Care Home: Ashlands Nursing Home

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What the care home does well Before anyone moved into the home the manager visited them to assess what care they needed and to make sure that their needs could be properly met at Ashlands. Everyone who returned surveys indicated that they were given enough information about the home to help them to make a choice about whether it was the right place. People who use the service said they were well looked after at Ashlands. Those who completed questionnaires said they always received the care and medical support they needed. One person wrote, "They cannot do enough for you." Another person, who had prior experience of care services, commented, "This nursing home is by far the best example of care I have seen and experienced." Staff encouraged people to make whatever choices they could about their daily lives. The routines in the home were very flexible and revolved around the people who lived there. One member of staff said, "Everything is for the residents, exactly as it should be." People had a choice of activities. There were traditional activities such as crafts and games. Those who did not wish to join groups were offered one to one time with staff so that they did not feel isolated. One person said she hadn`t been very well and staff came to sit with her in her room. There was also regular musical entertainment and a weekly movement to music group. One person said, "We do well for entertainment." People were offered a varied and nutritious diet. There were many positive comments about the meals. One person said, "The meals are excellent." Another person who filled in a survey wrote, "Everyone is asked what they would like to eat, just like at home, and they receive it." There was open visiting which meant that people could see their families and friends at times that were convenient to all. Visitors said that they were made to feel welcome. People who use the service said that they could speak to the manager if they were unhappy about anything in the home. One person said, "Whatever the problem Anna Mai (the manager) will sort it out." Another person wrote, "Anna Mai and the staff are always there for you." Staff who filled in surveys all said that they knew what to do if anyone raised any concerns to them. The manager made sure that new staff all had background checks before they started working at the home. This was to make sure that they were suitable to work with the people who use the service. Staff had training to help them to understand the needs of the people who use the service and to protect their health and safety. Over half of the care staff held an NVQ, which is a nationally recognised qualification in health and social care. People who use the service were all very positive about the home and the staff team. One person said, "I don`t think you will find a better place than this." Another said, "The staff are excellent, I would give them gold stars, all of them." A family carer saidtheir parent was treated with the utmost care and professionalism and one could not wish for a better placement. What has improved since the last inspection? The training records were clearer, which helped the manager to identify when staff needed refresher training in health and safety topics. There was more detail on most of the care plans. This meant that staff knew exactly what care the person needed and how they preferred to be helped. What the care home could do better: Possible risks to people`s health and safety caused by the use of bed rails must be thoroughly assessed in every case. Plans should be put into place to try to minimise any risks. Special instructions for medicines should always be recorded on the medicine administration charts. This is to make sure that staff are aware of and follow them. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashlands Nursing Home Turnpike Newchurch Rossendale Lancashire BB4 9DU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Craig     Date: 1 2 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Ashlands Nursing Home Turnpike Newchurch Rossendale Lancashire BB4 9DU 01706217979 01706226909 ashlandsnh@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Anna Mary Marriott Type of registration: Number of places registered: Mrs Anna Mary Marriott care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: A maxium of 4 service users of the category TI within the maximum number of 21. Staffing will be in accordance with the Notice issued dated 21 May 2001 Under Annex 2, a maximum of 21 service users who fall in category of either OP or PD Date of last inspection Brief description of the care home Ashlands Nursing Home is registered to provide care for 21 people who need nursing or personal care. The home is a family concern. The registered person, who is a registered nurse, manages the home on a day to day basis. Care is provided in a friendly atmosphere with a small staff team. The home is a former mill owners house, which was built in 1863. It is a grade 2 listed building, which has been adapted Care Homes for Older People Page 4 of 28 Over 65 21 0 0 0 21 4 Brief description of the care home tastefully whilst retaining many of the original features. It lies in two and a half acres of woodlands and lawns which are well kept and fully accessible to people who use the service. Accommodation is provided on 2 floors. The first floor can be accessed via a passenger lift. Communal areas comprise 1 large lounge and 1 small quiet room. The large dining room also has comfortable seating available. Bedrooms are mainly double, with privacy screening provided. There are no en-suite facilities. People who are thinking of using the service are sent a brochure and information about the homes website. Copies of the statement of purpose, service users guide and the latest CSCI inspection report are available on request. The range of fees at 12th November 2008 was 519.00 pounds to 640.00 pounds per week. There were no extra charges. Care Homes for Older People Page 5 of 28 