviously know the activities coordinator well said they liked her and how she organised lots of different things. Some activities were also organised through external entertainers, an organisation ‘Lost Chord’ which provides access to music for people with dementia and a local church visited approximately monthly to do a church service. Some activities aimed at helping residents with visual impairment were available such as large playing cards, large print books and taped stories particularly relating to local history were available. The home did not have a loop system despite some residents using hearing so was not as strong on providing services for the hearing impaired. The home has also become the owner of two Shetland Ponies that live in a paddock that can be seen from some lounge windows. Thee residents said they enjoyed watching them and some residents fed the ponies on occasions. The menus at the home indicated that a choice of main meal and dessert is routinely offered at each meal. At lunch times during the inspection 3 types of vegetable was offered at the main lunchtime meal. Residents were observed with varying portion sizes and plate guards were seen being used by residents to improve their independence. Some residents used spoons other forks and knives whichever was easier for them. Staff sat with residents who needed held and fed one resident at a time. Pureed and soft diets were served with food individually pureed to improve presentation for residents. At breakfast some cooked choices were offered every day as well as cereals and porridge. Records in the kitchen were kept of cleaning and what foods had been served. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents concerns and complaints are taken seriously and acted on. The appropriate procedures are followed in the event of abuse, which helps ensure residents are protected. EVIDENCE: A complaints procedure was in place and was made available to residents and their representatives in the Statement of Purpose in the foyer. It gave appropriate timescales for resolution of complaints and alternative contacts if anyone did not feel able to raise concerns to staff at the home. Since the last inspection the home had received two complaints both regarding the laundry service. A form had been completed which detailed that actions had been taken to rectify the concerns raised. Residents spoken said they would talk to staff if they had worries and were able to name the staff who they would go to. The Safeguarding Adults procedures were examined. The home had a copy of Derbyshire County Councils procedures and their own policy and procedure. This gave staff an overview of types of possible abuse and detailed that local procedures should be adhered to. Earlier in the procedure however internal investigation is advocated. The policy does also not urge consideration of any Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 16 interim action that may be required to ensure residents are given medical/emergency help or protected from repetition of alleged abuse. Staff training records indicated that most but not all staff, had received Safeguarding Adults training, particularly newer staff had not. Three training sessions in Safeguarding Adults were scheduled to be held in May where it was reported most staff would attend. One Safeguarding Adults investigation is currently being drawn to a close by the Provider. The concern was raised to the Commission for Social Care Inspection and Derbyshire County Council Safeguarding Adults procedures instigated. Referral was subsequently made to the provider for them to investigate the full outcome is not known at this time. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ongoing maintenance and improvement of the home takes place and the home is generally comfortable and clean for residents to live in. EVIDENCE: Ashgate House is not a purpose built home and whilst being converted from a period property has the advantages of larger rooms and period features such as fireplaces, ornate high ceiling and large windows it has the problem of being difficult to maintain. Work is ongoing to try to maintain standards. The communal lounges have been decorated since the last inspection and were clean and well maintained. There were two lounges and two dining rooms. One being quieter than the other and it seemed that residents each sat in the rooms they preferred. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 18 A paved garden area is available for residents with seating and tables for residents, staff said these were used in the warmer months. Since the last visit the majority of bathrooms have been fully refurbished. This had significantly improved the environment of the home. The refurbishments had been done to a good standard with three quarter tiling to walls and new flooring. Residents had a choice of bathing or showering. Further refurbishment was underway. Two bathrooms had windows which were not fitted with opaque glass. Blinds/curtains were fitted to protect the dignity of residents. A sample of bedrooms were viewed and all had some personal effects such as pictures, ornaments and photographs. Residents said they liked their bedrooms. Some bedrooms were shared and screens were fitted in these rooms to offer privacy to residents. Staff reported some new furniture had been purchased to upgrade rooms. Throughout the home in corridors and bedrooms there were areas of paper and paint peeling. Some ceilings were in need of repair after water leaks and aspects of general wear and tear. Carpets and flooring were in generally good order apart from one bedroom where a strange discolouration of the carpet had occurred. The handyman was spoken with regarding the checks he did to ensure the fire alarm was functioning and water temperatures did not pose a risk of scalding to residents. A maintenance book was in place and items were signed off when they were completed. The home was found to be clean and did not have any odours present. Dedicated domestic and laundry staff were employed 7 days per week to maintain standards. Residents spoken with said the home was clean and bedding was changed regularly. The laundry area was fitted with two washers and two dryers which were generally reported as functioning well. Garments were hung and returned to rooms by staff. The appearance of the clothes being worn by residents was that they appeared clean and ironed and well cared for. Two complaints had been received regarding laundry being lost and mixed up but this has been rectified. It was said that labelling of clothing had improved to include residents surnames to ensure they were wearing their own clothing. Staff had access to aprons and gloves and were observed to use these when attending to residents and when serving meals. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff at the home were present in sufficient numbers and demonstrated a good knowledge of residents needs. The provision and recording of training had gaps which may adversely affect the service delivered. EVIDENCE: The occupancy of the home was 29 residents at this visit with 23 of these residents needing personal care only. The staffing levels of 6 staff for morning and afternoon shifts and 2 care staff at night with at least one nurse for all shifts appeared to reflect the complex needs of some residents, some of which were funded for additional hours over the above usual fees payable. There has been some defining of staff roles since the last inspection with one Nurse taking on responsibility for the management of care. Some Care staff have designated as Senior Care and some staff have taken on responsibility for ensuring chiropody, dentist and optical needs are met. Observations of general care practices indicated that there were staff around to observe residents and where residents required help to eat this was done by a dedicated staff member sitting with them. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 20 A range of staff were spoken with regarding different aspects of care. All staff seemed to be knowledgeable about residents. Residents spoken to said staff were kind and came quickly when needed. A sample of three recruitment files were examined to assess if recruitment practices ensured staff were suitable to work with vulnerable adults. The files were well organised and largely contained all required checks including Criminal records Bureau checks and application forms. One deficit was found in that one file had only one reference in it when two are required. The training records were examined to establish if staff received training to enable them to have the skills to meet residents needs. There appeared to be some gaps in the training matrix available notably moving and handling seemed to be out of date for some staff. For others certificates were later found but the records did not contain the date of the training. The Acting Manager said that they and an additional staff member were in the process of completing a Moving and handling trainers course and that training was planned for May. It was also reported that a company had been sought to provide ongoing training in a range of subjects over the next year and a planner had been produced which was available. The staff whose files were examined indicated that some training had been received in Health and Safety, fire, basic food hygiene, challenging behaviour, Safeguarding Adults and equality and diversity. Not all staff had completed all training courses. Training was particularly found to be poorly documented where staff worked at the home on a bank basis. The home currently employed 20 care staff of whom 6 had achieved National Vocational Qualification level 2 or above. Some of these staff included agency staff who were working at the home to maintain staffing levels whilst care staff were being recruited. Some staff were working towards achieving a National Vocational Qualification. A skill based induction pack was available and supervision records examined indicated that staff had worked through this. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the people being supported, with systems in place that monitor how well it does its work. EVIDENCE: Since the last inspection there has been a change in Managers and an Acting Manager is in post. The providers have ensured there is a Manager in the home and there was a handover period between the Managers. The Acting Manager is a Registered General Nurse who has had previous home management experience. The Commission for Social Care Inspection registration process has also been started to register the Manager. The Acting Manager has been in post since 11th February 2008. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 22 It is evident that since the last inspection there has been some work done on improving the quality assurance processes in place. A relatives survey had been completed in November 2007 and a relatives/residents meeting was held on 11.3.08. A staff meeting has also been held in March. The findings of the relatives survey has been summarised in a bar chart format. This would not be an easy format for most people to understand and there were no quotes from relatives. Despite this the general feedback was found to be good. Feedback from relatives at the meeting was positive about the environmental upgrade of the home. The Acting Manager has also completed some auditing such as accidents and the laundry to identify if the service provided has deficits. The Provider has completed some Regulation 26 monthly visits although the recent ones do not quite meet the frequency of being done monthly. At each visit the record documents where staff and residents are spoken with and some records are viewed. Some monies are stored safely for residents and records are kept which contained two signatures to verify transactions. Three balances were checked two of which balanced, the money for one resident could not initially be found but was located and balanced. Some valuables were being stored for which there was no record. This has the potential for items to be missing and staff be unaware of this. The availability of monies gave residents the opportunity to access hairdressing, chiropody and the ‘goody’ shop run by the activity coordinator. The records told staff who provided the personal allowances for residents. The Acting Manager has implemented a system of staff supervision. Most staff have signed supervision agreements and initial supervisions have taken place. The supervisions documented included consideration of training needs. At supervision sessions it is documented that staff were issued with the General Social Care Council Code of Conduct Booklet. A sample of service records and the details provided before the visit on the Annual Quality Assurance Assessment indicated that checks on appliances and fixtures in the home were up to date. Where accidents had occurred the accident records were kept in residents care files. Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 x x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x 2 x x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 3 x 3 Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5 Requirement Service users must be provided with adequate information regarding the home which includes a Terms and conditions of residency contract in order that they can make informed choices Some progress has been made at this visit but is ongoing Previous timescale 31/07/07 2 OP9 13 (2), 17 (1) (a) Where entries on the medication administration record are handwritten these must be checked and verified by a second staff member - and signed/dated to ensure residents receive the correct medication Where variable dosages are prescribed staff must record the actual dosage given to ensure a complete record of treatment received by the resident is kept To ensure staff are suitable to work with vulnerable adults all required checks as detailed in Schedule 2 must be in place DS0000066966.V363231.R01.S.doc Timescale for action 31/05/08 31/05/08 3 OP9 13 (2), 17 (1) (a) 31/05/08 4 OP29 19 31/05/08 Ashgate House Nursing and Residential Home Version 5.2 Page 25 prior to staff commencing in post. On this occasion 5 OP30 18 An assessment of training needs must be made and provision of training put in place for staff to ensure they have the skills and competencies to meet the needs of residents Measures must be put in place to screen the clear glass bathroom window to sufficiently ensure service users dignity and privacy is maintained Previous timescale 30/06/07 30/08/08 6 OP21 12 30/06/08 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 2 Refer to Standard OP12 OP18 Good Practice Recommendations It should be considered if residents would benefit from a loop system for the hearing impaired The Safeguarding Adults procedure must be clear in detailing processes to be followed and consider what emergency/interim measures are required to assist/ protect residents A system of recording where residents valuables are stored safely on their behalf should be implemented 3 OP35 Ashgate House Nursing and Residential Home DS0000066966.V363231.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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