Care Home: Ashgrove Residential Care Home

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What the care home does well The manager is very proactive around health and safety and person centred care especially around the healthcare and personal care needs of all of the residents. There is an open ethos and culture and this was supported in discussions with residents and visitors, and also from correspondence which had been sent to the home by relatives. All residents have a comprehensive care plan which is regularly reviewed and updated where necessary. All appropriate and necessary risk assessments are in place for residents, staff and the home. The home is compliant with the Regulatory Reform (Fire Safety) Order 2005, and all staff undertake comprehensive fire safety training, in addition to other training as required. The menus are varied and food is well presented and residents told us that they enjoyed the meals and were involved in the planning of the menus. The nutritional needs of residents are monitored as are the weights, and referrals are made to specialists as necessary. The home is clean and free from offensive odours and is generally well maintained. What has improved since the last inspection? The requirements from the previous key inspection in 2007 have been met, and this has meant that there are now some external activities for the residents to enjoy. Regulation 26 visits, as required under the Care Homes Regulations 2001, are being undertaken on a regular basis. Staff are generally communicating better with residents, and this was confirmed to us in discussions with some of the residents who told us "the staff are lovely, kind and caring and nothing is too much trouble for them." What the care home could do better: Daily activities still need some improvement as discussed with the manager and the proprietor during the inspection. The proprietor has told us that she will shortly be employing an activities co-ordinator, and we are confident that this will happen. This will improve the stimulation and motivation available to people living at the home, and aid their retention of life skills and independence. The annual quality assurance assessment could be more comprehensively completed and again this was discussed with the manager and the proprietor during the inspection process. The proprietors need to give more impetus to the redecoration and refurbishment plan for the home, and this includes the promised landscaping to the external garden area. Again this will be beneficial for the residents whose home is Ashgrove. The proprietors are aware of this and we are confident that this will be done. Two requirements have been made: the first around the purchase of a specific controlled drugs cabinet as required by legislation, and also the need for advice on the use of keypads/locks from the London Borough of Havering deprivation of liberty safeguards team. This will ensure compliance with the deprivation of liberty safeguards, Mental Capacity Act 2005. Key inspection report Care homes for older people Name: Address: Ashgrove Residential Care Home 64-66 Billet Lane Hornchurch Essex RM11 1XA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Parnell-Hopkinson     Date: 0 3 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Ashgrove Residential Care Home 64-66 Billet Lane Hornchurch Essex RM11 1XA 01708458834 01708472294 care@ashgrovecarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Rajakala Elango,Mr Pathmanathan Elango care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 26 The registered person may provide the following category of service only: Home only Code P to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The registered manager for Ashgrove Residential Home is Ms. Lesley Burkett. The home offers 24-hour residential care to 26 people over the age of 65 years. The premises comprise a linked pair of Edwardian houses which have been modernised over the years as far as the building would allow. All rooms are spacious, airy and bright. They all have hand basins, TV points and a call system and some residents have their own telephone. The home has a passenger lift. There are two lounges with disabled access to the rear garden, and a dining room overlooking the garden. There is Care Homes for Older People Page 4 of 29 Over 65 0 26 26 0 Brief description of the care home disabled access to the front of the building, and there are also car parking facilities at the front of the property. The home is located on a busy road in Hornchurch, and is close to local services and facilities, including the Queens Theatre. Ashgrove Residential Home is easily accessible by car or by public transport and is situated in close proximity to the M25, A12 and A127. The statement of purpose and the last inspection report were available in the reception area, and a copy of the statement of purpose can be obtained from the home upon request. At the time of the inspection the fees are from £428 to £465. per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We did an unannounced key inspection on the 3rd August 2009 and arrived at the home at 09:00 hours and left at 17:45 hours. The manager was present throughout the inspection and we were joined later in the day by the proprietors. We spoke to residents, visitors and staff and also took evidence and information from records/documents which we viewed and from the annual quality assurance assessment (AQAA) which had previously been returned by the home as required by the Commission. The inspection process also included a tour of the home and taking information from notifications which had previously been sent to the Commission. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Daily activities still need some improvement as discussed with the manager and the proprietor during the inspection. The proprietor has told us that she will shortly be employing an activities co-ordinator, and we are confident that this will happen. This will improve the stimulation and motivation available to people living at the home, and aid their retention of life skills and independence. The annual quality assurance assessment could be more comprehensively completed and again this was discussed with the manager and the proprietor during the inspection process. The proprietors need to give more impetus to the redecoration and refurbishment plan for the home, and this includes the promised landscaping to the external garden area. Again this will be beneficial for the residents whose home is Ashgrove. The proprietors are aware of this and we are confident that this will be done. Two requirements have been made: the first around the purchase of a specific controlled drugs cabinet as required by legislation, and also the need for advice on the use of keypads/locks from the London Borough of Havering deprivation of liberty Care Homes for Older People Page 7 of 29 safeguards team. This will ensure compliance with the deprivation of liberty safeguards, Mental Capacity Act 2005. 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 29 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 29 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 who may use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: The registered manager understands the importance of having sufficient information available for prospective residents to help them make the right choice of home for them. The home provides a statement of purpose that is specific to the home and the resident group they care for. The guide details what the prospective residents can expect and gives a clear account of any specialist services provided, type of accommodation and how to make a complaint. The most recent inspection report is also available. The home also ensures that families understand dementia, and that the home is registered for both older people and people living dementia. Information is provided in formats which are suited to the needs of the people living at the home. Admissions are not made to the home until a full needs assessment has been Care Homes for Older People Page 10 of 29 Evidence: undertaken. The manager also visits prospective residents at his/her home and undertakes a full assessment to ensure that the home can meet the assessed needs. The assessment is conducted professionally and sensitively and involves the individual and his/her family where appropriate. Private residents have a contract and those funded by a local authority have a statement of terms and conditions which reflect the contract that the home has with the relevant local authority. Prospective residents and their families are invited to visit the home, on a day and time to suit them. They are invited to stay for lunch and longer if they wish, and can make a return visit to the home to aid their decision making process. The manager actively promotes and encourages opportunity for discussion and clarification of any issues that the prospective resident and or his/her family may have. Care Homes for Older People Page 11 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Residents receive effective personal and healthcare support using a person centred approach. Support is given based upon the rights of dignity, equality, fairness and respect. Staff spoken to were knowledgeable around the needs of the residents, and individual care plans clearly record the personal and healthcare needs and detail how they will be delivered. The home does have some shared rooms and these are only used as shared rooms when the residents using them have requested this. Screening is provided to ensure the privacy of each resident, and that this is not compromised when personal care is being provided, or at any other time. Shared rooms can also be relevant when couples are entering a care home and wish to be together. Personal support is flexible, consistent and is able to meet the changing needs of the Care Homes for Older People Page 12 of 29 Evidence: residents. One resident to whom we spoke told us the staff are excellent, and they are very kind and caring. From observation, documentation and talking to residents we are satisfied that staff respect peoples preferences and have knowledge about the individual personal needs when providing support including intimate care. The delivery of personal care is conducted in private and at a time and pace directed by the person receiving the care. Wherever possible all residents are encouraged to manage their own healthcare, with assistance from staff where appropriate. Regular healthcare appointments are viewed as important and the manager ensures that such appointments are not missed. All residents have access to healthcare professionals including GP, dentist, optician and chiropodist. The GP and the local district nursing service are very supportive, and on the day of the inspection we were able to talk to a visiting district nurse who had just administered insulin to a resident. She told us I have only been visiting this home for a short time, but I find it very caring, and the staff are knowledgeable about the residents. A letter from a relative said my father has now been with you since 2008 and I thought you may be pleased to know how happy I am that he is in your care. Lesley, Sarah and all the staff do a great job and I cannot thank them enough for their efforts. Their friendly, professional attitude is very much appreciated. Where