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: A key unannounced inspection, which included a visit to the home, was conducted at Ashlands on the 12th November 2008. The key inspection is the main inspection. At the time of the visit there were fifteen people living at the home. The inspector met with most of them and some of their comments are included in this report. Three people who use the service were case tracked. This meant that the inspector looked at their care plans and other records and talked to staff about their care needs. As part of the key inspection surveys were sent out to people living and working at Ashlands. Six people using the service and nine members of staff returned surveys. Their responses have been taken into account when making judgements about the Care Homes for Older People Page 6 of 28 service. During the visit discussions were held with the owner/manager, three members of staff and two sets of visitors. The inspector looked around the home and viewed a number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the care home does well: Before anyone moved into the home the manager visited them to assess what care they needed and to make sure that their needs could be properly met at Ashlands. Everyone who returned surveys indicated that they were given enough information about the home to help them to make a choice about whether it was the right place. People who use the service said they were well looked after at Ashlands. Those who completed questionnaires said they always received the care and medical support they needed. One person wrote, They cannot do enough for you. Another person, who had prior experience of care services, commented, This nursing home is by far the best example of care I have seen and experienced. Staff encouraged people to make whatever choices they could about their daily lives. The routines in the home were very flexible and revolved around the people who lived there. One member of staff said, Everything is for the residents, exactly as it should be. People had a choice of activities. There were traditional activities such as crafts and games. Those who did not wish to join groups were offered one to one time with staff so that they did not feel isolated. One person said she hadnt been very well and staff came to sit with her in her room. There was also regular musical entertainment and a weekly movement to music group. One person said, We do well for entertainment. People were offered a varied and nutritious diet. There were many positive comments about the meals. One person said, The meals are excellent. Another person who filled in a survey wrote, Everyone is asked what they would like to eat, just like at home, and they receive it. There was open visiting which meant that people could see their families and friends at times that were convenient to all. Visitors said that they were made to feel welcome. People who use the service said that they could speak to the manager if they were unhappy about anything in the home. One person said, Whatever the problem Anna Mai (the manager) will sort it out. Another person wrote, Anna Mai and the staff are always there for you. Staff who filled in surveys all said that they knew what to do if anyone raised any concerns to them. The manager made sure that new staff all had background checks before they started working at the home. This was to make sure that they were suitable to work with the people who use the service. Staff had training to help them to understand the needs of the people who use the service and to protect their health and safety. Over half of the care staff held an NVQ, which is a nationally recognised qualification in health and social care. People who use the service were all very positive about the home and the staff team. One person said, I dont think you will find a better place than this. Another said, The staff are excellent, I would give them gold stars, all of them. A family carer said Care Homes for Older People Page 8 of 28 their parent was treated with the utmost care and professionalism and one could not wish for a better placement. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 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 10 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a thorough admission process, which ensured that people had meaningful information to help them to make a decision about moving into the home and staff had enough information about the needs of the new person. Evidence: Anyone thinking of moving into the home was given an information pack which included relevant details about the home and the service that they could expect. People who completed surveys indicated that they received enough information to help them to make a decision about moving in. Two people commented that the good reputation of the home had assisted their decision. The annual quality assurance assessment (AQAA) indicated that the statement of purpose and service users guide were under review. The manager confirmed that this was to ensure that the documents provided accessible and meaningful information to Care Homes for Older People Page 11 of 28 Evidence: people using the service. Anyone who was thinking of moving into the home was assessed by the manager to make sure that their needs were understood and could be met at Ashlands. The assessments highlighted the persons strengths as well as their needs, which helped staff to understand how to help someone to maintain their independence. Information gained during the assessment was discussed with staff, who had opportunities to ask for extra guidance or training if the person had needs they were not familiar with. All of the staff who completed surveys indicated that they were given up to date information about the needs of the people they cared for. Following their assessment the person thinking of moving into the home, or their relative, received a letter confirming how their needs would be met. Standard 6 was not applicable. Intermediate care was not provided at Ashlands. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care met the assessed needs of the people who use the service and was provided in a way that respected peoples privacy and dignity. Evidence: The care files for three people were looked at as part of the case tracking process. One person, who had been admitted very recently, already had care plans to address each of her needs as highlighted in her original assessment. The nurse explained that staff would develop and personalise the care plans more as they got to know the person. There were some good examples of person centred care plans. This helped staff to understand what was important to the person and how they preferred to be cared for. In most cases care plans were written in sufficient detail to make sure that staff provided consistent care. Staff who returned surveys said they had good systems in place for passing on information. One member of staff said there was a thorough handover at each shift. Care Homes for Older People Page 13 of 28 Evidence: Care plans were reviewed every month. There were summaries to show the progress people were making, which helped staff to see whether their care was effective. Plans were updated when the persons needs changed. For example, one person had a new care plan after they had a fall. Records showed that staff were also monitoring this persons care plan more frequently. People could be as involved as they wished to be in drawing up and reviewing their care plans. Family carers said that staff always let them know how their relative was and informed them of any changes. Everyone had a set of assessments to monitor risks to their health, for example, from falls or poor nutrition. There were care plans in place to make sure that staff did all they could to minimise the risks and promote peoples health. There was evidence that ongoing health care needs were monitored. People were referred to outside professionals where necessary and any advice was transferred to the care plan to make sure it became part of everyday practice. For example, advice from the tissue viability nurse or the dietician. Following a recommendation at the last inspection, risk assessments for the use of bed rails were more thorough. However, in one case the assessment showed that the person was at high risk of injuring themselves by climbing over the rails. There was no record to show that this risk had been taken into account when the decision to fit bed rails had been made. There were no directions for staff to tell them how to try to minimise this potential risk. People who use the service said that they received good care and medical attention. One person said, I am very well looked after, they get my own doctor if I am not well. Another person wrote, Care is always delivered with sympathy and professionalism. Another commented that care was always and immediately available. All medicines were managed by registered nurses in accordance with the policies and procedures of the home. Medicines were stored securely and at the recommended temperatures. Records of medicines received and disposed of were complete and up to date, which helped with stock control and also provided part of the audit trail. There were no unexplained gaps on medication administration record (MAR) charts, which indicated that people received their medicine as it was prescribed. The balance of medicines in stock was recorded every day and checked weekly. As well as being a good audit tool, this practice reduced any risk of medicines being mishandled. Care Homes for Older People Page 14 of 28 Evidence: Handwritten entries on MAR charts were witnessed, which reduced the risk of transcribing errors. However, in one case, the staff had not recorded the special instructions for administration onto the MAR chart. This could potentially lead to instructions not being followed and the integrity of the medicine could be affected. Controlled drugs were stored, recorded and administered safely and in accordance with the policy. Staff talked about how they maintained peoples privacy and dignity. One said that these issues were very important to all of the staff team at Ashlands and people were treated how staff themselves would wish to be treated. The AQAA showed that the service had adopted the principles of the Dignity in Care Charter. The charter outlines a set of rights that people using services can expect and gives staff guidance on how to promote the core values of privacy, dignity, independence and choice. One person using the service wrote that care is delivered with special attention to the needs of the individual. Care Homes for Older People Page 15 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were supported to excercise choice and control over their lives. Evidence: Information about peoples preferred routines was recorded on their care plan. A member of staff said that some people liked to continue their own routines that they previously had before moving into the home, and staff respected that. People using the service confirmed that they could choose how and where to spend their time. They got up and went to bed when they wished. One person said that she liked to have a nap in the afternoon and staff came in to help her. Another person said, Sometimes I have my breakfast brought up to me and sometimes I like to go to the dining room. Staff said that people using the service had choices in all aspects of their daily lives. One member of staff said, Everything is for the clients, which is exactly as it should be. Staff said they sometimes had to make choices for for people who were not able to do so. One said, We do this by anticipating their needs, by recognising their body language and expressions. Throughout the course of the visit staff were seen to consult people at all times about their wishes. Care Homes for Older People Page 16 of 28 Evidence: Everyone had a list of their current interests on their care plan and the new activity coordinator had started to draw up individual plans to assist people to meet their social and recreational needs. Records of activities showed that people who were not able or did not wish to join in traditional