Care Home: Ashgrove House

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What the care home does well The management and administration of the home is done in a way that promotes the best interests of the people living in the home, and it is clear that the manager and staff have done a lot of work to ensure that people are not at risk by poor medication procedures. People who live at the home are supported by an appropriately recruited and well-trained staff team who are kind and respectful in their approach. People who live at the home enjoy a comfortable and clean environment. Systems are in place to give people confidence that their complaints will be appropriately dealt with and that people who live at the home are fully protected as far as possible from abuse. People who live at the home benefit from being supported to make choices and are generally happy about their lifestyles and now benefit from activities that are provided via an activities worker. People also benefit from good care planning and delivery of care from staff who treat them with respect. People are not admitted without being assured, through assessment, that their needs can be met at the home. What has improved since the last inspection? What the care home could do better: This visit did not identify any problems or issues at the home. The owner has the Commissions document called "Key Lines of Regulatory Assessment", which details what a poor, adequate, good or excellent service should look like. She will be looking at how further good practice improvements can be made to the service over the forthcoming months to further develop the quality of care provided. CARE HOMES FOR OLDER PEOPLE Ashgrove House 116 Manygates Lane Sandal Wakefield West Yorkshire WF2 7DP Lead Inspector Tony Brindle Key Unannounced Inspection 19th November 2007 10:00 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 Ashgrove House DS0000068472.V355232.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. Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashgrove House Address 116 Manygates Lane Sandal Wakefield West Yorkshire WF2 7DP 01924 255540 01924 253660 ashgrove@dsl.pipex.com 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) Warmest Welcome Ltd Elaine Tucker Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (30), Physical disability over 65 years of age (30) Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th May 2007 Brief Description of the Service: Ashgrove House is a care home offering personal care and accommodation to 30 older persons, a high percentage of whom have dementia or mental health care needs. The accommodation is an adapted detached Georgian property, which operates over four floors. Twenty-four of the rooms are for single occupancy and three for double occupancy. There is one large and one smaller lounge area, which are open plan to each other and a separate dining area. The floors are connected by a passenger lift and there is a stair lift between the first and second floors. There is a car park to the front of the property and a garden to the rear. The accommodation is sited at a main road junction in the residential area of Sandal on the outskirts of Wakefield. The home was registered to Warmest Welcome Ltd in 2007, and the new owners have started a complete refurbishment of the property. The manager informed the Commission that the charge for living at the home, as of November 2007, is £359 per week with extra charges made for hairdressing, newspapers and private chiropody. Information about the home is available within the Statement of Purpose and the Service User Guide, which are given to everybody who lives at the home and people enquiring about moving into the home. Details of the Commission for Social Care Inspection are included within the Service User Guide Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit started at 10:00am and ended at 15:00pm. This was a very positive and enjoyable visit. There was the opportunity to speak to people living at the home as well as the registered manager, registered providers and care staff. The care plan files of people living at the home were seen and included assessments, care plans, daily and medical records and the record of activities. Staff records were also seen and included, application forms, references, police checks, training and supervision records. A sample of peoples’ medications were checked and a look around the home was undertaken. Other information considered was the homes returned Annual Quality Assurance document and surveys that were returned Commission for Social Care Inspection. A good number of people responded to our survey, and the feedback received was positive. The inspector would like to take the opportunity to thank the manager and her staff team for their hospitality and people using the service and their relatives for their patience and co-operation throughout the visit. What the service does well: What has improved since the last inspection? Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 6 The issues that were found at the last visit with the way medications were being dealt with have been rectified, therefore improving people’s health and well-being. The décor has improved, providing a more attractive place for people to live. Care planning has got better with the staff looking at and supporting people’s mental health and social needs, not just their physical needs, which means people should have their care needs met. 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. Ashgrove House DS0000068472.V355232.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 Ashgrove House DS0000068472.V355232.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. (Standard 6 is not applicable as the home does not provide intermediate care) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are not admitted without being assured, through assessment, that their needs can be met at the home. EVIDENCE: Feedback from people who completed our survey indicated that they were satisfied with the information they had been given about the home prior to moving in and were happy about the way their move had been carried out. The home does not provide intermediate care. The manager said that no one is admitted to the home until a full needs assessment has been undertaken by her (or the senior staff if she is not available). She added that this applies to all people, including those who are self funding. The records confirmed this. The manager explained that admissions to the home only take place if the service is confident staff have the skills and ability to meet the assessed needs of the prospective new person. One staff member said that people looking at moving into Ashgrove Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 9 House would be given the opportunity to spend time in the home, prior to them moving in. The manager confirmed this. People living at the home said that they had been given enough information about the home and the service it provides before they moved in. Feedback from relatives confirmed that they had been given enough information about the to make an informed decision before their relative moved in. One of the owner’s of the home spoke about some intended planned good practice development of an information pack to accompany the home’s Statement of Purpose and Service User Guide. Ashgrove House DS0000068472.V355232.