Care Home: Ashlands Care Home

What has improved since the last inspection? Information about the home in the form of the service user guide has been improved so that it is easier for people to understand. People are given a copy of the terms and conditions of occupancy which keeps all parties informed. Medication systems have improved in some areas; a medication fridge has been provided and is used for storing medicines that require cold storage. People who like to spend time in their bedrooms are visited by the activities co-ordinator to make sure that they gain some social stimulation. There have been a lot of improvements made to the home to make sure the environment is developed to meet the needs of the people who live there. Some of these improvements are still ongoing. The lounge carpet has been replaced, fire doors are not held open by inappropriate means and the humid atmosphere on the upper floors of the home has been addressed to a large extent, to make sure the home is pleasant and safe for people who live and work there. Items stored in the kitchen yard to be discarded have been removed; this helps to keep the yard tidy. Staff receive regular safeguarding training which helps to protect people.Ashlands Care HomeDS0000071511.V375526.R01.S.doc Version 5.2 Page 7The care staff have achieved a fifty percent ratio who hold the National Vocational Qualification in Care at level two or three, this helps to enhance the care that people can receive. Staff have been able to speak with and develop their relationships with the Roche Healthcare management team since the home was acquired by this company so that staff feel listened to. What the care home could do better: Care plans must reflect people`s full and current needs, so that staff are well informed. Medication records could be better maintained to evidence that people are receiving medication as prescribed. Activities being provided should continue to be developed so that people always gain the social stimulation they require. The fridge and freezer temperatures for cold food storage should have their temperatures recorded daily to make sure food items continue to be stored within the correct temperature range to maintain food safety. The commission should be notified of all safeguarding incidents so that people are well supported. The temperature of the upper floors of the home should continue to be monitored and further action taken if it is felt the environment is too hot. This will make sure the environment remains comfortable for people who live and work there. Missing and damaged floor tiles in the laundry should be replaced to make sure that thorough cleaning can take place to help maintain infection control. Staffing levels should continue to be monitored to make sure there is enough registered nurse cover to give the nursing input people need. Better evidence of the auditing of personal allowance accounts should be available within the home. So that if people wish to see their record`s they are available. The clinical waste bins should have all items placed inside them and the lid should be closed before being locked to make sure clinical waste is stored securely. Key inspection report CARE HOMES FOR OLDER PEOPLE Ashlands Care Home 41 Main Street Methley Leeds Yorkshire LS26 9JE Lead Inspector Denise Rouse Key Unannounced Inspection 26th May 2009 10:10 DS0000071511.V375526.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 2 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 Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashlands Care Home Address 41 Main Street Methley Leeds Yorkshire LS26 9JE 01977 515823 01977 517130 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) Roche Healthcare Limited Susan Coleclough Care Home 50 Category(ies) of Dementia (50), Mental disorder, excluding registration, with number learning disability or dementia (50) of places Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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 are within the following category: Dementia - Code DE, maximum number of places: 50 Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places: 50 The maximum number of service users who can be accommodated is: 50. 5th June 2008 2. Date of last inspection Brief Description of the Service: Ashland’s provides 50 places for people who require nursing care with dementia or mental health needs. The home stands in its own grounds and has accommodation provided over three floors. There are passenger lifts to help people gain access to all areas of the home. There are small gardens and a small car parking available at the home. The home is situated in Mickletown an area of Methley, a former mining village between Castleford and Leeds. There are local village shops and good transport link to both towns. Information about the home is available in the statement of purpose and service user guide. The last inspection report is also available for people to look at. Fees charged on the day of the site visit ranged from £599.63 to £710.00 including the Registered Nurse Care Contribution. Extra charges are made for private chiropody and hairdressing. Ashlands Care Home DS0000071511.V375526.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 two star – good service. This means people who use this service experience good quality outcomes. The evidence used in this report has includes: A review of the information held on the homes file since its last inspection. Information submitted by the registered provider in the Annual Quality Assurance Assessment, AQAA. Information received from surveys completed by seven people living at the home and one member of staff. An unannounced visit to the home which lasted five hours, undertaken by one inspector. Evidence gained by direct observation during the site visit. This involved speaking with people living at the home, to some relatives, the deputy manager and staff from all departments to gain their views. Inspection of records, including care profiles, medication administration records, staff files and some of the homes policies and procedures. We have reviewed our practise when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations. But only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will take place. What the service does well: The service user guide is very informative and contains pictures of the home and the village which helps people to understand what the home has to offer them. Peoples needs are known so that their needs can be provided for. People are not admitted to the home if their needs cannot be met. People said they received care in a way that respected their privacy and dignity. Specialist equipment is available in the home so peoples special needs can be met. An activities co-ordinator has been employed and an activities programme has been created for people so that their social needs can be developed. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 6 The home is being improved so that it can meet people’s special needs and to make sure it is pleasant for people to live in. Staff receive regular training to keep their skills up to date. Comments received from completed surveys included: “The manager is approachable and I can always discuss any concerns with her. I believe that Ashland’s gives XXX the most appropriate care and meets XXX current needs and any minor problems are usually resolved”. “I am relieved that XXX is in a place where I know and can see that people are cared for and respected”. “It is a pleasant and happy environment this gives me relief and contentment”. “Staff always contact me if there are any problems, for example if XXX has had a fall I an always notified. The meals appear to be well balanced and on my visits I have noticed they are in good quality and portion size. I am pleased with the fact that the staff have been working at Ashland’s for a long time and this gives residents continuity and familiarity with their carers”. The management team monitor how the service is running and take action to correct any shortfalls found. This helps to keep people happy with the service they receive. What has improved since the last inspection? Information about the home in the form of the service user guide has been improved so that it is easier for people to understand. People are given a copy of the terms and conditions of occupancy which keeps all parties informed. Medication systems have improved in some areas; a medication fridge has been provided and is used for storing medicines that require cold storage. People who like to spend time in their bedrooms are visited by the activities co-ordinator to make sure that they gain some social stimulation. There have been a lot of improvements made to the home to make sure the environment is developed to meet the needs of the people who live there. Some of these improvements are still ongoing. The lounge carpet has been replaced, fire doors are not held open by inappropriate means and the humid atmosphere on the upper floors of the home has been addressed to a large extent, to make sure the home is pleasant and safe for people who live and work there. Items stored in the kitchen yard to be discarded have been removed; this helps to keep the yard tidy. Staff receive regular safeguarding training which helps to protect people. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 7 The care staff have achieved a fifty percent ratio who hold the National Vocational Qualification in Care at level two or three, this helps to enhance the care that people can receive. Staff have been able to speak with and develop their relationships with the Roche Healthcare management team since the home was acquired by this company so that staff feel listened to. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 8 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 Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (6 not applicable) People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they are offered a place in the home to make sure their needs are known and can be met. EVIDENCE: People who are considering moving to the home have a full assessment of their needs undertaken by a person who is competent to carry out this assessment. Information is gained by speaking with the person and to their chosen representative. Care plans, hospital discharge information and information from relevant health care professionals is gathered to make sure that the individuals, full and current needs are understood. The manager considers if the person would fit in with the people currently living at the home and she also considers if the staff have the relevant skills to meet the person’s Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 10 needs. Emergency admissions do not take place without a full care plan being sent to the home for the manager to review. Information is gained by speaking with the person, their family, social workers and health care professionals and the person is brought to the home for a few hours so staff can carry out an assessment to see if their needs can be met before a place is offered. People are not admitted to the home if their needs cannot be met. People are invited along with their chosen representatives to look round the home or stay for a trial period where they can experience the services the home has to offer them. This allows staff time to get to understand the person’s individual needs in detail and can help people decide if the home is the right place for them. Information is available to people in the service user guide and statement of purpose. The service user guide has just been re created with large print and photographs of the home and local village attractions so that it is clearer and much easier for the client group to understand. The last inspection report and home brochure is also available and there is a web site which helps to fully inform people what is available to them. We sent surveys to people living in the home before carrying out the site visit. Five out of seven people surveyed said they had received enough information about the home to make an informed choice about if it was the right place for them. Information is also available to people about the Mental Capacity Act and Deprivation of Liberty Safeguards leaflets are provided in the home so that people are aware of this information issues which help to protect people’s rights. Intermediate care is not undertaken. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, and 10. People using the 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’s health care needs are known and can be met. People are treated with dignity and respect. However medication records could be better maintained to evidence that people are receiving medication as prescribed. EVIDENCE: Care plans for three people were inspected in detail the care plans reflected what people could do for themselves and said what help staff need to provide to support each individual. Care plans were reviewed monthly however for one person the main body of the care plan did not say that the person had gained weight. This was recorded in the evaluation. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 12 Risk assessments are in place for individuals, they include information about people’s special needs and the risk of falls to help ensure people can maintain their independence whilst their safety is maintained. Three people living in the home who completed surveys said they always received the care and support they needed, three said usually and one person said they sometimes received this. One relative commented “XXX is always clean and tidy and does not appear to be in any kind of distress”. However another relative said on a survey their resident sometimes did not look as clean as they would like, especially their hair and nails. However people were seen to be well presented and were able to live their life as they wanted. Special equipment is provided to make sure that people’s special health care needs can be met and to improve people’s independence or their quality of life. Advice is sought from relevant health care professionals to make sure people’s special dietary and skin care needs can be met. People are accompanied to appointments to see health care professionals outside the home. Where people are not able to make this journey health care professionals visit the home to make sure people’s health care needs are met. Five out of seven people surveyed said that they always received the medical care they needed. One relative commented “Ashland’s has always provided adequate medical care for my relative when it was necessary”. The medication systems in operation were inspected. Nutritional supplements prescribed for people are now recorded on the Medication Administration Record (MAR) to make sure there is a record of when these are being taken. However one person who required cream for their skin had only three entries recorded on their MAR to say this cream had been applied. However this person’s wound was improving through wound care management and involvement of the Tissue Viability Nurse. Another person’s MAR was hand written and the dates on the top of the MAR were not recorded for all the dates medication had been given. These dates should be recorded so that the MAR is easy to read and staff can immediately see what has been given on what date. People are treated with dignity and respect. Staff knocked upon bedroom doors before entering and people are addressed by their preferred names. Ashlands Care Home DS0000071511.V375526.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People using the 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’s social needs are known and they receive a nutritious diet. However the activities programme should continue to be developed to make sure people gain the social stimulation they require. EVIDENCE: People can follow their chosen routines and activities are made available to them which are varied and match their preferred activities. There are televisions in the communal areas and music is available in the lounges and dining areas for people to enjoy. Everyone has a care plan which gives information about their preferred routines and social activities. Staff are aware of this, there is also a life and family history record called “Map of Life” so that staff can help people reminisce if they want to. There is an activities co-ordinator in place. She is keen and enthusiastic about her role she spends time to get to know people’s needs well and then produces Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 14 activities which are suitable for people to take part in; this makes sure that people’s social needs are known and can be developed. An activities programme is available and there are group sessions held for people Monday to Saturday. There have been local outings to take people to the shops, pubs or to feed the swans. Special occasions such as birthdays are celebrated and Valentines Day and Easter were celebrated with decorations and special food. People who completed surveys who live in the home were asked if the home arranged activities that they could take part in. One person said the home always arranged activities that they could take part in, two said usually, one said never, and three said they did not know. One relative commented to the question what could the home do better? They said “Activities”. Another relative commented “Often when I visit my relative they are laid on their bed with the curtains closed. XXX are very bored, and is physically very active unlike most of the fellow residents. About two times a week I take them out for a couple of hours. XXX loves this especially as we usually end up at the pub where XXX can have a small drink and watch people go by. I know Ashland’s staff occasionally take XXX out to the newsagents but apart from that XXX has little stimulation”. Thee activities being provided should continue to be developed so that people gain the social stimulation they need. People who prefer to stay in their bedrooms are visited by the activities coordinator and all activities are recorded so that there is a record of the activities that are undertaken. People who are frail and who cannot communicate have one to one activities which can include a hand massage or time in the “Sensory room” where there are fibre optic lights a projector and music as well as a massage chair to help stimulate their senses. People are not left alone but are observed to maintain their safety whilst using the sensory room. People are encouraged to maintain contact wherever possible with their family and friends and the local community. Visitors spoken with said “We are delighted with the home; we can come in to see our relative any time we wish. Staff always makes us feel welcome”. People’s religious needs are known and provided for by local clergy who visit the home on request. The catholic priest attends ever six weeks. A chiropodist and hairdresser also visit to provide their services to people for their convenience. Resident and relative meetings are scheduled to be held however no relatives attended the last meeting. Staff ask for visitor’s views when they visit the home so that informal information is gained to see if people are happy with the service being provided. One relative commented “As XXX is no longer mobile staff are happy and willing to take XXX from their room to the lounge, and vice versa, as XXX Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 15 wishes”. Another relative commented “Other residents are free to come and go as they choose within the confines of a safe environment, but with the ever watchful staff ready to intervene only when absolutely necessary” This helps to maintain people’s independence and self esteem. And a relative said to the question in the survey “What does the home do well?” they replied “Staff always make sure all the residents are treated like human beings with individual needs and feelings”. The kitchen was inspected. The food looked appetising and nutritious. Special diets are catered for and supper is available. The menu is displayed so that people know what food is available to them. Special crockery and cutlery equipment is provided for people who need this to help them eat independently. People who need assistance are fed by patient staff in an unhurried manner so that their nutritional needs are met. In the kitchen the fridge and freezer temperatures had not been recorded on two days this should be undertaken to make sure that food items continue to be stored in the correct temperature range to maintain food safety. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People using the 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 can raise complaints and these are listened to and acted upon. Staff receive training about how to recognise and report abuse, this helps to protect people. EVIDENCE: The complaints policy is available to everyone in the home and to their chosen representative. People who returned surveys all said they felt happy to raise any issues and felt they would be dealt with appropriately. There have been some complaints received since the last inspection these have been which have been investigated and dealt with appropriately. A whistle blowing policy and procedure is in place and staff have raised some safeguarding issues by this method which have been dealt with. Staff receive training about how to safeguard people during their induction and at regular intervals thereafter. Staff spoken with knew what to do if an allegation of abuse were to occur, this helps to protect people. Management report safeguarding issues to the local authority so that issues can be investigated and resolved. However one safeguarding referral was not Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 17 sent to the Commission in a timely manner. Management should make sure that we are notified quickly about safeguarding incidents to help keep us informed. One person’s personal allowance account could not be fully checked during the site visit as account details were being held at head office. Assurance was given that this account was being fully audited, but there should be evidence of this kept in the home. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is being improved to make it more suitable for the people who live there. However some floor tiles require replacing in the laundry to help maintain infection control. EVIDENCE: The home continues to be improved this work is set to continue for a while longer to make sure that all areas of the home are suitable for the needs of the people who live there. A relative commented “Since the last inspection I have seen redecoration of the home and it is cleaner and fresher and more appropriate to the residents needs”. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 19 There is a secure door entry system which helps to make sure that unauthorised people do not gain access to the home. There are two passenger lifts that allow people to gain access to all areas of the home. There is a small car park at the front of the home and a small garden with garden furniture, accessible by a ramp to help people who are not steady on their feet to gain access to the grounds. There is a very small patio area outside the downstairs dining room which can also be used by people who like to sit outside. The range of chairs used for people to sit in is varied in design to suit people’s complex needs this has been considered when the new furniture was ordered, this is about to be delivered to the home. The first floor has been improved with large picture signs on the doors of all lounges, bathrooms and toilets to help people to locate these areas easily. There are pictures from the past e.g. “Pears Soap” and “Bisto Adverts” to help people reminisce about the past and to help people find their way round. The dining room on this first floor has also been redecorated and people now enjoy going there for lunch which has become a more sociable event. These improvements are to be undertaken in all areas of the home. Some bedroom doors upstairs have been fitted with noise activated door guards that would that would close these doors in the event of a fire, this helps to protect people. At the last key inspection it was felt that the upper floors of the home were hot for the people who lived there and for staff to work in. The door guards have helped to make sure that there is better air flow by some bedroom doors being kept open. However management should continue to monitor this to make sure the temperature is comfortable for people who live and work at the home. Hand wash facilities are available throughout all areas of the home this helps to maintain infection control. The laundry was inspected some floor tiles on the plinth that the washers stand on and some tiles near the inner laundry wall were missing and require replacing to make sure that thorough cleaning of the complete laundry floor can take place to help maintain infection control. The storage area for the bins was inspected; the lids of the bins were locked. However there was one bag of clinical waste which had a part of the bag trapped outside the locked bin lid. Staff should make sure the complete bag is contained in the bin before the lid is locked to help maintain infection control and prevent vermin from being attracted to this. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People using the 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 are looked after by well trained staff so that people’s needs can be met. EVIDENCE: Staff work well as a team and help and support each other. Some staff have worked at the home for a long time and this helps to provide continuity of care. People who completed surveys said “All the staff show abundant and tireless good humour and kindness with the residents some of who can be challenging, due to the nature of their condition. They are respectful and responsive to the resident’s wishes”. Another commented “The staff are very helpful”. Three people said that staff were always available when they needed them, four people said usually. Two people said staff always listened and acted upon what they said, four said usually and one said sometimes. Recently the number of qualified staff on duty has been reduced during the day due to a temporary decrease in occupancy. Management decided that because care staff have to work in pairs the registered nurse numbers should be decreased. The inspector discussed this issue with the deputy management and one of the higher management team who said when a few more admissions were gained the number of registered nurses would be reinstated Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 