necessary, arrangements are made for health professionals to visit residents in the home. The manager is aware of the Mental Capacity Act 2005 and where the need for an Independent Mental Capacity Assessor is required then this will, and has been, used in the best interests of a resident. Nutritional needs are assessed on admission and these, together with weights are monitored monthly, or more frequently if the need is indicated. The manager and her staff are alert to changes in mood, behaviour and general wellbeing and fully understand how to respond and take the necessary action. Where necessary appropriate risk assessments are in place to ensure that staff have the correct information and of the action to be taken in certain circumstances. Staff are trained in health care matters, particularly in the care of individuals who remain immobile for long periods of time. Training is also provided on other health care topics that relate to the health care needs of the residents. Aids and equipment are provided to encourage maximum independence for people, and these are regularly reviewed and replaced to accommodate changing needs. Specialist advice is sought by the manager to ensure the effective use of equipment. The home has an efficient medication policy and procedure and staff have access to Care Homes for Older People Page 13 of 29 Evidence: this written information and understand their role and responsibilities. The manager has audit systems in place to monitor medication within the home. We looked at the medication administration records (MAR), and medications and found these to be in good order with good records being kept. Staff involved in the administration of medication have received appropriate training. Although there were no protocols in place for PRN (as required) medication, the manager and her staff were knowledgeable as to when this should be administered. However, it is good practice to have such protocols written, and we are confident that this will be put into place as discussed during the inspection. Controlled drugs were being stored safely but not in the appropriate cabinet as now required by legislation. This was discussed and this will be a requirement in this report. The manager and her staff are highly efficient when caring fro residents who are terminally ill or dying. Many of the residents have a preferred place of care/end of life care plan in place. However, some residents do not have such a plan because either they or their families do not wish to discuss this difficult issue. The manager continues to work sensitively and sympathetically with all parties to address this important area of care. Staff are proactive and are sensitive to the particular religious or cultural needs of the individual or their family. The home has a policy and guidance to help staff when caring for residents with degenerative conditions, terminal care and death. All staff receive in house training and practical advice and have continuous support and opportunities to discuss areas of anxiety and concern. Letters from bereaved families have been received by the home, and one read Thank you so very much for what you all did for my mum, as well as for all the support you always gave to our family. Mum could not have had more care and affection then she received in Ashgrove from all the staff over the 7 years she was with you. You all seem to be part of our family now. Another read Thank you so much for the lovely flowers for mum. I know we have said this many times, but it will never be enough - the care and support you have given mum and us the past three years is so greatly appreciated - especially during mums last precious months. Your staff have been so friendly and made me almost feel part of a family - you should be so proud of them. If ever you need any form of recommendation, please do not hesitate to contact me. The manager and her staff work to a very high standard and constantly monitor pain, distress and other symptoms to ensure that individuals receive the care they need. The home works closely with external professionals and specialists for advice and support to help the resident, their family and the homes staff. Care Homes for Older People Page 14 of 29 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. Generally people who use services are able to make choices about their life style, and supported to develop their life skills. Staff endeavour to ensure that social, cultural, religious and recreational activities meet the individuals expectations as far as is possible. Evidence: The manager has a strong commitment to enabling residents to develop or maintain their skills and generally individuals are supported to identify their goals and work is undertaken to help them maintain and achieve these. An activity person is currently employed for 2 hours each Monday and this person organises activities, discussions and quizzes with the residents who generally sit in the smaller lounge. These activities have greatly improved the skills of those residents who told us that they really enjoy this session. Staff spend more of their time with those residents who are living with dementia, and who generally sit in the larger lounge. However, although these staff have had some training they need to be able to interact more with the residents to ensure that they receive stimulation and their life skills are retained. People living with dementia Care Homes for Older People Page 15 of 29 Evidence: generally have a very limited concentration span and staff need to appreciate this, and be prepared to change activities at a moments notice. During the inspection we did observe staff trying hard to engage residents