group activities, were offered one to one time. For example, one person who liked to remain in her room, had hand massage and manicures. Another had reminiscence sessions. Most people who returned surveys indicated that there were always suitable activities on offer. During the visit one person said, There is something to do most days and coming up to Christmas there will be more so. Another person said, We do very well for entertainment, we have a lovely pianist who comes in. Regular church services were held in the home for those who wished to attend. Some people also went out to church. One person who completed a survey wrote, The home provides spiritual opportunities on a regular basis, through various churches. There was an open visiting policy which meant that people could receive visitors whenever they wanted to. One person using the service said they particularly liked that when it was someones birthday their family were invited to have a meal with them. Family carers said that they were always made to feel very welcome. They were offered refreshments and staff made themselves available for a chat if they wished. One relative said, Staff are very helpful and they welcome all the family. There was a set meal at lunchtime but people could request an alternative if they wished. At tea-time there was plenty of choice. The cook said, it is all about choice, we aim to give people what they want and like. Records of meals showed that people were offered a nutritionally balanced diet with sufficient variety. Everyone who returned surveys said they liked the meals. One wrote, Excellent food, home cooked with lots of choices. Another person said, I have never once had a meal I didnt like. Other comments included, Meals are excellent, and I am always asked what I want to eat and always get a choice A number of people who sent in surveys and those spoken with at the time of the visit made very positive comments about their lives at the home. One person said, I dont think you will find a better place than this. Another said, I am very comfortable here, I cant emphasise that enough. One of the comments on a survey was, I like being at Ashlands, I would prefer to be at home but this is as near to being at home as is possible. I am well looked after. Care Homes for Older People Page 17 of 28 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 using the service were protected by the complaints and safeguarding procedures. Evidence: There was a clear complaints procedure on display in the home. The AQAA told us that everyone also received a copy in their information pack. This practice had started because on a recent survey carried out by the home one person had said that they were not sure about how to make a complaint. Everyone who returned a survey to the Commission said they knew who to speak to if they were not happy and they knew how to make a complaint. Most people said they would talk to the manager. One person said, Whatever the problem Anna Mai (the manager) will sort it out. Another person wrote, Residents are treated like a family, making it easy to speak to staff about any subject at any time. Staff who completed surveys all indicated that they knew what to do if anyone raised concerns to them. In the past year there had been two complaints made directly to the home. The AQAA told us that these had been responded to within the timescales in the procedure. One had been resolved and one was ongoing. The safeguarding policy had been reviewed to ensure that it reflected the information Care Homes for Older People Page 18 of 28 Evidence: in the new local authority procedure. Staff received training in safeguarding during their induction and they were given a copy of the whistle blowing policy. Annual refresher training was also available. Staff spoken with were aware of the indicators of abuse and understood their responsibility to report any allegations to the manager. However, not all senior staff were completely clear about the role of outside agencies, which meant that they may not report at the correct time. The manager took immediate steps to rectify this by nominating them to attend training which was planned later in the month. There had been one safeguarding incident in the past year. The manager had responded appropriately. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service had a safe, comfortable and homely place to live. Evidence: There was a programme of routine maintenance and the home looked to be in a good state of repair. Staff said that repairs were always carried out quickly. The home is a listed building and all decor and furnishings were in keeping with the age and character of the property. Several areas of the home had been redecorated. A number of people who use the service commented that the newly decorated dining room was beautiful. One person remarked, the dining room ceiling is gold leaf and it took ages. Some bedrooms, corridors and a bathroom had also been redecorated. Many people personalised their bedrooms with pictures and ornaments. Those who were asked said they were satisfied with their rooms. One person described their bedroom as, very pleasant with a lovely view and very clean. The extensive grounds were well maintained and accessible to people who use the service. One person talked about a garden party that everyone had enjoyed in the summer. Care Homes for Older People Page 20 of 28 Evidence: At the time of the visit the home was clean and free from offensive odours. People who returned surveys said it was always like that. The AQAA told us that there was an action plan with regard to infection control that reflected best practice guidance. Care Homes for Older People Page 21 of 28 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. People using the service were supported by a stable and competent staff team. Evidence: People who returned surveys indicated that staff were available when they needed them. One person wrote that if staff were busy with someone else they came as soon as possible. Staff who returned surveys also said that there were enough staff to