21 back to two during the day. The manager and deputy are nurses and are working on the floor to support the nursing staff. However management must make sure that it is clear on the rota when the deputy or home manager are working on the floor so that it is clear how the home is providing adequate registered nurse cover to meet people’s needs and not place the nurses under pressure. This issue will be monitored and an improvement plan will be asked for in relation to this matter. The home have achieved over fifty percent of care staff who hold the National Vocational Qualification at level two or three, this helps to make sure that care staff have the skills they need to deliver care. Staff are recruited using a robust method; all necessary pre employment checks are undertaken. Staff do not start at the home without the results of these checks being known, this helps to protect people. Equal opportunities policies and procedures are in place to make sure that all applicants have a fair chance of gaining employment. New staff receive induction training and this helps them to understand what is required of them and gives them the skills they need to give good care. There is a training record kept for each member of staff, as well as a training programme for the year to make sure moving and handling, fire, infection control, safeguarding adults and training in all other relevant subjects is provided regularly for all staff. Meetings are held so staff can air their views; those not able to attend can read the minutes so they are kept informed. The management staff have an open door policy and staff can speak with them at any time, to raise any issues, this helps staff to feel valued. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that has been much improved and it is well managed. Peoples views are listened to and their health and safety is protected this makes it pleasant for people who live there. EVIDENCE: The home is run by an experienced manager and there is a deputy manager in place both are qualified nurses. The manager has become registered with the commission and is undertaking a management qualification to help her develop her managerial skills. Support is provided to her from the higher management team at Roche Healthcare Limited. One relative commented “I find the manager to be helpful and sympathetic”. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 23 Quality assurance systems are in place to look at how the home is running and how the services being delivered can be improved. People are sent yearly surveys to ask for their views about the home. Any issues identified are addressed by the management team. Staff and resident and relatives meetings are also held. Unfortunately the resident and relative meetings are not well attended so the staff ask people if they are happy with the service that is being provided. The home has been externally audited and has achieved the Investors in People Award. Better evidence of the auditing of one persons personal allowance account should be available within the home so that if people wish to see their records they are available. Health and safety checks are undertaken and the home is generally maintained. The improvements being made internally to the building should continue until all the planned upgrades to the home have been completed. The issues about the humidity on the upper floors should continue to be monitored. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 24 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 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 Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 25 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. 1 Standard OP7 Regulation 15 (1) (2) Requirement Care plans must reflect people’s full and current needs in relation to monitoring their weight and give clear guidance to staff, so that staff have the information they need to meet people’s needs. Medication administration records must be signed when medication is administered so that people’s health and wellbeing can be monitored. The registered nurses staffing levels should be kept under review to make sure that there are enough registered nurses available during the day to give people the nursing input they need. The rota should clearly state when the manager and deputy are to work on the floor as nurses. Timescale for action 28/07/09 2 OP9 13 (2) 28/07/09 3 OP27 18 (1) (a) 28/07/09 Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 26 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 Refer to Standard OP9 Good Practice Recommendations The date should be recorded on the top of any handwritten medication administration records (Mar). So that they are easy to read and staff can immediately see what has been given on what date. The activities being provided should continue to be developed so that people always gain the social stimulation they require. The temperature of the fridge and freezers for cold food storage should be recorded daily to make sure food items continue to be stored within the correct temperature range to maintain food safety. Management should make sure that the Commission are notified about all safeguarding incidents that occur to help keep us informed and make sure that people are protected. Management should continue to monitor the temperature of the upper floors of the home and take further action if it is felt the environment is too hot, to make sure it remains comfortable for people who live and work in the home. The missing and damaged floor tiles in the laundry on the plinth and floor should be replaced to make sure that thorough cleaning can take place to help maintain infection control. Clinical waste bins should have all items placed inside them and the lid should be closed before being locked to make sure clinical waste is stored securely. 6 OP27 The registered nurses staffing levels should be kept under review to make sure that there are enough registered nurses available during the day to give people the nursing input they need. The rota should clearly state when the manager and deputy are to work on the floor as nurses. Better evidence of the auditing of personal allowance DS0000071511.V375526.R01.S.doc Version 5.2 Page 27 2 OP12 3 OP15 4 OP18 5 OP26 7 OP35 Ashlands Care Home accounts should be available within the home. So that if people wish to see their records they are available. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 28 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshireandhumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 29 Ashlands Care Home DS0000071511.V375526.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!