living with dementia, but they did appear to give up quickly and then tended to stand around not knowing what to do. The manager has identified the need for a person to be employed who will lead on the provision of activities, and during discussions with both the manager and the proprietor we have been assured that such a person will be employed in the very near future. The proprietor also recognises the need that the staff need direction and encouragement to ensure that all of the residents require stimulation and motivation to retain their skills. Activities can include staff assisting residents to tidy their wardrobes or drawers, just go for a walk in the garden, help with laying tables or folding napkins. The home does purchase 3 newspapers daily for the residents, and again staff could sit and read these to some of those residents who no longer have these skills. Staff were seen to be attentive and ready to give assistance where required. Recently many of the residents have enjoyed a trip to Southend, and another such trip has been planned with the residents who have chosen Southend because it is not too far and they like going there. The home hires transport from the London Borough of Havering, and we were told that the transport staff are very helpful. All of the residents are enabled to develop and maintain important personal and family relationships, and relatives are welcomed into the care home at all times. This was confirmed by residents and staff spoken to, and also through documentary evidence. A quote taken from a letter was Your staff have been so friendly and made me almost feel part of a family - you should be so proud of them. Whenever possible relatives are involved in the celebrations within the home, and the home will be shortly organising a summer barbecue, weather permitting. Through information and discussions with the manager and staff, relatives are also helped to understand dementia and through this are supported to continue to be involved in the care of the residents. There is a small library which has books available in large print and some of the residents enjoy reading these books. The religious needs of residents are respected and promoted in accordance with individuals wishes, and religious meetings are held at the home from time to time. Residents are involved in the development of the menus, and some spoke to told us that they really enjoy the food. It is well presented and they have choices. Drinks and Care Homes for Older People Page 16 of 29 Evidence: snacks are available for the residents at all times, and this includes during the night should any request these. Menus are varied and sometimes includes dishes that encourage individuals to try new and sometimes unfamiliar food such as a curry. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance at mealtimes. Staff are aware of the importance of giving assistance at the pace of the resident, making them feel comfortable and unhurried. Mealtimes can be flexible to suit the needs of the residents. Lunch time has been moved to 1p.m. because the home found that this time suited the needs of the majority of the residents. The service understands and actively promotes the importance of respecting the human rights of residents, with fairness, equality, dignity respect and autonomy all being seen as central to the care and support being provided. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure and are protected from abuse and have their rights protected. Evidence: We viewed the complaints log and spoke to staff, residents and visitors and there are no outstanding complaints. Residents told us that they knew about the complaints procedure and that they would speak to the manager if they had any concerns because she always deals with them immediately. The home has an open culture that allows residents and relatives to express their views and concerns in a safe and understanding environment. The service has a complaints procedure that is given to all residents and is also available to visitors. It is made available in various formats, including large print to make it easier for those people who have some difficulties in reading. The manager ensures that lessons learned from complaints are used in a positive way to improve the service to residents. The policies and procedures for safeguarding vulnerable people are available to all members of staff and give clear specific guidance to those using them. Staff spoken to were aware of the procedures to follow in the event of any safeguarding incident seen Care Homes for Older People Page 18 of 29 Evidence: or heard by them. There is a clear system for staff to report concerns about colleagues and managers. Staff who whistle blow on bad practice would be supported by the service. The manager understands the procedures for safeguarding adults and would always attend meetings or provide information to external agencies if requested. There have not been any referrals because of a lack of incidents. We are confident that in the event of a referral the manager would ensure that the outcomes would be managed well and issues resolved to the satisfaction of all involved. Training of staff in safeguarding is regularly arranged by the service and other training around dealing with physical and verbal aggression is also made available to staff as appropriate. Staff understand what restraint is and alternatives to its use in any form would always be looked for. Equipment that may be used to restrain individuals such as bed rails, keypads, recliner chairs and wheelchair belts are only used when necessary. People are involved in the decision making process about any limitations to their choice in this