meet peoples needs. One member of staff wrote, The home is well staffed to meet the needs of each individual client. Several people using the service made positive comments about the staff. One person said, The staff are ideal, I dont know how they manage to pick them. Another said, The staff are excellent, I would give them gold stars, all of them. People who returned surveys described the staff as, caring, kind and professional. Staff also commented that they had a strong team. One, recently appointed member of staff, said, I came here because I wanted to be part of a good team. Another wrote, All staff work closely together. Another commented, Team members support each other. The files of two recently appointed staff were looked at. All the required preCare Homes for Older People Page 22 of 28 Evidence: employment checks were carried out to make sure that staff were suitable to work with the people using the service. All of the staff who returned surveys indicated that they had background checks before they started work. One wrote, We are not allowed to work on our own if we do not have a CRB yet. New staff went through an induction programme. Those without a qualification had more extensive training which met the standards recommended by the national training organisation. This ensured that they had basic skills to help them understand and meet the needs of the people using the service. Other staff had training relevant to their role, qualifications and experience. Staff said that the manager assessed their competence to carry out care before allowing them to work alone. Staff who returned surveys indicated that their induction covered everything they needed. One person wrote, I felt comfortable to ask any questions I had. Another commented, I was supervised by my mentor on every shift. There were also good opportunities for further training. The records of training had improved, which made it easier for the manager to identify when staff required refresher training. The numbers of staff with up to date training in the safe working practice topics, such as moving and handling and first aid had increased. Staff commented that they also attended courses to assist them to meet the special needs of people using the service, such as palliative care and nutrition. One member of staff wrote, All training and courses have helped me to become confident and competent in my job. Another wrote, Training courses are put in place that reflect the needs of the clients that we nurse. The AQQA told us that 80 of care staff had an NVQ, which is a nationally recognised qualification in health and social care. This meant that most of the staff team had a qualification specifically designed to help them to understand and meet the needs of the people who use the service. Care Homes for Older People Page 23 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from a safe and well managed home. There was a good level of consultation, which meant that people were able to contribute to the development of the service. Evidence: The registered person managed the home on a day to day basis. She has many years experience in managing services for older people. She is a registered nurse and also holds a qualification in palliative care and a relevant management qualification. The registered person keeps her skills up to date through self study and extra training. She is knowledgable about best practice guidance, which she adapts and implements for the benefit of people who use the service. The registered person was clear about how she wanted the service to develop and the AQAA provided clear examples of the improvements she intends to make in the next year. A number of people who use the service, their visitors and staff made positive Care Homes for Older People Page 24 of 28 Evidence: comments about the registered person. One person wrote that Ashlands was very professionally run with a caring attitude. Staff who completed surveys indicated that the manager gave them the support they needed. One wrote, The manager does everything possible to meet the needs of the service users, relations and staff. The manager did not hold any money or valuables on behalf of people using the service. She confirmed that recording procedures and secure facilities were available should people need to hand over money or valuables for safekeeping in the future. There were a number of systems in place to monitor the quality of the service. The home held the Investors in People award. The Blue Cross Mark of Excellence was used as an annual internal audit. The AQAA included the results of the annual resident questionnaire. This showed us that the people who completed the surveys were satisfied with the home and the care they received. There was also evidence that the registered person made appropriate changes as a result of listening to the people who use the service. All staff had received fire safety training. Those spoken with were clear about the procedure to follow in the event of a fire. Fire alarms were tested regularly and other fire safety equipment had been serviced. The AQQA showed that the maintenance and servicing of other equipment and installations were up to date, which helped to protect the health and safety of people living and working in the home. Care Homes for Older People Page 25 of 28 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 28 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 8 13 All potential risks must be 05/12/2008 taken into account before the decision to fit bed rails is made. There must also be a plan to minimise any identified risks. To minimise risks to peoples health and safety which may be caused by the use of bed rails. 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 9 Handwritten entries on medication administration charts should accurately reflect the information on the medicine label. This is to ensure that any special instructions are followed. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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. 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