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, and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live at the home benefit from good care planning, safe medication practices and delivery of care and from staff who treat them respect. EVIDENCE: The records show that personal healthcare needs, including specialist health nursing and dietary requirements, are clearly recorded in each person’s plan. The manager said that personal support is carried out in relation to the individual needs and preferences of the people who use services. One person living at the home said that the personal care given to them is consistent and that the staff are reliable. Staff were seen to respect the privacy and dignity of people in the home, and were seen to respond people’s individual choices and requests. The records show that home has a medication policy, which is supported by procedures. Medication records were found to be fully completed, contained the required entries, and were signed by appropriate staff. The manager Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 11 explained that regular management audits take place to monitor the medication. These records were seen and were found to be in good order, showing a steady increase in compliance from poor in May 2007 to very good in November 2007. The manager explained that she is looking at introducing a risk assessment that will be used to determine whether people who use services need to be given help to manage their medication. She added that if the assessment shows that people can self-administer their medication, then they will be given the opportunity to do this. The records show that the manager has in place a good record of compliance with the receipt, administration, safekeeping, and disposal of Controlled Drugs. The staff training records show that staff at the home have completed appropriate training in medication. The care plans were found to contain clear information about individual’s wishes, choices and decisions in relation to their healthcare needs. Information within people’s files showed what they can and cannot do, how the staff should support people and what to do if problems arise. The records show that care staff work to monitor pain, distress and other symptoms to ensure individuals receive the care they need. Staff working at the home confirmed this. Nutritional screening records were seen, and the manager said that this is undertaken on admission and subsequently on a periodic basis. The records confirmed this. A record is maintained of people’s weight gain or loss, and the records showed what action needs to be taken depending on either a weight gain or loss. The manager said that people are registered with a GP, and the records confirmed this. The records also show that people have access to hearing and sight tests according to their needs. Feedback from relatives confirmed that they believe their relative is looked after well, and that the staff at the home do consult them about aspects of care, that is then recorded in people’s individual care plans. People living at the home said that they believed they were well cared for, and one person said that the staff really know people as individuals and know what each person wants. Another comment from someone living at the home was, “We’re all different you know, and the staff know that as well. They do a good job”. Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live at the home benefit from being supported to make choices and are generally happy about their lifestyles and now benefit from activities that are provided via an activities worker. EVIDENCE: Staff working at the home said that people who use the service have the opportunity to develop and maintain important personal and family relationships. One person living at the home said that their relative can come and see them at any time, and they added, “That’s really important because you can loose touch with what’s going on in the big wide world”. Visiting relatives were seen to come and go throughout the day, and those who were spoken with said that they are made to feel welcome and that they feel their relative is being well cared for at Ashgrove House. The manager explained that various different in-house and external activities are on offer to people living in the home. This was supported by information held within people’s individual files. People living in the home spoke about this, and confirmed the information given by the manager. Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 13 The menu was seen to be varied with choices of food. The menu was seen to be balanced and providing nutritional value. The staff at the home said that the cook does cater for the varying dietary needs of the people living at the home. People confirmed this saying that the food was very nice. Feedback from relatives confirmed that they believe the food to be of a good quality. One person living at the home said, “I think we get too much food, but I’m not complaining. It’s really nice, like a hotel”. An observation made at mealtime showed that meals are presented in an attractive manner and that people living at the home were enjoying their food, and being supported appropriately. One person living at the home said that there is a good choice of meals, which the menus confirmed. Staff were seen to interact with people in positive ways, enjoying pleasant conversation and offering people drinks whilst talking about peoples day. Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Systems are in place to give people confidence that their complaints will be appropriately dealt with and ensure that people are safeguarded. EVIDENCE: The owners of the home said that they have tried to foster an open culture that allows people to express their views and concerns in a safe and understanding environment. One person living at the home said that they could go and speak to any staff member about problems, and added that the new owners are approachable. The records show that there is a complaints procedure that is clearly written and easy to understand. One of the owners said that if people wanted it put into another format (e.g. on a tape), then this could be done very easily. At present, no one has asked for this to be done. The records show that there is a full record of complaints and this includes details of the investigation and any actions taken. The policies and procedures for Safeguarding Adults were seen to be available to people living at the home, staff and relatives. After talking with staff at the home, it was clear that they understood the procedures for safeguarding adults. The records show that there are a low number of referrals, and the manager said that this is due to lack of incidents, rather than a non-reporting of events. The manager explained that training of staff in the area of protection is regularly arranged. Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 15 This was supported by documents found within people’s individual training files. People living in the home spoke about feeling safe in the home, and also that they knew who to speak to if they wanted to complain. Feedback from relatives confirmed that they too believe their relative to be safe in the home, and know who to speak to about complaints. Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live at the home enjoy a comfortable and clean environment. EVIDENCE: A walk around the home found that it is well maintained, pleasantly decorated and of a suitable layout for the people living at the home. One of the owners explained that there are plans to build an extension to the home. This will contain a new lift and some new bedrooms, however, there aren’t any plans to increase the numbers of registered bedrooms. The owner explained that the rooms that are currently shared rooms will be made into single rooms, and the rooms that form part of the extension will also be single en suite rooms. Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 17 The manager explained that people who use services are encouraged to personalise their bedrooms. This was supported looking at people’s individual rooms. People living in the home spoke about this, and confirmed the information given by the manager. The shared areas were found to provide a choice of communal space and one staff member said that opportunities are created for relatives and friends in private. People living in the home spoke about this, and confirmed the information given by the staff member. The bathrooms and toilets were found to be are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and were found to be in sufficient numbers and of good quality. The home was found to be well lit, clean and tidy and smelling fresh. The manager has a good infection control policy and the manager explained that she would seek advice from external specialists, e.g. infection control if and when required. People living at the home said that it is easy to get around the home. Feedback from people who completed our survey indicated that they believed that the home is kept clean and hygienic. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten. Appropriate hand washing facilities are available; the records show that there is an appropriate infection control policy and procedure in place. Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are supported by an appropriately recruited, well-trained staff team who are kind and respectful in their approach. EVIDENCE: The rotas show that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. Observations on the day found that they were sufficient numbers of staff on duty that were able to meet the needs of the people living in the home. The records show that staff members undertake external qualifications beyond the basic NVQ II. The manager said that the staff receive relevant training that is focussed on delivering good outcomes for people using the service. This was supported by information held within people’s individual files and confirmed by staff. The staff training records confirmed that staff receive training in areas such as health and safety, fire safety, movement and handling, safeguarding, and food hygiene. Feedback from people who completed our survey indicated that they believed that the staff were well trained. The manager explained the recruitment procedure, which was found to be satisfactory. She said that two written references are obtained before appointing a member of staff, and any gaps in employment records are Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 19 explored. The records confirmed this, and show that new staff are confirmed in post only following completion of a satisfactory police check, and satisfactory check of the Protection of Vulnerable Adults register and Nursing register. The records show that staff meetings take place. Individual staff files detail that supervision sessions are regular and staff confirmed that they find them helpful. The records show that induction procedures are in place and that new staff receive the new induction in common standards in line with the Skills for Care Council. One staff member discussed the induction process and was able to talk at length about topics such as understanding principles of care, maintaining safety at work and recognising and responding to abuse and neglect. The records show that National Vocational Qualification (NVQ) training has been arranged for care staff and that 18 out of the 23 care staff hold an NVQ II care award. Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 20 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, and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service People best interests are promoted by the management and administration of the home, and it is clear that the manager and staff have done a lot of work to ensure that people are safeguarded. EVIDENCE: The Commission records show that the manager has the required qualifications and experience to run the home, and that she is registered with the Commission. The manager explained that she and the staff undertake routine health and safety checks. This was confirmed by people living in the home and supported by information held within the office files and all was found to be in good order. The records show that the home has good policies and procedures in Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 21 place, and the manager and owner explained that they review and update these as and when required. The records confirmed. There is evidence is show that the home has a quality assurance and quality monitoring system which is based on the views of people living in the home, with feedback from relatives and visiting healthcare professionals gathered. The records show that there is suitable insurance cover in place and the certificates are displayed in the office of the home. The manager said that the home does not hold money for people. However, if the money of individuals needs to handled at the home, then there are systems in place to make sure that the personal allowances are not pooled and to make sure that appropriate records and receipts would be kept. The records show that the care staff receive formal supervision at least 6 times a year. One staff member said that supervision usually involves talking about the care people need, how the home should operate and their own training needs. The manager confirmed that she also gets supervision from one of the homeowners. The records confirmed this. The records show that the staff have had training in health and safety, fire, movement and handling, food hygiene, safeguarding, infection control and first aid. The manager said that she undertakes checks on issues such as the risk of Legionella, risks from hot water/surfaces, Gas and electric safety, Fire safety and maintaining equipment e.g. hoists. The records confirmed this. Feedback from people who completed our survey indicated that they feel safe living in the home, and that they believe it is well run Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 22 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashgrove House DS0000068472.V355232.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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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