area. Individual assessments are always completed with the involvement of the resident where possible, their representatives and any other professionals such as the social worker or the GP. With the introduction of the deprivation of liberty safeguards (DOLS) under the Mental Capacity Act 2005, to ensure that no resident is being deprived of their liberty through the use of keypads or locks, currently used for the security of the home, we are requiring the service to seek advice from the London Borough of Haverings DOLS team. This was discussed with the manager and the proprietor during the inspection process. Care Homes for Older People Page 19 of 29 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. Residents can be sure that they live in a home that is safe, well-maintained and comfortable and encourages independence. Evidence: We understood a tour of the home and found it to be clean and free from offensive odours. The home does have an ongoing programme of refurbishment and redecoration and some areas were in the process of being redecorated. This included the large lounge area. Previously there had been one very large lounge but some of the residents were unhappy with this, and therefore this has now been altered to be one smaller and one large lounge. Although carpets are cleaned and shampooed on a regular basis, some areas are now showing signs of deep staining and there are plans for these to be replaced once the redecoration has taken place. It is to be hoped that this programme will be made a priority for the owners, and that it will be completed in good time. Bedrooms are personalised according to the wishes of the individual, and are redecorated when required, but especially when a new resident moves in. There are still some shared rooms but there use is only by agreement with the people concerned. Screens are provided for privacy and the rooms reflect the chosen decor and personal belongings of both people. Some shared rooms are used for single Care Homes for Older People Page 20 of 29 Evidence: occupancy. A married couple will be moving into the home shortly, and were very pleased to find that they could have a shared room as other homes have had only single rooms. The kitchen area is clean and following a visit from the local environmental health officers in February 2009, all of the recommendations made have been complied with. The kitchen has also now been fitted with a new extractor canopy over the cooker. The previous food store has now been altered to be a staff room, and the previous garage has been altered to be a food store which is much more convenient as it is at the front of the home and next to the kitchen. Because of this change of use, the advice was sought from the homes fire safety consultant who was visiting on the day of the inspection. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the residents and are in sufficient numbers. The rear garden is generally well maintained, but previously the owners had agreed to this being landscaped for the benefit of the residents. This landscaping has not yet been undertaken and it is hoped that the owners will make the changes as previously promised. Some relatives have also asked when this work will be carried out. The management has a good infection control policy and the manager will seek advice from external specialists, and also ensures that staff work to the homes policy to reduce the risk of infection. On the day of the inspection we were able to speak with the fire safety consultant, who was also visiting, and he confirmed that the homes fire risk assessment is compliant with legislation. Care Homes for Older People Page 21 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and skilled and are in sufficient numbers to support the care needs of the people who use the service. Evidence: We spoke to many of the residents and some visitors, and also looked at documentation, and were told that the staff are very kind and caring and that the residents have confidence in the people caring for them. On the day of the inspection there were sufficient care staff on duty to meet the assessed needs of the residents. However, as previously mentioned in this report staff need more training and support in the delivery of daily activities/skills to daily living. Staff members undertake external qualifications and currently 75 of the care staff have achieved NVQ level 2 (National Vocational Qualification). The manager encourages training and recognises the benefits of a skilled, trained workforce. Staff spoken to confirmed that the training is good. Staff have job descriptions and specifications clearly define the roles and responsibilities of staff. The staffing structure is based around delivering outcomes for residents, and there has not been any use of agency staff. This has been beneficial for residents who have received more consistent care. The manager has contingency plans for cover for vacancies and sickness and generally the permanent staff will cover vacant shifts. Care Homes for Older People Page 22 of 29 Evidence: Staff meetings take place regularly and all staff receive regular supervision in line with the National Minimum Standards. The manager has plans to make some changes to the recording of supervision so that the direct observations of care practices are included in the formal supervision sessions. Direct observations of care practices do currently take place but are not recorded as formal supervision. On the day of the inspection fire safety training was being undertaken for staff. The inspectors were invited to attend and found that this training was very relevant to Ashgrove, informative and made staff think about fire safety for the residents and themselves. The manager is very proactive in training, especially in health/safety and other related courses. There is a good recruitment procedure, and this procedure is followed in practice and the staff files viewed confirmed that the necessary application form, interviews and references have been taken up. The manager has plans to involve some of the residents in the future interview process, and this was discussed during the inspection. Care Homes for Older People Page 23 of 29 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 management and administration of the home is based on openness and respect, and generally has effective quality assurance systems. Evidence: The registered manager has the required qualification and experience, and is highly competent to run the home and meets its stated aims and objectives. The manager communicates a clear sense of direction and is able to evidence a sound understanding and application of best practice operational systems, particularly in relation to continuous improvement for customer care and health and safety. Equality and diversity, human rights and person centred thinking are given priority by the manager who is able to demonstrate a high level of understanding and demonstrates best practice in these areas. Satisfaction surveys are undertaken and there are relatives meetings which also include residents who wish to attend. The manager is aware that she does need to increase the frequency of the residents/relatives meetings and will be addressing this issue. This was discussed during the inspection process. Care Homes for Older People Page 24 of 29 Evidence: There is a strong ethos of being open and transparent in all areas of running of the home, and this was confirmed in discussions with residents, visitors and some staff. The managers practice, skills and knowledge are based on continuous development gained through training and enthusiasm for the role. There are sound policies and procedures which are reviewed and updated in line with current thinking and practice. The manager ensures that staff follow the policies and procedures of the home, and there are effective systems to monitor staff adherence to policies and procedures. The home works to a clear health and safety policy and staff are fully aware of the policy and are trained to put theory into practice. Regular random checks take place to ensure that staff are working to the policies and procedures of the service. On the day of the inspection comprehensive fire safety training was being undertaken by a fire safety consultant, and this training was specific to Ashgrove. Records are of a good standard and are routinely completed. Maintenance records were viewed and all were up to date as was the insurance for the home. Appropriate and necessary risk assessments are in place, including a compliant fire risk assessment. On a daily basis the manager walks the home to ensure that there are no hazards or areas that need attention by the handyperson. The home does not hold money for residents, but those residents who manage their own money are supported to do so. The home will pay out monies for residents who need their hair done or other needs, and will then invoice for the recovery of the expenditure. The annual quality assurance assessment was completed and returned to the Commission as requested. However, this could have been much more comprehensive and this was discussed during the inspection process with the manager and the proprietor. The home continues to inform us of incidents at the home as required under Regulation 37 of the Care Homes Regulations 2001, and the proprietor continues to undertake visits as required under Regulation 26 of the Care Homes Regulations 2001, and copies of the reports of these visits are maintained within the home. Although the proprietors are supportive, they do need to be more proactive in ensuring that the redecoration and refurbishment programme is implemented in good time for the benefit of the residents and staff, and this does include the promised landscaping to the garden and the employment of a promised activities co-ordinator. Care Homes for Older People Page 25 of 29 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 26 of 29 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 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The secure storage of controlled drugs is specified in the Misuse of Drugs (Safe Custody) Regulations 1973. In the 2007 Amendment the term nursing home has been placed by care home. The requirements for CD storage are: metal cupboard of specified gauge; specified double locking mechanism, fixed to a solid wall or a wall that has a steel plate mounted behind it., fixed with either rawl or rag bolts. Suppliers of CD cabinets can confirm compliance with legal requirements. 31/08/2009 Care Homes for Older People Page 27 of 29 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 2 18 13 The registered person shall make arrangements, by training or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered persons are required to seek advice from the LB Haverings DOLS team regarding the use of keypads/locks. This is to ensure that nobody is deprived of his/her liberty under the Mental Capacity Act 2005. 30/09/2009 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 19 The registered persons are recommended to ensure that the redecoration and carpet/flooring replacement, together with the landscaping of the garden are given a priority and completed as soon as possible for the benefit of the residents whose home is Ashgrove. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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